An Interview with Dr. John Glaser

PULSE: What are the big technologies in the digital health space that you are excited about?

DR. GLASER: We are in the early stages of a very profound change in healthcare business models. Changes that result from going from reactive sick care to proactive management of health and wellness; from care that focuses on a particular area of care like pediatric care or cancer care to care across the continuum; and from reimbursement that rewards volume to rewarding efficiency and quality. These are significant business model changes.

Anytime you have business model changes that are that significant, you see IT innovations contribute across the board. There are many areas where digital technologies will prove quite useful and contribute to improving outcomes. I can give you several examples.

One is in the area of Electronic Health Records. After having implemented them, it is now about using them to optimize care. A second area, which goes with the first, centers on improving interoperability. There is lot of emphasis on improving the exchange of data; not only between providers but between providers and patients and providers and public health. A third area is composed of technologies that are designed to help us manage the health of a population; examples include disease registries and care coordination technologies. A fourth area which is getting a lot of attention is consumers using technologies to manage their own health. These uses range from Fitbits to technologies to measure blood sugar levels to applications that perform gait analysis. A final area, which is about to take off in a very big way is telehealth. Telehealth has many different use cases within it, including remote monitoring, semi-urgent care guidance and clinician to clinician consultation.

PULSE: It is interesting you mentioned technologies which allow consumers to manage their own health. What really is driving this space – is it innovation in new sensor technology or is it new algorithms and analytics tools or is it a new emerging trend in how physicians and providers are integrating this data in their care delivery methods.

DR. GLASER: There are some complex dynamics at play. If you look at what percentage of US population uses Fitbit-like technologies, it is small. When we look at the evidence of the impact of these technologies on improving chronic disease management the results are mixed. So there is still a fair amount to learn about how best to optimize the contribution of these technologies.

Clearly there have been advances in sensor technology, both in terms of what can be measured and the accuracy of measurements. But I believe that the main advances have been in the analytics. And not just in analyzing the data from a particular sensor but combining the data from a multitude of sensors with data from the electronic health record and the inclusion of environmental parameters.

The combination of these diverse types of data can be used to come to a “context-aware” conclusion. As an example, let’s say you have sensors attached to an elderly male which indicate that his heart rate is up, his blood pressure is up and based on the chemical composition of his sweat, he is dehydrated. You combine this data with the information from his EHR and you see that he also has a history of cardiovascular disease and is quite frail. You also combine this with data from sensors in the environment which report it is a hot and humid day. So you immediately know that this person is at risk. You know the risk because of that combination of sensor data, patient history and environmental parameters. If on the other hand, instead of being an 84 year old man, this was a 24 year old man, you may not be as worried.

While there is enormous potential we often haven’t yet quite figured how to combine the technology with other things that we do to improve health and wellness. Sometimes, the right way to help a diabetic, if they are poor, is to get them a ride to their doctor’s office or helping them with their copay for their medications. Or if they are not a native English speaker, helping them with language and tailoring interventions to more appropriately fit with their culture. It won’t be just technology that will help manage health but technology combined with other things to provide a comprehensive package.

PULSE: How do you see physicians responding to these developments in technology? What can be done get physicians to more readily embrace new technologies?

DR. GLASER: The physicians sometimes find that their experience with health information technology is not all that pleasant. Take the example of EHRs. Sometimes they feel that it is taking too much of their time. Sometime they look at all this data coming from the sensors and health information exchanges and they feel overwhelmed. Sometimes they have decision support systems which are way too sensitive. And these are all legitimate concerns.

There is work to be done in building analytics which can look at all the data that can come to them and filter it down to the two or three pieces that the physicians really need to pay attention to.

Physicians are no different than anyone else. They will embrace technology that helps them do a better job and saves them time.

PULSE: How do you see incumbents react to new entrants?

DR. GLASER: There are different kinds of incumbents. There are the EHR players whose customers are trying to become Accountable Care Organizations. These players are strong at providing certain products and services – like EHRs across the continuum, the revenue cycle across the continuum, analytics that help providers look at cost and quality and set pricing for various capitated and bundled contracts, and population health management technologies.

Another set of players are the health plans trying to improve member engagement and manage care costs and quality. These will be looking to be more consumer oriented and more focused on partnership with providers in new risk-sharing models. There are also the life sciences companies, particularly the big pharma companies, trying to ensure that their medications are used more appropriately and effectively.

All of these big players are trying to reach out to the consumers and engage the patients. And all of these players are trying to improve the appropriateness of care.

I expect to see a fair amount of acquisitions in this space by all players. Larger organizations can’t always innovate. Sometime smaller companies are more nimble. We will see acquisitions devoted to innovation – bringing in innovative ideas that are occurring at the edge, in areas that the major players are not currently. Sometimes acquisitions are related to increasing scale or footprint (like increasing the customer base). Sometimes acquisitions are directed to broadening a portfolio. For example, a large EHR vendor may see that their customers are beginning to take on features a health plan so they might want to acquire a mature company that does health plan technology.

Regardless, the significant changes in healthcare business models presents many opportunities for incumbents and entrants.