Author Archives: Al Shar

Patient Privacy: The Elephant in the Room

Aug 25, 2014, 12:30 PM, Posted by Al Shar

Albert Shar / RWJF

Albert Shar, managing principle at QERT and former Robert Wood Johnson Foundation vice president and senior program officer reflects on lessons learned from the RWJF-funded project, “Testing a system of establishing voluntary patient identification across multiple health care records to improve outcomes and reduce costs” (Shar is a guest blogger. His opinions are not necessarily those of the Robert Wood Johnson Foundation).

When it comes to improving patient safety, patient privacy is the elephant in the room.

Virtually every developed country except the United States has a method for identifying patients.  Misidentification of patients is not only costly and inefficient—it’s also dangerous.  According to data from the Institute of Medicine and the Joint Commission, in the U.S., nearly 60 percent of the 200,000 deaths per year caused by medical errors are cases of mistaken identity.

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Pioneering Reflections

Jan 3, 2013, 12:53 PM, Posted by Al Shar

Al Shar B&W Al Shar

Before retiring, Al Shar, vice president and senior program officer, reflected on his time with Pioneer and the Robert Wood Johnson Foundation.

Along with a few others here, I’ve been on the Pioneer team since it began in 2003. What makes my case somewhat unique was that I didn’t have to be on the team. I had a “day job,” and no one asked or told me to join; I was there exclusively because I wanted to be. Looking back, what’s interesting about that is how little I, and others, understood about what Pioneer should be.

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Believing in Design: Return to Mayo Transform

Oct 4, 2012, 3:46 PM, Posted by Al Shar

Albert Shar / RWJF Al Shar

How can design affect health and the delivery of care? Last year I and a group of Pioneer's guests interested in Project ECHO went to Mayo Clinic’s Center for Innovation Transform Symposium without knowing much about the conference's focus of design and innovation in health. I entered as a skeptic but left a believer. This year, Pioneer brought no guests but we did provide funding so that a number of students in the design, pre-medical, and medical professions could attend.

What do I mean by design? You might think that design doesn’t have a place in delivering innovative health care. Design is predicated on understanding the way people and the environment react to how solutions are packaged and presented. This is critical in the acceptance and ultimate success of health care solutions, and successful outcomes are an essential health care goal.

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Gaining Perspectives on mHealth

Dec 21, 2011, 10:14 AM, Posted by Al Shar

In my recent blog post summarizing December’s mHealth Summit, I began by saying that the mHealth organizers must have been pleased with the conference, given its growth in attendance and engagement.

We were equally pleased with RWJF and Pioneer’s presence at the meeting – in fact, I’d say the meeting was a resounding success from our perspective.

Pioneer grantees Ben Sawyer and Debra Lieberman were both on panels featuring their work in health games and mobile technology. Deborah Estrin and Ida Sim announced the launch of Open mHealth, which is supported with funding from RWJF’s Pioneer Portfolio. And a session focused on this summer's mHealth Evidence meeting that was conceived of and co-sponsored by Pioneer.

Our Public Health Portfolio was also there looking for interesting perspectives on how mHealth could be deployed by public health departments to address a variety of health issues.

And finally, I was lucky enough to moderate a special session on a topic of keen interest to me and the portfolio.

“What I Really Need from mHealth: Five Perspectives on Value” featured a great cast of panelists including Robert Jarrin, senior director of Government Affairs for Qualcomm; Carol McCall, chief strategy officer at GNS Healthcare; Anmol Madan, founder of Ginger.io and visiting researcher at MIT Media Lab; and Richard Katz, director of cardiology at George Washington University Hospital.

Our session was structured around an imaginary mobile health application. The panelists discussed the value  of the application and how to demonstrate that value from the point of view of the individual, provider, various payers, regulators and researchers. This generated a fascinating conversation in which participants spoke from both a professional and personal perspective. Toward the end, we opened the discussion up to the attendees, which led to an informative and engaging discussion that will hopefully extend far beyond the session. The various perspectives are not completely aligned but yield something quite important when they do come together.

But wait, as they say on TV, there’s more! In addition to our panelists, we brought together about a dozen thought leaders, including representatives from organizations like NIH, Google, GNS Healthcare and the National Science Foundation, for a series of lively discussions about the future of mHealth and how to build value for all the players in the ecosystem. There was no lack of good ideas or strongly held opinions, and more questions were raised than answers offered. However, at the end of the night, we could all see light at the end of the tunnel. And that light came from a greater understanding of the value others saw in mHealth. From this newly fashioned broader vision, I’m hopeful we all left with a better sense of the way forward and with new ideas on how we could each play a role. 

I look forward to sharing more of what we learned and what this might mean for our investments in mHealth moving forward – and hearing your thoughts as well.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Reflections from mHealth Summit 2011

Dec 16, 2011, 10:49 AM, Posted by Al Shar

I'm sure that the organizers of this year's mHealth Summit were more than pleased. There were more than 3,600 people in attendance, up 1,200 from last year. The exhibit floor was larger and more complex, rivaling some trade shows. There were tracks for business, research, policy and technology along with a slew of special sessions and keynotes from Secretary of Health & Human Services Kathleen Sebelius and Surgeon General Regina Benjamin, among others. Some presentations soared with whiz-bang demos and promises of how technology will change the world; others bemoaned the complexity of interoperability, the "silo-ization" and the lack of demonstrated value.

While there is no question that mHealth is on the rise, some, including myself, are wondering if we’re heading toward a bubble of inflated expectations. As with all bubbles—dot com, housing etc.—the question isn’t whether there is significant underlying value (there is), but instead “how do we invest in the value that can be realized without buying into overinflated hype?” In the context of the ‘90s’ dot-com bubble, “How do we place our bets on Google and not on pets.com?”

The answer isn’t going to be found in the next jazzy consumer-oriented gadget, but by connecting great ideas that will help us lead happier, healthier lives over the long haul – connecting business, research, technology, and policy interests to find shared value.

I came away from the 2011 mHealth Summit optimistic in the overall potential of mHealth, but a little skeptical about the direction it seems to be heading in. Introducing multiple new and evolving health innovations is inherently complex, as is the perversity of our current health infrastructure. Yet one can’t help but notice that there are some very smart people working on developing the promise mHealth can offer to address some of our most pressing health challenges.

A central question will be how willing those from the “m” will be to ensure that the “health” is improved? And how open will the folks from “health” be in fulfilling the promise of “m” technology?

This will require us all to see value from others’ perspectives in this growing ecosystem. I’ll explore this more in my next blog post, so stay tuned.

In the meantime, take a moment to peruse RWJF’s coverage of the Summit on NewPublic Health.org, which tapped into some of the conversations, new collaborations and innovations in mobile health that might feasibly be applied to public health, and started a conversation about the potential for mobile technologies to help the public health field connect with hard-to-reach populations and bridge disparities.  Read what they learned in interviews with Susannah Fox of the Pew Internet and American Life Project about advances in mHealth, with Yvonne Hunt of the National Cancer Institute about the potential for mHealth in public health, and with Robert Kaplan, director of the Office of Behavioral and Social Sciences at the National Institutes of Health about the rigorous research still needed to support the field. We’d love to know what you think, so don’t forget to comment on each post or below to share your insights.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

What Do We Really Need from mHealth?

Nov 29, 2011, 1:04 AM, Posted by Al Shar

The December 5-7 mHealth Summit is approaching and I’m pleased and excited to be moderating the special session: What I Really Need from mHealth: Five Perspectives on Value.

Pioneer has been involved with multiple aspects of mHealth since very early on and has seen interest grow into what sometimes seems to me to be an “irrational exuberance,” to borrow a phrase from Alan Greenspan. I’m concerned that we’re on the way to another bubble that’s in danger of bursting with unfortunate consequences. The fact is we often don’t know what “works,” and even what “working” means. And that’s why it’s so important that we discuss the different ways value needs to be demonstrated in mHealth.

This mHealth Summit panel will talk about value from the perspectives of the individual, the provider, the payer, the regulator and the researcher. These can be different, but from time to time they converge. Rather than having a number of separate presentations, experts will engage in discussion around a hypothetic but realistic scenario of a mobile health device and what’s needed to provide enough “value” for each to adopt, approve, purchase, share, fund and embrace this as a tool for better health. It is sure to be a lively and informative discussion.

I hope that you’ll be able to join us either in person in Washington, D.C. or electronically to help us shape the dialogue.

Follow the conference discussion through #mHS11, leave a comment below, or follow me on Twitter to join in the conversation.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Converging Ideas at the 2011 mHealth Summit

Nov 22, 2011, 9:55 AM, Posted by Al Shar

Sometimes things just come together. We funded the first mHealth Summit because it was interesting and pioneering, and it seemed to have a connection to a few of our Project HealthDesign grants. Then came our involvement with and support of Quantified Self, Open mHealth, the Stanford Mobile Health 2011 conference and the mHealth Evidence meeting. Other programs, like our national program Health Games Research, Games for Health Conference and the Reality Mining meeting that we funded at MIT in 2009, also have strong mHealth associations.

This is more than just coincidence--rather, mHealth focuses on many of the qualities that make Pioneer “pioneering.” mHealth has the potential to radically change the way health and health care is delivered, it is inherently oriented to the individual, and it is an area not yet burdened with the organizational and bureaucratic complexities of traditional health care. mHealth is a place where something radical can happen.

It is therefore particularly gratifying to see that Pioneer will be well-represented at the 2011 mHealth Summit on December 5-7 in Washington, D.C., with grantees featured in sessions on Open mHealth, The Evolution of Gaming and its Effect on Prevention and Wellness, and Wireless Patient Monitoring in Care Facilities: The Future of Wearable mHealth Applications, Devices, and Sensors, and with a  Pioneer-sponsored session, What I Really Need from mHealth: Five Perspectives on Value. This session builds on a discussion that began in August at a Pioneer co-sponsored workshop on mHealth Evidence.

I hope that you’ll be able to join us at the conference, tweet me at @alshar using #mHS11,  and help frame what I’m sure will be a very important discussion.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Time to Bring Designers to the Table: Thought's From Mayo's Transform Symposium

Sep 14, 2011, 2:52 AM, Posted by Al Shar

I'm just back from an exciting Mayo's Transform  Symposium. Before saying anything about the conference, I need to mention that being a pedestrian in Rochester, MN may present a significant health danger. I'll have to remember that cars don't stop on the East Coast just because someone is ready to cross a street.

We brought some guests to the meeting both to excite and engage them in helping move our support of Project ECHO forward. I'll let others write about that aspect of the meeting.

Regarding the meeting. I didn't realize that the theme was one about design innovation more than health or healthcare. At first this was off-putting: I wanted to learn about innovation that was going to help change health, not health packaging. I was wrong. I thought that figuring out how to solve a problem was the hard part. Implementing the solution would more or less follow. That's naive. Understanding the way people and the environment react to how solutions are packaged and presented is critical in their acceptance and ultimate success.

This is a good thing and bringing skilled designers to the table is important. We know that understanding where and how a person lives is important in determining what interventions will work but it's equally important to frame them in ways that are consonant with what they think and feel. Seeing the effect of a pediatric MRI designed to look like a pirate ship ride on a child's acceptance of the study or even just a simple reframing of an intervention in a context that resonates makes a world of difference.

It's sad that a collaboration between design and medical professional, with active consumer engagement, is not more common. Designing a solution to the wrong intervention and poorly implementing the right one are wasteful at best. But when things come together well, it can be a beautiful thing.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

What does mEvidence need to look like?

Aug 19, 2011, 4:40 AM, Posted by Al Shar

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There is something magical that happens when talking about mHealth. People start believing all of the wonderful things that a phone, together with the right gadget, can do: remind me to take my medicine, monitor my vitals, inform my doctor when something goes wrong, just plain automatically keep me healthy. The last few years have seen a huge growth in cell phone companies, technology companies, governments, application and device developers rushing to deliver product in this space. Just look at the over 500% increase in attendance between the 2009 and 2010 mHealth Summit (with the 2011 meeting promising to be even larger.) Along with the hype and the hope, people are beginning to ask for evidence and to question the value of growing a collection of isolated gadgets and apps.

I’d say that mHealth is somewhere around the asterisk on the “hype cycle” model developed by Gartner.

With that as context, RWJF’s Pioneer Portfolio, together with NIH, NSF, HHS and McKesson Foundation, organized a one day event to begin the process of advancing the Science of mHealth. What does mEvidence need to look like? What are the right methods to accelerate the evaluation of the efficacy of mHealth technologies?   First steps to address this have largely been focusing on attempts to demonstrate value by using a traditional randomized controlled trial, which is often ill suited to testing the interventions that mHealth enables. (It’s interesting to note that on August 14, Paul Meier died. I’d be interested in knowing what he’d be thinking.) When we first started to plan this meeting, I wondered how interested the field would be. After all, this is the drier, academic side of mobile health. I was surprised! We had 106 responses to our call for whitepapers of which we were able to choose 23. The demand for attendance was such that NIH had to arrange for a webcast.  Perhaps looking at transforming the way conduct research [in light of new technologies] is not so dry after all. While the attendees were predominantly US-based, academic, international and corporate interests were represented. The outcome was even more surprising. The group agreed that this was a good and important direction, that we needed to have a collaborative, ongoing and forward looking agenda and that the Science of mHealth was critical to achieving a high enough plateau of productivity. The group will soon issue a statement of direction and commitment, publish the key outcomes of the meeting and develop a longer-term agenda. We are also developing an online community so that we can keep the discussion going. In a couple of weeks the webinar will be available for people who missed it and we will work to keep the groundswell moving.

I’d be remiss not to include the fact that closely aligned is the ideas and ideals of Open mHealth and the work of Pioneer grantees Ida Sim and Deborah Estrin. Not only were they and a number of people in the open mHealth area participants, they organized a second day to help formulate how they were going to develop and move forward.

This is important and people are paying attention. One way that you can help is to respond to the request from the NIH Director’s Common Fund, which is designed to fund transformative research that is of interest to the health community. The Common Fund officials are looking for the community (that is you!) to weigh in on new ideas for funding. Go here to add your comments.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Drug Facts Boxes Featured in New York Times

Jul 15, 2011, 3:19 AM, Posted by Al Shar

Last week, the New York Times published an op-ed by the Dartmouth Institute’s Steven Woloshin and Lisa M. Schwartz that discussed the critical need for a redesign of something that can empower consumers to make informed decisions about their health care – the information that accompanies prescription drugs. As stated in their own words: “Bombarded with pharmaceutical ads listing what seems like every conceivable side effect, American consumers might think they are already getting too much information. But they — and their doctors — are not getting what arguably matters most: independent, plain-English facts about the medication.”

Prescription medication labels are hard to read, confusing and often leave out crucial information contained in Food and Drug Administration (FDA) review documents. Major side effects or potentially dangerous drug interactions can be hidden to patients on their medication packaging. By giving drug packages a simple makeover and creating a standardized, easy-to-read drug fact box—akin to what’s currently required for nutrition labels—information that is critical to enabling an individual to make the best health care decisions possible will be readily available to all.

Woloshin and Schwartz are leading the charge on the effort to develop these “Prescription Drug Facts Boxes.” Recognizing the opportunity for a simple design change to create better access to information and have a big impact on how people engage with their health care, we have been supporting their efforts since 2008. You can read more about that support here. This idea was simple and powerful enough to be included in the health care reform law.

Policymakers say that an additional three years of study are needed before beginning to implement the facts box. To me, it’s unclear what more they will learn in those three years. I don’t think it’s the lack of an evidence base. Woloshin and Schwartz have done a number of good studies about the efficacy and adding to them should not take three years. I don’t think it’s figuring out how to operationalize the production, a hand book is easily developable. I do think it’s a combination of two important factors: an underrepresented constituency and an overly strong concern for the potential adverse impact of any change.

The underrepresented constituency is the consumer. We are already given information about the intent of the drug and the dangers. The perception is then that the only thing the drug box adds is the ability to make a more informed choice. And that’s not seen as very important. Given that, it’s easy to see why the potential downside of the change needs so much study. If you don’t weight the value very highly, you need to be very sure that there are no “adverse events”.

That’s wrong. We’re being told (and in some cases, compelled) to take more individual responsibility for our health. Being denied access to clear and actionable information is wrong.



This commentary originally appeared on the RWJF Pioneering Ideas blog.