Discovering Medical Tourism

Serge Fabre, my dear business partner, was now sure of his decision: it was LASIK at Excellence. Bye, bye glasses, aurevoir les lunettes, adios gaffas.

One morning he went to have a preliminary check up. The verdict came within two days: his right eye needed more correction than the left, he was a little bit of everything eye wise, here is the price tag, are you willing to proceed Mr Fabre? Serge was really tired of his glasses and when he understood that recovery time will take only 3 to 4 days he was 100% ok.

After a mere 5 days, the operation was set up. It was very fast according to him with almost no sensation. No blood, no sweat, no tears… Where is the drama!!! but after, I had the biggest laugh of 2008.

Serge came the following day to our office with dark pitched sunglasses, the one that Jack Nicholson was wearing in Easy Riders… I had my own Ray Charles at the office. He didn t want to take them off fearing to hurt his eyes. Actually he just had to  firmly protect his eyes for a day before going out in the daylight, with his 80 s glasses. From transparent high tech looking glasses, to these pre Ronald Reagan Ray Bans, what a rip off! I immediately ran to the shopping center to buy a leather jacket and a motor bike, we had something great  going on.

I Know, I could have find a better picture (look at this shirt!), but at least you can witness his nasty grin, saying: Ain’t I sexier now?

I must admit that after he was feeling confident enough to get rid of his dark glasses, I had the impression of seeing a new man. His face changed, became rounder (to me), he looked younger, sharper and even… wiser. What an aesthetical makeover thanks to Lasik. Serge told me he was feeling strange without his glasses on, as if his nose was lighter but needed to be heavier (I translate litterally, sorry if it sounds strange). but wow he lost 50 years in the process and looked again like an angel! He was seeing even better than with his glasses and told me: “If I knew how good I could feel, I would have done better”

Here is our first customer being extra extactic over his first procedure.

Now Serge, tell us, what will be your next medical tourism experience. take a look to our catalogue on Bemyspa.com someday….

As stated in the previous article, Indian medicine has a great asset: its past. In fact, Ayurveda, the hollistic medicine principle derived from centuries of medical tradition, is an original medicine with a certain efficiency that can be built into a decisive competitive factor by Indian hospitals!

Previously, we talked about preventive care and diagnosis according to ayurvedic medicine. What about Disease management? there are four main methods by which and Ayurvedic physician manages disease:

• Cleansing and detoxifying (shodan)
• Palliation (shaman)
• Rejuvenation (rasayana)
• Mental Hygiene and Spiritual Healing (Satvajaya)

Cleansing and detoxifying (shodan)

This is the gore part of Ayurvedic medicine unfortunately and this can really scare off any person willing to discover ayurvedic medicine: pancha karma is all about vomiting, bowel purging, nasal douching to remove toxins from the body. The good part is that in preparation for cleansing an herbal oil massage may be performed (oil is well absorb by the skin and helps to eliminate toxins while passing through the body). herbs can also be introduced in certain parts of the body (especially the noze) to increase resistance to enzyme reaction. After the cleansing, the patient is given ghee (clarified butter) and yogurth to restore the intestinal flora.

Hi! Let me take care of your bowels

Palliation (shaman)

Shaman focuses more on the spiritual part of the healing and uses a combination of herbs, fasting, yoga streches, breathing exercices, meditation and lying under the sun (ah! that’s better than cleansing the body). in fact, the sun is not only a source of heat and light but according to ayurveda a way to better absorb vitamin D, to improve circulation and to strenghten the bones (the time of exposure required depends on your dosha type). Actually Shaman is often used as an alternative to pancha karma (see above ) for those who are mentally weak to undergo this kind of treatment (like me!). Shaman is really sweeter: one of the herbal therapies prescribed consists in consuming honey with certain herbs such as pippili (long pepper), ginger, cinnamon and black pepper…

Meditation as an alternative to cleansing

 Rejuvenation (rasayana)

Rasayana is a program of tonification which is similar to a physiologic tune up.  It is used to restore virility and vitality to the reproductive system, countering strterilirty and infertility, bringing forth healthier  progeny and improving sexual performance. Ayurvedic medicine uses three methods for rayasana: special herbs prepared as powder, pills, jellies and tablets; mineral preparations specific to a person’s condition and exercices (again yoga exercices).

Mental Hygiene and Spiritual Healing (Satvajaya)

Satvajaya is a method aiming at releasing psychological stress, emotional distress and unconscious negative beliefs. This is one of the precursors of stress management and operates in a very original and “modern” way. The categories of satvajaya include mantra or sound therapy to change vibraotry patterns of the mind, yantra or concentrating on geometric figures to take the mind out of ordinary modes of thinking and gems, metals and crystals for their vibratory healing powers.

Yantra: one type of the geometric figures to alleviate stress 

CONCLUSION 

All in all, Ayurvedic medicine is extremly original and should be put forward by Indian hospitals as an innovavtion in treatment. When people hear about Ayurveda they can barely figure out hwat it’s all about. My gut feeling is that some Indian HospitalGroups are being too conservative and too “un Indian” in their product offer for international patients. Again if the market is price driven today, I really think that it will all result to quality on a few years: ”MADE IN KOREA” used to be a problem but then Hyundai and Samsung surfaced with their different and new products to propell the cognitive perception  of Korea very high in people’s mind. To  me, the same can occur with the label ”OPERATED IN INDA“: nobody will feel confortable with it up until quality and differentiation  will be knitted to Indian medical providers

The main problem with medical tourism is the natural feel of isolation that stems from it. By deciding to go abroad, a patient will fill his suitcase with medical reports and cross his fingers to get the right diagnosis. In fact, diagnosis is the tumbling rock of medical travel as people fears to be misled, misunderstood by a doctor that barely speaks English. There are many portsaals to find information about health such as WebMD or Doctissimo (my personal favorite one is intelihealth by Aetna as the information is clearly displayed and very practical).

Several entrepreneurs have worked on projects tying up any individual with genuine experts on a specific medical problem allowing a more effiicient management. We have previously talked about Xoova, an online doctor registry… These Health 2.0 formats are more proactive as they ask an action - reaction process pretty much like a forum with the notable eception that some people are willing to keep their personal health issues strictly private and don’t want 120000 readers to hear about their problems.

In fact, Health 2.0 is different from Web 2.0: the community is in osmosis in optimal Web 2.0 business models (everyone is crearting contents and freely displaying to community members (think about Wikipedia). For Health 2.0 there is the desire to tap the community resource (the doctors, healthcare specialists) without any comitment to the whole community. Health 2.0 is a gated community Web 2.0

Think about a pyramid where doctor are at the top and information seekers at the bottom. To add coherency to the pyramid, Health 2.0 communities entices to create communication between information seekers. This is not a soap opera, there are no triangular relations possible: if a information seeker will contact a doctor the latter will not tell a random community member about their exchange! You have to type of movement within the pyramid:

+ HORIZONTAL –> TO Community members with no medical expertise but a common hardship (i.e. similar health condition)

+ VERTICAL –> TO Specialised doctors able to give hindsight

Here are a few examples of such communities:

 Tau med is still at a Beta stage but is quite interesting. TauMed is a community system articulated around three features: interaction with the community (by asking an open question), share an experience based on a medical experience or question and health videos. Questions a re asked among community members that are then able to vote for their favorite answer or flag an answer if find inappropriate. Community members also have the possibility to create and share their personal care journal (“Health Share”) hence having people discussing their medical issues together (we can ponder over this fact considering one’s desire of privacy when discussing medical issues). Tau Med privileges an HORIZONTAL Communication but is looking into VERTICAL communication.

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 Everydayhealth.com is a large site that reaches over 4.0 million U.S. monthly unique visitors . The site attracts a primarily female, skewing older audience. The site’s audience’s affinities are magazines (Parent & Child, AARP Bulletin, Prevention, Home), retail (Giant Food Stores, Sweet Bay, Ingles Markets, Dollar General) and specialty retail (Catherines, Marshall’s, Sharper Image, Brook’s Running). Everyday health appears to be an information center that features 33 specialized “Health centers” on specific conditions such as depression, diabetes, inflammatory bowel disease. These centers are taking the full scope of each condition: from understanding the condition, to diagnosing, preventive techniques, possible treatments, ongoing management, and related facts. Each center is independantly managed by one specialised doctor establishing a clear connection between a precise health issue and a specialist that can give advice. Hence the website only entices a VERTICAL communication.

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 IMedix is another of those start ups with a very neat presentation. I Medix only functionnality is to have people discussing about their common health troubles and NOTHING else. I don’t see how I Medix can bring up a community with so little functionality and a zero zest of fun. Let’s figure out: “Hi I m John, I’m suffering from the Dawn Syndrome. Namely I am suffering from Dementia… Is anybody there?”… Perhaps somebody will be there but it takes a lot to write about your issues. There’s no positive factor, nothing that really makes you feel willing to participate to the community. Too little elaboration, I don’t like it (still perhaps they ll improve for their official launch…).

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 MedHelp is a first entrant on the internet scene as the company was created in 1994. At that time no Web 2.0, online community blabla. So they started with a simple stone. One of the creator of the website had her mother misdiagnosed during years and when a doctor with the appropriate qualificatfions and knowledge diagnosed her mother it was too late. To avoid this Medhelp intends to connect people with qualified experts on precise health conditions. With the evolution of internet the site has brilliantly evolved spurring VERTICAL and HORIZONTAL communication: you have now Doctor forums (43 forums) co existing with Users community (81 groups). The webiste is now featuring MyMedHelp, an online personalised portal that should focus on the problems you are facing.

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The quality of MedHelp forces me to think that Health 2.0’s new entrants are jumping too quickly to the users and are not trying to build what they really need: an expertise infrastructure that is going to be tested for several years. Tthe point is that such “infrastructure” is expensive and new entrants are more willing to burn their money on web development and online marketing than to create (understably) a backbone with a far fetched return on investment.

I love web 2.0! I have quickly reviewed Medtrotter, and to be honest I was extremy skeptical about patients ranking their surgeon…. Yet, let s now just consider a health condition such as asthma. You are living in Charlotte, north Carolina and you are looking for some information: you got it, through a new online doctor directory called Xoova.

Xoova besides being graphically and ergonomically remakable has the notable advantage of proposing consistent entry keys. One will write its location (state, town in the US exclusively) plus a health condition among a list: the cross research will lead to a series of profile. I have for instance typed Los Angeles California and aging: I got 1439 profiles most of them being relevant on the 8 first pages ( I was lazy going onwards). With 500000 doctors featured and 20000 profiles completed by the doctors themselves, we can talk about critical size! Doctors are not ranked everyone has a chance to grab new customers!

Now is one question I would like to ask Xoova: where is the money? please shed the light on this, I really have no clue. Xoova even advertises: “physicians who have integrated Xoova into their practices report a new patient yield of 5% or better, significantly better than typical phone-based patient referral services. There is no cost, software to install or contract to sign, meaning you can create an effective online marketing tool for yourself without risk”. In fact, the model of revenue is blur: appointements online are free, registration is free (for a positive yield…). I don’t get it.

Xoova is however developing an innovative new point of entry for its database: it consists in indicating your health plan to find the right doctors. Perhaps this will lead to an interesting revenue model sharing with Xoova promoting some HMO (through their doctors) or conversly HMO communicating on their plans through Xoova. The company is planning to further extend by raising 5 million USD beginning 2008, perhaps to cash in the strong community they have been building for 2 years? 

This morning I’ve had the surprise of testing a brand new website: MXS ! Medical experts Services is a  … french…. company (this was totally not compulsory) whose purpose is to dig into eating habits. They have hence created a software that helps you to manage your nutrition through several questionnaires.

We first have to get at odds with the classical size - weight - sports related questions. But then the software really impressed me. In fact, MXS tries to understand your eating habits by probing into one typical week of breakfirst, lunch and dinners. The software then treats you to depict all these meals through a series of screens where you can precisely elect all the elements of your meal with simple tools. For instance, let’s imagin that this morning I took white bread and nutella, the software will propose me a series of bread (including white bread) and then ask me what did I put on this bread. I elected chocolate and indicated I took what looked to be one regular spoon of nutella. The interactivity of their system is great, and honestly you go through the screens quickly. When finished, the software will then analyse your meals and give a series of comments on your eating habits. Even though this is only a sampled week, the conceivers of the software supposed that a typical week of eating could be significant enough as eating habits only sightly change from one week to another.

 Another interesting application was the relative adjustement of your suppers. Let’s say I depict my breakfirst: a bowl of hot chocolate, two croissants and a banana. The software will process this information, evaluate the current nutritive elements that were ingested and propose a lunch and a dinner that suits me in order to comply to the minimal daily nutritive needs (enough vitamines of all categories namely).

On the left side, our advised menu, on the right side, the predicted nutritional ripoffs…  

Honestly, it is very simple to use, the ergonomy of the website is well studied. Thumbs up. Yet, I am confused as I don’t understand how they are making money. In their demo all the features of their offer is for free and I wonder how they are going to commercialize this product and to whom?? Perhaps another great idea with no market. Readers? What do you think?

PIPS (Personalised information Platerform for Life and Health Services) is another european medical project we would like to dwell upon. I really loved this project when told about it while visiting Brussels a few weeks ago. Why? Because this project perfectly encompasses the Hypocrate oath by trying to diffuse the best medical services available for all.

PIPS is one the major projects in the European Commission PIPEline

The project is an holistic approach opf medical services as it joins Healthcare suppliers, citizens, Public Organisations, drug suppliers, food industry, health policy makers etc etc. How is it working. Let me reproduce an exemple quoted from their brochure:

“Mary Johnson is a diabetic/infracted and her GP suggest to contact a specialist dor an appointement. Mary goes to Dr Brown who uses the PIPS system and prescribes Mary a therapy and a set of tests to be done at ho,e. At home PIPS reminds Mary to take her test and after having done it recognizes an abnormal state. The system may change the prescription following t he doctor’s indication and asking for approval or will alert Dr Brown who, looking at her vital signs and the results  of the questionnaire will suggest Mary to fix an appointement to review the therapy”

Simply put wow! We here have  all rolled in a dime:

+ an appointement manager

+ a knowledge manager (convening heterogeneous information into an intelligible flow)

+ an at home medical care manager with high user interaction

+ a follow up system with an active warning system able to fix a prescription (decision support system)

The sustainability of the system in the mind of the PIPS creators relies upon the involvement of all healthcare actors to create a fluid delivery value chain that can generate valuable information. PIPS has been conceived to be always auto sufficient. The preventive care generated by PIPS is for instance doubled: a primary prevenetion after a disease to reduce side effects and a secondary prevention to reduce the risk of relapse or other collateral disease. Another interesting contribution made by PIPS is the help it provides to act over the prevalent cuases of non compliance such as abandoning treatment before completion.

PIPS is a great project because it is a societal project where everybody is involved in order to help everybody. It is a great vision of medical practices where all forces are garnered in order to help all three kinds of actors involved in medical care namely experts, medical professionals such as GP looking to tie up with qualified experts on rtare condition disease and the end-user at the other end of the delivery value chain that can use this system to assist him in his everyday life according to his IT litteracy (which is simplified to the extreme..)

Health-e-Child is the second software we will review. Conversly to health plus; health e child is not a health assistant but more a preventive care and medical care tool specialised in following the condition of young children.

Merger of Information, Acquisition of Knowledge: M&A is everywhere

Children are in fact suffering from a disconnection of pediatric care and medical care oriented towards adults making it difficult to have a transgenerational biomedical information plateform to build up cross modality and longitudinal information fusion (they phrase it like this) to enhance research and disease treatment on the long run, this being particularly blattant for chronic diseases or chronic pain. How about paediatric heart diseases or early brain tumors for instance? Paediatric care is not as well organised as medical care given the difficulty to make a good screening + prescription process (parents can describe the pain experienced by a child not the child himself given his lack of vocabulary when young)

I really liked this program because it helped me to understand that the assumption I have made in a previous article. In fact I was talking about paediatric preventive care education in order to underline the paramount importance of driving programs that dwell upon young children care. However the Health e Child program helped me to understand that a bigger issue was the lack of knowledge stemming from early age disease which ripple effects are hardly mastered today. Paediatric preventive care could therefore help to give more cohesion to medical care as a whole and determine the real roots of a late detected disease by consulting early age records.

There is an ongoing dream among medical specialists: it is that people can take care of themselves and well manage their health status at any moment. In the following days, I will try to list some very interesting initiatives regarding this matter, namely web based projects for weight control, diabetic control and so forth serving as a lifestyle assistant

Health plus: minus weight!

Health Plus is the first project we will dwell upon. It specialises in fighting against obesity which affects 200 million European citizens  and which costs nearly 5% of the healthcare expenses in Europe. This program is organised around two thnigs:

+ an experimental approach through the monitoring of certain populations by creating and diffusing food frequency questionnaires and food registration diaries.

+ a practical approach whereby health plus helps providing personalised nutritional programs to support any user defining and implementing a personal nutrition plan

What is very interesting about Health plus is its action for pediatric nutrition action. In fact, together with the University of Parma, the Health plus program is building up a plateform among children aged from 6 to 12 to asses their eating ande lifestyle habits (though testing effects are quite important when testing young children habits) in order to design and test corrective measures on the long run.

This kind of preventive care actions make particularly sense, as we are not talking about self care but care under the tutelage of the parents with long term benefits as young children will benefit from his early nutritional education. Preventive care systems should really focus on pediatric applications in order to create sustainable results and ease up the diffusion of self care habits.

The United Kingdom is made out of 4 sub countries as you all know: Wales, Scotland, Northern Ireland and England. What is really flabbergasting is the fact that each country has its own national health system and even though interoperability exists there are some differences in terms of organisation but also in terms of vision.

Will the Highlander register in Scotland or in England?

Let’s talk about what really interests us namely On line medical follow up. England is by far the leader among all 4 systems with various initiatives stemming from the NPfIT, the largest e healtrh project in Europe:
+ first the NHS CRS (Care records services) that allows GP to access patients data when the latter are consenting
+ the PACS (Picture Archiving Communications Systems) where at the end of 2006 83 million pictures were already stored
+ Electronic hospital bookings with a rythm of 10000 bookings a day
+ the EPS (electronis transmission of prescription) 16 million prtescriptions among the 370 million in England wentr through a dediacted electronic portal in 2006
+ The N3 (new national network), heralded as the largest VPN in Europe a very important component for the validity of a medical system.

Hence, we can point out a huge number of positive points, yet, England is not perfect and furthermore the UK. Today there are 12000 different systems available for 250000 NHS staff in England? Why that? Is it because the aforementionned systems are barely efficient or because medical system is the hot potato considering the huge investment driven by the English NHS?

One of the main problem we have noticed in many countries is the lack of focus on leading up an aggregator that makes sense from a legal and technical point of view. A lot of operators are trying to interpret the thinking of the NHS bigwigs yet nobody is able to promote the best solution. Another problem could stem from the lack of vertical integration in the software business. When thinking about an OS (operating System) we clearly see a link between the promoter of an equipment (such as a PC) and the software. Couldn’t this be done to a certain extent for medical devices?

…At least indirectly as I am the latest addition to Jeremy Fain’s blog, Tech it Easy, a blog dediacted to IT in general. I will be focusing on medical technologies in direct connection with our main focus on this blog, medical tourism. Here is my first article on this blog talking about Medical maps. I know that multi blogging is a risk but I wanted to keep this blog simple… I have been blogging for more than a month now and I feel I am starting to define my style. About 200 people are visiting this blog every day and I want to thank every reader for keeping tack with what I am intending to do, and foir commenting regularly. This gives me additional forces to increase the amount of work I am putting into this blog!! 

The medical secret is experiencing hard times in the US. For instance, three years ago, Bill Clinton underwent heart surgery in the New York’s Presbyterian hospital, Even though he went there through a fake identity, some people tried to crack the security system and elicit some confidential information. A local sportsman even got crazier “attentions”. The director of that same hospital states that he thwarted 1500 attempts to rip some medical information about this sportsman from his own employees!

Many companies are currently adapting themselves to carry out a 100% informatics medical approach by transferring all medical procedures online (for instance, Intel , Google, IBM, Wallmart). The latter companies have all expressed a strong interest in putting up personal medical dossiers for all its employees. However, the generalization of such systems will take time. According to a research done by the General Hospital of Massachusetts, in 2005, 1 out of 4 medics  were using such electronic medical dossiers (against 89% in the UK) when they could access to it and 1 medic out of 10 (!!) were using technology while making an impacting decision such as diagnosis, prescriptions…

Besides there is a genuine fear of people usurpating the identity of someone to get some medical information. In 1996, the Congress voted for a law that states that such misdemeanor is a criminal infringement.  Yet, cases have not led to real punishement…

However a looming debate is not on piracy but privacy. The underlying question is what kind of information one could keep secret and what the doctor should keep for them. Let’s take a practical example: I am a woman that got raped at the age of 19 and got pregnant in the process. I needed to abort (what a scenario Uh?). However I don t want my relatives to know about this last fact. Hence I need to cover up part of the medical fact related to the rape which is the case with the redtape cluttered system.

More extensively, companies are now asking for people to fill up medical dossiers before getting employed or even while employed. In a funny fashion, the people entitled to getting these insurance related information are HR managers often also in charge of sacking employees. This puts up a system whereby people will be less willing to give all the information they have in hands on their health status.

Medical tourism is directly concerned by such measures and problems. In fact, as we have stated in an article before, medical tourism needs an electronic follow up to be efficient. The current debate on electronic medical dossiers leads to know which kind of information can be retrieved or filled during a medical check up in Asia and poses the problem of a common software (or at least format) between all hospitals…

The last days were extremely interesting for me. I was really wandering in the medical tourism jungle, checking which definitions people had in mind. I remember writing the ‘About this website’ page a week ago and I was so unsatisfied by this page that I decided to shelve it and rewrite it later. 

Every time I have a debate about medical tourism, people portray this industry as an unethical way of making money using the despair of people who can’t afford surgery in their country, plus a dangerous production system with all the infamous stories of botched mammoplasty or rhinoplasty.

Yesterday during a dinner, I tried to argue with a cardiologist that medical tourism is not boiling down to low cost procedures but is a wider access to unknown techniques perfectly mastered in Asia. These techniques range from ayurveda to tsubo chiatsu to Lasik surgery etc etc. I acknowledge the cost differential (we were talking about angioplasty) but for me, he was focusing on a non sustainable medical tourism. 

I am using the words ‘non sustainable’ because I feel that the existing business models of medical tourism are all one shot models:

+ heavy medical procedures motivated by a low cost effect or long waiting lists

+ no follow up stemming from the procedure + no customer relationship management approach. 

It is a run and gun approach that certainly has people smearing about the association of words ‘medical tourism’. But again there is hardly any tourism implied by this method> I have pinned this idea as medical travel. Let’s call it INDUSTRIAL medical tourism (as an input -output chained process)

 Yet, this is definitely not the vision I have about medical tourism. NOT AT ALL !

To me, medical tourism in Asia is an open window leading to the best healthcare procedures in the world, innovative techniques to solve rare condition techniques, the best preventive care solutions, unheard of manipulative therapies plus an opportunity to enjoy a tourism experience and so forth. Perhaps my definition is wrong but this is what medical tourism sounds to me. One could argue that I am speaking about health tourism…

Medical and Health Tourism as we define it as a longer life expectancy and a higher volume than the classical model

When considering biological methods such as herbalism or manipulative techniques such as psychotherapeutic postural integration or ayurveda are we only talking about health? These techniques are a genuine front end to medical procedures so how can they be restrained to mere health procedures… Medical tourism must be a sustainable experience and therefore must entice repeated visits: diversifying methods, proposing long term follow up (using tools such as the PRM we have previously reviewed) 

Here is my real first tentative definition of Medical Tourism, that we will call from now on Medical and Health Tourism: 

 ‘ an experience of medical and healthcare techniques culturally connected to a specific place or technically knitted to an hospital for preventive, aesthetic or curative needs ’ 

Experimenting these techniques boils to an exploratory approach that is tied up with traditional tourism (going from one place to another to try out a technique etc etc) but with the particularity of positively affecting our body  Talking about how angioplasty could cost only 10000 USD is definitely not the goal of this blog.   

Discovering medical tourism is going to take a major u turn. In order to carry out a clearer perspective on what we consider medical and health tourism is we will from now on stress upon THIS definition of medical tourism by digging into health and medical procedures specific to Asia and all the techniques that can make medical tourism a sustainable tourism.  

Medical call center is perhaps one of the most interesting niches in the call center business as it only represents 3% of the total activities of call centers in Europe and in the US (acc. Euromonitor) yet it is expanding at a very high rate.

The underlying question is dual: is customer satisfaction high with medical call centers and are medical call centers efficient? Some experiments were done to analyse this second point

In July 2006, PHT Corporation, the market-leading provider of electronic patient reported outcome (ePRO) solutions made an experiment in partnership with Temple University School to investigate the potential clinical benefit of using call centers, staffed by pulmonary medical personnel, to support and follow up with Pennsylvania residents suffering from chronic obstructive pulmonary disease (COPD).

A bunch of friends indeed…

COPD is not an isolated chronic pain but a real health issue. According to the Pennsylvania Department of Health, COPD was responsible for 8 million office visits, 1.5 million emergency room visits, 726,000 hospitalizations, and 119,000 deaths in the year 2000 throughout the United States.

This trial is unique because it is evaluating the impact patient access to a call center may have on reducing hospitalizations and deaths due to COPD exacerbations and on improving patient quality of life, lung function, and everyday activity levels.

The technology used (the LogPad), implemented by PHT on Palm, automatically calculates a graded score from baseline and triggers an on-screen alert telling the patient to contact the call center if certain thresholds are reached. At the same time, a software, PHT StudyWorks allows call center personnel to review real-time reports online, enabling them to prepare for a subject’s call or to identify and contact patients who triggered an alert but chose not to call.

Reactivity is the key benefit of this new kind of medical call center. In fact, many people who have access to a call center at an instant T can feel that the exacerbation they suffer from at this very moment is not the right trigger even though they are in real dire straights. Hence, improving the classification and quantification of symptoms that herald an exacerbation may greatly benefit those who suffer from COPD.

The medical call centers is hence well adapted for chrnoic pains because of its abaility to closely follow up subscribers. Yet, is the medical information delivered satisfactory and/or efficient?

Complaints are rising in the US because of the lack of price and quality informlation and health care.  A study from the National Center for Policy Analysis (NCPA) (february 2007) says the complainers are causing the problems they are so vexed about because unlike in other market qualitative information and transparen,t price are services that are available only if the end customer pays for it.

“The primary reason no one knows what doctors and hospitals charge prior to treatment is that they do not compete for patients based on price,” said NCPA President John Goodman, who co-authored the study. “When they don’t compete on price, it turns out they don’t compete on quality either. In a very real sense doctors and hospitals are not competing for patients at all.”

At the end of the day, hospitals have little stake when trying to lure patients. In fact, the orientation of a customer depends on a problem of convenience as an insurer will decide to send a customer to an hospital according to its localisation ans its belonging to the network. This game is hampering the development of the overall quality of healthcare services as insurers typically do not pay for many services that would lower overall health care cost and would improve the quality. 

The NCPA study lists down the following downfalls resulting from this lack of competition:

+ No Integrated Care:

+ Taking responsibility for the treatment of a patient’s case from beginning to end.

+ No Patient Education resulting in no self care:

+ No Telephone and E-Mail Consultations:

+ No Electronic Medical Records: 

All this downfalls can be perfectly adressed by medical tourism as international hospitals have to create genuine competitive advantages and online solutions in order to justify the outsourcing of the medical procedure. 

Selling the competitive advantages of a foreign hospital to make a difference as an insurer

When looking at Phillipines, actually 5th competitor among Asian medical tourism players, thlocal hospitals must find innovative solutions to compete with mega groups such as Sunway, Parkway or Fortis. What makes this study about the American Health particularly intersting is that the elements listed above are excellent leverage to make a difference for any hospital or for any medical service provider. 

In fact, even though the game played by insurers bypasses hospitals, insurers cannot dodge the competition between each other. If American hospitals cannot provide them competitive advantages to make a difference an Asian hospital could give an insurer a clear cut hedge if the latter decides to give credit to medical tourism strategie. Some insurers are now pondering over the fact of proposing medical tourism as an option, referring all the specific features of these foreign based hospitals as differentiating factors.

There has been a sprawling development of medical centers in Asia but more specifically of aesthetical centers with the need of bringing differentiated quality to potential customers. The practice of cosmetic has proved to be very profitable stirring the proliferation of smaller centers whose practitioners pose as real cosmetic surgeonseven though in a country such as Phiklippines seven years of residency education at a reputable hospital are needed to pretend such a thing.

Creating barriers of entry is a new challenge for aesthetic centers. There are several ways of upgrading the quality of a center:

+ recruiting seasoned surgeons

+ showing dedication to care, prevention and decease treatment, the primary functions of doctor in an aesthetic center

+ using breakthrough technology 

The Aesthetic and Dermatology Center that has opened in March 2007 in Manilla is a perfect example of this upward trend through the use of new technologies to complement the surgery such as Aesthera, a machine used for hair removal and skin rejuvenation or the LPG machine (named after its designer, French engineer Louis Paul Guitay) to prepare the body before liposuction, or to contour the body after the procedure. This example put forward the high degree of penetration of new technology; innovation is an important differentiation factor of medical procedures in Asia as some treatments are approved and available in Asian hospitals months before their actual diffusion in the US and in The UK

The new paradigm … not the old woman!

Defining a new paradigm

The Health industry is gaining foothold on the Medical industry as a new paradigm surfaces. In fact, the new trend is not to wait to get sick or spend on chronic care but get to grip with our pitfalls at an early stage through medical screening. Indeed, Medical check ups appears as the real centerpiece of this new paradigm. However,  the cost of an extensive medical check up is extremly high in the US and some parts of the check up are not available in some hospitals. On the other hand when looking at Asian Hospitals we find that the top JICT accredited hospitals are well equiped to treat demands of extensive check ups and offers a real cost differential.

Hence, Medical tourism should focus in a near future on light medical procedures such as Medical Check ups to open the total array of services connected to medical tourism. Medical check ups appears as the stepping stone of the industry, but how?

Following our tour of medicasts now let’s take a look on the evolution of tourism videocasts and podcasts. I have surfed on the net in order to find some of the new podcast players indulging in the tourism business and came out with three of them:

Podibus (http://www.podibus.com/). This website offers to download videos of reputed tourist places in France, for instance a free video of the chateau de Versailles (40 minutes!) or a video tour of the Versailles’ garden (2 euros). The website is planning to launch on the 26 oppof april a guided visit of the Chateau de Chenonceau in 11 languages (45 minutes for 3 euros). A quite interesting manner to buy a postcard or prepare ourselves for the trip at the Chateau!

Pocket Vox (www.pocketvox.com) is way more international as it podcasts tours of cities spreading from  Marrakesh to St Petersbourg. These visits last for one hour and a half and price at 5 euros.

Cityspeak (http://www.cityspeak.com/) is focusing on three cities Paris, London and Rome with a real in depth approach. However, the prices are way above the former services as an audio podcast (let’s call it tourcast!) costs above 17,80 euros. We can wonder if this service is profitable…

 All in all we have a service that is marketable and for which people are ready to pay for! So what about combining medicatss and podcasts and see whether or not people are ready to pay. Indeed the implicit value for a user is not the same:

+ for a medicast: get rational information about medical practices. Objective: get to be more acquainted with some practices

+ for a tourcast: visit a place, prepare a holiday. Objective: be enticing enough to spur imagination

+ for a meditourcast: prepare ourselves to a surgery or light intervention. Objectives: get informed about the hospital where te surgery will be performed

… We hence took out pleasure from the equation by mixing both approaches. Is a meditourcast a potential source of revenue from this point of view? Yes, if people are ready to pay a premium to be reassured. Yet, it is conflicting with the duty of a medcial tourism agency whose purpose is to male a travel easier from a practical and psychological point of view

Another night surfing to discover the wonderful world of podcasts. And oh my I meet this fabulous trend of medicasts: medical podcasts. Podcasting is a practical way to keep in touch with a center of interest: you only need to subscribe to a podcast to receive a regular flow of information.

nevertheless we have various kind of medicasts: the ones that talks about complex medical procedures, for specialists only, and the other one talking about self care, health awarness.

Tech medecine and its author Joshua Schwimmer has recently posted extensive desciptions of some of these podcasts. the most interesting examples I have come through being: the Health Update podcast made by Jane Brody, columnist of the New york Times and the John Hopkins Health News podcast by Dr. Rick Lange, chief of clinical cardiology at Hopkins, and Elizabeth Tracey, director of the Hopkins Health NewsFeed. These are two interesting podcasts as they offer non technical information that can be used to monitor ourselves the evolution of our health status or get information about medical practices.

before getting to the PRM, let’s here from MY hospital

What is interesting beyond the existence of such podcasts is the array of utilisation of the latter most notably from a marketing point of view. The podcast has generated what some has called ‘narrow casting’ (Dr. Johnathan Sterne - Mc Gill University) namely, podcasts bty imposing an active elective step (subscribing or not), implicates in heavier mode the podcast auditor. Podcasting helps to better target a more attentive audience.

Marketing of private hospital through basic advertising channels perhaps has met its limitations and medical podcasting could be a new way to market an hospital as a whole and its doctors and surgeons. the direct ripple effect could be to accentuate the identity of an hospital by promoting a community effect that goes beyond the patient doctor relation.

However, this practice is not risk free: the expectations that a podcast should meet in terms of quality is way higher than what an add in a magazine should reach. The qualitative work that sustains a podcast has to be satisfactory enough to generate positive feedback or the backlash could be impressive… Medicasts propagated by hospitals should hence focus on one objective: bring practical and simple information to its audience while still keeping at bay its promotion scheme.

Still we can ponder over the possibility of using podcasting/videocasting for the sake of promoting medical tourism activities….

While talking about medical tourism with one of my friends achieving a degree in computing sciences at Centrale Paris, the latter told me to check out Voluntis a specialist in medical follow up. I found this advice extremely interesting as I was still wondering how medical tourism could work without a good follow up service. 

Voluntis is a specialist of PRM, patient Relationship Management. Besides the fact that it is a French technology (Yes!!) sponsorised by the ANVAR, the PRM is a multi channel medical device that brings coaching, medical advice and regular check ups through various instruments most notably SMS, mobile applications, call centers… This company created in 2001 has developed Medpassport, the core software that permits to diffuse this medical education and coaching service.

Using a PRM: feeling healthier?

Quoting Pierre Leurent, the CEO of Voluntis: “This innovative paradigm offers the unprecedented opportunity to bring value to the key health care stakeholders at the same time: pharmaceutical companies, payors, physicians, pharmacists and patients”. Indeed, when looking at their customers we find companies such as AstraZeneca, Sanofi-Aventis, Roche, Bayer or Respironics. 

A PRM mainly serves to assess dynamic health issues such as chronic pain and be able to follow timely any negative evolution. The PRM helps to increase the reactivity of a follow up team, however I wonder how a PRM could be used to track preventive care issues.. Could we design such a tool as an interactive device to check out a medical tourist?

We will try to further investigate this technology in the following weeks by directly meeting with Voluntis and understand how it could fit with the development of medical tourism activities…