By Cristen Bolan
The day when control over patients’ health will always be within hand’s reach is not too far off in the future. The number of health apps is staggering, with over 40,000 apps categorized as “Health & Fitness” or “Medical” in Apple’s App Store alone. Mobile health is “the biggest technology breakthrough of our time,” said former U.S. Secretary of Health and Human Services Kathleen Sebelius.
One of radiology’s luminaries is a trailblazer in the direct-to-consumer health apps, Khan M. Siddiqui, MD, a visiting associate professor of radiology at Johns Hopkins University. As a self-proclaimed serial entrepreneur, Dr. Siddiqui helps startups focus and raise funding, and he is the co-founder of higi, health stations that provide bio-metrics to consumers. higi stations are kiosks found at retail pharmacy, grocery and other consumer-targeted locations, allow users to receive stats on their weight, Body Mass Index (BMI), blood pressure and pulse. Users can track trends and changes in their body stats with a personal higi Score. The company plans to have approximately 4,100 high Stations deployed across the United States by 2015.
Radiolopolis spoke with Dr. Siddiqui about the role of radiology in direct-to-consumer health apps.
Radiolopolis: Can you tell me a little about how you have branched out beyond hospital IT and into healthcare start-ups?
Dr. Siddiqui: I’ve been doing software development throughout high school and medical school. I see informatics as a tool to get things done. Software as a tool to communicate our health care experience. My work in medical school involved data mining. After my radiology training, I started exploring opportunities in informatics, and connected with Eliot Siegel, MD, at the Baltimore VA and helped him build their informatics lab and program. From there, I trained some many well-known radiologists, such as William Boonn. I then did a search start-up called Yottalook, doing semantic search for medical imaging, and then joined Microsoft for 4 years and then joined Higi. At Microsoft, I lead the medical imaging team and then it became multiple products. We did research on recognizing anatomic structures on medical images, which became the foundation for XBox Connect. Connect recognizes body parts. In addition to other products, we built a medical image archive in the cloud, and built the HIPPA-compliant infrastructure to do a truly cloud-based medical archive. In my last year at Microsoft, I worked on Health Vault.
Radiolopolis: Did Higi evolve out of this?
Dr. Siddiqui: In order to do anything in direct to consumer healthcare space – how do you acquire users. Based on organic growth in social networks, what we realized you need to figure an existing habit. What we realized was to do it fast you find how users are already engaged. When Google+ came out, when you reach 15% to 20% usage of adoption, your hockey stick evolves. Facebook took three years to get 10 million users. But with Google+ they got 10 million users in 16 days because those who had Gmail accounts, then they added another tab on the top and everyone became a Google+ user over night. That became my belief – if you want to launch a product you need to find an existing habit or existing user base.
In 2011, I received a call from Michael Farrell, who at the time was the Chairman of Merge Healthcare and he was trying to use social media in healthcare. I decided to join on March 2012, and Higi went from PowerPoint to where it is now. The total available health kiosks out there are used by 17 million unique users on a daily basis. We found the kiosks in the right locations and by the end of this year, we will have already deployed 6,000 plus kiosks nationwide.
Radiolopolis: What are the biggest Trends in health care IT?
Dr. Siddiqui: Direct to consumer solutions such as Higi. I divide it into two aspects of the grade. If you think of the informatics aspect and the infrastructure is evolving into next generation technology. From an infrastructure point-of-view, you will see more sensors. Even your cell phone has become a sensor; it tells you where you are, what you are doing, it captures your location data; it captures symptoms; will sense allergies; tracks calories and counts how many steps you are taking.
The same thing will start happening in the clinical environment and that becomes your infrastructure in the hospital environment. We have had the trend toward the cloud infrastructure where all of the storage data is centralized, now we are sending data from and to the cloud. From the informatics point of view, it is really the data. We used to talk about volume data overload in radiology—that is nothing compared to what the sensor data will bring in — it will bring in more data that is very complex. So how do you extract useful information and contextualize it and than the image volume data, and apply knowledge. There are many people who do informatics, and there are others who build technology to drive health care and generating that data.
Radiolopolis: Are radiology groups taking full advantage of EHRs?
Dr. Siddiqui: If you only have a prior exam from a year ago and all you can tell is there is change from year-to-year. If I have access to labs, and I knew the white blood cell count was high and the patient had a fever, and patient was a drug abuser, then you know it can be a cancer. If you are practicing in just a RIS/PACS environment, then do you do a biopsy or CT scan to see what it is. There are so many examples of disease entities and we cannot give an exact diagnosis because there can be so many options and unless you have the lab history or other information, it is very difficult to figure out. How do you get that information? That is where the gaps are. Most EMR workflows are designed for family care practice, not for radiologists. What is important for the primary care point? That is where the data shows up right away in the EMR. That is the frustration for the radiologist, the EMR is laid out as if a family care physician is looking at it and it’s not contextual to what the radiologist is trying to figure out for the patient.
Radiolopolis: How PACS with the EHR will transform and help transition in value-based care model?
Dr. Siddiqui: For radiologists to be part of a true-value based practice you need to know more about the patient. Our ability to provide a better diagnosis and add value to care is much higher. If you are only living in a PACS/RIS environment, there is no access to that information and in many cases there are so many options of diagnoses. How do you get that data? Most EMRs are designed for primary care and not for radiologists. That’s the frustration from the radiologists’ point of view, it is not contextual to what I need to determine. It’s difficult to find information in the EMR. For radiology to be a true-value based practice, you need to know more about the patient.
Radiolopolis: Where do you see mobile PACS and RIS technology going?
Dr. Siddiqui: That should have been happening yesterday. There are so many scenarios where you need to provide information at the point-of-care where you don’t have access to your workstations, even from a radiologists point of view, it’s important to quickly look at data and provide feedback. Most value today is seen by non-radiologists that need to look at the patient data right away including images.
There used to be a wet read, but you still had to do a final read. Why not treat mobile as a wet read – you can see what is the problem is with the patient with the majority of CT and MRI scans. If you talk about value-based radiology and its much easier to part of the care team; you can’t carry along your PACS workstation with you but you can carry your iPad with you to see images, provide consultation, than stop at a PACS workstation.
Radiolopolis: What is your view of point-of-care ultrasound by non-radiologists and where do you see that going?
Dr. Siddiqui: I always see what benefits the patients first – does it benefit the patient if someone can make more accurate diagnosis than waiting for a radiologist to come along. The faster the delivery of care, the more quality, more value is going to win. So should the radiologist change their practice to be available to the ER docs immediately as needed. If I’m an ER physician, and I need to look at a gallstone and gallbladder, it’s so easy to just put a probe and look at it. People talk about the telescope of the future being an ultrasound. You can carry an ultrasound in your pocket now. You can’t stop that – it doesn’t help the patient to wait for radiologists to evaluate a vessel.
So what is the value radiologists provide? Evaluating malignancy and doing a comprehensive exam and consulting with the physician — that’s not going to go away. But if you tell me about doing drainage or putting in an IV line, that is something the physician is going to do at the point of care. The radiologist needs to value not just value to the physician but also to the patient. For us to survive as a specialty, they need to engage with patients. In our practice we used to reach out to the patient. In mammography, radiologists call the patient with the results. Each practice needs to design its own plan of engagement how to engage with the patient directly.