HxRefactored 2014 Round-up

Highlights from the HxRefactored Conference 2014.

Last week the Viking team had the opportunity to attend the HxRefactored conference. The conference brought together the best and brightest from health IT, experience design, medicine, software engineering, behavioral psychology, human factors and more. The best part for us — it was hosted at the Brooklyn Bridge Marriott — pretty much in our backyard!

Here's our round-up.

Tuesday, May 13

Sanjay Khurana from AARP have a great talk about the opportunities of designing for the 50+ demographic. He stepped through some absolutely fascinating and stellar research the organization put together. The report was called Health Innovation Frontiers (pdf).

This got my entrepreneurial wheels turning. It's a brilliant call to action to get designers, developers, and investors thinking about products for this demographic. 

Mr. Khurana also stepped through a bunch of innovative products for this market, beginning with Wello (recently acquired by Weight Watchers). Wello pairs personal trainers with down-time with those who want to exercise virtually. 

Lively is a passive sensor which allows family members to understand changes of routine for independently seniors. These sensors are put on pillboxes, keychains, refrigerators, and other places. A reporting interface is shown to select family members.

Breezie is an Android tablet which greatly simplifies the UI for technically challenged seniors. Depending on how challenged a person is, features can be added or taken away. As confidence with the platform builds, features can be added remotely. 

Careticker helps you track your caregiving activities, connect with other caregivers and earn incentives for the care you provide. We haven't used it, but this UI looks beautiful and we'd love to take a look inside.

Hello Doctor is a free mobile app that empowers you to control your health, organize, and understand your medical records (paper or digital). Feels like Shoeboxed, OneReceipt or even Evernote for health records!

Thanks Sanjay Khurana for organize such a tasty list of startups.

Thomas Black discussed about Blue Button, which helps patients to access their own data. Lots of people questioned about more standardized format for both developers and non-developers.

Shortly thereafter, Dr. Catherine Rose and designer Derek Cascio presented the story of LightAide: "a teaching tool for children with cognitive disabilities."

In Ms. Rose's own words: "Its dynamic scope covers topics ranging from turn-taking, color identification, and basic arithmetic to complex letter- and number-based literacy and math practice, providing a bright, enriching experience for children of all ages."

Tuesday's keynote was by Sean Nolan of Microsoft HealthVault. Complete with example XML on screen, his talk gave an outstanding glimpse into the challenges Microsoft faces with health data. Wen Dombrowski followed with a great advice on how to network.

Wednesday, May 14

Wednesday's opener (or maybe I should say shocker, pun intended) was Cindy Gallop from MakeLoveNotPorn.com. She very gracefully shined the light on bizarre this culture view sex. Her mission seems to be to bring it out of the bedroom — to acknowledge the truth of it — how awkward, funny and significant it is to the human condition. 

At the end, she described how difficult it was for her company to raise money, find a hosting service, and especially a bank. Companies don't want to be associated with porn in any sense — no matter the company is called MakeLoveNot Porn.

Next, Howard Zucker took the stage to explain "New York's Health IT Revolution." The most interesting part of this was the protesters that jumped on the stage to demand equal view for transgender individuals in New York State.

Next up, Jared Strawderman, Director of Voice Design at Nuance Communications, discussed how voice recognition software can enhance the physician-patient clinical encounter. Doing this in real-time can free physicians from screen and keyboard, allowing them to focus on communication with patient.

He discussed different rules for designing voice interfaces. He talked about how current technologies are applied in voice recognition software and its limitations. It was interesting to see how voice design possibly change patients experience in the future as well.

One of the tracks of the conference was Behavior Change. This ended up being my personal favorite, perhaps because these the concepts with which I'm least familiar. Kerry Evers gave a great primer on "the TTM," or transtheoretical model of behavior change. This stuff can literally be applied everywhere.


Next on the behavior change track was a great call-to-action from Nick Crocker of MyFitnessPal, who began by highlighting many of the issues we address in the Dollars and Sense of American Health. He said we need a "blockbuster drug for behavior change," which could include trackers, coaching (active/passive + human/computer) and a few other items I wasn't fast enough to jot down. At the end, he stepped through what a successful SMS exchange between a trainer and a trainee would look like.

Dr. David Sobel then look the stage and gave a smart and very humorous talk about his experience running the prevention programs at Kaiser Permanente. He talked about how in his experience folks are mostly concerned about sex, sleep and stress — not soda, smoking, exercise, etc. He suggested creating an "enjoyment" vital sign, then told a great anecdote about how he couldn't reach a patient until he asked: "What do you really like to do?" The answer was "trout fishing," and afterwards he made some progress with the patient. Dr. Sobel suggested the need to "align with intrinsic motivations" to affect behavior change.

Next, I switched to the Wearables track, whee Amar Kendale from MC10 gave a superb talk about MC10's experience creating the Reebok Checklight. It's a beanie worn by football players to quantify the impacts to their heads. If the light turns red, it means the impact was severe and the player needs to be removed from the field. The most interesting part of this was that the players started playing the game differently, working together to avoid getting lit. Kids started coaching each other to ensure the light stays off.

Mr. Kendale talked about wearables enabling "observations outside the clinical environment." He talked about how a wearable, even if worn temporarily, would expand a physician's observation window tremendously — from minutes to weeks (1,000x). He suggested the future of the form-factor.

Arlen Moller talked about health related game design and human motivation. He discussed Wii and Microsoft Xbox Kinnect as successful examples, but noted that even these are not truly successful as healthcare devices over the long-term from business and engagement standpoints. In the beginning people are super interested, but over time engagement drops as people become bored.

He also discussed autonomous motivation (internal, self-motivated) versus controlled motivation (external, a personal trainer).

Next, Dr. Gautam Gulati gave a refreshing and well illustrated talk on the need for transformational change in healthcare. He led with an Ivan Illich quote: "Modern medicine is a negation of health. It isn't organized to serve human health, but only itself, as an institution. It makes more people sick than it heals." The healthcare system was never designed. He believes we can't follow the same routines and process to get us out of the woods. The whole audience had a good laugh at his comparison of the healthcare system to "Dear Guy Who Just Made My Burrito." 

Switching gears from the healthcare system, but continuing his call-to-arms, he stepped through a handful of qualities he's identified in innovators. We're looking forward to more color from his forthcoming book. 


Speaking for the whole Viking team, we found the conference stimulating and educational. We met some interesting folks. We got to put a collective finger on the pulse of the industry for a few days, which is key to our being able to deliver the high quality work to our clients.

Outside of that, I found myself a little disappointed with the industry, especially what I heard from the panel of EMR vendors (Cerner, Practice Fusion, AllScripts, and athenahealth). Collectively, they sounded about as inspired as one would expect from the insurance companies. 

Dr. Gulati called for a "transformational change." Based on our understanding of the health system, we couldn't agree more. With all the data, the EMRs are well positioned to be at the forefront of this change. They can look at the aggregate practices of their customers, try to understand what approaches improve outcomes, then deploy those best practices to the rest of their networks.

Beyond that, it would have been inspiring to hear these companies are taking baby steps to transition from the sickness economy to a wellness economy. We believe this is the "transformational change" Dr. Gulati highlights. Every one of these companies has their own PHR. Do any of them integrate with wearables? If they do, does it report to the physician? How can the PHRs employ some of the methods Dr. Sobel highlighted in his talk? How could the PHR/EMR relationship be transformed to focus on keeping people well? Could it focus the physician on remote observation and communication? Maybe identify problems prior to the clinic? How could Nick Crocker's idea of a "blockbuster drug for behavior change" be implement in this ecosystem? What can these technologies do to mitigate chronic diseases (75% of which are preventable)?

Once proven effective, these ideas will lead the real disruption, create the transformation. With Medicare costs projected to be nearly $2T by 2022, no doubt we need help. That's around 18% of projected GDP. 

Thank you to all those from Mad*Pow and Health 2.0 who organized and volunteered at the conference, and we look forward to 2015!

Published on by Anthony Ina.