Dishman: Mobile health needs culture innovation, not just tech innovation

By Jonah Comstock
09:25 am
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eric-dishman-heroWhat do you get when a major technology player in the mobile health world becomes ensconced in the health care system as a patient with a serious medical condition? Well, if that person is Eric Dishman, a founding member of Intel's Digital Health Group, you get a sobering talk on just how far mobile health still has to go.

From the mHealth Summit main stage, Dishman spoke about his recovery process from a kidney transplant that helped save his life. Dishman wanted to see whether he could put the mobile health technology he encountered in his professional life to work for himself as a patient.

"Can an early adopter like me, who knows the key CEOs at the key companies, who makes money, who speaks English, who has all the advantages I do, could I pull off making the hospital obsolete?" he said. "Well, I'm going to give you some tough love from a very frustrated patient."

Dishman said he found a huge market of apps with no way to sift through and choose the best ones. The situation with devices was even worse, as he found himself having to learn five different interfaces and found nothing remotely resembling interoperability.

"There were eight different software packages claiming they would be my personal health record," he said. "They would be my central repository and help take care of me. But none of them could do anything other than what came with that particular device."

Even when he managed to make the technology work to monitor his vital signs, Dishman ran into additional problems bringing his care team into the loop, even though his doctors were eager to work with him.

"We're not quite there yet. We're not quite ready for prime time. But the public is," he said, citing Intel's recently released global study of healthcare expectations. "The public is ready to be part of the solution. More than 80 percent of the people in the survey were optimistic in terms of innovation and technology."

The problem with mobile health today, Dishman said, is that there is too much focus on developing technology, which a multitude of companies is doing in a siloed way, and next to no focus on reinventing the system, training, workflows, and reimbursement models to needed to make that technology work for people. He presented a three-part plan for creating that system, consisting of care networking, care anywhere, and care customization.

Care networking means moving from solo to team-based care within the hospital, as well as using technology to enlist networks of non-professional caregivers like friends, neighbors, and patients themselves to do monitoring outside the home. That monitoring itself is the notion of care anywhere.

"That's the paradigm we need to move to -- care anywhere, of which certainly mobile health is a key aspect," he said. "Shifting from this institution-centric brick and mortar paradigm we've had for over 200 years to mobile, home-based systems as the default. Your illness will earn you into the brick and mortar system only when its absolutely the necessary tool, but care anywhere needs to be the default."

Care customization includes both biological customization, such as using genomics to find the best outcome for a patient, and behavioral customization, such as fitting the patient with the medication adherence app that will work best for them, personally.

Dishman said the biggest barrier to these changes was still reimbursement, a structure that is currently far too tied to the hospital. He cautioned against mobile health innovators becoming too focused on reimbursement for just their own devices.

"Many of you have worked this out for your particular device, and I run into you on capitol hill trying to secure reimbursement for your particular device," he said. "We're going to end up in trouble if we continue the fee for service model for digital versions of existing devices. If we don't collectively do more than just device innovation, and do all the way up to culture innovation, figuring out, when you develop your device, what are the roles and relationships it creates, we're going to have difficulty mainstreaming and scaling it. An independent vendor might secure reimbursement, but we'll lose the war even if we win a battle."