Tech Challenge Aims to Quash Readmissions

I've attended hundreds of Silicon Valley technology conferences, but last Saturday was the first one led by a hospital executive determined to disrupt how tech improves patient health.

Paul Tang, MD, is vice president and chief innovation and technology officer at the Palo Alto Medical Foundation (PAMF), a Sutter Health affiliate with 1,200 physicians in Palo Alto, CA.

What Tang is doing challenges our conventional thinking about how technology gets developed in healthcare, by borrowing from techniques that are all around Silicon Valley.

Tang has issued a challenge to developers: Create a low-cost, hospital-backed social safety net for seniors.

"The hard part about doing these new things, these disruptive innovations, isn't really about coming up with the ideas," Tang told a packed room at the Computer History Museum in Mountain View, Calif. "It's really about getting the old ones out."

In a study released six months ago, Tang said, a review of 26 readmission prediction models, two found that perceived social isolation—rather than actual isolation—was a more important determinant of bad outcomes than any objective measure of social isolation. Individuals with adequate social relationships have a 50 percent greater survival rate than those with poor or insufficient social relationships. It's as big a factor to survivability as smoking cessation.

In studies PAMF conducted, one quote from a senior stood out: "Your world dies before you do." Anecdotal evidence abounds regarding the quick decline of surviving spouses. Tang's developer challenge aims to do something about it.

The project goes by the name linkAges and Tang kicked it off April 14 with a hackathon and a rousing speech by newly-appointed U.S. Chief Technology Officer and Assistant to the President (and former HHS CTO) Todd Park, among others. The "big, hairy audacious goal" is to create a hospital-sponsored social safety net for seniors who need rides or other support and in return can offer their own skills and talents, such as gardening, in a barter system that ends up costing the hospital system practically nothing.

The primary enabling technology is the mobile phone, now ubiquitous, with apps powered by vast amounts of free U.S. government data, published in machine-readable form, and ready to present to seniors everything from the locations of farmer's markets to directories of healthcare facilities.

In the process, seniors become engaged, energized, develop new bonds, and are motivated to seek out and ask for help.

It's the next step beyond meaningful use. Call it Meaningful Life. "What if we created activities of meaningful life and supported that instead?" Tang asks.

Undergirding and supporting all this will be a network of sensors, many connected to those mobile phones, which will detect any changes in daily living patterns of seniors. This technology, famously championed by Intel Fellow Eric Dishman for the past ten years, extends the telemetry of hospitals into the home, and aims to track changes in physical condition on a moment-by-moment basis, between doctor visits, which is when those changes occur anyway.

This level of healthcare system knowledge of our lives will creep out some people. I certainly wouldn't feel comfortable with my health insurance company knowing too much about my activities of daily living. But for seniors living in isolation, this trend has been coming for a long time. Japan is way ahead of the U.S. on this one, even investigating robots in the home to assist seniors.

The true disruption of linkAges is imagining the hospital or healthcare system as the hub of the social network despite these concerns. Certainly there are lots of social networks already, and in Silicon Valley, the thought of one more triggers groans from the digerati. But your garden-variety social network such as Facebook doesn't have at its core the notion of improving health, let alone something as specific as looking after seniors with an eye toward cutting readmission rates.

If this is played right, healthcare systems can become change agents for lots of ills that afflict communities and inform population health concerns. Park pointed out one health app in particular that won last year's HHS competition. Food Oasis. It allows seniors (or anyone) living in one of the infamous "food deserts," where fresh fruit and vegetables are seldom sold, to text their requests to a farmer's market which then would set up local deliveries—a system that can also lower the cost of fresh foods to all by creating a delivery mechanism more efficient than traditional grocery stores.

I will be very interested to see what apps the linkAges competition produces when the accelerator hits its July 30 deadline for the first round.

I'll be even more interested to see what DIY social services develop around PAMF when those apps hit the street, and how those apps affect readmission rates for PAMF. I also suspect this is the first of many hospital-led challenges to use communities, developers, and technology to disrupt the pace of change in healthcare.