Dr. Homero Rivas on digital health for hospitals & patient centered innovation

Health 2.0 Europe interviewed Stanford surgeon, faculty, and entrepreneur, Dr. Homero Rivas on the integration of digital health tools for hospitals and the importance of a patient centered health care innovation movement.

Aline Noizet: Homero, you are an early adopter, a big user of new technologies.  Can you tell us how you use the new technologies in your practice every day and where you see the biggest opportunities for the healthcare professionals?

Homero Rivas: Well, yes. In my work I have to be very involved with new technologies; because I’m a surgeon, I do minimal access surgery, so I have to find ways to give no scar to patients.

Now, there’s a really fine line between health care and innovation in the sense that most health care providers are going to be extremely conservative.  Most people are going to be very risk averse because they want predictable risks.  They don’t want to do things that may get their patients in trouble.

I’ve been an early adopter in the way that I’ve tried lots of those things from wearables to scales to things that help you assess what lifestyle you may have or not. Some of those I’ve been recommending to some of my patients for the last few years because I believe that they would benefit from them.

As far as the biggest opportunities that health professionals may have, 1% of healthcare expenses are dedicated to prevention. I think much more should be dedicated to prevention and it makes lots of sense to use digital health wearable technologies towards prevention, so you can actually invest more and better in health than on disease.

AN: Regulation can be a barrier to use these technologies for some practitioners, but you are using them. We often see healthcare professionals as obstacles to adoption and use of those new technologies. What do you think can be done to pass that?

HR: In most cases, it’s the mindset of people.  With any innovation, you’re going to have a few obstacles. It can be cost, availability, learning curve or the battery life of a device.

But the biggest, biggest hurdle that an innovator will have is the mindset of the potential user, because if they don’t have a mindset that is conducive to adopt something, it’s not going to happen. In healthcare innovation, when it comes to new technologies, the biggest hurdle is going to be the mindset of physicians. We want predictable risks and make sure that we can avoid any potential thing to happen to our patient.

If we find solutions that are conceptually safe, easy to adopt and that have been used by others, it will be much more likely that we can overcome that obstacle.

AN: Do you think that health care professionals receive enough education, enough information on those new technologies?

HR: Of course not.  It’s related to the nature of innovation itself because it is so new that clearly, there’s no course on the medical training to know about those things.  Now, more and more schools and training programs are actually including in their curriculum lectures or seminars or even classes dedicated to innovation in health care.

Innovation doesn’t have to be only technological.  It could also be innovation processes: how to organize your practice, how to do things in different ways.

I think it’s very important to educate people about the potential benefits, and also to inform them about the potential problems that you encounter with those new technologies.

AN: How did you learn about those technologies yourself? Are you proactively searching for them?

HR: Yeah.  Well, I’m a little bias, of course, because I’m from Silicon Valley.  I’m exposed to many things.  But you would be amazed.  We really truly live in a flat world. Today, from anywhere in the world, as long as there is connection to the web, I could be very well connected.  I could be well aware of all the new technologies and devices.

In medical school, unfortunately, they teach us about how to see a patient, how to talk to a patient, how to do things one on one, but there’s very few business type of lectures or instruction where you actually get the highlight of the importance of creating networks of people.  I think it’s very important.  That’s how you learn. That’s how you meet most of the people you’re going to learn things from.

You have to reach out to everyone and that’s how you learn and connect.  But as I said, nowadays, we live in a different world.  Anyone can be aware of those things.  But there’s a difference between seeing them online and actually seeing them in front of you.

Not everything that shines is gold, and there are so many things that look great on videos and when you try them, they are not very good.

AN: You were talking about Silicon Valley, saying that you’re kind of lucky because innovation is very important there.  But I know that you’ve got some connection to Europe. How do you see the difference between the States and Europe in terms of adoption, entrepreneurship, and regulation?

HR: Very good question.  Well, let me tell you one thing.  I’ve been very fortunate, yes, having lived in Latin America, Europe and the U.S. for a great amount of my time.  With no question, here in the U.S., we have lots of resources.  We have Silicon Valley with unlimited resources to do, create, explore and try many, many, many things.  It’s very conducive to innovation.

Now, everyone throughout the world has tried to replicate the same ecosystem that we have without great success.  Some people have done really good things, but no one has really come up with the same environment that we have at Silicon Valley.  I think lots of that is very unique as far as the diversity of the people, their characteristics as I have said before about entrepreneurs and innovators and the fact that they embrace risk, they embrace failure, they feel out of that, and they don’t mind trying and trying again.  They push the boundaries.

That could be the same anywhere else in the world.  I think that Europe has very successful examples of innovators that have succeeded with their value propositions.  But in the same way that here in the U.S., I think it’s going to be more on silos, it’s not generalized.  I mean, I’m here in California but if I go to Kansas, it’s not going to be the same.  There are going to be some successful cases in Kansas, and the same thing is going to be in Detroit and in some other states.  It’s not everywhere.  I think that we need to find ways to nurture the ideas that young entrepreneurs may have, so we can connect them with the right people.

AN: Talking about entrepreneurs, I know that you’re not only using technologies but you’re an entrepreneur yourself. Can you tell us a bit more about that?

HR: Of course.  I work at a university. That means I have got a mission.  I can teach and transfer knowledge to other people. We have a success story with our massive open online course where we taught people from all over the world through online, but it is just one of few examples.

Being an entrepreneur allows me, to actually bring and transfer my passion to the masses. Although I’m very interested in apps for patient with obesity etc., at the moment, I’m more focused on the use of telemedicine for those minorities in the U.S., for Spanish-speaking people who have no insurance or limited insurance, and for those travelers who come from Latin America, South America, Spain. When they have small acute problem, they would otherwise have to go to the ER to get a prescription, now with Doc Toc, our telemedicine platform, they can take care of those things online by visiting with healthcare providers online. You tell them what you have and they connect you with the right guy.  They just evaluate you online and give you the prescription you need, all for a low fee.

I believe that care providers are all entrepreneurs to a point. Some in their own little practice every day with a few patients, and some, I want to say more visionary like me.

AN: As an entrepreneur and a care professional, what would you say to digital health entrepreneurs ?

HR: My suggestion to all the companies that are developing propositions in digital health: the patients are always your target customer.  Your best customer is going to be the patient.  The worst customer will be the physicians or the administrators. Why is that?  Because as I’ve said before, we are very risk averse and we want predictable risks.  On the other hand, patients are their best advocates to themselves.  They would explore and they would try pretty much anything especially something that is highly innovative, something that bring sorts of potential benefits to them.

All companies need to focus on patients.  The key is to find advice or persuasion for patients to actually adopt those technologies.  There’s a very famous guru on persuasion called BJ Fogg, here in Stanford. According to him, you need to make things that are very simple, that have a high index of motivation and that are easy to do.  If you do, if you put those three things together, you might have the triggers of persuasion for people to adopt those new things.

So, if you make something that looks attractive, but is very difficult to adopt and patients are not that motivated, it’s not going to work.  You need to combine the three things: easy, very attractive and with a high index of motivation and patients will get on board.  I would advise companies, you need to concentrate on patients, and you need to know them. Almost like the same way that you’re going to have a medical director, you need to have a patient director, someone who knows the needs and the wants of patients.  That is key.

You need to talk to them and go out in the field and evaluate what they complain about, what they want, what they would like, how much they would pay for those things.  All those things, it’s like doing a micro-research study.

AN: Homero, we are very, very excited to have you with us in Barcelona in May for the Health 2.0 Europe Conference, where we will discuss the European digital health landscape.  What are you most excited about, thinking about that conference?

HR: Everything.  It’s great to be back to Barcelona.  No question.  I am very excited about reaching out to the European community, the European digital health community to learn from them the things that we may not be exposed to.  I think that having been present in many of the events of Health 2.0 is one of the best environments for us to learn about new things that are happening, people who are doing lots of traction in their own geographical areas and being in Europe is going to be a phenomenal way to connect with others.  So I can learn from them as much as they can learn from me.  That’s what I’m the most excited about.

AN: Last question, Homero, how do you imagine the hospital of the future?

HR: That’s a good question. Nowadays, what we have is almost a crisis in the sense that we don’t even have space and we don’t have enough beds. We want to send patients home as soon as possible especially after an operation, because here it is the best place for people to get in trouble.  There are lots of sick people. You can get a disease from someone else that you didn’t have, and that’s not very good.  It’s not very efficient, let’s put it that way.

One day, you’re going to have pretty much as much or more level of medical attention at your own place where you can have all your body function activities traced every second and you can get anything that you may need like medication, etc. So you can prevent the patients from coming to the hospital.

I think there’s going to be more and more service like virtual clinics where you can meet with providers online and the only time when you will need to come at the hospital would be when you need an operation or when you get really sick and need sophisticated care. There are going to be artificial intelligent engines that will be able to help you diagnose and maybe treat many problems that you have and therefore, you won’t need to go to the hospital. There are going to be lots of robots diagnosing and doing things, but there are still going to be people behind it and there are still going to be some people interacting with you.

I think our business is never going to go away.  We will always have hospitals but they’re going to be rather small, and more and more virtual. It will be much more efficient.  That’s how I see things. It will happen sooner or later, I promise.

Dr. Rivas will be joining Health 2.0 Europe in Barcelona, Spain on May 18-20 as a keynote speaker. Find his keynote schedule and session on the full agenda here.

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