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Future of connected healthcare includes chatbots, Medicare changes

Remote patient monitoring and chatbots will be mainstream in healthcare -- eventually. Partners HealthCare's Joseph Kvedar, M.D., offers his view on why it takes so long.

During the Connected Health Conference in Boston, Joseph Kvedar, M.D., vice president of connected health at Partners...

HealthCare, discussed his views on everything from blockchain to chatbots and remote patient monitoring. Kvedar -- who's been involved with health IT for the last 25 years but is quick to point out he's no technologist -- said changes are coming to healthcare, but at a slow pace. However, he believes connected healthcare can be beneficial to patients if designed properly.

This Q&A has been edited lightly for clarity and brevity.

Does connected healthcare technology have a role to keep patients healthier and on track, and can it do so without being annoying?

Joseph Kvedar: Yes, although it's all about design. If we design our technologies to be annoying, they will be. I think changing behavior in healthcare is more about inspiration than education or nagging, at least for most people. Some people welcome being nagged -- everyone's different. The nice thing about where we are all now is we give enough digital exhaust to show our unique personas. Software can recognize that and start to use that as a substrate to message you about inspirational things you might do in a way you might find compelling. Whether it's you get five points toward money for a charity or 10 points to spend on gum at Walgreens, everyone's a little different. But we have enough understanding from the marketing, mobile and retail industries that know ... how to get people to change their behavior, and we can apply some of that.

Is there anything you've glimpsed in connected healthcare this year that might become more real next year?

Kvedar: A year is a short time in healthcare. There are some things happening, but I don't know that this time next year we'll see dramatic changes. One of them is [changes to] reimbursement codes for things like what we call an e-consult. I'm a dermatologist, and a primary care [physician] sends me a little bit of history and an image and I respond. So as of January 1, Medicare starts paying for that. There will also be three new remote monitoring codes. If I want to monitor your blood pressure in the home, I will get paid for my clinician in my office to explain it to you, I can get paid to help set it up and I can get paid for reviewing the data, so that should encourage some adoption. There are a whole series of those [kinds of changes].

Again, I don't know if [it will happen] in a year, but there's more and more interest in chat tech as a front end for interacting with patients for simple things. The business behind that is often targeted referrals to a doctor. You get in with whatever your symptom is, you interact with the chatbot and once the chatbot determines you need a doctor, it sends you to one of my doctors. So we might be a purchaser of that service. I mention that because it's comforting to know there might be a business model to support something that's happening. Still, I believe it's too early to see signs of penetration of these computer-vision AI tools for dermatology or ophthalmology.

Many think blockchain might be a natural fit for healthcare. What do you think?

Kvedar: I joined the advisory board of a blockchain company to learn what it actually is and I still haven't. lt is kind of a mystery to me. I vaguely get it. I use this analogy: Right now it reminds me a little bit of where we were in the early '90s with Mosaic. We really didn't know what a hyperlink was or about the internet or how the world wide web worked, and then all of a sudden Netscape came in and it didn't matter. You didn't need to know how it worked. The terms all went away. We need something like that for blockchain so we don't have to copy big long numbers and store it somewhere. It's way too technical and complex, and that's holding it back. Someone's got to make it simple. I don't know enough about it to even have a vision for what it means.

We spend a lot of time studying the behavior of patients with chronic illness who we want to monitor in the home. Anything to do with health for the most part is last on the to-do list. If you make it complicated it's even further down the list. The example I use is the difference between a Bluetooth pairing and something like a blood pressure cuff. For some reason people will fiddle with a Bluetooth ear piece and repair it, but if the cuff stops they just quit and move on. If you're going to use something as complicated as blockchain for health, you can't expect patients to spend a lot of time and energy with keys plugging in numbers that are 12 digits long and dealing with hexes.

How widespread is remote monitoring at Partners HealthCare today?

Kvedar: We're still in our infancy. We have a couple hundred people in the program right now, and I think that's a meaningful number because we haven't gone out and promoted it programmatically. We have gone out and made clinicians aware the infrastructure exists, and if they want to sign patients up they can and it's totally up to them. We're seeing sort of a drip, drip, drip of adoption. So I think that's where it is. People are feeling like connecting with a patient using a Skype-like interface is innovative. That's the mindset where most clinicians are.

The [new Medicare] codes may help us with that. This really changes the workflow completely. I might have 100 people on blood pressure medication being monitored, and I am only going to interact with the ones where the software shows me they have high blood pressure. It's just so different than say, 'Just schedule them all for a visit in the office,' even if you don't need to be seen. ... It's so much of a brain cramp and the workflows are different etc., whereas if you do a video visit [the doctor] might as well be in the office. [The patient gets] the pleasure of being at home so it's more convenient, but it's not enhancing efficiency and it doesn't really change how you gather information or make a diagnosis or offer care. I don't mean to be discouraging. It's a first step but remote monitoring is a couple steps beyond [telehealth] and we're working on it.

What do you think is next for connected healthcare? Let us know in the comments or on Twitter @SearchHealthIT.

This was last published in November 2018

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