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Is the New Clinic, Forward, Only Reasonable for the Silicon Valley Elite?

Posted on January 19, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A new clinic has been opened in San Francisco called Forward which is an attempt to reinvent the doctor’s office by several dozen former employees of Google, Facebook, Uber, and Palantir. On the one hand, this new clinic is an amalgamation of all the innovation that’s been happening in the digital health space. On the other hand, it seems to illustrate Silicon Valley excess and culture. Let’s take a look at each perspective.

Forward starts the patient experience with an iPad sign in that’s setup looks a lot like the Apple Store. It sounds like they’ve built all new software for their clinic, but tablet check in or other kiosk check in options have been in healthcare for quite a while. After checking in on the iPad, the patient then goes to a body scanner that identifies you using 2 fingers and then gathers your height, weight, body temperature, heart rate and the amount of oxygen in your blood. All of this data is available to doctors today, but this is a novel way to collect the data that likely saves time for patients and the clinic staff.

The exam rooms look like a really well designed exam room, but still feel like an exam room you might go to in most doctor’s offices. However, one notable feature of the exam room is a massive touch-screen display on the wall.

What makes the exam room and this touch screen unique is that the exam room listens to what’s being said in the room and pulls out information for the medical record and displays that information on the screen in real time. This sounds a lot like what I described in my Video EHR idea. The screen will also show the patient’s health history including sensor data and suggests diagnoses and treatment plans. How well it does at this is a good question, but in true Silicon Valley fashion I’m sure it’s an MVP (Minimum Viable Product) that will improve over time.

Many are touting Forward’s unique approach to Urine Sample collection, but this has been done in many other offices for years. Is this really an issue? I don’t think so. Forward also has essentially a health store as well that sells everything from wearable sensors to vitamins and supplements to skin care products. This has a kind of Apple Store feel as well. This can be a great revenue stream for clinics. Eventually you can imagine all of these items being ordered at the doctor’s office and delivered to your house or office by drone. Until then, UPS/FedEx/USPS will have to do.

As you can imagine, all of the biometric data that’s collected at check in, lab results, etc syncs up with a mobile app that the patient can use to access their health data. Looks like they have plans for genomic data as well. Forward has also committed to responding to messages from it’s members (yes, they call you members, not patients) within 1 minute day or night. I wonder if that response is a real human or an AI bot.

As I mentioned, this feels like an amalgamation of everything that’s been happening with digital health. If you’ve followed the digital health space, then you’ve seen almost all of these things done individually somewhere already. This isn’t necessarily a knock on Forward. The iPhone largely was an incorporation of a bunch of innovations that were available elsewhere. However, Apple packaged it nicely into an extremely usable package. Is that what Forward’s done here? I personally think that’s overstating things since they haven’t completely transformed the model (yet?), but it has made a high end medical office experience.

That leads to my second observation about Forward. In many ways, Forward just looks like Silicon Valley excess in the same vein as the over engineered $1500 Smart Oven. How many of the things mentioned above actually improve your care or inspire you to be healthier and how many of them are just for show?

I guess you could make the case that the whole package makes for a better experience that makes you want to go to the doctor, but that’s butting up against a massive desire we all have of not going to the doctor that’s been built into our DNA for years. Plus, the package doesn’t seem like it’s reached the nirvana of treating healthy patients, but instead is just a high end doctor visit experience.

I’m not suggesting that there’s anything wrong with creating a high end doctor visit experience. That very well could work in wealthy areas like Silicon Valley and other areas of the country like New York and LA. That very well could be a good business (although, my guess is they raised too much money for that to be their only business), but it’s not going to transform healthcare as we know it. I don’t see how Forward scales down to the lower end of the market. They should go and talk with ZDoggMD about his experience with Turntable Health which he just had to shut down. They could learn a lot from his experiences.

I’m not saying that no good will come from the Forward experience. It’s quite possible that the Forward clinic is used as an incubation lab for new ideas which the company can then commercialize and sell to the rest of the medical world at a reasonable price. Their excess could produce learnings that could benefit the rest of healthcare if they package it the right way and don’t just try to build a new health care system themselves. That would be an incredible outcome for healthcare.

I know every doctor would rejoice at the idea of a smart patient wall that listened to their interaction with the patient and did the proper documentation for them. That’s the face to face interaction for which doctors and patients now yearn. The big challenge here is that Forward doesn’t have to worry about things like insurance reimbursement, meaningful use, and MACRA. So, will their technology apply to the rest of healthcare? Or does it just enable the high end unlimited primary care model that they’re executing today?

Also, Forward is only working on primary care, wellness, and men’s and women’s health. That still leaves specialists in the regular insurance controlled world (Yes, you still need insurance and the $149/month membership to Forward). Can high quality primary care change healthcare? I think it could, but it’s going to take a shift in mindset (payers, employers, patients, doctors) by many for it to happen.

I know another medical practice in San Francisco that built their practice on the back of cash patients who got a great, fast customer experience. Employers in San Francisco were happy to pay cash for the visit because they knew their employee would be off work at the doctor’s office for less time then traditional healthcare paid for largely by insurance. The cash cost of a visit was much less than having that employee away from work. San Francisco is a unique culture and so that worked for this medical practice and Forward could work in San Francisco as well. I just don’t see the path for them to scale the clinic model across the country. I hope they don’t try, but instead focus on spreading their innovations across the country. If all that fails, at least the Silicon Valley elite now have an opportunity to network with other Silicon Valley elite at the doctor’s office.

Heart Rhythm Biometric Wristband

Posted on September 6, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It seems that lately I’ve been more and more intrigued with what I’ve been calling the “battle for the wrist.” The battle got real earlier this week with Qualcomm and Samsung both announcing their Smartwatch technologies. I’m sure this is just the start of the smartwatch movement.

Today on EMR and HIPAA, I wrote about what I called a Biometrically Controlled Healthcare System. It’s a forward thinking post that considers how our biometric identity could be integrated into our healthcare experience. I’m sure this idea will scare many people, but I find it incredibly exciting.

In response to that post, I got a tweet from @XimenaTrade suggesting that heart rhythm could be the basis of someone’s biometric identity. Then, she linked me to another wrist based product by Nymi. While not a healthcare specific device, it does make for an interesting extension to the discussions around the battle for the wrist and biometrics. Here’s a video which demos the Nymi heart rhythm product:

I’m not sure I’d buy the story that this is a very good stand alone device. It seems like putting this on is just about as difficult as carrying a key. Although, the built in accelerometer and gyroscope do offer some interesting gesture options. I just don’t see this as a standalone device. Instead, I think one of the smartwatch vendors is likely to snatch up this technology (or recreate it themselves) and integrate it into a much more powerful device.

The idea of a biometric smartwatch that acts as your passwordless key is really interesting. Reminds me of a local Vegas Tech company called LaunchKey which is trying to Kill Passwords opting instead for authentication via your smartphone or tablet.

All of this helps me realize that we’re just at the beginning of smartwatches and biometrics.

A Biometrically Controlled Healthcare System

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently had a nice conversation with Brian Dubin, VP at CERTIFY, where we discussed biometrics in healthcare. Brian got me interested when he described CERTIFY as a biometrics based “big data” company. When I first started this blog, I fell completely in love with all the various biometric options. Check out one of my first posts on Facial Recognition back in April 2006. Shortly after that I even made this EMR and biometrics contribution to a healthcare IT wiki as part of a “blogposium”. [Excuse my moment of nostalgia]

While CERTIFY works with all of the major biometric fingerprints: Finger, Palm, Iris, Facial, Voice, and Signature, I was even more intrigued by a discussion we had around a healthcare system that was biometrically controlled (my word not CERTIFY’s). I realize that the word “controlled” might have negative connotations surrounding it, but I think it is fascinating to consider all of the ways that your biometric identity could be incorporated into healthcare.

Here are some examples I’m considering (some are a reality today and others will be in the future):
Arrive at the office – Imagine that when you arrive at the hospital or medical practice and a video camera grabs your image and the front desk already knows who you are and can say, “Hi John, glad to have you hear today.” Yes, this freaks out some people, but many of the front desk people remember the faces of the patients. Now they can know your name and check you in much quicker.

Positive patient identification – If you don’t like the video camera identification of a patient, you can also do positive identification of the patient using biometrics in a less big brother’s watching you way. When they sit down at the desk to check in, the patient can use a biometric device to identify themselves. Technology like the one I talk about in my post Retina Scanning vs. Iris Recongition are what can be used for this approach.

Voice recognition for a call center – Imagine when you call into a call center they used voice recognition to identify you. This could be used to access your information more quickly. Although, it could also be used to make sure that whoever the person in the call center pulled up matches the voice on the phone. This could solve them pulling up the wrong “John Smith.”

Single sign on – If your biometric identity is stored in the cloud, then that should make that identity available on any system. Plus, I’ve always been fond of single sign on with Facial recognition. The camera is always watching if you’re there or not and so if you open a new application it can immediately authenticate you since it’s constantly authenticating your biometric identity.

I’m really intrigued by the idea of using biometric identities across multiple systems. I’ve heard many hospital CIOs talk about the hundreds of IT systems they have to support. I’ve also heard doctors and nurses complain about the number of logins and passwords they have to remember. Could biometrics be the solution to this problem? Could a biometric identity be shared between systems or would each system need to do more of the traditional single sign on integration?

Unattended computer – Related to the single sign on, facial recognition can also identify when you’re no longer at a computer. If you leave the computer it can automatically lock the computer to ensure that the health data is kept private. You have to balance how quickly the device locks, but this can be great for security.

Location access – A lot of places already do this with fingerprint or palm scans to access private areas. Plus, this prevents the sharing of keys. You can’t really share your fingerprint very well.

Signatures – There’s certainly an art and identity in someone’s signature. However, why don’t we incorporate even more biometrics into someone’s signature? The combination of a signature plus some other biometric identity would be even more powerful. Plus, when I sign to pick up a prescription, if the pharmacy knew my fingerprint, they could indeed verify that I was the right patient.

HIE identification – I don’t know anyone that’s doing this, but I wonder if instead of trying to make a unique patient identifier, using social security numbers, or some other convoluted method of identity management, could we just use someone’s biometric identity? If we aren’t there today, I think we’ll get there eventually. I’m sure there could be mismatches when it comes to matching two biometric identities that were captured by two separate systems. However, we have plenty of mismatches using ssn, name, birthdate, etc. Maybe the real answer is a combination of biometrics and name, birthdate, etc.

A Biometric Healthcare Experience
Those are some general examples. Now let’s imagine a patient visit where they walk into the hospital and are immediately recognized as a patient seeing Dr. Jones for a surgery. The front desk knows who you and has you sign any forms using your biometrics and then directs you to room 315. When you arrive at room 315 you gain access to the room using your biometric identity. The nurse arrives to prep you for surgery and knows she’s working on the right patient because of your biometric identity.

The nurse signs into the EMR using facial recognition and that biometric identity is captured so the EMR knows exactly who is entering the data into the system. The lab arrives and attached your biometric identity to the blood draws and the results will automatically be sent to the EHR matching on your biometrics.

Your doctor writes a prescription for you which gets sent to the pharmacy. The pharmacy knows that he is indeed a doctor based on the biometric identity of the doctor. Once you go to pickup the prescription they verify your biometric identity to ensure you’re in fact the right patient for that prescription. You later go to your family doctor who’s received all of the information and reports from your surgery which were easily matched to you thanks to your biometric identity.

I could keep going, but I think you get the idea. I’m sure there are major holes in the above example, but I think it’s interesting to consider what a biometrically controlled healthcare experience would look like. Plus, to take a line from Google’s Founder, maybe I’m still thinking too small. It’s possible that biometrics will be able to do so much more. It’s not going to happen tomorrow or all at once, but I’m certain that biometrics will play a big part in the future of healthcare.

I’d love to hear your thoughts on this. Are we on the path to a biometric controlled healthcare system?

Retina Scanning vs. Iris Recognition in Healthcare – Best Technology Seen at AHIMA

Posted on November 1, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at AHIMA, I was lucky enough to meet John Trader from RightPatient (A part of M2SYS Healthcare Solutions). During our meeting he showed me the coolest technology I’ve seen in quite a while. Ever since I first started this blog, I had a serious interest in seeing how biometric solutions could benefit an EHR implementation. I’ve tried fingerprint, facial (and this review), voice, typing, etc and been amazed by the technology. Facial recognition was probably my favorite despite its weaknesses.

The funny thing is that I always shot down anyone that suggested the use of some sort of eye related biometric identification. Thinking to my only reference for retina scanning biometrics (movies like Mission Impossible), I didn’t see how that was going to integrate well with healthcare.

Turns out that I was wrong, and my big mistake was that I was looking at the technology from a doctor, nurse, front desk staff identification perspective as opposed to a patient identification perspective. Plus, I didn’t get the difference between retina scanning and iris recognition.

With this background, you can imagine my surprise when I fell in love with the RightPatient iris recognition technology that John Trader demoed to me at AHIMA. I shot this short video embedded below where John discusses the differences between retina scanning (the laser scan you see in the movies) and iris recognition. Then, John demos their iris recognition technology.


Much more could be said about how the iris technology works, but I think it’s best deployed at a hospital front desk during registration. Imagine the number of duplicates that could be avoided with good biometric iris recognition. Imagine the insurance abuse that could be avoided with iris recognition.

In the video I only showed one of the model’s that RightPatient deploys. They have another model that automatically swivels until it locates your iris. It’s hard to explain on the blog, but when you try it first hand it’s like magic.