Mark Scrimshire (ekivemark) HIMSS 2012 presentation from the "Leading From the Future" education stream in Las Vegas, February 2012. Empowering Health Care Engagement. Break the Glass Wall in Health Care, Sensors and Designing for Engagement.

1. Empowering
HealthCare
Engagement
by
Pu6ng
the
Person
at
the
Center
Mark
Scrimshire,
Chief
Ins2gator
&
Co-­‐Founder
-­‐
HealthCa.mp
Founda2on
We don’t have a good, consistent word for Patient in the Health Care World. Are we People, Patients, Consumers, Citizens, Care
Givers, Family Medical Officers, Care Team Members?
In this session I want to run through this presentation to give you some “food for thought” and then open up for questions. Let’s have
some interaction and learn from each other.

2. Participant Poll -1
• Do you use Social Media (Twitter, Facebook,
LinkedIn etc.)?
– No, I don’t actively use social media
– Yes, I occasionally use social media
– Yes, I regularly use one social media service
– Yes, I regularly use multiple services
(Facebook, LinkedIn, Twitter, Foursquare etc.)
2
The purpose of these polls is to learn a little about you, the participants, in this session.

3. Participant Poll -2
• Do you use an Electronic Health Record (such as
HealthVault, Dossia, NoMoreClipboard)?
– Yes I Use a Personal Electronic Health Record
– Yes, I use an Electronic Health Record provided
by my Health Plan Provider, Employer or
Physician
– No, I don’t use an Electronic Health Record
3
We are supposed to be the professionals - but how many of us use a Personal Health Record.

4. Participant Poll -3
• Do you use a health/fitness tracking device/
sensor?
(such as Fitbit, Jawbone UP, BodyMedia, Zeo,
Polar, NikePlus)
– No, I don’t use a tracking device
– Yes, I use a personal tracking device for my
health and fitness
– Yes, I use a tracking device provided by my
physician or health plan
4
How healthily active are we? Do you use a sensor or tracker to help you monitor your well being? Do you keep a record of that
data? Does it influence your life?

5. Conflict of Interest Disclosure
Mark Scrimshire, BA
@ekivemark
Has no real or apparent
conflicts of interest to report.
I am an independent Health and Social Technology Consultant.
As Co-Founder of HealthCamp I don’t have any particular axe to grind.
I have worked with a lot of different organizations across the health care world.
Okay - I LIED - I DO have a conflict of Interest.
I, like many of you in this room, are consumers in a broken health care system.
Together WE have to fight DPS - Disassociated Patient Syndrome.
So My Conflict of Interest is that I want to Empower Health Care Engagement - To do that We have to put the Individual at the
center and empower them to manage their health and the health of their loved ones.

6. Learning Objectives
• Break down the glass wall in Health Care
• Embrace:
– Consumer-oriented Sensors
– The “Life” record
– Consumer Generated information
– The power of patient stories
• Transform health and wellness with
engaged health partners
@ekivemark
So in the next hour I want to address three interconnected issues and suggest some approaches to solve some of these challenges.
Let’s talk about the “Glass Wall in Health Care”.
How Sensors are transforming our world.
How the industry is witnessing an explosion in health relevant data, but is largely ignoring most of that data. How do we tap the
power of Patient Stories.
Addressing these areas will help us transform this industry in to one that really focuses on Vitality and Quality of Life.

7. hEp://healthca.mp @ekivemark
Who the heck is he?
7
Let me give you a frame of reference by telling you a little about me:
I am a “techie” at heart. I have been involved in Technology for many years working in a wide variety of roles up to and including CIO.
The blue tint is also there to give you a hint about my recent past working in Health Care. Yes, I am a recovering Blues Plan
Technologist.
Picture: http://www.mccowngordon.com/images/projectTypes/DataCenterView1.jpg

8. hEp://healthca.mp @ekivemark
Who the heck is he?
8
This is not me!
This is one of the HealthCamp events I have organized in conjunction with Kaiser Permanente. This was from 2010 at the Sidney R.
Garfield Innovation Center where 250 people came together to create their own day of learning and discovery.
HealthCamp is different from your typical conference. The participants define the agenda. In real time on the day. It brings those
fascinating conference hall way conversations back in to the room.
HealthCamp was created four years ago to provide a venue for networking and discussion that brings people together from inside
and outside healthcare, breaking down the silos that we so often see in our industry.

9. @ekivemark
Who the heck is he?
Who the heck is
9
I am a Health and Social Media Consultant.
I have spent the last 5-6 years working with Web 2.0 and Social Technologies. HealthCamp has enabled me to weave together my
experience from Four different worlds: Health, the Web, Mobile and Social.
You can find me in Social Media by using my “handle” ekivemark.

10. hEp://healthca.mp @ekivemark
Consumerization
of Health
10
Health Reform, Insurance Exchanges and the emergence of Smartphones and mass-produced sensors are ushering a new era of
health care consumerization. As consumers are more aware of the costs of care and bear more of those costs they will seek
alternative solutions.
This is a good thing.
We can’t settle for just “bending the cost curve.”
We have to completely fracture it!
In the words of Joseph Smith of West Wireless Health Institute - “we need to jailbreak health care!”

11. hEp://healthca.mp @ekivemark
Health
May
be
Private
11
HIPAA is the 800 pound gorilla in the room. It is the excuse used by many to avoid modernizing health care, to avoid sharing data with patients. The dark, dirty secret of HIPAA is that when you put
the patient in control, many of the challenges and restrictions disappear. Just look at what happened with the VA’s Blue Button. Once a member downloads their health data file they can do whatever
they want with it.
Let’s remember - privacy is a choice, a personal choice. That is why I say “Health MAY be private.”

12. hEp://healthca.mp @ekivemark
Exercise
is
oPen
Solitary
12
Exercise and nutrition is one of the main routes to optimum health and while Health may be private - Exercise is very often solitary.

13. hEp://healthca.mp @ekivemark
but...
Effec%ve
Wellness
is
Social
and
Fun 13
Don’t under estimate the power and influence of our peers, friends and loved ones in achieving effective wellness. Effective Wellness is both Social and Fun. We need to architect social in to our
health platforms from the outset - not tack them on as an afterthought.

14. hEp://healthca.mp @ekivemark
Is there a
recipe for
Engagement?
14
So let’s consider if there can be a recipe for Engagement. I believe there is. It may not be simple. There may be more than one way
to bake that cake. But there are some important ingredients. Let’s look at those ingredients....
Picture: http://www.flickr.com/photos/girlhula/321810053/

15. A
hEp://healthca.mp @ekivemark
E
I
O
U 15
I have tried to drill down the ingredients in to 5 elements. To make it easy to remember I went back to basics: A E I O U. Do we all
remember learning that in school?

16. Ac2onable
hEp://healthca.mp @ekivemark
Easy
Immediate
Open
Unobtrusive 16
12
We live in a world where Attention is at a premium. So if we are going to provide information. Make it ACTIONABLE. Let’s make it
EASY - to Understand, to consume. Yes - I want to see the death of the traditional EOB. It was neither an explanation, or a benefit.
Indeed EOBs were a tax on our attention.
It needs to be IMMEDIATE - Real Time. At a recent conference our health care systems was described as providing data like a
speedometer telling you how fast you were going four years ago.
We need to be OPEN. Monolithic systems will no longer cut it. We can’t all do everything. We need to leverage what others are
doing. So we need to build OPEN Bi-directional systems that play well with others.
We also need to make our systems UNOBTRUSIVE. We need to design for consumers that have a thousand other things to do. So
we need to design solutions that fit in to a person’s lifestyle.

17. hEp://healthca.mp @ekivemark
We are seeing an explosion
in Consumer
Wellness Sensors
Withings
Nike
Plus
Fitbit 17
We are seeing an explosion in the number of consumer-oriented sensors. Yet, the industry risks largely ignoring these devices
because they don’t control them. Instead we prefer to acquire and deploy medically oriented solutions that cost many times more yet
don’t necessarily provide the same leap in quality of data and they don’t get utilized because they have not been designed to fit a
person’s lifestyle.
And don’t go looking for that perfect device. People have personal preferences. You need a strategy that leverages any of these
devices.
We have moved beyond the world of industrialized production line medicine. We are entering a world of personalized medicine.

18. hEp://healthca.mp @ekivemark
Sensors contribute to the
accelerating growth in data
1750
1200
750
480
275
200
125
2005 2006 2007 2008 2009 2010 2011
Exabytes
1018 Source:
IDC 18
The explosion in sensors is contributing to an explosion in the amount of data that is available. That data is not only coming from
wellness devices, but also from Smartphones, computers, networks and millions of connected devices.
Sensors are the new frontier of the Internet and of Health Care. How can we tap this? How can we handle the exponential increase
in volume of information and How do we make sense of all that data?
Do we want to be the data aggregator, or do we want to be a data aggregator plus data accessor. Combine our core data with data
from a myraid of other sources. This brings us to...

19. hEp://healthca.mp @ekivemark
We have a
“glass wall”
in HealthCare
© Absolut_photos | Dreamstime.com 19
© JLProductions.co.uk
The glass wall in HealthCare. Consumers are collecting data about themselves at an increasing rate. Big data is the next frontier in HealthCare. We need to embrace user generated data. We need
to tap the growing personal life streams that each individual is generating.
This is the coming “Mind Shift” in Health Care. We have to smash the glass wall.
We have to overcome the fear of liability.
We need to think about a Health Engagement Metric. A metric that doesn’t measure our Healthiness but rather measures our engagement in maximizing our health and wellness.

20. hEp://healthca.mp @ekivemark
The Personal Health Record
will become the “Life Record”
‣ Google, Microsoft & others are spending
millions to leverage life data
‣ Web businesses know value of big data
‣ Web powerhouses build hard to re-create
data:
‣ Amazon – Enriched media catalogue
‣ Google – Search index
‣ eBay – Seller reputations
‣ The Life record - a battleground that will
change the dynamics of the health sector
‣ Who will the consumer trust?
‣ Will consumers let their record be held hostage?
20
To that end I believe that talk about EMRs/EHRs and PHRs is often misguided. Yes, the EMR and EHR have a growing role in health care: Capturing and leverage institutional knowledge to deliver
the best care in a team-based setting. But the PHR will disappear as we know it. The PHR must give way to the “Life Record.” Why? - Because we don’t know what information may be relevant to
our health in the future. But we do know that Computers are effective tools when we need to search, filter and correlate enormous volumes of data.
Owned by the individual, the life record will become a tool that we will allow our trusted care team to tap in to. And the Life Record will be managed by an organization that an individual trusts. They
will not want that data held hostage.
This is an opportunity and a challenge in Health Care. Google may have exited the PHR world but they, and other Internet companies, understand the value of big data and building hard to re-create
data.
Our life record could become the next battleground.

21. hEp://healthca.mp @ekivemark
How Do We Trigger That Leap
of Engagement?
21
Baldface
Lodge
So the question is how we trigger the leap of engagement?
What we have to do is recognize some traits that are there in most of us. We need consider these traits when we design for consumer engagement.

22. hEp://healthca.mp @ekivemark
Can we engineer
engagement?
22
So, Can we engineer for Engagement. Remembering our A E I O Us - If you look at Facebook, Twitter, Google+, Pinterest and other
Social sites the answer has to be yes, up to a point. We can leverage social activity through authentic engagement.

23. @ekivemark
Mobile
is
a
start...
Are
You
Ready?
hEp://healthca.mp 23
In simple terms - everything that applies in Social Media can be applied in Mobile. Everything is going mobile. We want information at the point of action. The patient in the doctors office, or the
hospital, or pharmacy does not have their computer to hand. But they have their phone.
Mobile is no longer an option. Are you ready?
But Mobile Only is not the answer. We need Mobile+. Phones, Tablets and Computers are different devices. Used in different ways. For some people their phone, may be their only device, but for a
growing number of people multiple devices are used, for different purposes.

24. @ekivemark
Empowered Engagement
Demands Trust
hEp://healthca.mp 24
One essential component in all of our plans MUST be TRUST. Walk the talk. Be consistent. Be authentic. The consumer will have more information than you do and as such you need to either gain
their TRUST or strike a bargain in order to gain access to their information.

25. http://healthca.mp @ekivemark
Elements in designing
for engagement
25
I like to keep things simple, so I thought about what elements in designing for engagement would work for someone like me....

26. The Patient: A Reluctant Consumer
We have to remember that for the vast majority of encounters in Health Care - the patient is an unwilling consumer. They don’t want to be ill. Just like cars. They may love driving. BUT they hate
when the Check Engine light comes on and they have to visit the dealership.

27. hEp://healthca.mp @ekivemark
Laziness 27
We are lazy (or busy, or distracted). Don’t make us jump through hoops. Make my life easier - not harder. Look at the adoption of standalone Personal Health Records. The usage levels are pitiful.
Only the most committed key in their data manually. We want someone else to do the work for us. I have seen personal health records provided by Health Plans where the PHR doesn’t even “know”
you are a member of the health plan that is providing the PHR. Come on! #FAIL

28. http://healthca.mp @ekivemark
WIIFM 28
What’s In It For Me. Put you patient or consumer hat on. What do I get out of sharing? I’ll take the free appetizer at Chili’s for having
checked in there.

29. http://healthca.mp @ekivemark
Competitiveness 29
We are competitive (although this picture makes me want to say - We should design for Stupidity). How many mayorships do you have on Foursquare? Look how we are incorporating gaming
mechanics in to wellness applications.

30. http://healthca.mp @ekivemark
How do we tap the
power of Patient’s Stories?
ICD-­‐9
>> ICD-­‐10
30
The industry is facing a transition from ICD-9 to ICD-10 or even a delayed transition to ICD-11. But what will the benefit be for the
patient? Greater specificity may allow payers to more accurately gauge what and how treatments are applied but would we be better
focusing our efforts on understanding our patients more effectively. Learning their motivations. Learning about the trade offs they
make to balance their lives.
Picture: http://www.hccs.edu/hcc/System%20Home/Departments/Continuing_Education/Paula/Health%20Sciences/health3.jpg

31. @ekivemark
hEp://healthca.mp 31
Patients are still the most under utilized resource in Health Care. Yet care givers are probably the most over abused resource in health care. We must tap this resource and empower it. We must
learn how to incorporate the insights from patient stories in to our treatments.

32. @ekivemark
The narrative is out there...
32
The narrative is out there. A friend of mine lost her husband to cancer. When she looked back at his status updates in that final year,
more than 60% of his updates gave indications of his cancer symptoms.
Patient stories are out there - if only we took the time and effort to listen. And increasingly the devices we carry will provide deeper
insight to these stories.
Let’s step up to the challenge and embrace the power of the patient. Let’s break through the glass wall in health care. To pile on in
support of E-Patient Dave. "Don't just give me my damned data, Take it too!"

33. hEp://healthca.mp @ekivemark
We
haven’t
even
scratched
the
surface
yet
33
We haven’t even scratched the surface of what is possible.
We don’t have all the answers, but we must rise to the challenge and search for them.
We must bring our unique perspectives and our expertise.
But we must remain humble on that journey of discovery.
So let me just end with an insight that was shared with me by an astute person who said:
“My Wii knows more about me and my health than my doctor does.”
Picture: http://lewisshepherd.files.wordpress.com/2010/11/playing-kinect-at-mahockney-1024x867.jpg

34. Q
>
A
mark@ekivemark.com @ekivemark
Health and SocialTechnology Strategist
34
I hope that has given you some things to think about. Let’s open it up for questions. If you are like me and think about a question
after the session then just reach out to me in Social Media and ask me.