Monday, May 9, 2011

Thoughts on the Stanford Mobile Health conference

I like to blog about events, conferences, and shows after a few days have passed, so I can see what might have what really stuck with me, what's still rattling around in my head. In particular, the Roni Zieger quote is not something I would have written about had I written this blog Thursday night, after the show ended.

There are several great blog posts already available on the Stanford Mobile Health Conference, including those from Text in the CityKevin Clauson (@), Craig Lefebvre (@chiefmaven), Andrew P. Wilson's wrap-up (@AndrewPWilson)  and what I believe to be the very first blog on the conference, over on Jeremy Vanderlan's Thulcandrian tumblr (@thulcandrian). These folks all did quite a good job summarizing the show, so there's no need to repeat them. I highly suggest you go and read their entries first, in particular, if you did not attend the show.

I've also included a list of other resources about the show at the bottom of the post. If I've missed something, go ahead and drop a note in the comments and I'll add it.

Here are some of the things that stuck with me after the conference:

1. Quality of People and Creating Opportunity
As you've already read from the other blog posts, the show was extremely well run, with a huge amount of credit to BJ Fogg, Tanna Drapkin, and the entire group of  Stanford student volunteers, A/V professionals, and catering team. I don't think it can be overstated how well the conference was prepared and executed. In particular, the show was crafted to create a community feeling among the attendees, provide lots of interaction opportunities, and keep the attendees engaged.  

It felt very much like everyone in attendance was a speaker or presenter, but it turns out that not only was that not true, the percentage was actually lower than most conferences. By my estimation, there were about 450 people at the conference and 47 speakers, which includes BJ and the three folks that made up the "walk-on" session. So for the sake of discussion, let's call that 10% of the attendees were also speakers. For comparison's sake, the American Telemedicine Association (ATA) conference had "over 4,000 attendees.... and 260 presentations". Let's assume the ATA had an average of  two presenters per presentation (by a quick review of the ATA agenda, that's very conservative), they far exceeded the speaker/attendee percentage. Yet at ATA, it never feels like you get to interact with the speakers, deeply discuss their position and findings, and debate important topics. I should be clear, the ATA is a fine show, focused very much on the industry, vendors and business aspects of the Telemedicine space, but has a very different feel to it on an intellectual level. 

It's my belief this feeling of connectedness was established through the creation of opportunity to interact, amazing quality of attendees, and speaker engagement. Nearly all of the speakers were in attendance the entire show, and were introduced to the crowd, one-by-one, at the start of the conference. This technique immediatley reduced the transaction friction between attendees and speakers. Secondly, I would proposed that the majority of the people in attendance could have been speakers. The quality of the attendees was unmatched by nearly every conference - healthcare, startup, or technology focused - that I have attended in the last 24 months. I met so many people I am honestly excited to meet up with later this month, and walked away from dozens of conversations stimulated and challenged. 

Additionally, we should not overlook the use of techniques such as Topic Tables, copious breaks, great food and a contained environment kept people off their mobiles and in the conversation. 

Now, lest you think "contained environment" means that the conference team locked us all in a room, let me explain. The conference was held at the Frances C. Arrillaga Alumni Center on the Stanford campus. As you can see, the Google Maps gods are on my side, and I was able to get you a picture of what the grounds look like when set up for a conference. A large amount of outside seating, directly off the main hall, created a great environment for interaction, and limited the exit points for attendees. Quite literally, there was nowhere else to go, and we were herded into interaction, even if it was very, very subtle. 

2. "The Missing Sessions"
Over the next few weeks, I'd like to blog about each of these topics, but in lieu of that, here's a brief summary of topics I think should be addressed in the 2012 curriculum, and more importantly, debated by the community immediatley:

How do we keep mHealth from deepening the divide between the "haves" and "have-nots"?
While there was a lot of healthy and inspired talk about SMS in Africa, the role of mobile phones in lower-income areas in the US, and related topics, I'd like to see a specific panel focused on the possibility of a divide between socio-economic classes that may be driven by mobile health. I personally have a fear that the majority of the most innovative developers and startups - and the venture capital that backs them - tend to go towards native applications for Android, iPhone and iPad. This is not only for patient communities - Sharon Bogan from Kings County (Wa.) talked about how "even [our] managers have Windows98 machines." Even with their Herculean efforts to get around budget shortfalls, the lack of quality equipment means compromises not only in the latest technology, speed, and access, but basic things like advanced security. No one deserves to have their personal information compromised because their health department cannot upgrade to a modern browser. 

What's the role of mHealth in innovating the caregiver process?
I've already talked about this a bit in other posts. I think discussing mHealth only in the context of the patient is a significant limitation to our space. To his credit, Roni Zieger did discuss Google Body, and innovative uses of tablet technology by physicians in the field. For me this only highlighted the missing professional representation of mHealth. Google Body is amazing use of WebGL, but is not exactly mobile, and the tablet demonstrations were innovative home grown use. We have to start somewhere, so this was an adequate introduction in 2011, but in the 2012 curriculum, I'd like to see a session based on professional use of mobile. Including a study that shows how to manage SMS at scale - that seems like the next burden will be how to manage, prioritize, and route a large-scale inbound SMS load.

What failed? 
This is a little unfair of me to mention, given the title of the conference was "Mobile Health:What Really Works," but I'd like to see some failures and post-mortem analysis. This years mHealth show was full of amazing presentations, and I learned something from nearly each one of them. That said, as our market grows, I'm convinced I would learn just as much from someone who failed , but learned something meaningful they can share. Like any budding market, mHealth is going to have a lot of casualties, but the mark of a great community is one that embraces their failures, shares them with the group, and rewards risk-taking. I think the community of people I met at the conference can inspire and support that type of greatness.

How to manage a global regulatory process?
The role of the encryption, security, privacy, HIPAA, and even the  FDA and regulatory process did come up quite a bit during the conference. The FDA was a diamond sponsor of the event, and had a few people in attendance, all of which is a very positive trend. That said, for companies who want to bring products into this space, it's going to be critically important to understand the global nature of the regulatory and legal landscape. As it stands today, there are some major legal differences between the EU, Asia, and US that make healthcare product development costly and challenging. The idea of adding patient mobility, international networks, and different legal systems into play makes for an intellectually challenging - but daunting - task. A panel of regulatory experts from across the globe would be fascinating. Let's not forget patients in that global picture, either - the different cultural expectations of privacy, sexual taboos, and role of the physician could have a profound effect on successful mHealth.    

3. Roni Zieger's quote
During the second day of the conference, Roni Zieger said "I've tried to make a conscious effort to stop saying 'no'. It makes me a better physician and a better parent." This has little to do with mHealth, but like so many events, if you fill a room with smart people, you get a return on that investment in many different areas. Roni did not go any further on the topic, but as a parent I started to notice how often I was saying no, don't, can't - and every time, I heard Roni's comment in my head.  I've tried over the last few days to internalize this into a more proactive, empowering, even Socratic approach to communicating. I'm hopeful it will make me a better parent (She's only 6, there is only so far we can debate Skill vs. Inspiration in the context of iCarly), but I'm pretty sure it will make me a better leader and a better communicator. 

4. Some resources that may be helpful to you:
Update #1 - Added Andrew P. Wilson's blog entry to second paragraph.

Friday, May 6, 2011

How I Stopped Worrying and Love [the name] mHealth

Matthew Holt is very outspoken about his dislike of the name "mHealth" or "Mobile Health".

Although we've traveled in the same circles, both professionally and geographically, for many years (and share a love of EPL, no less), I've never met Matthew.  I have only been able to consume his displeasure in Twitter comments, such as these:

This always left me wondering, do Matthew and I share the same concerns, or is this something else?  Over the last few weeks I've tapped into my network to try to understand the comments, as everyone from my former VCs, employees and friends seem to have a connection to Matthew.  Thankfully, this week, Matthew answered it himself in a recent post to the Healthcare 2.0 blog. This won't surprise you if you know me, but I've got an opinion on his post.

Matthew's key point is that the terms mHealth and Mobile Health limits us to a specific device, such as a mobile phone:

"Calling something mHealth traps it to a device, in particular a cell phone, and ignores the rest of the ecosystem of the technology and culture that the cell phone is but one part of"

I personally don't share that point of view. Some of you may even go further and say  "ah, but at the Mobile Health conference this week, fitbit, dailyfeats, and zamzee all presented, and they do not use a mobile phone!" The reality is, the conference was dominated by SMS and mobile-phone solutions. This is not at all a bad thing, as we saw some wonderfully innovative work. But if you were to oversimplify Matthew's comment to "phone or not phone", you would miss the bigger point, which is the ecosystem and platforms. Specifically, he called it “unplatforms.” 

This is where Matthew and I violently agree.

I'm a platform guy. I believe in systems-thinking. Haley Joel Osment sees dead people, I see platforms and ecosystems. It's what I love, and that was my last role at Bosch, spearheading a new Telehealth Platform.

To that end, I believe one thing that was missing from the Mobile Health conference was the impact on mobile to the caregiver, a key part of the ecosystem. This is something I personally really missed the boat on at Health Hero. Tying a caregiver to a computer screen is a rather ridiculous idea, given this is the industry that made the pager market. That said, when I tweeted that idea of the role of the professional in mHealth, I got a lot of backlash, a lot of "mHealth is about patient empowerment, nothing more". I hope that's not true, or we're missing a good part of how we can improve the health industry with mobile technology.

Naming and terminology, especially in Healthcare, can be analyzed and debated to endlessly - I sometimes think debating mission statements is less painful, if you can believe that. These activities usually resulting in terminology that is either very narrow and specific, or so vague that it has no meaning. As an industry, we have not done a good job of creating a nomenclature that is inclusive of the ecosystem.

For example, I am personally fascinated by the use of Television for providing healthcare and worked on many prototypes in my spare time. Despite the struggles of Motiva, I am sure there is opportunity here. But what to call it? Telehealth? Taken, but who knows what it really means. Telecare? Taken, and differently on different continents! tHealth? Dear lord. I'm already exhausted. (Speaking of which, if I step out of my "Patient Centered Medical Home", is it my "Patient Centered Medical Yard?") Someone will come up with a clever name, and we'll follow along. This only highlights the point that the Television-based solution is but a part of an overall ecosystem, and the clever naming of the solution is far less important than it's systematized impact.

Now, do no misinterpret my point - naming does matter, especially as we, as an industry, achieve scale and impact. Naming is particularly important when it removes our attention from the integrated delivery of care across the ecosystem.

For twelve years at Health Hero, I called our solution everything from "Telehealth" to "Remote Patient Monitoring" and everything in-between. If you want to see someone make a face that looks like they just stepped in something nasty, tell a German during the due-diligence process that you provide "Remote Patient Monitoring" - the idea that patients want to be monitored may seem creepy to someone in the United States, but is down-right blasphemous in more privacy-sensitive cultures like the EU.

I have a somewhat "lighter" story that illustrates the same point. I spent a lot of time in Germany at Bosch Headquarters and UK launching NHS after the Bosch acquisition. I spent so much time, that I came back to to States and once asked someone at Starbucks to "please give me my handy". My advice to you: Don't do that in San Francisco.

As we increase the role of the consumer in their care, these names and terms really do matter. They need to be culturally and globally sensitive, provide a brand and market concept with an aspirational vision, and most importantly, provide simplicity. If I cannot explain to you, the patient, what we do in thirty seconds, why would you even try it?

At the same time, as a group of people trying to effect how care is delivered, let's not lose site of the fact that whatever we call it today will, over time, be adapted and change, and it's far more important that we don't forget the importance of the system of care and the role of our processes, technologies, and people in the healthcare ecosystem.

Update #1: Fixed a few wording and typos based on feedback, mutual friend told me Matthew prefers Matthew to Matt, so fixed all the "Matt" references