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07-06-2017, 06:15 PM
HxRefactored 2017 Day 2: Healthcare Policy, a Deep Dive into Blockchain, and Yoga
https://www.medgadget.com/wp-content/uploads/2017/06/hxr-2-300x192.jpghttps://www.medgadget.com/wp-content/uploads/2017/06/mholt-headshot-1.jpg
Welcome back for a summary of Day 2 of HxRefactored which featuredآ*key**tes and breakout sessions around the design of healthcare processes, systems, and tech**logies.آ*Matthew Holt, Chairman of Health 2.0, returned to the stage to kick things off with a key**te on the current changes taking place in Washington, D.C. and the potential impact those changes will have on healthcare systems and policies. A key takeaway of his discussion wasآ*the claimآ*that under theآ*AHCA, as a result of tax cuts to the rich and reduced subsidies for Medicaid recipients, those making less than $50,000 per year may end up paying disproportionately more for their healthcare.
https://www.medgadget.com/wp-content/uploads/2017/06/robit-2.jpgMatthew was followed by Robin Farmanfarmaian, author of The Patient as CEO and a familiar face from the Exponential Medicine stage, and Bakul Patel, Associate Director of Digital Health at the FDA. Robin spoke about how tech**logy is raising the bar on interactions between patients and physicians and gave examples of how new tech**logies, like virtual and augmented reality, are shaping theآ*future of patient education and therapy. One specific example is how VR is currently being used to help patients struggling to cope with phobias. Bakul followed withآ*a short history lesson and reviewآ*of theآ*FDA’s current position on digital health tech**logies.
https://www.medgadget.com/wp-content/uploads/2017/06/Baikul.jpgIn summary, there are three tiers to how the FDA looks at mobile apps: (1) mobile apps that are **t considered medical devices , (2) lower risk mobile apps that meet the definition of a medical device but are **t considered mobile medical applications (MMA) and are **t regulated, and (3) mobile apps that are considered MMA and are therefore regulated. Bakul summarized that the approach was designed to be pragmatic and focus on higher risk functionalities and that would cause concern if the product in question did **t work as planned. Heآ*also revealed that the FDA is currently reimagining a new paradigm for digital health regulation that better aligns with the timelines of tech**logy development, the methods of development, and global healthcare trends. This reimagining is in part coming from a new unit at the FDA that is currentlyآ*focusing purely on digital health and has been taking a stronger look at software. We’ll keep a look out for updates to current regulations that Bakul mentionedآ*that should be expected in the coming months.
Before pausingآ*for the first of two rounds of breakout sessions, Matthew and Amy Cueva of Mad*Pow returned to the stage to an**unceآ*Health Payment Systems (https://www.hps.md/) as the winner of the thirdآ*annual Design for Health Award. Motivated by the idea that patients shouldn’t need to be CFOs to understand their health bills, Health Payment Systemsآ*eliminates healthcare billing confusion by consolidating a consumer’s healthcare bills and explanation of benefitsآ*into a single statement.
The first ****** of breakout sessions for the day covered topics ranging from data security and privacy to navigating the health system. The second breakout session touched on in**vation within pharma as well as tech**logy for aging populations. One session that Medgadget had a chance to participate in coveredآ*blockchain tech**logy and its applications to healthcare.
https://www.medgadget.com/wp-content/uploads/2017/06/user_194425.jpg
The session began with moderator Michael Dillhyon, CCO of Graftworx, setting the sceneآ*of the session as a discussion on how to create benefits around blockchain tech**logy focused on gaps in healthcare. Michael made a point that blockchain in**vators’آ*goal right **w should **t focus on creating new models for healthcare but on fixing the underlying issues that exist today and, once that has been achieved, build models around those solutions. He went on to outlineآ*four corrections to popularآ*myths permeating the conversation around the potential for blockchain tech**logy: (1) the blockchain, in and of itself, can**t be used as a universal health data repository, (2) the blockchain does **t enable patient data ownership or provenance, (3) enterprises are in factآ*interested in data sharing, and (4) one blockchain does **t fit all and all data does **t fit on the blockchain. Michael ended his introduction with a concept echoed for the duration of the session: the blockchain is **t a panacea solution but a tool around which applications can be built.
Jay Marehalli, an Information Security Advisor fromآ*Aetna Global Security, was the first panelist to present. Jay spoke about how Aetna is thinking ofآ*using blockchain tech**logy for member identification and access. Specifically, a desire for better user experience, member protection, and fraud prevention are driving an effort to eliminate reliance on traditional usernames and passwords. In addition to being an**ying to recall, alternatives such as password managers and multifactor authentication add more steps to the user experience and can be expensive to support. So where do we go from here? Jay laid out a vision of authentication that is ** longer an event but something integrated into the user experience through decentralization, cognitive biometrics, real-time authorization, and analytics powered by a risk-based engine. The opportunities for collaboration across industries in such a model is compelling. For example, if a healthcare organization is participating on a blockchain with financial services, aآ*financial service, through a credit card transaction can say, “I’ve identified and authenticated this individual.” Aetna can then turn around and say, “OK, maybe I trust you a little so let me check with someone else to confirm.” The combination of confirmations from multiple financial services can then be used to affirm the legitimate authentication of an individual, eschewing the need for a username, password, or ID card. Today, Aetna is using these principles and ideas to build an Authentication Hub based on FIDO, an open standard for security.
https://www.medgadget.com/wp-content/uploads/2017/06/AAEAAQAAAAAAAAP1AAAAJGRiMDYyNmM3LTY0ODktNGQwYS04Zm I1LTlhNjQxYmY3NDYxYw.jpg
Next up was Diego Espi**sa, CEO of healthcoin, a company trying to address the network challenge of chronic disease. Imagineآ*the stakeholders and resources supporting a patient as a network of **des. The root of the problem, according to Diego, is that a chronic condition can**t be addressed at any given **de because the healthcare system is oriented around episodic treatment of disease. Chronic conditions are continuous issues that are poorly addressed with episodic interventions. To address chronic conditions in this network, you’d effectively need to change the entire network rather than any give **de, which isn’t really feasible. As a general rule, blockchains are used to solve network problems by organizing and coordinating the components of those networks in a more effective or efficient way.
Switching focus to his work at healthcoin, Diego described how the company uses blockchain to give patients the keys to their own data and, through certificates and smart contracts, allows them to control who, when, and how third parties gain access to that data. For example, proof of disease prevention or improvement in a patient’s health may exist today but that information is often siloed. Health certificates create transactable proof that an individual could reveal, without sharing all of their personal health data, to an employer, insurer, or community incentive program, to trigger a reward for achieving aآ*goal. Similarly, if a pharmacy company wanted to offer a research license to use a patient’s ge**me, a smart contract could be executed for limited commercial use that would allow access to the data for research purposes only and would generate a lawsuit if the ge**me was used for anything else.
Despite the fact that personal health records (PHRs) have historically failed to scale successfully, Diego believes the time is ripe for a new type of PHR due to the backlash against the selling of de-identified data without the patient’s consent, value-based care driving an impetus for change around chronic disease management, and the opportunity to create viable business models around the new tech**logy. On the last point, what Diego effectively described is a token-based model where patients are charging tolls for information over which they have ** pricing power. Therefore, the only way to increase the value of the toll is to increase the value of the network, ultimately aligning the interests of both the business and the network.
https://www.medgadget.com/wp-content/uploads/2017/06/AAEAAQAAAAAAAAxFAAAAJGE3OTU3NDhiLTdiNmUtNDBkZi04Mj dmLWE5ODliMWYwNmE3MQ.jpg
VP of Engineering at Gem, Siva Kannan, followed Diego to speak about his company’s platform for simplifying complex data sharing and exchange. Echoing a key takeaway of Michael’s introduction, Siva clarified how the blockchain interacts with data. Instead of storing data directly on the blockchain, the blockchain is used to establish identifies which are then associated with data from different sources and locations. Putting it a**ther way, data can be stored anywhere but the existence of the data and who it is associated with is stored on the blockchain. Once that is achieved, collaboration and exchange of that data is possible. In Gem’s case, this takes place through GemOS, a Data and Identity Collaboration and Exchange Platform (DICE) that sits on top of the blockchain. Some of the key product features of GemOS include being able to view lists of transactions happening on the blockchain as a participant in the network, an API viewer that lets the user see what kind of APIs they can exercise on the blockchain, and a resource viewer that shows how a given set of data is linked with other data sources on the network. Siva touched on some Gem projects already in the works including a partnership with Philips for patient-centric care coordination and a**ther with Capital One for revenue cycle management.
https://www.medgadget.com/wp-content/uploads/2017/06/download-2-1.jpeg
Wrapping up this deep dive was Denise Gosnell, Senior Technical Evangelist at PokitDok. Much to the edification of the audience, Denise began by clarifying the concept of what smart contracts really mean. Smart contracts give control, in a decentralized manner, to those who inherently do **t trust the network. They function as a digitally signable, computable agreement between two or more entities that relies on a consensus system to reduce vulnerabilities. Denise next spoke about how her company, PokitDok, set out to create a way to pass information around any entityآ*in healthcare. Their vision is to drive a new eco**mic model as claims are adjusted with context and executed via smart contracts, ultimately reducing the time needed to amend claims down the road. In terms of security, Denise reminded the audience thatآ*onlyآ*the access grants to various pieces of information are written to the blockchain public ledger while the details themselves, such as claims and eligibility information, are cryptographically secured and stored off chain. Having designed and created smart contracts herself, Denise also commented on the need to separate healthcare policy from the design mechanics of healthcare systems. She believes in**vators should be allowed to develop the blockchain and explore what it has to offerآ*whileآ*policy isآ*developed in the context of these new offerings.
https://www.medgadget.com/wp-content/uploads/2017/06/AAEAAQAAAAAAAAM_AAAAJGRmNzhlMWY1LWU5NWMtNGE0NS1iMD QwLWExZWM2NDVkOTQxNg.jpg
Following the breakout sessions, attendees reconvened forآ*two more key**tes thatآ*touched on two **ntraditional approaches to improving patient health: music and relaxation. First up was Kathleen Howland, Professor at the Berklee College of Music speaking about the healing power of music. Kathleen backed up her claims with neuroscienceآ*evidence showing that patients who sing, especially those who sing with others, see increased brain activity and activation.
https://www.medgadget.com/wp-content/uploads/2017/06/jay-gupta.jpgNext up was Jay Gupta, President of RxRelax (http://rxrelax.com/), an organization working to combine the k**wledge of Western medicine with research-based, integrative health practices such as meditation and yoga. Jay encouraged the idea that polypharmic trends can be reversed with appropriate applications of proven strategies to improve patient health and wellness without drug interventions. Jayآ*also made a point to juxtaposeآ*the Western definition of yoga, which often emphasizes strenuous contortion, with theآ*original tenants of the practice which include self-reflection and breathing exercises.
With a final sign off by Matthew and Amy, we’re at the end of this year’s HxRefactored conference. It’s been a concise two days of conversations and insights that will hopefully inspire new opportunities to apply design thinking methodologies to theآ*experience of healthcare. While this is one of the smaller conferences this editor has covered in recent history, the intimate nature of the event lowers the barrier toآ*connecting with many of the key**te speakers and thought leaders in attendance. A quick shoutout is also in order to Bizzabo that provided a mobile appآ*to help attendees navigate and connect during this year’s event. It was a great experience to directly contact and schedule side bars with other attendees and potential collaborators based on areas of mutual interest. Speaking of those very conversations, make sure to go back and check out Medgadget‘s interview with dacadoo (http://mdgdgt.com/2tkjtCl), a digital health company demoing at this year’s event.
https://www.medgadget.com/wp-content/uploads/2017/06/divider-4.jpg
Previous:آ*HxRefactored 2017 Day 1: Purpose Driven Design, Health Equity, and the Clinician Experience… (https://www.medgadget.com/2017/06/hxrefactored-day-1-purpose-driven-design-health-equity-clinician-experience.html)
Link:آ*HxRefactored… (http://www.hxrefactored.com/)
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https://www.medgadget.com/wp-content/uploads/2017/06/hxr-2-300x192.jpghttps://www.medgadget.com/wp-content/uploads/2017/06/mholt-headshot-1.jpg
Welcome back for a summary of Day 2 of HxRefactored which featuredآ*key**tes and breakout sessions around the design of healthcare processes, systems, and tech**logies.آ*Matthew Holt, Chairman of Health 2.0, returned to the stage to kick things off with a key**te on the current changes taking place in Washington, D.C. and the potential impact those changes will have on healthcare systems and policies. A key takeaway of his discussion wasآ*the claimآ*that under theآ*AHCA, as a result of tax cuts to the rich and reduced subsidies for Medicaid recipients, those making less than $50,000 per year may end up paying disproportionately more for their healthcare.
https://www.medgadget.com/wp-content/uploads/2017/06/robit-2.jpgMatthew was followed by Robin Farmanfarmaian, author of The Patient as CEO and a familiar face from the Exponential Medicine stage, and Bakul Patel, Associate Director of Digital Health at the FDA. Robin spoke about how tech**logy is raising the bar on interactions between patients and physicians and gave examples of how new tech**logies, like virtual and augmented reality, are shaping theآ*future of patient education and therapy. One specific example is how VR is currently being used to help patients struggling to cope with phobias. Bakul followed withآ*a short history lesson and reviewآ*of theآ*FDA’s current position on digital health tech**logies.
https://www.medgadget.com/wp-content/uploads/2017/06/Baikul.jpgIn summary, there are three tiers to how the FDA looks at mobile apps: (1) mobile apps that are **t considered medical devices , (2) lower risk mobile apps that meet the definition of a medical device but are **t considered mobile medical applications (MMA) and are **t regulated, and (3) mobile apps that are considered MMA and are therefore regulated. Bakul summarized that the approach was designed to be pragmatic and focus on higher risk functionalities and that would cause concern if the product in question did **t work as planned. Heآ*also revealed that the FDA is currently reimagining a new paradigm for digital health regulation that better aligns with the timelines of tech**logy development, the methods of development, and global healthcare trends. This reimagining is in part coming from a new unit at the FDA that is currentlyآ*focusing purely on digital health and has been taking a stronger look at software. We’ll keep a look out for updates to current regulations that Bakul mentionedآ*that should be expected in the coming months.
Before pausingآ*for the first of two rounds of breakout sessions, Matthew and Amy Cueva of Mad*Pow returned to the stage to an**unceآ*Health Payment Systems (https://www.hps.md/) as the winner of the thirdآ*annual Design for Health Award. Motivated by the idea that patients shouldn’t need to be CFOs to understand their health bills, Health Payment Systemsآ*eliminates healthcare billing confusion by consolidating a consumer’s healthcare bills and explanation of benefitsآ*into a single statement.
The first ****** of breakout sessions for the day covered topics ranging from data security and privacy to navigating the health system. The second breakout session touched on in**vation within pharma as well as tech**logy for aging populations. One session that Medgadget had a chance to participate in coveredآ*blockchain tech**logy and its applications to healthcare.
https://www.medgadget.com/wp-content/uploads/2017/06/user_194425.jpg
The session began with moderator Michael Dillhyon, CCO of Graftworx, setting the sceneآ*of the session as a discussion on how to create benefits around blockchain tech**logy focused on gaps in healthcare. Michael made a point that blockchain in**vators’آ*goal right **w should **t focus on creating new models for healthcare but on fixing the underlying issues that exist today and, once that has been achieved, build models around those solutions. He went on to outlineآ*four corrections to popularآ*myths permeating the conversation around the potential for blockchain tech**logy: (1) the blockchain, in and of itself, can**t be used as a universal health data repository, (2) the blockchain does **t enable patient data ownership or provenance, (3) enterprises are in factآ*interested in data sharing, and (4) one blockchain does **t fit all and all data does **t fit on the blockchain. Michael ended his introduction with a concept echoed for the duration of the session: the blockchain is **t a panacea solution but a tool around which applications can be built.
Jay Marehalli, an Information Security Advisor fromآ*Aetna Global Security, was the first panelist to present. Jay spoke about how Aetna is thinking ofآ*using blockchain tech**logy for member identification and access. Specifically, a desire for better user experience, member protection, and fraud prevention are driving an effort to eliminate reliance on traditional usernames and passwords. In addition to being an**ying to recall, alternatives such as password managers and multifactor authentication add more steps to the user experience and can be expensive to support. So where do we go from here? Jay laid out a vision of authentication that is ** longer an event but something integrated into the user experience through decentralization, cognitive biometrics, real-time authorization, and analytics powered by a risk-based engine. The opportunities for collaboration across industries in such a model is compelling. For example, if a healthcare organization is participating on a blockchain with financial services, aآ*financial service, through a credit card transaction can say, “I’ve identified and authenticated this individual.” Aetna can then turn around and say, “OK, maybe I trust you a little so let me check with someone else to confirm.” The combination of confirmations from multiple financial services can then be used to affirm the legitimate authentication of an individual, eschewing the need for a username, password, or ID card. Today, Aetna is using these principles and ideas to build an Authentication Hub based on FIDO, an open standard for security.
https://www.medgadget.com/wp-content/uploads/2017/06/AAEAAQAAAAAAAAP1AAAAJGRiMDYyNmM3LTY0ODktNGQwYS04Zm I1LTlhNjQxYmY3NDYxYw.jpg
Next up was Diego Espi**sa, CEO of healthcoin, a company trying to address the network challenge of chronic disease. Imagineآ*the stakeholders and resources supporting a patient as a network of **des. The root of the problem, according to Diego, is that a chronic condition can**t be addressed at any given **de because the healthcare system is oriented around episodic treatment of disease. Chronic conditions are continuous issues that are poorly addressed with episodic interventions. To address chronic conditions in this network, you’d effectively need to change the entire network rather than any give **de, which isn’t really feasible. As a general rule, blockchains are used to solve network problems by organizing and coordinating the components of those networks in a more effective or efficient way.
Switching focus to his work at healthcoin, Diego described how the company uses blockchain to give patients the keys to their own data and, through certificates and smart contracts, allows them to control who, when, and how third parties gain access to that data. For example, proof of disease prevention or improvement in a patient’s health may exist today but that information is often siloed. Health certificates create transactable proof that an individual could reveal, without sharing all of their personal health data, to an employer, insurer, or community incentive program, to trigger a reward for achieving aآ*goal. Similarly, if a pharmacy company wanted to offer a research license to use a patient’s ge**me, a smart contract could be executed for limited commercial use that would allow access to the data for research purposes only and would generate a lawsuit if the ge**me was used for anything else.
Despite the fact that personal health records (PHRs) have historically failed to scale successfully, Diego believes the time is ripe for a new type of PHR due to the backlash against the selling of de-identified data without the patient’s consent, value-based care driving an impetus for change around chronic disease management, and the opportunity to create viable business models around the new tech**logy. On the last point, what Diego effectively described is a token-based model where patients are charging tolls for information over which they have ** pricing power. Therefore, the only way to increase the value of the toll is to increase the value of the network, ultimately aligning the interests of both the business and the network.
https://www.medgadget.com/wp-content/uploads/2017/06/AAEAAQAAAAAAAAxFAAAAJGE3OTU3NDhiLTdiNmUtNDBkZi04Mj dmLWE5ODliMWYwNmE3MQ.jpg
VP of Engineering at Gem, Siva Kannan, followed Diego to speak about his company’s platform for simplifying complex data sharing and exchange. Echoing a key takeaway of Michael’s introduction, Siva clarified how the blockchain interacts with data. Instead of storing data directly on the blockchain, the blockchain is used to establish identifies which are then associated with data from different sources and locations. Putting it a**ther way, data can be stored anywhere but the existence of the data and who it is associated with is stored on the blockchain. Once that is achieved, collaboration and exchange of that data is possible. In Gem’s case, this takes place through GemOS, a Data and Identity Collaboration and Exchange Platform (DICE) that sits on top of the blockchain. Some of the key product features of GemOS include being able to view lists of transactions happening on the blockchain as a participant in the network, an API viewer that lets the user see what kind of APIs they can exercise on the blockchain, and a resource viewer that shows how a given set of data is linked with other data sources on the network. Siva touched on some Gem projects already in the works including a partnership with Philips for patient-centric care coordination and a**ther with Capital One for revenue cycle management.
https://www.medgadget.com/wp-content/uploads/2017/06/download-2-1.jpeg
Wrapping up this deep dive was Denise Gosnell, Senior Technical Evangelist at PokitDok. Much to the edification of the audience, Denise began by clarifying the concept of what smart contracts really mean. Smart contracts give control, in a decentralized manner, to those who inherently do **t trust the network. They function as a digitally signable, computable agreement between two or more entities that relies on a consensus system to reduce vulnerabilities. Denise next spoke about how her company, PokitDok, set out to create a way to pass information around any entityآ*in healthcare. Their vision is to drive a new eco**mic model as claims are adjusted with context and executed via smart contracts, ultimately reducing the time needed to amend claims down the road. In terms of security, Denise reminded the audience thatآ*onlyآ*the access grants to various pieces of information are written to the blockchain public ledger while the details themselves, such as claims and eligibility information, are cryptographically secured and stored off chain. Having designed and created smart contracts herself, Denise also commented on the need to separate healthcare policy from the design mechanics of healthcare systems. She believes in**vators should be allowed to develop the blockchain and explore what it has to offerآ*whileآ*policy isآ*developed in the context of these new offerings.
https://www.medgadget.com/wp-content/uploads/2017/06/AAEAAQAAAAAAAAM_AAAAJGRmNzhlMWY1LWU5NWMtNGE0NS1iMD QwLWExZWM2NDVkOTQxNg.jpg
Following the breakout sessions, attendees reconvened forآ*two more key**tes thatآ*touched on two **ntraditional approaches to improving patient health: music and relaxation. First up was Kathleen Howland, Professor at the Berklee College of Music speaking about the healing power of music. Kathleen backed up her claims with neuroscienceآ*evidence showing that patients who sing, especially those who sing with others, see increased brain activity and activation.
https://www.medgadget.com/wp-content/uploads/2017/06/jay-gupta.jpgNext up was Jay Gupta, President of RxRelax (http://rxrelax.com/), an organization working to combine the k**wledge of Western medicine with research-based, integrative health practices such as meditation and yoga. Jay encouraged the idea that polypharmic trends can be reversed with appropriate applications of proven strategies to improve patient health and wellness without drug interventions. Jayآ*also made a point to juxtaposeآ*the Western definition of yoga, which often emphasizes strenuous contortion, with theآ*original tenants of the practice which include self-reflection and breathing exercises.
With a final sign off by Matthew and Amy, we’re at the end of this year’s HxRefactored conference. It’s been a concise two days of conversations and insights that will hopefully inspire new opportunities to apply design thinking methodologies to theآ*experience of healthcare. While this is one of the smaller conferences this editor has covered in recent history, the intimate nature of the event lowers the barrier toآ*connecting with many of the key**te speakers and thought leaders in attendance. A quick shoutout is also in order to Bizzabo that provided a mobile appآ*to help attendees navigate and connect during this year’s event. It was a great experience to directly contact and schedule side bars with other attendees and potential collaborators based on areas of mutual interest. Speaking of those very conversations, make sure to go back and check out Medgadget‘s interview with dacadoo (http://mdgdgt.com/2tkjtCl), a digital health company demoing at this year’s event.
https://www.medgadget.com/wp-content/uploads/2017/06/divider-4.jpg
Previous:آ*HxRefactored 2017 Day 1: Purpose Driven Design, Health Equity, and the Clinician Experience… (https://www.medgadget.com/2017/06/hxrefactored-day-1-purpose-driven-design-health-equity-clinician-experience.html)
Link:آ*HxRefactored… (http://www.hxrefactored.com/)
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