Tonight is the launch party for Jay Parkinson's first storefront Hello Health location in Brooklyn.
Today is a bit of an experiment - I'm taking a road less traveled - instead of flying I'll try a Boltbus (supposedly free WiFi, but we'll see).
If I can grab or borrow a wireless signal this evening I'll liveblog the event (and yes, provide some tweets), but if not stop by tomorrow for a review.
To current healthcare friends who can't attend (hup Holland hup!) I'll send photos - to 'new' healthcare friends I'll meet in person this evening - can't wait.
It's exciting to celebrate the potential for what's next in primary care with Jay, Sean and Co. Too often in healthcare we alienate our mavericks. This isolate and destroy approach will be eclipsed by consumer-centric firms like Myca.
What Jay and the guys are doing reminds me of a favorite Dave Barry quote:
"Never be afraid to try something new. Remember that a lone amateur built the Ark. A large group of professionals built the Titanic."
(And yes, the Ark replica above was built by a Dutchman).
PS - If anyone has questions for Jay (and fellow physician and blogger Sean Khozin), leave a comment or txt to 301.904.5136. I'll be happy to pass it along.
Click here to see the latest in Maarten's "Patient 2.0 Journey," including a video interview.
Maarten also shares scans showing Theo (his tumor) has shrunk 50% after the second round of chemo (Yeehaw and giddyup little doggy!), and in we find Mr. Maarten and family also has a snazzy new lime green swimming pool.
Maarten, one question - when's the e-patient pool party? :) Do you have to be bald to get in? (I'm not beyond it, but don't think it would be as flattering a look for me...best of luck with going in for your next round!
Sorry for the long radio silence-I've been in Blacksburg, VA for the past week nannying for my 1 month old niece Baby Ellen.
Let me tell you that there is no more joyous work in this world (except for maybe healthcare blogging, but I'm biased).
Also, I am now officially going to never have a little genetic replication of my own until science has placed us at the level of dubious distinction by which we can spring forth a fully formed 7 year old child ready to park in front of some cartoons or creative kid skills development thingy (on which Target makes approximately 1.6 gigagillion dollars a year, .5 gigajillion based on my spending for Baby Ellen alone).
My sojourn into adjunct infant care leads me to think being a good burping, changing, singsong aunt depends on 4 factors (other than not being nearly tonedeaf, which Ellen doesn't seem to mind - or at least she's polite enough not to say anything about it).
Being an aunt is about working the right resources in the right combinations. Performing the programmed responses at the correct times. Like working genetic code, without the right combination of nucleotide base pairs, A, a T, a C, or a G, the whole delicate but powerful structure collapses and something goes really wrong in the expression phase.
Here are the nucleotides necessary for coding being a new aunt:
1. C = A regular supply of coffee. We're talking dark, Mississippi Mud style coffee. We're talking burn your esophagus coffee. We're talking coffee that is so dark the pot turned off 2 hours ago and you don't even care that it has the consistency of Jello chocolate pudding coffee. Yeah. That kind of coffee. Medical residents, I'm sure you can empathize.
2. T = A ready attitude towards working through sleep deprivation. You're literally holding the most important thing in the world (your niece) in your hands and what, you're going to be clumsy with her, not change her, because you're a *little sleepy*? My mental mantra for the week was "suck it up." And I'm not even one of Ellen's parents, who got approximately 5.67e4 to the 3rd LESS sleep than I did. Respect, major, MAJOR respect to all new parents, whom, whether they stay at home or not, I believe now have the most complicated job in the world outside of nuclear waste handling or theoretical astrophysicists sniffing after proving the concept of multiverses.
3. A = A willingness to put aside self more often. It's very difficult to be selfish, nay, impossible to be selfish in the context of caring for a baby (gee, I'd like to be perusing my blogroll right now, Baby Ellen, you can wait for that changing and burping right?! Just give me 20 more minutes...). This is a tough thing to explain BEFORE the little bundle of new genomic joy has arrived and has you panting over seeing whether her phenomic expression more closely resembles dad, mom, gramps, or perhaps Auntie Niffer...literally, you watch new parents navigate the mental minefield that is realizing your life is no longer your own. That baby owns you, heart and mind and body and soul.
4. G = A desire to get out there and continue learning. Constantly. Via theory and practice. One thing being a new aunt gives you a lot of time to do is read. My afternoon nap pattern with Baby Ellen is either a walk in her Graco car seat and Strollee OR sitting in the rocker, baby in the Boppy (if you're a parent YOU KNOW about the miracle that is Boppy - if you're expecting, go out and buy 34 of them right now), book balanced on my knees. I did start to read "What to Expect the First Year," but staring at that creepy baby illustration on the front cover by nightlight at 2am and breaking out in an abject sweat, nervous about whether I'd stunt Ellen's development for life somehow or whether she was showing signs of some obscure neurological syndrome in the spasmodic sucking of her NUK orthodontic pacifier (patterned with sailboats, of course new from Target), I decided to read about how to fix healthcare for her generation instead. Oh and a little about how to protect the minute replication that is my niece, surely the cutest baby in the history of babies.
I'm certainly not alone in this desire to educate, educate, educate. New parents like my sister do tons of reading to beef up on baby care lore before delivery. We do tons of teaching in healthcare management, theory, administration, delivery, and practice. We should be doing more.
In doing some reading for Medical Education Evolution, the Ning group Berci Mesko, Ted Eytan and I kicked off earlier this month, I realized docs do a lot of CME activities (not an especially brilliant analysis of the field, but remember, I'm working in a sleep deprived state).
Question of the week: Why don't healthcare managers, hospital executives, HMO board members, medical students, geneticists, evolutionary biologists, PAs/NPs/Nursing managers, even, gasp, healthcare bloggers do more creative, constructive CME?
Journalists are expected to beef up sufficiently on a subject so as not to be total boobs during interviews. I'd heartily suggest the medical blogosphere take up that banner and run with it. I've read too many entries lately (including my own) that indicate we're just phoning it in this summer.
Yes, to some extent, we have excuses: it's vacation time. I'm busy caring for my grandma/mother/dad/friend/new niece. I'm on sabbatical. I'm preparing research for my fall paper and presentation schedule. It's the blogosphere - no one wants to read a research odyssey in each post.
Most of that's crap.
I stopped making excuses this week and decided to take myself 'back to school' and beef up my reading list.
Without putting forth much time, effort, or money (remember, time and effort are in short supply, and money is going to the Target Baby Ellen Time Wasting Fund), I compiled the reading list above.
The photo of books stacked in that photo are sources I'll read for the rest of the hot, humid weeks. I want to be done by mid-September, but we'll see.
The best part is I spent less than 150$ bucks - about half one credit hour fee for a course at a local community college. I'll use my online and offline networks to review the books and talk myself through critical evaluation of themes.
So, if you're willing to act on that "G" codon, number 4 above, you can obtain graduate level reading resources in three relatively easy, accessible places, most of them free:
1. Library. Blacksburg public library is a boon for medical, business, and science reading. Plus, you can buy pod machine coffee for 1$. I didn't tell them I would have paid 20. Bring your own bag so you don't use on of theirs.
2. Thrift Store. The Goodwill in Blacksburg, town which hosts Virginia Tech students and teachers, is a literal goldmine for poetry, literature, scientific, and other texts and abandoned reading list sources. Most go for under 5$ and are a "few" years out of date. But sometimes older books unexpectedly blow your mind - check out "The Medusa and the Snail: More Notes of a Biology Watcher" by Lewis Thomas, published by G.K. Hall and Co in 1980. Thomas was president of the Memorial Sloan-Kettering Cancer Center in New York and won a National Book Award for his book "Lives of a Cell." This book should be on every medical students required reading list. Head to your nearest college town, find the thrift stores/used book stores, and bring plenty of sturdy cloth bags. If the town is near-dead and only filled with groaning graduate students and summer school attendees, hit the local independent coffee shop and ask after places to buy used books. Also bring cash - not all thrift stores take plastic.
3. Twitter and Blog Recommendations. My Twitter friends' reviews influenced me to cave in and buy "Here Comes Everybody" and "The Back of the Napkin," so if you look closely you'll see both of those in the stack above. While I haven't *yet* tried tweeting a Twitter friend and asking to borrow a book, I may do just that. Especially as buying these books begins to cut into my Baby Ellen toy, ahem, educational resource purchases.
And now I'm off to work on codon 1...coffee. I'm more than willing to share my list, but challenge each of you to venture out and find resources that make sense for your particular phenomic expression within our industry.
Happy reading. The future of healthcare may depend on more of us being willing to go back to school.
"I wish my industry wasn't 15 years behind." - Dr. Jay Parkinson, Myca, Hello Health
During our interview last month, Jay Parkinson mentioned Hello Health's intention to use ZocDoc.com to schedule specialist appointments for patients. Embarrassed to report I'd never heard of the company, I did what any good (read: nosy) blogger would do - visited the site.
After 5 minutes, and a fortuitously timed email from a good friend in DC asking for a specialist recommendation, I was wishing the ZocDoc crew would pack up camp and move to the nation's capital.
Then ZocDoc's Trevor Leb shot me an email with more info, and I was hooked. Yesterday I spoke with two members of the company's leadership team: Cyrus Massoumi, CEO (cofounder) and Dr. Oliver Kharraz, COO (cofounder).
The ZocDoc team has garnered an impressive array of awards and publicity since launch in September 2007, including a TechCrunch prize. After talking with cofounders Cyrus and Oliver about the business model and strategic goals, I think the buzz is well-deserved - this is a breakout Health 3.0 firm.
Anyone who wears prison-orange scrubs (NY Tech Meetup) and invokes the voice of God (TechCrunch 2007) to demo the firm earns my respect - it's about time HIT firms approach the level of creativity and scrappiness exhibited by their mainstream consumer tech cousins.
But don't take my word for it - read our interview (lengthy but worth it) and decide for yourself. That's what consumer-centric care and participatory medicine is all about, right? Using information available to make up your own mind?
Q: It's not about size, but it is about numbers. Can you share search numbers for ZocDoc.com?
A: (Cyrus) Sure. We have a little north of 25k visitors per month. The interesting thing about ZocDoc is that we're geographically constrained – an overwhelming percent of our users are in NYC, and we're growing at a rate of 20-50% per month.
Q: Are you growing without advertising?
A: (Cyrus) Yes. Minimal advertising – a lot has been word of mouth, and we've gotten a lot of really good press (Wall Street Journal Blog, NYTimes). We launched at TechCrunch last year, and they picked us as one of the hottest 40 startups in September of 2007 (Watch the presentation – I've never seen a Health 2.0 startup invoke the “voice of God” during a demo). We're self-funded up to this point (NOTE: ZocDoc has received some funding from angel investors, including former backers from Facebook, but hasn't raised an institutional round). We want to grow virally – grew 70% last month.
Q: How many ZocDoc users are leaving ratings, both self-identified and anonymous? Do you have info on the percentage of users that choose to rate anonymously?
A: (Oliver) That's an interesting question. I don't know right now how many patients self-identify – but we do read through reviews to ensure they don't include offensive content - so I can tell you early on people were more reluctant to put up their names. Now people use the rating system more because their friends use it, so they're more comfortable including names.
Q: Right now on ZocDoc I can pick a Dentist, Dermatologist, or Primary Care Physician – what are people requesting on the waiting list, and what are your plans to expand practice areas (when will ophthamology go online, for instance?)
A: (Cyrus) We're seeing requests for ortho, ENT, mental health, and general family care – lots of families want to use us for pediatricians, OB/GYN. Our goal by the end of year is to have 10 specialties live on ZocDoc. We want the 80 percent of practice areas that people go to most frequently, the other areas are sort of the long tail - we want to solve the 80 percent problem (More support for the 10-80-10 rule – ZocDoc is providing online scheduling for the Middle 80). We want as many people booking using our platform as possible, this makes it as useful as possible. That's the reason we made our API available, because the platform can enable companies like Jay's Hello Health to do things that they just weren't able to do before. Other people that have approached us with other ideas. We have people building applications for an IPhone. Our API is very broad, Jay is using it for his practice, but imagine we have a button on your IPhone where you can geolocate a doctors office near you and set up an appointment . With regard to other partnerships, we have 10 employees, we just can't pursue all these types of partnerships with this size, that's why we released the API. We also think of our function as a little more broad. We've been compared to the OpenTable of healthcare, but if you use the travel analogy, look at SABRE, which powers travel reservations – that's really our goal, to be THE platform people are using to book doctors appointments.
Q: One of the touchy areas of Health 2.0 relates to business models (or lack thereof) – tell me a bit about ZocDoc's model and revenue structure?
A: (Cyrus) Sure. Practitioners create a profile for free, but if they start using the scheduling service and such there's a subscription fee that physicians pay. The fee varies. When we launch a new specialty we make it free for a time to encourage adoption and so we can learn more. Right now practitioners use our web based calendar to make times available. We also have integrations we've built for leading practice management solutions and we charge fee to access these in addition to using the ZocDoc calendar.
Q: Tell me about expansion plans....what's your current staff strength? See you're hiring for some key positions (VP Operations, VP Membership Sales) Where do you want to be by the end of 2008? Also, you're currently only available in NYC – what other regions do you want to reach?
A: (Cyrus) We'll probably double in size - or more – in the next 6 months. Half of those staff people will be dealing with practitioner-facing roles, lining up physicians to use the service and training them. We have a pretty extensive waiting list of doctors. We haven't had a lot of work to grow our waiting list. We jumped from listing 1 to 5 percent of dental practitioners in Manhattan with no activity on our part. Started with dentists, then added primary care docs 5 months ago, and added dermatology 1 month ago. We're also building developer base because there are so many interesting expansions. In this market too, really talented developers are really hard to come by . If you know any please send them our way, we've been very selective. Entrepreneurs have told us the first 20 employees are the most important in the company. Since September we've had 1200 people apply at ZocDoc – we're bringing on employee number 10 now. With Trevor (who set up our interview), we had to talk to 100 people before we found him, so we're really trying to get a very quality team.
Q: Why go head to head with a multitude of other doc search and ratings firms? What's different about ZocDoc? Who do you consider to be competitors?
A: (Cyrus) I actually had an issue, one year ago during a January flight from Seattle to NYC, when I landed I ruptured my eardrum. It was a horrible experience. I went to my insurance company website and it just didn't cut it for me. It took me four days to get to a doctor. NYC has highest density of docs in the world, Tel Aviv is number 2. There's an oversupply of doctors in NYC, but the information was just bad on my insurance company website. If you pull up your insurance company website, and pull out 10 doctors names, at least 20 percent of them are going to be bad – maybe even the doc has died and is still on the insurance company roles for years. The other thing ZocDoc supplies is who is really good (according to other patients). We're the category killer for patient booking online. You see your practitioner's availability instantly. You don't have to spend a whole day making calls. The second thing is that we're the only site on the internet I'm aware of that confirms patients are the only ones leaving feedback.
Q: So how does that process work?
A: (Cyrus) The doctor confirms the patient has showed up. Then the patient gets an email inviting them to leave a rating. If a patient doesn't show more than once, they're actually locked out of the system. Practitioners love that habitually bad patients are locked out of ZocDoc. Our no show rates are significantly lower than practitioners own no show rates. This is because we send so many reminders. After booking, patients receive reminders at 1 week, one day, and 1 hour ahead of time. We also verify the individuality of each patient – you must provide a phone number and that phone number is verified.
Q: Ok, so how do you get docs to join? Active recruiting? Do they find you? How do you expand the ZocDoc pool, and do docs get anything from joining other than new patients? NOTE: One doc reports 20% increase in patient flow – do you have staff managing physician relations?
A: (Cyrus) Doctors find us, and sign up on our waiting list. We'll go and say opthamology is next because we had great waiting list. Then we look at the distribution of practitioners – you have to have availability every few blocks – so we don't want one doctor in the Upper East Side. In every neighborhood we need a selection of doctors. We make a concerted effort to fill in the gaps so to speak.
Q: Seems like I got different results when I entered “I'm paying by myself.” Can docs vet prospective patients ability to pay using the service (I see that there's an optional place for me to enter my healthcare coverage information and how I'll be paying) does this automagically weed out physicians who don't accept my form of payment?
A: (Cyrus) From our perspective patients want someone who's in network for them – that has very heavy weighting in how search results show up. They're weighted using an algorhythm so that in-network practitioners show up first, but all docs do show up. Our goal at all times is to operate completely in the patients' best interest. We have had practitioners approach us with requests for search optimization services like Google, but won't do that, because we put patients first in 100 percent of everything we do. If patients don't trust us, we will not be successful.
Q: Has that happened yet? Has a patient come to ZocDoc with an issue about scheduling, or a complaint about a physician, etc.? How did you solve the issue?
A: (Cyrus) Ok, here's a good example. A patient booked an appointment on Saturday. The practitioner got the email about the appointment in his car, and he was stuck in traffic. We love the Saturday appointment, so we were on top of this. The practitioner told us he was going to be late. Our COO Oliver called around and found a dentist who could see them on Saturday.
A: (Oliver) We get love letters from our patients on a regular basis. I practiced for a few years, and I never got that feedback from my patients, so it's quite nice. We had dentists open on Thanksgiving Day. I wouldn't have known who to give a call to on Thanksgiving Day – so we had patients with dental pain on Thanksgiving day, I would never have known.
A: (Cyrus) Here in NYC, GHI is HMO specific insurance – it takes month before primary care doctors can see GHI patients. If they use ZocDoc, we're going to have 10 primary care docs who could see them in a week.
Q: I'm not a doctor, but I have a friend in DC who knows I'm in healthcare, so she's asked me for a recommendation for a specialist. I don't know anyone, but if ZocDoc was there I'd refer her. Any plans to expand into other regions?
A: We hope to be in DC soon. We're letting people submit requests to the waiting list and vote for expansions.
Q: Tell me a little bit about your backgrounds. How did you get into the Health 2.0 sphere?
A: (Cyrus) We've all been entrepreneurs – our entire management team has done startups before. We're involved in health because we do believe we are changing the world. There is a very big altruistic element to what we're doing. Doctors love us and patients love us. It's a real problem that many, many people have. Both of us (CEO Cyrus and COO Oliver) left McKinsey directly. It was very compelling because it was just needed, no one else is doing it.
A: (Oliver) It's been a really great start. Being a doctor myself I know I wanted to do something in the healthcare space. It's about how you can really move the needle – quality is great, but we've gotten to the point in this country where we can only make incremental quality improvements. Coming from Europe myself (Germany), our access is sort of a little bit easier – there's not this sort of scheduling issue, you just walk into a doctor and see them. This is a problem here and we need to make it easier. The experience proves that we are right, scheduling is more of a pain point. It's a very obvious. People hate the way the system works right now because it's inefficient for all parties.
A: (Cyrus) Our entire management team comes from families with doctors in every generation. So we all grew up in the healthcare industry.
A: (Jen) As the daughter of a nurse, you know what I'm going to say next right? You need someone with a nursing background (laughter) to round out the team.
Q: I see ZocDoc is on Facebook – are you using other social networks like MySpace, Plurk, Britekite, Twitter?
A: (Cyrus) Yeah, anyway we can reach people and get them to talk in a viral manner. You can imagine docs who are on FaceBook, right? Well, what if you are able to book an appointment directly via their FaceBook page.? One thing we keep in mind – that 80 percent number (healthcare for the Middle 80)– pare it down to solving 80 percent of the problems. A lot of the healthcare people go after these are things that are on the long tail.
A: (Cyrus) Also your earlier question about partnerships is interesting. We have our feedback system. People don't book doctors appointments often enough for there to be specific social site just for this. But we have waiting lists in other parts of the country – San Francisco, DC, Boston. We had an opthomologist in South Dakota email us. But the ability to do one-off partnerships takes a lot out of the entire team. Going in and doing deals in the short term – it's something we'll consider. We are talking to a lot of players in the Health 2.0 space. That's why we made our API available. At this point it's probably more effective to pound the pavement and do things our own way. It's early, is what I'm trying to say.
Q: Everybody hates this question, but final thoughts about where you think healthcare in the US is going?
A: (Oliver) That's a very broad question - where it's going from the consumer perspective – I think there will be more responsibility that consumers will have to take on as they make more decisions. But right now, there's not enough information out there for patients to make these decisions well, so I think that is certainly one of the areas where more innovation and more products are needed. From a physician perspective, we're at interesting crossroads right now. I think many are waiting to see what the next Administration will do. And with respect to universal healthcare – it has a lot of potential. And I really hope it will get a good stand. This may be a politically contentious view, but we need to be getting to the point where people are covered earlier in the disease process, where we don't have to catch them in latter stages of 3 diseases in the ER
Q: Thanks very much gentlemen for your time. As an e-patient and consumer-centric healthcare advocate I'm encouraged to see a service like this. Hope to see you at Health 2.0!
The Great American Road Trip is not dead - it's morphing to meet the needs of the next generation of artists, journalists, filmmakers, and summer savants.
Tomorrow I'm hopping in a rental car, picking up a director friend from Baltimore, and highway-hiking up to NYC to shoot some film of Jay Parkinson's Hello Health enterprise for a documentary.
Like Jay's practice, our little guerilla webumentary will be the opposite of big-budget, deep pocket business innovation. It's a stealth review of healthcare in the US - a gut-level, highly subjective, opinionated look at where we might be headed. Hello Health is a fitting primary locus for shooting.
If done right, Jay's practice could be the start of a more accessible way for patients to access primary care in the 'real world' - creating a sort of Starbucks of general medicine.
Of course, the documentary, like Hello Health, could turn out to be a big fail - but we'll just have to wait and see...it's encouraging to see the initial tentative stirrings of people creating products that migrate slightly outside the 'traditional' delivery space - where it's a lot of talk and very little action - to take big risks. In real life, nobody hands out A's for effort.
I learned about the launch of Hello Health last month, watching Jay present at 2:30pm @HIMSS DC Summit, 6.9.2008.
This isn't catastrophic coverage, and it isn't quite concierge care - it's a cash and carry way for the middle 80 to get access to physicians in their neighborhood.
Here are my thoughts from the show, and a record of the brief chat I had with Jay afterwards:
The Grand Ballroom North at the Renaissance Hotel in DC has one of the most happening healthcare speakers at the podium, but he's preaching to a crowd of 14. Most are fidgeting, have arms crossed, or are looking slightly shell-shocked as Jay Parkinson walks us through Hello Health's army of ground-breaking widgets.
Jay is consumer-healthcare's golden boy, or the doctor you love to hate, depending on who you're asking. The good doctor presented today at The Healthcare Information Management and Systems Society's DC Summit 08.
He's wellspoken, sardonic, and one of Health 2.0's fashion icons (if there isn't such a group, I just invented it).
I had the chance to grab Jay after his talk for about 10 minutes.
Here's what the guy who's determined to change the face of American primary care delivery had to say (just after we finished commenting on the miniscule size of the audience pool).
Jen: Why did you decide to do such an intimate presentation on Hello Health and Myca here at HIMSS? It's a pretty stodgy event (no insult intended) to release something of this disruptive nature – so why here?
Jay: It wasn't really released here – I don't know, because they asked me. I mean, I will never back down from an opportunity to tell people what I'm doing and what Myca is and what our platform is. I mean you have to do publicity. Any publicity is good publicity.
Jen: Any publicity is good publicity, ok, lesson number 25 for the day.
Jay: Lesson number one.
Jen: Afternoon session (2:30-3:30pm), I noticed that there were not a whole lot of people in the room. Looked like maybe some doctors, 2-3 reporters. I guess I'm shocked because this is a natural fit for me, about people's reticence to accept the concept. Does that worry you at all? Are you unconcerned about people's opinions?
Jay: No, I don't care what the healthcare industry really thinks of me and this concept. I only care what consumers think. If you can create the consumer experience that Apple has created, I think people will choose to buy it, or they won't.
Jen: And they'll talk with their wallets?
Jay: They'll talk with their wallets – And my job is to get them to use their wallets for healthcare, you know?
Jen: Yeah, and that's because you're a cash-only practice?
Jen: And you're charging, what was it for a base fee per month? How do those costs work?
Jay: It's 25 dollars a month and then 75-100 dollars per in-person visit, depending on what it is, complexity, that kind of thing.
Jen: Ok. So I can set up an online account and you take a direct debit right out of my bank account (for the monthly fee), I can do all of that online, I can have basically a doctor, a Hello Health doctor on retainer, and then if I need to see you I come in and I'm dropping 75-100 dollars cash. That's it? And it's done? No billing to insurance? No secondary billing? No collections?
Jay: No, I think we'll build the engine that if you have insurance we'll submit the claim to the insurance company. And then you...
Jen: Fight the company. To get a check.
Jay: Yeah, we're not doing that!
Jen: They're never gonna give you a check.
Jay: No it's strictly cash or credit card. You put the credit card on file, and then that's where we take the money out (25 dollar monthly fee).
Jen: That's awesome. And the whole health interface that you've shown at Health 2.0 Spring Fling in San Diego, and now here at HIMSS, bits and pieces, the widgets that you have – and you've shown a little bit more here. You said that will be operational this month?
Jay: That'll be about 2 months.
Jen: Ok, and you're looking to open the first storefront in New York?
Jay: July 1st.
BLOGGER's NOTE: Hello Health opening changed to (soft launch) July 15th in Brooklyn.
Jen: July 1st. We're all invited right?
Jay: Yeah of course – big party. Big Health 2.0 party (Jay will be wishing he'd never joked about that...)
Jen: You're having a launch party right?
Jen: You are now!
Jay: Yeah I thought about that – it's sort of, I don't know how much you want to 'launch' something like this with a big-ass party but yeah. Definitely gonna be people there.
BLOGGER's NOTE: Contact Jay for details about the launch event.
Jen: You'll be staffing on the first day. If I walked up to Hello Health on July 1st who else would I see?
Jay: You'd see Doctor Sean Khozin he's my partner, and doctor number 2, and a couple other doctors are ready and willing, and have already said yes in New York City. And they're great. You know, it's sort of like we're self selecting for doctors, because they're frustrated. And they're like “There's got to be a better way. And I want to do my job better but I can't.”
Jen: And if they come after you, then you know that they're interested.
Jay: Yeah and that's where you start the conversation, where you kind of do the vetting process. Because you know some docs are just like “eh.” You know.
Jen: This isn't the fit for you or for Hello Health...
Jay: Yeah but I haven't really seen that. I mean I've just seen doctors that are like this is impossible. It's a viral spread I think. If this is successful, and I wholeheartedly believe that this is going to be successful, it's a viral spread amongst doctors and patients because it meets needs for both.
Jen: Will there be any nurses with you, an administrative person, or will we just walk in and see the doctor?
Jay: Yeah there's like a receptionist who's there for education and support stuff.
Jen: And can I schedule for Hello Health online?
Jay: Oh god, yeah, that's easy.
Jen: Of course. That's when it all begins...
Jay: Yeah, that's really all the consumer sees right now – people aren't interested in exploring all their health information, you know what I mean? Sometimes they will be, but people want access to their information when they need it, but they're not going to be doing much with it. But it's all there for them.
Jen: Like their 401k accounts.
Jay: Yeah. You don't go there every day and like, explore it all. I mean, who cares? You have better things to do.
Jen: Like worry about your healthcare.
Jay: Or just go hang out with your friends, like leave me alone kind of thing, you know?
Jen: Doctor when you need it.
Jen: So if I come into your office, and I see a Hello Health doctor, and it needs to advance to a specialist referral, what happens then? What are the incentives as a consumer that help me stay with you, if for instance, I have a chronic condition like diabetes but I'm young, I'm tech-savvy, I just want to see a Hello Health doctor and have that continuity, um, how does that process work? If I need to see a specialist do you refer me to one? Do I need to go out on my own and find one?
Jay: Yeah, we're actually partnering with ZocDoc, a new startup based in New York City. They're recruiting doctors to sign up for their online scheduling service. And so they have an API, and it's let you find a consulting doctor. And it's awesome, the service is awesome, the business is awesome...
Jen: I've never even heard of them.
Jay: Their API is open and we are integrating that into our platform. So if I need to send you to a dermatologist within our platform you can do a search, for who's the next dermatologist open, and I see that Dr. Smith is open tomorrow at 9:30am, ok, you're done.
Jen: Oh my gosh.
Jay: And then, those doctors are rated, so oftentimes they see “Oh, ZocDoc.com,”doctors know who their ZocDoc patients are and give them a little special treatment because they're rated online.
Jen: Just like secret shoppers in the retail industry.
Jen: Ok. Doctors of the world, please please consider opening a Hello Health branch.
1. Commentary crossposted @nexthealth.nl.
2. This is a long post. To skip the running panel transcript, scroll down the page for thoughts on the current state of consumer-direct genomics and where the sector may be headed.
Matthew Holt is up next at the Ronald Reagan International Center in DC (July 6, 2008), where the US DHHS has arranged today’s “Understanding the Needs of Consumers in the Use of Genome-based Health Information Services” workshop.
Michael Cowan, Bearing Point and former Navy Surgeon General – opens the panel with a bang, comparing the healthcare sea change taking place courtesy of genomic advances to the recent release of Manhattan Project data.
This area of medical investigation is high-impact, no doubt about it.
To Matthew’s left on the dias is Esther Dyson of Edventure Holdings, flanked by Linda Avey, 23andMe, Inc. To his right, is Rebecca Fisher, MLIS, a patient advocate.
Esther kicks things off by asking the audience how many have had their genomes sequenced. Only 6 raise hesitant hands. She asks how many more would use the procedure if it were free. 6 or so more hands, including mine. Then: “how many of you would never undergo genome sequencing?” Again, 6 or so people agree. That means more than 2/3rds of the audience are undecided. But at least we’re willing to raise our hands…as Esther emphasizes, “value comes from the dialogue.”
They’re starting with Rebecca Fisher, listed as a “Patient Advocate” on the bio sheet. This turns out to be a gross underestimation of Rebecca’s utility. A 47 year old BRCA1 positive, breast cancer survivor and medical librarian, Rebecca says we need to “temper rhetoric about the excitement in all that we are learning.”
Rebecca’s main points:
Most consumers are not familiar with methods/vernacular surrounding genetic testing – this language is composed of words that belong to something very foreign to most people.
I’m a medical librarian, so I can figure out how to navigate the system (inference – I have professional tools and experience that place me above the ‘average’ e-patient consumer).
Both sisters had prophylactic mastectomies. The family later discovered the lab tested RNA rather than DNA – mastectomies were most likely unnecessary.
Main concern when consumers receive information based on genome sequencing: “There is no person standing at the point of decision for that patient.”
“This is a subtle and nuanced world. We should proceed with caution. We have no deadline.”
Matthew chimes in and agrees. Heads nod around the room. “In this emerging world of genomic information, there’s a real gap between the information that a person can download and the information that they need to make decisions about their health.”
Point well taken: Access doesn’t guarantee utility. Availability doesn’t equal value.
Esther: Rebecca’s concerns have “very little to do with direct to genetic consumer, and more to do with information and knowledge available to overall consumer.”
Rebecca: “What concerns me is the commodatization of human life - when a kit comes in the mail for you to turn in a cheek swab, and there’s no human being there. That person, I’m just thinking that person is not going to be equipped, if your own doctor is not equipped. I guess I side with the ‘proceed with caution naysayers.’”
Esther: What do we do to better equip doctors?
Rebecca: That’s the central question.
Esther introduces Matthew as a noted healthcare blogger and enfant terrible.
Matthew’s up now, and opens with the idea that he too, would have started a direct-to-consumer genetics firm, except that “I’m not a blonde female, which seems to be a major requirement for running a direct-to-consumer genetic testing in the state of California.”
If you’ve read more than a single entry on The Health Care Blog, you know where Matthew stands on privacy and access related to the sharing and disclosure of health information.
Matthew: “In my view we need to fix insurance coverage first, worry about genomics and privacy second. I’m a good Cambridge-trained Marxist and I believe in socialism and socialism insurance- but I also think things that are cost-effective should be covered. I don’t think it’s clear yet as to whether most genomic testing is cost effective.”
Esther: How would you solve Rebecca’s problem of undereducated doctors?
Contrary to his socialistic tendencies, Matthew has a capitalistic solution: “You have to introduce some level of competition, from other doctors and medical groups and organizations. There is a huge need in this country for medical advocates – in my mind that is personally a fair commercial opportunity. If you have the capability to afford 1-3k for a genetic test, then you can pay 100-200 for a medical coordinator.”
Linda Alvey: “I come at this from completely different direction, having worked in research for 20 years, working with people who are really trying to discover these genetic markers that will lead to personalized care. We’ve had problems finding enough people to run these trials on a scale that delivers actionable information. It’s all about statistical power – and if you don’t have that you don’t get to the endpoints that you need. At 23andMe we’re arming people with the specific information of their genomes - providing a mechanism for taking these results and taking them back to our customers but asking them to participate – let them tell us what diseases do you have, what problems are you having taking drugs, did you have a severe reaction? I don’t want my kids to go through the same thing.”
Linda is an idealist at heart but a capitalist in practice: “Hopefully we’ll get to the endpoint where we work together as a medical community – no one player in this space is going to do it alone.”
Esther: “I think narcissism is underrated. To some extent your genome is just another bit of consumer-information about how fascinating you are.”
Rebecca: “When I look out there I don’t see what Matthew mentioned, a coordinator, an advocate, an ombudsman. And I’d like to see that.”
Me, Matthew, audience: We need a high-tech patient advocate service.
Linda: “Things change for people when there’s a change in their health…it depends on where someone is in their life (lifeline).”
Final thoughts from the panel:
Linda: “At 23andMe we’re having a user gathering tomorrow night, which I’ll miss because I’ll be here at a meeting. But we want to find out what people are doing with that information. How can we be sure people are using this information in ways that positively impact their lives, not OVER acting on data?”
Matthew: Behavioral change is not emphasized via incentives (cultural and economic in this society). I have been tested, got some slightly above normal risk factors, but nothing so immediately catastrophic as Rebecca’s study.
Esther: So your results didn’t influence you to change your behavior?
Mathew: Nope. Because I know I should exercise more and drink less (laughter). I identify with Yankelovich’s “Could Care More demographic” or whatever group it is.
Rebecca: “When my family gets sick, we get really sick, so I don’t know how I would respond to a casual finding. When patient is diagnosed, they get curious, and bring information/questions back to their doctor and the doctor will learn from that.”
Now to everyone’s favorite segment - audience questions:
Q: Privacy and security – are you 100% sure my genome won’t be hacked? (An impossible question, medical information isn’t 100% secure NOW in our paper-based system, nor is financial information).
A: Linda Avey: The banking industry has done fantastic job of making tools and websites that people feel secure about using them…we look to other industries that have already played in the space and developed the technology. We allow people two levels of sharing – the minute people get their genetic information. The minute a new paper (on genetics) comes out people are running about our office and asking each other “do you have it? What do you have?”
A: Matthew: The core problem is what if this data gets out? What are the possible consequences? Most people are concerned about access to healthcare and access to health insurance first…
Q: Reporter from Consumer Reports: Have you found your customers want genetic counseling, and do you offer it?
A: Linda Avey: We haven’t found any direct requests for genetic counseling yet, but we may find this as we move forward….Blogger’s Note: I asked this same question last week in Berci Mesko’s Second Life meeting.
Q: Dr. Jim Evans, I’m a medical geneticist, and I’m a naysayer. I think the emphasis on mass marketing individual genomics takes our eye off the real value of this type of endeavor. I think that understanding our SNPs has incredible potential for illuminating disease, drug targets.
Several other physicians and researchers in the audience voice similar critical viewpoints.
Now some final thoughts based on the panels varied responses, and, despite the title, the lack of e-patient input other than Rebecca’s:
1. Genetic predisposition is not certainty.
Tracking SNPs is like unearthing fossils - we’re looking at the history of a battle, determining cause of death by the autopsy, except we’re not sure how all the organ systems work together yet (SNP webs of interaction).
2. The availability of consumer-based genetics tools doesn’t mean 100% of consumers will use them, or even that 10% of consumers who DO opt-in to buying “pay to play” genome sequencing will use results the SAME WAY even some of the time.
3. There is a great deal of debate about the utility and value of of genome sequencing with respect to population versus individual health targets and benefit.
The point that individual, consumer-based genomic sequencing doesn’t reveal “useful medical information” is crap.
I’m not a pedigreed health population worker, so I can’t speak from that perspective.
Let me talk from what I know (admittedly, not a lot). As an e-patient I’d emphasize health information has no power without personal involvement and consequence. All of our healthcare data are merely tools that we decide whether or not to employ.
4. A tool is just a tool, whether it’s a hammer, an alarm clock, a scalpel, or a genomic sequence - what matters is how you use it to achieve your end goal. What is the end goal of consumer-direct genome sequencing? Faster, more complete diagnoses?
This is, by the way, an open-ended question with many answers, which vary widely depending upon whether or not we’re looking at risks/benefits for individual versus systemic, or population-based, healthcare.
Let’s look at one potential individual end-goal for consumer-direct genomics…Diagnoses rock our world because they encapsulate meaning related to how our world will drastically change.
The consequences of reviewing healthcare information related to risk factors, genetic predispositions, etc. for consumers is firmly grounded in the way we view it with respect to potential impact on personal, daily life.
5. So, the consumer-centric genomics industry will mature past the toddler-stage when these developmental stages are complete:
STAGE 1: Provide “medically useful information,” which is anything that helps me learn about my health, risks, alternatives, and options. The industry is already here.
STAGE 2: Cooperate with companies, agencies, and NGOs developing medically useful tools, which are anything that help me engage with/and utilize ‘medically useful information.”
STAGE 3: Provide a petri dish for training providers and patients to interpret, share, and engage in conversations surrounding results of genome sequencing. “Medically useful” staff members in the genomics industry are those that help me consider the risks and benefits of interpreting the data and modifying behavior. They might include physicians, genetics counselors, consumer health coordinators, etc.
Here are some potential industry developments you’ll get from pay to play direct to consumer genetic testing:
1. Genomics testing will spread kind of like Fantasy Football. A few people start doing it. They talk about it at home, at work. You’re curious. How do your genes stack up? It will spread like a social, competitive, interactive game, with growth facilitated by online social networks. Look at the growth of similar activity around the nexus of particular symptom-based communities like Diabetes Mine and Sugarstats.com.
2. CONSUMER availability pushes the market to develop new tools. Consumer popularity pushes increasing market share and utilities for existing players, but also spurs new market segment development. Think about how you use your Ipod. How do you recommend new songs, new books? There will be similar variation in how consumers choose to adopt, access, share, and disseminate genomic information. Or not. Remember, this is a pay-to-play market, like the Lotto or Vegas. You judge risk and return and decide if you want to cough up the cash to get your results.
Because consumer-direct genomics, like consumer-centric care, is opt-in.Will you pay to play?
This bit of research is feeling personally relevant... navigating the discussion on genome sequencing at today's DHS workshop on 4 hours of sleep is no simple matter...
If we spend an average of approx. $7,500 per person on healthcare annually in the U.S. and chronic insomnia is capable of upping that cost by over 3k - isn't it about time to seriously consider federally mandating daily siesta breaks?
Sounds like it's time for another cup of coffee...
Quoted in: 'Costly Cancer Drug Offers Hope, but Also a Dilemma' - NYTimes
Prolonging life is one of those tricky medical issues that makes The Happy Hospitalist drool and twitch, especially for those at the latter end of their lifespans with a bleak clinical picture.
But what about the case of Avastin, an expensive cancer drug that may extend life by 4 months or so, for the bargain basement price of almost $50,000?
How would you respond if your doc told you a cure wasn't clinically possible, and your only recourse was to "manage your cancer?"
I doubt many of us could predict what we'd do in that scenario. The decision is as individual as your genotype, so I can only speak from a personal perspective.
My first impulse would be to extend life a few months to tie up loose ends - and finally get to the top of the Eiffel tower (2 attempts - 2 strikeouts), even if it meant eating the cost of Avastin somehow.
If you're uninsured/underinsured, to 'afford' spending that much to prolong your life for 16 weeks, you'd have to be making more than $150k a year, and that's JUST to cover the cost of the drug.
This figure doesn't include "legacy costs" (a polite term for describing a terrible series of arrangements) like establishing a will, setting aside money for burial/cremation and funeral services, or paying for any of the rest of care that might be incurred in the end-months, including chemo which often accompanies Avastin use, radiation, hospice, home health, etc).
However, Genentech, maker of Avastin, places the cost for the insured around an average of 129 bucks a month.
So wait. If I'm insured, with terminal cancer, and want an extra 16 weeks to play with, I'd need to make, oh, $516 to cover the cost of my pharmaceutical preservative?
And if I'm uninsured, the price of my ticket to ride the Avastin river of life for 4 months equals the average annual salary of a US school teacher?
Who decides if the cost of the drugs are worth it? The patient? The physician? The person at Genentech's PAP (pharmaceutical assistance program) who reviews my application for reduced/free drugs?
For the first time the disparities of concierge care and covered vs. not covered really hits home.
I don't know how I've missed it. In talking about patient access, I usually blog in 'participatory,' action/interaction based terms, not 'commercial' transaction based terms. And despite how often I harp about healthcare being a business, I somehow avoided thinking deeply about 'misaligned' incentives for patients.
In certain scenarios, those covered by health insurance in the US can actually. afford. to. live. longer.
Money can't buy you love, but in some cases it can buy life.
Food for thought: Read this NYTimes article.
How do you put a price on a few months?
An even more important question is how we define successful adoption - does this mean 50% of physicians are using EMRs? Does adoption of this scale indicate success if the EMRs are from 30+ vendors and the utilities don't communicate to each other readily?
Does successful adoption mean a 'killer app' is introduced that drives end-consumer (e-patient) adoption from 3% to 30% (or more?)
Good questions - no easy answer(s), but it's important we postulate solutions.
Continued advancement of patient independence and freedom to participate in the medical system depends upon quick, easy access to our medical data (via PHAs)- as well as the capability to add notes, share images, and send relevant info to current/future providers.
Unfortunately I haven't seen any fireworks marking a day of medical data freedom for e-patients yet, but we're well on the way.
A few good blog posts addressing the PHR development front:
- Bruce Friedman at Lab Soft News (quotes John Moore @ Chilmark Research, who believes Google and Microsoft's entry has "reignited" the market)
- WellingDigital (Australia)
- Luke Koupparis at OnMedica (UK)
Lately there's been an unfortunate plentitude of opportunity for e-patient, consumer health advocates to become involved in the debate surrounding who 'owns' our genetic information and how we may legally obtain access to it (or not).
The US government is trying to keep up.
Our DHHS Secretary named "The Personalized Health Care Initiative" one of 10 priority areas for the department - with the goal of "engaging in helping to create a health care system that is consumer-centric, preventative, and personalized."
Next week, Matthew Holt of The Health Care Blog and co-founder of the Health 2.0 Conferences will be speaking at a US Dept. of Health and Human Services workshop tackling these issues.
I'm attending at Matthew's invitation, and thanks to Berci Mesko's organization of the 23andme seminar in Second Life, I'm well prepared. It's an open meeting, and the consumer perspective is highlighted. As Matthew says, it's a 'star-studded' event - check out rosters for the Q&A panels (speaker bios here).
If you're in DC, VA, or MD, PLEASE mark your calendars and participate if at all possible. Register online here.
The conference will also be available via webcast - register for that here.
In the interests of full disclosure and transparency (and so you can't use the click-through requirement as an excuse for not attending), I'm also posting full details of the meeting below:
The workshop will explore the information needs of consumers in utilizing consumer-directed genetic testing services and will be held on Monday, July 7, in Washington , D.C. The attached document contains a brief meeting description and the agenda. Registration is available at http://events.SignUp4.com/ASPE.
The Personalized Health Care Initiative at the US Department of Health and Human Services is one of the Secretary’s ten priority areas and has been engaged in helping to create a health care system that is consumer-centric, preventative, and personalized. An upcoming development for this personalized system is an increased understanding of the genetic basis of disease. Recently, services have emerged that provide genome-based health information directly to consumers. These new services have occasioned considerable press and public attention. At the same time, questions have been raised quickly regarding the real value of these services to consumers.
The Personalized Health Care Initiative has conceptualized a workshop to explore the information needs of consumers in utilizing consumer-directed genetic testing services. The workshop will be held on July 7 at the Reagan International Trade Center in Washington, DC (and via the web) and is aimed at the public benefit where stakeholders can bring differing perspectives and look toward actions that will help consumers make informed use of genome-based health information services. It is important to emphasize that the consumer perspective is the theme.AGENDA
- 12:30 – 12:45 pm: Welcome, Meeting Objectives and Overview, Richard Campanelli, JD Counselor to the Secretary for Science and Public Health, US Department of Health and Human Services
- 12:45 – 1:05 pm: Medical decision-making empowered by genomic information, Eric Topol, MD, Director, Scripps Translational Science Institute, Dean, Scripps School of Medicine
- 1:05 – 1:30 pm Consumer interest in health and genomic information, Steve Bodhaine, MBA, Group President, Research/Product Development, Yankelovich
- 1:30 – 2:30 pm Panel 1: What is the consumer interest in genome-based health information?
- 1:30 – 2:10 pm Panel Discussion
- 2:10 – 2:30 pm Q&A, Linda Avey, Co-founder, 23andMe, Inc., Esther Dyson, EDventure Holdings, Rebecca Fisher, MLIS, Patient Advocate, Matthew Holt, Co-founder Health 2.0 Conference
- 2:30 – 2:45 pm Break
- 2:45 – 4:00 pm Panel 2: Is the testing process reliable, and is the information’s privacy maintained?
- 2:45 – 3:25 pm Panel Discussion
- 3:25 – 4:00 pm Q&A, Deven McGraw, JD, MPH, Director, Health Privacy Project, Center for Democracy and Technology, Ryan Phelan, Founder and CEO, DNA Direct, Kari Stefansson, MD, Dr. Med President, CEO, and Director, deCODE genetics, Reed Tuckson, MD, FACP, Executive Vice President and Chief of Medical Affairs, UnitedHealth Group
- 4:00 – 5:15 pm Panel 3: What is currently useful to consumers, and what can they expect in the future?
- 4:00 – 4:50 pm Panel Discussion
- 4:50 – 5:15 pm Q&A, Mari Baker, President and CEO, Navigenics, Katherine Johansen, PhD, Senior Scientist, American Medical Association Program in Genetics and Molecular Medicine, Nancy Johnson, Senior Public Policy Advisor, Baker Donelson, Ronni Sandroff, MA, Director/Editor, Health and Family Information, Consumer Reports, Angela Trepanier MS, CGC, President, National Society of Genetic Counselors, Assistant Professor, Clinical Center for Molecular Medicine and Genetics, Wayne State University
- 5:15 – 5:30 pm: Looking to the future of consumer services (moderated discussion), Michael Cowan, MD, Chief Medical Officer, BearingPoint 3
They're also stepping up the competition surrounding opensource/openid signons and sharing APIs (within set strategic parameters of course - this is still MS World we're talking about).
Who has the better health product? Debatable. At this point, probably inconsequential.
Both Google and Microsoft's slide into the consumer-centric PHR space are helping advance the market in general, as Keith Schorsch points out over at The Health Care Blog.
What matters right now is which company is able to establish a cutting-edge, market-share takeover.
My personal opinion? Neither utility is consumer-friendly enough to reach 'killer app' adoption rates of 30-40%.
Why? I've played with both tools and won't use either one, and I'm definitely the type of hyperinvolved e-patient these firms want to be wooing.
I agree with Keith that the firms are still getting it wrong:
"PHRs and electronic medical records remain an industry-driven vision, not a consumer-driven one — focused on efficiency and reducing costs. It seems we’ve lost sight of whether the consumer really desires and is willing to participate in these services."
I most definitely desire and am willing to participate in these services, when I find one that's functionally useful, stores information in an easy-to-share format, and is above all else, user friendly.
Current offerings don't come anywhere close on ANY of these points.
Unfortunately for consumers, the Health 2.0 PHR domination wars are currently all about quantity, not quality.
Right now it looks like Microsoft is winning. But looks can be deceiving.
And it remains to be seen if this early leading edge will allow Big Evil to stay ahead of the competition, especially if a new killer app enters the market and consumers adopt it quickly en-masse.
A scrub of press releases reveals multiple Microsoft partnerships in the past month (I'll do some digging and see if I can't figure out a TechCrunch-style list later today).
Now, Google could have inked just as many agreements, but may not be releasing info on them yet.
Let the Health App Wars begin...
- William Weldon
Chairman and CEO, Johnson & Johnson