Bringing Health Home: Recap of #frogHealth's Twitter Chat

On Thursday (6/4/09), frog design hosted its second live one-hour conversation on Twitter about Connected Home Health (CHH). Initially, we defined CHH as connected "ecosystems of people, devices, and services to better manage health & wellness at home" but the conversation extended far beyond a definition and generated some innovative ideas for the future of healthcare. (Participants even kept the debate going after the chat had "officially" ended).

The chat brought healthcare professionals and thought leaders, reporters, bloggers, and designers together for a lively discussion that offered provacative insights on CHH and proposed ideas for technology that could radically change our relationship with the healthcare system.

We will be doing another Twitter healthcare chat soon so please stay tuned to this blog and follow frogdesign on Twitter for more details. (In case you missed it, our first chat on mobile health is fully archived here.)

Thanks to everyone who participated in our second Twitter chat exploring the theme of Home Connected Health.

A recap/summary of #froghealth Chat Second Edition-6.4.09:
Connected Home Health
“How technology can help us manage health and wellness at home”

Q1- How would you personally define “Connected Home Health”? Why is it interesting to you?
deremer  Q1- Home health means being able to connect caregivers with people at home so they don't have to be in a hospital #froghealth

frogdesign Our sample definition: "connected ecosystems of people, devices, & services to better manage health & wellness at home"

deremer Q1- You need sensors, computers, wireless monitoring devices, maybe video conferencing and connect it with dr/nurses

fabtweet #froghealth seems like there are two issues that overlap: self-management. could be in the home or not. and then connected environments.

emmazure Q1: nowadays consumers have a dozen different devices and hooked up environment everywhere. but not disconnected with

emmazure Q1: to me it is connecting my home enviroment to the whole health & wellness information and facility, making accessible at home

fabtweet #froghealth the latter is about technologies specifically embedded / tailored for the home or others environment outside health system
 
deremer Q1- I find using all the technology people already have with healthcare to be an interesting idea.

johnattebury @frogdesign Q1 The elimination of time & space between patient & physician knowledge, authority, & records.

idLaurenn Q1 - Creates an awareness of one's own health. Can aid in bringing responsibility back to patients and their own health. #froghealth

emmazure #froghealth Q1 - speaking of information and health record, hooking up consumers, payers and caregivers can also be considered a part of CHH

connected_tech @frogdesign Q1 health awareness is critical to empowering people to make better decisions - key goal of CHH #frogHealth

AlexTam Q1 Q2: A challenge/opportunity I see here is offering timely attention and also making it easy for physicians to bill effectivly #froghealth

followsprocess @frogdesign Q1- Your definition is good, "eco"system is a misnomer though, just define as connected systems #froghealth

Q2- Who are the major participants in a home health network? Which participants would find it valuable and/or benefit the most?
deremer Patients, Family, Caregivers, Nurses, Doctors, (Insurance Companies!!)

emmazure #froghealth Q2: i think everyone will benefit from the connected ecosystem. a specific example might be home nursing

deremer Q2- I would think Dr's would benefit the most, less patients to see all the time, but someone needs to follow the data #froghealth

emmazure #froghealth Q2: but I also feel interested in promoting the concept to a broader spectrum of users for prevention and general wellness

idLaurenn My mind is boggled. There's just so much. #froghealth

emmazure @deremer #froghealth more efficient house calls

deremer Q2 @emmazure That's true I think we always think of home health being for old people with disease #froghealth

fabtweet @deremer #froghealth not just old people. more and more studies show that visiting doctors and hospitals exposes us to a lot of risk

deremer Q2- Actually for me home health would be something more like FitBit http://www.fitbit.com/

fabtweet @deremer #froghealth look at swineflu. a lot of value in giving people tools to diagnose and info to manage and stay home

deremer Q2- @fabtweet good point, why do we bring our sickest people together in the same place? they should just stay home! #froghealth

mcrate_s @frogdesign Everyone can benefit from a connected home. Each participant has something to offer and something to gain. #frogHealth

noahr #frogHealth Q2: How about network providers, app developers, device makers, and database builders?

Q3- What are the key user scenarios for home health - Managing chronic illness? Helping w/ diet/exercise? Elder care? What else?
Turk182 Home health - all mentioned, also prevention (in essence diet and exercise) and remote family participation #froghealth

idLaurenn Q3 - Medication adherence, EMR execution, TRUST: which opens a whole new box of goodness. #froghealth

emmazure #froghealth Q3: connecting those fitness video games to your nutritionist's office makes the diet/exerice more fun and customizable

deremer @Turk182 What do you mean by "remote family participation"? #froghealth

johnattebury Q3 Why not ask what scenarios require a physical visit , everything else gets managed/done at home. #frogHealth

connected_tech @frogdesign Q3 - i would add medication compliance also #frogHealth

mcrate_s Q3: Hard to separate "scenarios" because so much of what you do affects your health. it's one big scenario #frogHealth

Turk182 Q3: personalizing care - supporting movement to home visits #froghealth

deremer @johnattebury I'd agree with that logic, if most things can be done at home, then we only need to isolate what CAN'T

svyas79 #froghealth Q3 - I think that preventative care would be a great scenario for home health

emmazure @Turk182 #froghealth like the idea of remote family participation! group support and the sense of community helps ppl achieve health goals

mcrate_s Q3: but in order to understand and deal with it, it has to be broken down. seems like moments within scenarios... #frogHealth

Turk182 Q3 - John, move towards premium care with home visits may change what it means to have a physical visit #froghealth

mcrate_s @deremer & @johnattebury - yes. certainly getting an MRI at home isn't possible today, but what does the future hold? #frogHealth

ichrisbarnes Q3 Agree w @Turk182 about remote family participation. Also, facilitate health/fitness w info, monitoring, and feedback

michelet @deremer there has to be a balance though - those face-to-face moments are key to good medicine. #froghealth

Turk182 David, 'remote family participation' an aspect of elder care when the family is helping but not in same location #froghealth

emmazure @deremer @johnattebury #froghealth and also can significantly improve the efficiency of caregiving facilities

frogdesign @mcrate_s Ok, what are the moments within key user scenarios that are important then? #froghealth

michelet Is there a mobile equivalent of the "oh-by-the-way" questions patients ask as they leave that are usually key concerns? #froghealth

idLaurenn @mcrate_s : Which is why this is so fun to figure out :D

mcrate_s @idLaurenn indeed. and yes, it's mind boggling but breaking it down is key to begin to solve the problems. #frogHealth

emmazure #froghealth i see a scenario emerging from the tweets. connecting the health communities, with docs, families, friends, or other patients

deremer Q3- I have a pain, and I'm freaking out...would be great if I could find out it's nothing without spending # at the Dr #froghealth

mcrate_s @emmazure question for you, are there still a great deal of house calls (HC) in china? #frogHealth

emmazure @mcrate_s #froghealth not really. there's no role of family physicians in China either

mcrate_s On Housecalls, Kaiser has a number you call. Telemedicine...sort of...and one can speak with a Nurse Practitioner. #frogHealth

connected_tech Problem with Connected Home Health is the number of conflicting agendas between the major stakeholders

followsprocess @frogdesign Q3 - healthy user who has onset of unclear symptoms. A device to help sort out if further attention is warranted. #froghealth

followsprocess @frogdesign Q3 - User with depression/mental illness to help monitor mood and encourage support network #froghealth

Q4- Let's focus in on a scenario: What are some home devices that could improve remote family participation?
ichrisbarnes For my health, I want accessible reliable exchange of info w provider & health resources, and tracking to keep me accountable.
mcrate_s @connected_tech agreed. it has to be a divide and conquer strategy. put appropriate & willing stakeholders together #frogHealth

deremer Q4- Most people I know have an HDTV and fast Internet. Why is home video conferencing finally popular? #froghealth

mcrate_s @frogdesign & @emmazure mentioned earlier but the gaming consoles have become a point of connection #frogHealth

mcrate_s @emmazure on HC, that's interesting. perhaps the game consoles could be leveraged to enhance a service like Kaisers. #frogHealth

Turk182 Q4: if my father's blood sugar dropping to the 30's or 40's would send me a tweet so I could call him. #froghealth

deremer Q4- Meant why is it NOT popular? It'd be cool to SEE my grandma in Florida when we talk (it'd have to be easy for her though)

AlexTam Q4: online health record, networked vitals devices (BP, Glucose, HR), historical trending visualizations, medication reminders #froghealth

mcrate_s Q4: what if health providers had a console as the window into the home. infrastructure is there. #frogHealth

Turk182 Q4: A PHR that had info easily input and up-to-date so I could help my parent with adherence to doctor's recommendations

johnattebury Q4 a scale which uploads weight & allows family members to see & track their weight "oh, you've gained 4 pounds, let's workout"

emmazure #froghealth Q4: connecting wii fitness of family members in different locations. play and compete and keep healthy :)

Turk182 Q4: In many ways the cell phone + a bit more is the ideal support for remote family participation #froghealth

deremer For any of this to work we need some pretty invasive technology. How do you listen to a stethoscope remotely? #froghealth

mcrate_s @johnattebury that's a good one. connecting the home, one device at a time. #frogHealth #frogHealth

Turk182 @emmazure - that'd be fun! Particularly for the grandkids and grandparent - mental/social and physical activity #froghealth

deremer @mcrate_s Are doctors the people who monitor "home health" data? Seems like a big data stream...only need to see what's wrong

idLaurenn We can create new interoperable devices that use platforms such as Microsoft's new Embedded software, HealthVault

Turk182 @deremer - did you see the bluetooth enabled pills - swallow and body chemistry creates a battery to signal you took it

mcrate_s @Turk182 I think the Cell is great. built in communication for sure, but there should be multiple options. #frogHealth

Turk182 Q4: invasive - ideally this isn't solved by creating more devices, but enabling current ones to do more. Connect & integrate

emmazure @deremer #froghealth sending alerts to docs' mobile devices. it is a huge data stream. better let the machine do the monitoring

johnattebury A program analyzes your health data, hx, & family hx, flags trends to you & to doctor. "high blood pressure, time for a visit"

Turk182 @mcrate_s - more than one option definitely - web, cell etc #froghealth

AlexTam A key moment happens right when people get a test result or some news. Patients have the most questions and need support then.

deremer @Turk182 Totally, there is so much tech people have already, do we need more devices? But then we need to sell something

kaleemux #frogHealth Q4 Home devices that could improve remote family participation include ambient information devices. See @fabtweet #IxD09 talk.

Q5- Who would pay for connected home health products & services? Where would consumers buy them if they could?
Turk182 q5: obviously a lot of the movement here is because medicare and insurers will pay much of this to reduce other costs

johnattebury @mcrate_s many of these devices won't need direct doctor intervention but would make data available for trend analysis

deremer @AlexTam Ah, would be cool to be able to connect patient, family, & Dr all together to review results remotely... #froghealth

mcrate_s @AlexTam within the overarching scenario, the moment of diagnosis is key & becomes a starting point for lifechange #frogHealth
Turk182 q4: @deremer - yes we need to sell the services, the turning of data into information, less lots of new devices #froghealth

emmazure #froghealth Q5: i would get consumers tend to buy products than services, though we know it's a service era.

idLaurenn @deremer I wondered that too. We would need to create an new team(in a hospital)dedicated to managing the CH and it's components #froghealth

mcrate_s @deremer & @turk182 no new devices. we can sell software. #frogHealth

deremer For healthy people, the key is to convince people they need to think about their body before something is wrong #froghealth

Turk182 Q5: Things that connect people in a meaningful way and integrate health benefits - that I can see the consumer paying for. #froghealth

kaleemux #frogHealth Q5 Consumers would would pay for connected home health products & services if there is real value. See home alarm industry model

emmazure #froghealth Q5: so there should multiple revenue streams for CHH players. beyond device sales and service subscription fees as basic ones

AlexTam @deremer yes, perhaps scheduling time, but more likely in an asynchronous with messaging but somehow more real time than email

mcrate_s @idLaurenn yes & no. a NP at Kaiser could just as easily take video conference calls, as phone calls. #frogHealth

deremer Q5- I think most people expect insurance or government to pay for healthcare #froghealth

emmazure #froghealth Q5: just think about the value of the huge data stream. pharms and insurance companies would like to sponsor big-time

johnattebury Q5 Consumers will pay until a company develops a complete service, then insurance will discount for using that service. #frogHealth

deremer Q5- The key to consumers buying it is making it feel cooler, like a consumer electronic. The BluRay of health devices, etc. #froghealth

ichrisbarnes Q5. Payers could have big incentive. Consumers would pay if value is delivered. Purchase at Best Buy, Amazon, WalMart. #froghealth

Turk182 Q5: I think the key is that it's not just a health device - particularly for the prevention space #froghealth

Turk182 Q5: cost structures are very diff (though shouldn't be) if you ask consumers to pay vs. insurer or gov't. #froghealth

ralenda @frogdesign emergency preparedness at the home?

johnattebury @frogdesign Are you capturing all #frogHealth tweets for future analysis? Will you report on your findings?

deremer @ichrisbarnes Buy a health device at Walmart? That's kind of scary, no? Discount health products? #froghealth

kaleemux #frogHealth Q5 Connected home health products & services are high value to parents; families w/ elderly; families of those w chronic illness

deremer Q5 Even alleviating anxiety around uncertainty or providing clarity or reassurance is a huge seller #froghealth

Turk182 Q5: if I could buy Dad a blood sugar monitor/heart rate monitor/watch that would tweet me when things go so south - I'd do it. #froghealth

emmazure @ichrisbarnes #froghealth agree. it's analogous to the google model somehow. big user base and good data mining will get sponsored

johnattebury @emmazure That's a fantastic point! Will people anonymously share their health data for cheaper healthcare & better health?

deremer Read http://bit.ly/1arIfV about HDHP. They r terrible for low income families. This would likely extend to "cool" med devices

kaleemux #frogHealth Q5 Connected home health products & services are high value to physicians: ongoing ambient health monitoring of those under care

Turk182 Q5: so if you're motivated enough you'll buy. For that watch, add a GPS, and I'd pay $200 plus $40 annual fee split with sibling

Turk182 Sharing health data for less cost... Google works specifically because it does track data back to an individual. #froghealth

emmazure @johnattebury #froghealth also a critical question to promote PHR. if you use the data in a right way, like reducing errors, you'll be liked

deremer Q5- Two options: 1-very discrete items so you don't know they're there that only act when there's a problem

deremer Q5- Two options: 2-very obvious items that are styled and have personality, want show them off - very different effects #froghealth

ichrisbarnes @deremer You could be right re: WalMart. I don't shop there, but MANY do. Ubiquity has pros. Glucose monitors sold there.

mcrate_s @Turk182 yes on the sibling split. taking care of our parents has led us to communication and cost issues. #frogHealth

nphill sources to diagnose conditions cause a lot of anxiety in patients. when doctors diagnose we consider the worst scenarios first #froghealth
Q6- Any core user needs that must be met for any of this to work?

nphill pts who have researched their condition at home online first tend to freak out because of this and are much harder to manage #froghealth

emmazure @Turk182 #froghealth maybe a family plan as seen at mobile carriers. clinics pay for the master and distribute less-costly ones to patients

deremer Q6- Grandparent-(or even parent)-proof! Must be super easy and unobtrusive

kaleemux #frogHealth Q5 Connected home health products/services help improve data,build new models,shift intervention to prevention & lower care cost

mcrate_s @nphill & then eliminate till the actual problem reveals itself? trust seems key. how must these systems engender trust? #frogHealth

johnattebury Q6 #frogHealth You have to get the technology into hands & homes - otherwise there is no connection. (cost as biggest factor)

nphill they demand antibiotics and unnecessary tests, which drs give to keep them happy, drives up the cost & creates resistant strains #froghealth

mcrate_s @deremer unobtrusive. seamless data entry. clear feedback to the right users.
emmazure #froghealth Q6: information transparency and accountability

deremer @johnattebury Not to mention the cost of getting all those systems to actually work together seamlessly #froghealth

AlexTam Q6- key is more complete information from the measurements. Opportunity here for us to use design to make compliance easier

johnattebury @nphill as you note, part of the "connection" could include patient feedback about their previous "over"reactions

deremer @emmazure Interesting. Who's accountable then? Doctor? Patient? Family? Sony? Walmart? #froghealth

nphill @mcrate_s start w/ most life threatening possibility & rule it out 1st w/o causing unnecessary panic then rule in what we think #froghealth

emmazure @mcrate_s #froghealth agree. unobtrusiveness is critical to making consumers embrace this at home. few ppl want their home feel like clinic about

kaleemux #frogHealth Q6 Core user needs for connected home health to work: Non-intrusive, fits into lifestyle, low barrier to entry, trust & privacy.

frogdesign Thanks for joining everyone, keep it going if you want! Follow @frogdesign for updates and to see when a summary is posted.

AlexTam @emmazure woule be interesting to isolate the motivations that get each of the players to do their part in the system. #froghealth

johnattebury @AlexTam #froghealth agree, easier compliance is the key - system should be 2nd nature, unnoticed, great design opportunities

mcrate_s @nphill keeping panic at minimum seems to get back to trust again. and @kaleemux mentioned trust again! hmm

nphill @johnattebury true, but it costs so much extra time & money that there really needs to be a better way to get answers & avoid it

deremer @johnattebury Tracking "over-reactions" is cool, don't scare people away tho. Use past interactions to inform future ones!

johnattebury @deremer #froghealth you could even have various presentations according to "patient type" - if you overreact, present info diffrently

johnattebury @nphill It costs extra time & money now, but the system must alleviate that - pt experience with system being right will help

nphill needs to be a syst where pts can enter their symptoms & be told if they should make a drs appt or go to er and not give diag

deremer This is making me realize how antiquated hospitals and doctors offices really are...the idea of them anyway... #froghealth

deremer Except trauma or severe disease why fill hospital beds when everyone has a bed at home? (Probably very scary to hospital Dir's!)

kaleemux @mcrate_s Trust in a system in all its aspects is the likely the core requirement underpinning success of connected home health.

mcrate_s Distributed Hospitals: Numerous, small clinics rather than single, large, centralized

johnattebury @mcrate_s #froghealth interesting, distributed hospitals would make healthcare "local" again

nphill needs to focus on prevention, when to seek help, and education about diseases and treatment options, not diagnosing #froghealth
So for kids, who spend a great deal of their lives online ...more trusting of a connected home system? #frogHealth