A Health, Social Media and Technology blog by Mark Scrimshire (@ekivemark), Chief Instigator of HealthCa.mp - Empowering Health Care Engagement.
Saturday, October 31, 2009
Wednesday, October 28, 2009
Left alone in a room with temptation. More than a #microchoice
Here I am left all alone in the facilities office at CareFirst as I get things together for a SharePoint DesignCamp. Oh the temptation!! But I am making a healthy #microchoice! No, with this many doughnuts to choose from this is a health #macrochoice!
Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone
Saturday, October 24, 2009
#hcmn - The moving story of Zach
real time commentary from HealthCampMinnesota #hcmn
Rachele - loves telling the inspiring story of Zach. @AlbertMaruggi tracked Rachele down on Facebook.
Zach has a rare degenerative disease. He was perfect when born - life was good. At 18 months things starting going backwards.
The first concern of the pediatrician was Multiple Distrophy. He continued to regress.
The second neurologist took a look at the notes and sent them away for 6 months.
The pediatrician sent him back to the first neurologist. Agreed something was wrong. Still no solution.
New doctors but no diagnosis. a mis-diagnosis of cancer. 6 months of scans and no tumor was found.
Rachele started doing internet searches. Found a doctor in Illinois thought they found a diagnosis. but it turned out not to be.
Third misdiagnosis - myocondrial disease. A bad test led the doctors to advice he had a terminal disease.
After 5 years. INAD - for Zach it was ANAD.
the 6th MRI they found something. PCAN - 99% sure. But internet searches led Rachele to doubt the diagnosis.
Following the symptoms and pointed to INAD. Spoke to the Physician who had never heard of INAD. The Gene that identified this disease was found. This confirmed: Infantile Neuro Dystrophy. Only about 100 people in the world. Most kids don't live to 10. Only about 6 pkids in USA with the disease. His diagnosis is Atypical hence ANAD.
Navigating the Journey - Advice :
Pick your Quarterback.
Helpful things:
- Laughter
- Don't sweat the small stuff
- Friends
- Faith
- Accepting help.
"It is never the trail it is what you choose to do with it that matters"
There is a lot of dubious information on the Internet.
Trust yourself and be persistent but don't get obsessed.
Use the Internet
Spread the story. Pass the smile on!
When you have a disease you have to realize you become the expert - above and beyond your physician. Patients and Doctors have to recognize this issue.
The Internet has been a huge resource for Research. Caringbridge has been a great support.
Rachele got annoyed with the "brush of" she received from doctors.
Coping with disease is a process.
How about dealing with the insurance companies. Actually didn't have many problems. Now in a disabled program. $6k/ month for a special IV but so far the IV is being paid for.
1 in 200k chance of
parents both having the same recessive gene.
#hcmn the story of Zach West who lives with ANAD
#hcmn Rachele West telling Zach's story and how they got to the diagnosis of ANAD
Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone
#hcmn - American Idol Doctors
Real time commentary from #hcmn HealthCampMinnesota
Panel moderated by Chris Bevolo, President of Interval (@IntervalChris)
BlueCross BluesShield Minnesota
TheHealthCareScoop.com leting consumers tell health related stories. Feedback and discussion
Tammy Young: (@ymmat)
Very focused on the customer narrative. The stories matter - it is trying to capture the personal word of mouth.
HealthScoop has a 4 to 1 positive reporting. The positive is more passionate.
Chris Boyer @chrisboyer - Social Media Strategist From HealthGrades.com
Rating Doctors and Hospitals.
The internet is becoming a bigger influence than friends and family.
Tammy: Narrative is more powerful than a simple rating. People can gain a sense from the language used.
The Site is community moderated.
@chrisboyer Why do we know more about sport scores than we do about our health scores.
HealthScoop: Providers can participate on the site. Slow uptake.
HealthGrades every hospital with medicare data. Some build a relationship, some don't.
Data is sourced from Medicare. Doctor ratings will come from same source. Only 17 states report all payer data in a consistent manner.
When Hospitals pay for HealthGrade license to use the Grading. They also pay to get help in promoting and using gradings.
Health Grades has an annual summit to evaluate the interpretation of the data they are using.
Language differences:
Hispanic audiences use Family and Friends more. They also use internet less but mobile devices more.
What is missing?
The Audience: Quantitive data.
Chris Boyer: State of NY reports quality. Quality improved after reporting started.
Minnesota has Quality Reporting:
HealthGrades - their home page is no longer their home page. They realized people are going to Google to search and getting to HealthGrades specific pages from Google.
HealthGrades: Social Media is here to stay and is real conversations and not just "chatter"
CMS provides the information but people go to HealthGrades because it is more accessible.
How do physicians get in to the conversation: HealthCareScoop: enhancements
#hcmn American idol - has it come to this?
Big crowd at #hcmn
Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone
#hcmn can device manufacturers benefit from Social Media
Real Time commentary from HealthCampMinnesota #hcmn Patrick Kullmann (@growthcreator) moderating a panel on medical devices and social media. Panelists: - John Reid - Abbeymoor Medical (@theSpannerStent)
- Mary Halet - Regional Director National Marrow Donor Program (Registry of unrelated donors) AbbeyMoor small company. Created a temporizing stent for men with Prostate issues National Marrow Donor have 8m people on file with access to 5M others worldwide. John Reid was very new to Social Media until the daughter of an investor suggested using YouTube and humor to raise awareness.
After stuggles with issues of professionalism. Within 24 hours of the first youtube video they went from 80 visits per day to http://www.thespanner.com to over 2100 unique visitors today. The 18-21 year olds created a second wave of interest. The pass through to their elder friends and relatives creates awareness. What the experience did is that if this connects people and raises awareness but the community will come up with answers. Encourage this community to share how they made decisions. Fear of being a laughing stock. Actual impact has been amazing. It is now recognized by peers as a bold step. NMDP - 2 full time staff on facebook and twitter. Uses Social Media to build roster of donors. Facebook fan page. Have to be deliberate in creating concise and consistent messages. Staying out of conversation risks the message getting muddled and obscured. Highly motivated and energized participants because Diseases are life threatening. Advances in treatment are being vetted in the court of public opinion. Taken deliberate space to provide transplant education. Provide credible resources for families. Paul K: many Pharma and Medical companies are not listening to social media about what is being said about their own companies. John R: Physicians are slow to adopt new technology. Don't have resources for outbound marketing. Using innovative ways in Social Media to get physicians and patients to call them.
- Mary Halet - Regional Director National Marrow Donor Program (Registry of unrelated donors) AbbeyMoor small company. Created a temporizing stent for men with Prostate issues National Marrow Donor have 8m people on file with access to 5M others worldwide. John Reid was very new to Social Media until the daughter of an investor suggested using YouTube and humor to raise awareness.
After stuggles with issues of professionalism. Within 24 hours of the first youtube video they went from 80 visits per day to http://www.thespanner.com to over 2100 unique visitors today. The 18-21 year olds created a second wave of interest. The pass through to their elder friends and relatives creates awareness. What the experience did is that if this connects people and raises awareness but the community will come up with answers. Encourage this community to share how they made decisions. Fear of being a laughing stock. Actual impact has been amazing. It is now recognized by peers as a bold step. NMDP - 2 full time staff on facebook and twitter. Uses Social Media to build roster of donors. Facebook fan page. Have to be deliberate in creating concise and consistent messages. Staying out of conversation risks the message getting muddled and obscured. Highly motivated and energized participants because Diseases are life threatening. Advances in treatment are being vetted in the court of public opinion. Taken deliberate space to provide transplant education. Provide credible resources for families. Paul K: many Pharma and Medical companies are not listening to social media about what is being said about their own companies. John R: Physicians are slow to adopt new technology. Don't have resources for outbound marketing. Using innovative ways in Social Media to get physicians and patients to call them.
#hcmn - Its Your Health Deal with it
Real time from #HealthCampMinnesota Collen McGuire - IHC Health Solutions (@CollenMick)
David Moen, MD Fairview (2nd largest health system in Minnesota) @Albertmaruggi - How has Social Media impacted health care: David M: Talented clinicians are less nervous than others around them. Most view the current communicaiton model as very challenging. Social Media has great potential to build on the 15 minute interaction with the doctor Collen McG: NAIC controls what they can and do say. High Deductible plans push more financial responsibility on to members. People in that situation are more engaged. 2008 - 150M people did health related searches on the Internet. Plans putting lots of wellness information and then listening. Let members come to them. Patient Physician Collaboration - is there too much information? Clinicians make sense of information for the patient. The Internet is great for empowered people but the challenge is getting people on the road to empowerment. How can clinicians participate in disease communities when payment models don't support the effort. Fairview recently started an Autism group and Parents are most interested in finding what causes this condition.
David Moen, MD Fairview (2nd largest health system in Minnesota) @Albertmaruggi - How has Social Media impacted health care: David M: Talented clinicians are less nervous than others around them. Most view the current communicaiton model as very challenging. Social Media has great potential to build on the 15 minute interaction with the doctor Collen McG: NAIC controls what they can and do say. High Deductible plans push more financial responsibility on to members. People in that situation are more engaged. 2008 - 150M people did health related searches on the Internet. Plans putting lots of wellness information and then listening. Let members come to them. Patient Physician Collaboration - is there too much information? Clinicians make sense of information for the patient. The Internet is great for empowered people but the challenge is getting people on the road to empowerment. How can clinicians participate in disease communities when payment models don't support the effort. Fairview recently started an Autism group and Parents are most interested in finding what causes this condition.
#hcmn @LeeAase 5 theses in Social Media
Real time commentary from HealthCamp Minnesota What's unique about Healthcare and Social Media. We need HealthCare Reformation. 5 Theses: 1. Social Media are the defining trend in communications in the 21st Century
2. Social Media will dramatically affect every industry
3. Hand-wringing about merits and dangers of social media is unproductive.
4. Healthcare organizations should thoughtfully engage with Social Media
5. Social Media tools offer unprecedented opportunity for transformational change "You're Unique... just like everyone else" Healthcare is less unique than you think Social Media has been critical to Mayo Clinic SINCE its founding. The first social media was Air waves. People talked. dizzy dean: It ain't bragging if you can back it up. It ain't bragging if other people say it. For Mayo Clinic word of mouth is primary source of recommendation: Social Media amplifies word of mouth. When Mayo added radio Mp3 to iTunes Podcast their downloads went from 900 to 74,000 in ONE Month! Total cost of Facebook, YouTube and Twitter use is $0.00 A key tool has been the Flip Video camera:
- Affordable
- Recording interviews improves existing processes
- Authenticity without writers cramp
- Provide potential blog resources (audio of full interviews PLUS Video excerpts)
- Setup a limited group of editors to ease adoption and ensure quality. The Trinity of Gatekeepers:
- PR
- Legal
- IT @danielg280 is mayo legal. Realizes that Social Media is not going away. When Lee joined facebook in 2006 there were already 900 mayo email addresses on facebook. The genie was already out of the bottle. For IT - No additional servers. Mayo uses WordPress for blogs. This costs $75 per year. Mayo has a HealthLine radio broadcast. They have a DIY syndication plan that costs nothing (v. 20k/month from a formal PR operation)
Questions now come from 4 continents and syndication has grown to 10 stations. A video of an octogenarian couple on YouTube (they were playing piano in the Mayo Clinic lobby) grew to nearly 5m views and went to national media and TV. Downsides:
Simplicity and low cost means anyone can publish or broadcast
- Filter then publish - replaced by publish then filter. How to handle complaints:
- comment on notes left on facebook, twitter and blogs.
- Take the discussion off line People are more likely to share positives than negatives. Especially on facebook where people have to use their real names. Push the envelope:
1. On-line chats about research findings
2. Disease oriented bloggers getting journalistic access
Innovate:
"Your kids aren't smart they are just not afraid to look dumb" Lee's deck in on the SMUG site.
2. Social Media will dramatically affect every industry
3. Hand-wringing about merits and dangers of social media is unproductive.
4. Healthcare organizations should thoughtfully engage with Social Media
5. Social Media tools offer unprecedented opportunity for transformational change "You're Unique... just like everyone else" Healthcare is less unique than you think Social Media has been critical to Mayo Clinic SINCE its founding. The first social media was Air waves. People talked. dizzy dean: It ain't bragging if you can back it up. It ain't bragging if other people say it. For Mayo Clinic word of mouth is primary source of recommendation: Social Media amplifies word of mouth. When Mayo added radio Mp3 to iTunes Podcast their downloads went from 900 to 74,000 in ONE Month! Total cost of Facebook, YouTube and Twitter use is $0.00 A key tool has been the Flip Video camera:
- Affordable
- Recording interviews improves existing processes
- Authenticity without writers cramp
- Provide potential blog resources (audio of full interviews PLUS Video excerpts)
- Setup a limited group of editors to ease adoption and ensure quality. The Trinity of Gatekeepers:
- PR
- Legal
- IT @danielg280 is mayo legal. Realizes that Social Media is not going away. When Lee joined facebook in 2006 there were already 900 mayo email addresses on facebook. The genie was already out of the bottle. For IT - No additional servers. Mayo uses WordPress for blogs. This costs $75 per year. Mayo has a HealthLine radio broadcast. They have a DIY syndication plan that costs nothing (v. 20k/month from a formal PR operation)
Questions now come from 4 continents and syndication has grown to 10 stations. A video of an octogenarian couple on YouTube (they were playing piano in the Mayo Clinic lobby) grew to nearly 5m views and went to national media and TV. Downsides:
Simplicity and low cost means anyone can publish or broadcast
- Filter then publish - replaced by publish then filter. How to handle complaints:
- comment on notes left on facebook, twitter and blogs.
- Take the discussion off line People are more likely to share positives than negatives. Especially on facebook where people have to use their real names. Push the envelope:
1. On-line chats about research findings
2. Disease oriented bloggers getting journalistic access
Innovate:
"Your kids aren't smart they are just not afraid to look dumb" Lee's deck in on the SMUG site.
#HCMN HealthCamp Minnesota Kicks in to Gear
Bright and early on Saturday October 24th HealthCampMinnesota kicks off. A massive Thank You has to go to Albert Maruggi (@albertmaruggi) for organizing the event. This will be a slightly different HealthCamp Event. It will follow a similar model that was used at HealthCampNash earlier this year.
Albert has arranged a fascinating set of speakers to lead a series of panels. The objective is to stimulate discussion around HealthCare Delivery, Payments and Medical Devices. So much is up in the air as Washington debates Health Care Reform that these three themes will no doubt intersect during the camp.
One of the leading lights in Health Care Social Media - Lee Aase (@leeAase) is kicking off HealthCampMN. I am thrilled to finally meet Lee. You can follow the Twitter feed for the event using CoverItLive - embedded below - or catch the #hcmn search stream.
If you are planning to be at HealthCampMn you can contribute to the day by registering on the Wiki and updating it with your ideas and contributions. Post links to your blogs, photos and video streams. The Wiki can be reached via a bit.ly short url: http://bit.ly/hcmn_w.
Now, just because there are a series of panels arranged for this HealthCamp don't think you can just sit back passively. We want you to join in. Test the panel, ask the tough questions. Ask a question even if it seems like a dumb one. We all have different perspectives and the value of HealthCamp is in bringing those perspectives and experiences together, sharing and learning together. HealthCampMn is very much "on the record" - Take photos, capture video, blog and tweet about it. Use the #hcmn hashtag when you post content to Flickr, YouTube and elsewhere.
If there are issues that you haven't seen addressed then stay after lunch and we can create discussion groups on the fly - in true HealthCamp style.
HealthCamp is your day. Dive in. Get engaged. You are a participant and not just an attendee. Most of all - have fun. We want you to come away energized.
If you can't be there then check out the Intro to HealthCampMn on YouTube.
Finally don't forget. If you want to run a HealthCamp there are resources available at http://healthca.mp to help you do that. Or drop a comment here. I am always happy to instigate a new Healthcamp that will spread the word about Participatory Medicine.
Labels:
Barcamp,
collaboration,
CoverItLive,
Healthcamp,
Social Network,
twitter,
video,
wiki,
youtube
Friday, October 23, 2009
#ITOH what am I taking away from the conference
Thoughts as I head to #hcmn HealthCampMinnesota that takes place tomorrow (10/24). Like a lone bird....
B: http://ekive.blogspot.com
....Sent from my iPhone
There were a lot of great people at the conference. Many intense conversations but at the end of the day the industry seems very inwardly focused. The patient consumer got a few passing thoughts.
A lot of discussion about EHR/EMRs but I am concerned that the industry will be caught offguard by the emergence of the untethered PHR. We are already seeing powerful inter connected solutions with vizualization tools for the PHR. Just look at what Polka is doing in mobile and Keas is doing with care plans. The EMR is a complex beast but at the end of the day the core data a doctor depends upon is a very limited subset. This could well end up sitting in a PHR with the patient becoming the defacto health information exchange vehicle. Driven by consumers these will be intuitive applications unlike the EMR that has roots in complex enterprise applications that require substantial training and support investments. When was the last time you read the user manual for Google or eBay or Amazon? My discussions also seemed to support the idea that i have been pondeting recently. The idea that we need a reputation quality metric in healthcare. Something that works for patient and provider. This is really just the formalization of the mental assessments that providers have done informally for many years. The quality/reputation metrics goes to the question. "Do I trust what I am being shown?" Mark ScrimshireB: http://ekive.blogspot.com
....Sent from my iPhone
#ITOH Virtualization
Real time notes from IT Optimization in Health Care. Redhat and Nationwide Children's Hospital and Princeton Health System Virtualization - Running multiple operating systems on a single piece of hardware. Server Virtualization and Desktop Virtualization Thee options
1. How to get ready
2. Experiences
3. Desktop - VDI - Virtual Desktop Infrastructure Virginia Commonwealth - Wintel 700 server virtualization also storage virtualization VMWare is the largest usage. Desktop Virtualization is the main interest. Some pilots. Why Virtualize the Desktop:
- Lock down
- Security
- Move data back to data center
- Cost of ownership 15-20% of helpdesk calls to replace icons. Use virtual desktop for app testing. VDI may help to skip a refresh cycle. Use XP box as repurposed thin client. Evaluating VDI Technology:
- Density of sessions on Server side without compromising performance.
- RedHat 65 guests on a 16GB Blade. Use in memory page sharing.
- Storage - thin provisioning. One main image and multiple provisioning files with minor changes per desktop.
- Transparently supporting applications. ISV's are not supporting Virtualized apps. (Red Hat has 1000 ISVs that support virtualization. Red Hat/Microsoft also support each others OS on their hypervisors. ISVs - Reproduce problem on bare metal and then they talk. End users want to see it as a transparent experience - to current experience. - Stable profiles,
- Streaming video
- Multi-monitor support.
- USB support (with security) without choking bandwidth
- USB Policy Manager
- High End graphics support (OpenGL etc.)
- Portable profiles. VCUMC is piloting a symantec solution for portable profiles. Desktop pooling. eg. Call Center. Locked down applications. pool of desktop images. Wipe out on completion and re-commission a new image to the pool. Pooling keeps the image set space utilization from growing. RedHat Licensing based on number of desktops running concurrently. Latency is more critical than bandwidth in delivering good performance.
1. How to get ready
2. Experiences
3. Desktop - VDI - Virtual Desktop Infrastructure Virginia Commonwealth - Wintel 700 server virtualization also storage virtualization VMWare is the largest usage. Desktop Virtualization is the main interest. Some pilots. Why Virtualize the Desktop:
- Lock down
- Security
- Move data back to data center
- Cost of ownership 15-20% of helpdesk calls to replace icons. Use virtual desktop for app testing. VDI may help to skip a refresh cycle. Use XP box as repurposed thin client. Evaluating VDI Technology:
- Density of sessions on Server side without compromising performance.
- RedHat 65 guests on a 16GB Blade. Use in memory page sharing.
- Storage - thin provisioning. One main image and multiple provisioning files with minor changes per desktop.
- Transparently supporting applications. ISV's are not supporting Virtualized apps. (Red Hat has 1000 ISVs that support virtualization. Red Hat/Microsoft also support each others OS on their hypervisors. ISVs - Reproduce problem on bare metal and then they talk. End users want to see it as a transparent experience - to current experience. - Stable profiles,
- Streaming video
- Multi-monitor support.
- USB support (with security) without choking bandwidth
- USB Policy Manager
- High End graphics support (OpenGL etc.)
- Portable profiles. VCUMC is piloting a symantec solution for portable profiles. Desktop pooling. eg. Call Center. Locked down applications. pool of desktop images. Wipe out on completion and re-commission a new image to the pool. Pooling keeps the image set space utilization from growing. RedHat Licensing based on number of desktops running concurrently. Latency is more critical than bandwidth in delivering good performance.
#ITOH Telemedicine
Realtime commentary from IT Optimization in Health Care
In Texas there are a number of Telemedicine programs. AT&T experience is that EMT (Paramedics) are a good person to place at the Patient end in a Video/TeleConsult. If a patient gets in to distress the EMT is experienced and ready to help the patient. Molina HealthCare is looking at mobile vans to deliver TeleHealth. Alaska has Telemedicine to deal with remote villages. They allow asynchronous consult. The two cases: Satellite comms in one box. Store and forward and exam equipment to do the consult. Data is collected on a laptop and brought back for teleconsult management.. Telehealth needs to be standards based. eg. Bluetooth. AT&T think Continua will drive standards for devices. Building on Bluetooth. Avaya: You can't rely on end user to make integration happen. It has to be bullet proof. Alcatel-Lucent: We need to make sure there is broadband coverage for everyone. It raises the lowest common denominator bandwidth. However we are under-estimating what can be done with SMS Texting. Africa is running rings around the USA in its use of text to engage the public and support health programs. USAC.gov to find pilot programs for advanced networks. eg. Internet2 and Lambda Rail. AT&T has resisted being a Business Associate status. This seems to be under review. AT&T's view on HIPAA is that they do not do HIPAA consulting but they do Security and Privacy consulting that enables their clients to achieve HIPAA compliance. Technical standards are only one element of HIPAA.
In Texas there are a number of Telemedicine programs. AT&T experience is that EMT (Paramedics) are a good person to place at the Patient end in a Video/TeleConsult. If a patient gets in to distress the EMT is experienced and ready to help the patient. Molina HealthCare is looking at mobile vans to deliver TeleHealth. Alaska has Telemedicine to deal with remote villages. They allow asynchronous consult. The two cases: Satellite comms in one box. Store and forward and exam equipment to do the consult. Data is collected on a laptop and brought back for teleconsult management.. Telehealth needs to be standards based. eg. Bluetooth. AT&T think Continua will drive standards for devices. Building on Bluetooth. Avaya: You can't rely on end user to make integration happen. It has to be bullet proof. Alcatel-Lucent: We need to make sure there is broadband coverage for everyone. It raises the lowest common denominator bandwidth. However we are under-estimating what can be done with SMS Texting. Africa is running rings around the USA in its use of text to engage the public and support health programs. USAC.gov to find pilot programs for advanced networks. eg. Internet2 and Lambda Rail. AT&T has resisted being a Business Associate status. This seems to be under review. AT&T's view on HIPAA is that they do not do HIPAA consulting but they do Security and Privacy consulting that enables their clients to achieve HIPAA compliance. Technical standards are only one element of HIPAA.
#ITOH EMRs and the future of HealthCare
real time notes from the sessions at IT Optimization in HealthCare. #ITOH Presentation by Dr. Lyle Berkowitz - director Szollosi HealthCare Innovation Program (http://www.theSHIPHome.org) Lyle also blogs at http://www.DrLyle.blogspot.com Will we get to a new architecture that enables innovation. This session will look at some of the crazy ideas for innovation. Peter Szollosi "Dont tell me what you can't do" Easy to say no but more interesting to try something. Innovation as a science. Peter Drucker says it is a systemic process. Time for a Paradigm shift with EMRs. We have had slow evolution and have replicated the paper record. The result is poor. Focus on what we need and not worry about the legacy EMR. Use IT. Examples: ExpectED - A web-based app that allows physicians to electronically notify the ER of an incoming patient. Inflection Navigator - A web-based tool to guide navigators in leading a patient through a health care inflection point. eg. When someone discovers they have cancer. First Principles of the new EMR: - Flexible
- Intuitive
- Reliable
- Speedy
- Topical
Stop thinking about discrete tasks and consider the context of the task. Provide the supporting information that provides the context. The ideal future of the EMR will redistribute the time spent dealing with a patient. Payment and Delivery innovation in recent Stimulus legislation will trigger innovation. Pilots will report back to Congress in 2012. We have to challenge EMR vendors to support real openness. New Care Models such as Medical Homes are emerging. Also online care is coming in to the picture. Questions:
- 400 Vendors in the Ambulatory EMR market. Innovators should focus on the User Interface - not the plumbing and data models. We need openness to allow innovators to tap in to established EMR platforms. Docs that have never lived with an EMR will probably choose something simple that looks like the traditional paper record.
- Intuitive
- Reliable
- Speedy
- Topical
Stop thinking about discrete tasks and consider the context of the task. Provide the supporting information that provides the context. The ideal future of the EMR will redistribute the time spent dealing with a patient. Payment and Delivery innovation in recent Stimulus legislation will trigger innovation. Pilots will report back to Congress in 2012. We have to challenge EMR vendors to support real openness. New Care Models such as Medical Homes are emerging. Also online care is coming in to the picture. Questions:
- 400 Vendors in the Ambulatory EMR market. Innovators should focus on the User Interface - not the plumbing and data models. We need openness to allow innovators to tap in to established EMR platforms. Docs that have never lived with an EMR will probably choose something simple that looks like the traditional paper record.
#itoh Lyle Berkowitz presenting to the conference
Innovation in EMR
Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone
Thursday, October 22, 2009
#ITOH the Hitech effect
Real time notes from the itoh confernce Anthony Guerra healthcare informatics Hospitals are watching waiting and listening. Back on plan and moving forward. No stimulus effect. Vendors seen a stall in market as people understand impact. Some hold up because reporting requirements are unclear. The first wave:
Consulting is busy. "like y2k" Regional Extension Centers don't depend on them. Confusion reigns. "HIT consulting Medicaid"
Being established by Dec2010 but incentives are to be paid in Oct2010 The second wave:
The vendors
Most clients will stick
New version is a big change is as big as switching vendors Getting up and running:
Develop order sets
Implement it and interfaces
Workflow redesign
Training and support
Holy Grail of CPOE slow them down, reduce productivity Some orgs are using scribes to input. Be sensitive to the book of business when implementing Just need to get 10% adoption Moving beyond transactions Improving population health
Will require intricate quality reporting. Dara management issue. Go as granular as you can stand for data input but it makes adoption harder REC will yield little
Implementation failures will start late 2010. Timeline rather than provide issue. Rise of hospitalist and cmo
Hospitals will acquire more practices
Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone
Consulting is busy. "like y2k" Regional Extension Centers don't depend on them. Confusion reigns. "HIT consulting Medicaid"
Being established by Dec2010 but incentives are to be paid in Oct2010 The second wave:
The vendors
Most clients will stick
New version is a big change is as big as switching vendors Getting up and running:
Develop order sets
Implement it and interfaces
Workflow redesign
Training and support
Holy Grail of CPOE slow them down, reduce productivity Some orgs are using scribes to input. Be sensitive to the book of business when implementing Just need to get 10% adoption Moving beyond transactions Improving population health
Will require intricate quality reporting. Dara management issue. Go as granular as you can stand for data input but it makes adoption harder REC will yield little
Implementation failures will start late 2010. Timeline rather than provide issue. Rise of hospitalist and cmo
Hospitals will acquire more practices
Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone
#ITOH The Path Forward for HIEs?
#ITOH Real time notes from IT Optimization in HealthCare
Panel Discussion
David Miller - University of Chicago Medical Center
Bill Fera - University of Pittsburgh Medical Center
Chris Stevens - CTO of Orion Health
It is challenging to integrate within a Hospital system let alone across a wider exchange.
UPMC: Looking at Personal Health Records as the de Facto exchange mechanism. ie. Using the Patient as the connector. Partnering with Google because needed an un-tethered PHR.
Orion Health looking at Integration and provide a HIE solution. State of Maine launched in June 2009. Lahey Clinic local HIE - reach out to referring physicians.
The challenge for HIEs is to engage with Legacy EMRs.
Privacy is an issue everywhere. Get consumers involved. Figuring out business rules is very complex.
What is Interoperability?
Interoperability is a means to an end. CCR is a potential vehicle for inter-operability.
Orion has found that only a small amount of information is needed to create value. Everything is not necessarily the right answer.
I think this means that we need to look at incremental evolution of records. We don't need to define everything before we get started.
Successful HIEs
Need an anchor organization to do some heavy lifting.
Documentation, Visits and Labs are the key pieces of data to start with.
There is value in EMR + Claims + Patient data. But need to know source so reviewer can evaluate value of content.
Standards need to move from point to point interface to transaction orientation.
Also need to keep it simple. eg. Do we need al the complexities of SOAP for transactions.
An Anchor institution only makes sense if the Anchor has EMR data to share. No data - no value.
#ITOH EHR's what has worked.
#ITOH live panel discussion from IT Optimization in HealthCare captured in real time. Mark Anderson, The AC Group What is going on with EMRs in the real world. Hybrid EMR (Paper + electronic) as a transition Big Clinic Representative - Evolved a Patient Centered Record. Separate data in an Enterprise + Patient View. Patient view is observations that are relevant to the Patient.
Other data e.g. about equipment used to draw blood, or take image etc. is the Enterprise data.
Meaningful Use: From the perspective of the patient Mark Anderson, AC Group:
- 73% of Docs are still not using EMRs when seeing a patient 1 year after installation
- 83% of Docs are not associated with a hospital - they are independent. In-Patient and Ambulatory EMRs are different and have different perspectives. Hospital Incentive from Stimulus $2M + $225 per discharge up to 23,000 discharges. We have to get out of in-patient to really treat health and wellness. Everything in the Ambulatory setting is pertinent to the Electronic HEALTH Record. Only a fraction of In-Patient EMR is pertinent to Patient's EHR. CCHIT only certifies on functionality and NOT usability. One of the biggest issues is USABILITY. CCHIT will be starting to look at usability. ie. How long it takes to perform a function. Mark A: 73 systems were certified by CHIT in 2008 but they have vastly different usability AND functionality. Meaningful Use: Intent is to encourage use of EMRs with a certified product but Meaningful use can be accomplished using alternative products to create reporting and metrics. Mark A: Sales have dropped off 42% due to uncertainty of Meaningful use definition. Which is not finalized until April 2010. 83% of sales are going to certified vendors. Organizational alignment and transformation is beyond the scope of the EMR Vendor but is the really driver in achieving meaningful use within an organization. People may be placing too much dependence upon use of certified products. One of the challenges with going live is getting existing data loaded so that value can be gained from using an EMR. Systems slow Doctors down because with no data in the EMR it is the equivalent of seeing a new patient every time. One way to improve use is to look at the patients at the top of the wellness pyramid (the sickest) and load their data because they will be the ones coming in most frequently. Vendors are looking at transcription tools to populate the EMR. ie. natural language processing.
(tags: EHR, ITOH)
Other data e.g. about equipment used to draw blood, or take image etc. is the Enterprise data.
Meaningful Use: From the perspective of the patient Mark Anderson, AC Group:
- 73% of Docs are still not using EMRs when seeing a patient 1 year after installation
- 83% of Docs are not associated with a hospital - they are independent. In-Patient and Ambulatory EMRs are different and have different perspectives. Hospital Incentive from Stimulus $2M + $225 per discharge up to 23,000 discharges. We have to get out of in-patient to really treat health and wellness. Everything in the Ambulatory setting is pertinent to the Electronic HEALTH Record. Only a fraction of In-Patient EMR is pertinent to Patient's EHR. CCHIT only certifies on functionality and NOT usability. One of the biggest issues is USABILITY. CCHIT will be starting to look at usability. ie. How long it takes to perform a function. Mark A: 73 systems were certified by CHIT in 2008 but they have vastly different usability AND functionality. Meaningful Use: Intent is to encourage use of EMRs with a certified product but Meaningful use can be accomplished using alternative products to create reporting and metrics. Mark A: Sales have dropped off 42% due to uncertainty of Meaningful use definition. Which is not finalized until April 2010. 83% of sales are going to certified vendors. Organizational alignment and transformation is beyond the scope of the EMR Vendor but is the really driver in achieving meaningful use within an organization. People may be placing too much dependence upon use of certified products. One of the challenges with going live is getting existing data loaded so that value can be gained from using an EMR. Systems slow Doctors down because with no data in the EMR it is the equivalent of seeing a new patient every time. One way to improve use is to look at the patients at the top of the wellness pyramid (the sickest) and load their data because they will be the ones coming in most frequently. Vendors are looking at transcription tools to populate the EMR. ie. natural language processing.
(tags: EHR, ITOH)
#ITOH IT Optimization in HealthCare - Lyle Berkowitz Keynote
These are realtime notes from the IT Optimization in HealthCare conference. Please excuse typos and sometimes cryptic comments.
Dr. Lyle Berkowitz - Professor of Medicine, Feinberg School of Medicine
EMRs and Innovation
"There is no Meaningful Use without Use"
What is an EMR/EHR - it is:
A database that provides:
- Review
- Messaging
- Orders (eRx)
- Notes
That taken together provides Decision Support capabilities.
How are we doing?
"Not well"
Been around since the 1960's. We are still "Five Years away"
Barriers to adoption:
- Incentives (Focus on Efficiency and Volume) EMRs don't support that.
$44k per Doctor is not a big incentive.
- Usability
Not very usable
Paradigm problem - Built to look like Paper charts.
Focused on compliance not care.
Too much clinician data entry
Transaction system rather than thinking system
Problems with data sharing and integration
-Staffing
Demanding too much data entry of the most expensive resources in the system
Do you really need an EMR?
- ePrescribing alone - is that meaningful use.
Reporting on measures?
Most EMRs are poor at reporting
Information Exchange
- Uncertain on scope of information exchange . To a local hospital, to regional or national exchange?
Data rich EDWs can provide reporting?
What type of adoption rates?
To get good adoption:
- Aligned incentives
- address staffing
What we need in an EMR?
Traditional:
Metaphor: Paper
- Word/Excel
- Info overload
- Static views
Task oriented:
-
Future EMR:
Metaphor: iPhone, Web
- Graphical
- Information Vizualization
- Interactive/Actionable views
Workflow Oriented
- Context is critical
- One click
- Documentation as byproduct
User Control:
- API
- Widgets
Bill Stead - Get vendors to separate data from application
Questions:
In patient doc: Sharing data - if I import it how do I trust it like "My Data".
The question of trust in data keeps coming up. This ties in with my thinking on Portable Reputation.
Vendors are paying lip service to standards. They say the support standards such as HL-7 but data doesn't flow between systems easily.
(tags: HealthCare, PHR)
Monday, October 19, 2009
Recycled percussion Sparks flying during ballroom blitz
Recycled Percussion performing live at Stevenson University.
Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone
Recycled Percussion performing Live at Stevenson University
Direct from Las Vegas
Download now or listen on posterous
Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone
Saturday, October 17, 2009
is TV moving to the cloud
TechCrunch has a great post on "What on demand media really means and why your cable company should be scared"
The article by John Biggs is fascinating. It gives evidence that the hackers are already getting to the point where Cable and Satellite is no longer necessary. However, In some ways the article doesn't go far enough. TV is going mobile. We are seeing content delivered to mobile. There are in fact a number of threads that are going to come together in this space:
- The work that Dave Winer is doing with RSSCloud
- The development of Boxee
- Apple's iTunes Store making content easily available
- Apple's continued interest in their AppleTV "hobby"
- Roku's NetFlix player
- NetFlix delivering on demand movies
- The emergence of Hulu as a go to place for network TV content
- The evolution of YouTube and the deals being done with the movie studios
Over the next couple of years I think we are going to see these threads come together and dramatically change the face of TV.
Things the innovators have to remember:
- We are fundamentally lazy so any solution has to deliver ease of us
- Convenience wins over constraints
- Simplicity wins over complexity
How do I see this playing out?
- I see the Personal Video Recorder moving in to the cloud - Think Boxee meets AppEngine
- I see emerging aggregators that parcel video content in to RSS feeds that are delivered via real time RSS.
- I see the Personal Video Recorder becoming a feed handler that will build personalized "TV Channels" to match our tastes.
- The Personal Video Recorder can deliver content to us at whatever device we have to hand. In this area I think the video streaming over HTML work that Apple is promoting has great potential. iPods, iPhones, AppleTVs connected to High Definition TVs all become delivery points.
What we shouldn't under estimate is the potential for Apple to win big in this evolving world. As I wrote in a post a couple of years ago. Microsoft's approach is desktop centric where the Media Center is embedded in to a PC. Apple has taken a different approach. They have put the consumer at the center and made it easy for them to connect multiple devices to an iTunes application. The AppleTV and it's ability to stream other content is the first step in an evolution. The ability for the iPod Touch and iPhone to pull content directly from the iTunes store also hints at alternatives. I
I can see the new data center Apple is building on the East Coast being used to help move our iTunes library and preferences to the cloud. In this way I can build my library and sync all my devices to it. This direction would place Apple in a great position to create the Digital Personal Video Recorder in the cloud. And they have over 100 Million users who have registered their credit cards with them. This gives them a massive market to leverage and the convenience could be a big factor in persuading users to adopt this new style TV.
Back in 2007 I wrote a number of posts for AOL (their 2.Open internal blog and touched on some of these themes then. I am reproducing those posts here:
Internet video on TV - An opportunity?
I have been fascinated by the changes going on in the TV, Video and Movie industry, both online and offline. A lot of people are working on convergence issues but we, the consumers, stubbornly refuse to change. There is some movement, but the I believe the current approach by the established players to apply digital rights management is treating their customers like thieves. Because of these controls consumers don't have real choice over how, when and where they consume the content they have legitimately acquired. I also believe that the more the industry tries to make this fool proof, the more they will push consumers to adopt the piracy practices that they are trying so hard to prevent.
Consumers will pay for convenience.
There is a fascinating article in the Wall Street Journal on the attempts at achieving convergence between Internet and the TV. Apple's AppleTV seems to be off to a slow start. Amazon and Tivo are not setting the world on fire with their Unbox service either.
So read the Wall St. Journal article and we can discuss alternative approaches to bringing about convergence in tomorrow's blog.
In the meantime if you have ideas on how to drive convergence please share them. How would you like to see video convergence? Share your ideas. Leave a comment.
Converged Video - Consumer driven
If you read yesterday's post [above] and read the Wall St. Journal piece on Internet and TV convergence then you will have some idea of the many attempts to achieve convergence. When I look at these attempts I realize that very few of them embody the principles of Web 2.0 and the Internet. They are all closed systems to one extent or another.
What is needed is an open solution. One that leverages technologies such as RSS. As I have pointed out in a post back in April [April 2007: Post Video - channelling Community - See below] there is an opportunity to provide video RSS-style feeds that can be merged in to a personalized channel or channels. If user interaction can then be monitored with the channel you can build Pandora-style interaction to modify the feed. In theory this could be done on the back-end without requiring changes at the TV end of the service. Think of it this way:
- As a subscriber I setup four or five or more channels that have specific themes. For example: a news channel, a sports channel, a reality show channel, a comedy channel and a lifestyle channel.
- A back-end server could monitor the delivery of these feeds learning our preferences based upon how we switch channels and how we skip forward or backward within a channel.
- The back-end server could use our choices to add new content to our chosen channels. The more we tap in to our chosen channels, the better the service gets.
An open platform that aggregates channels could simply be pointing to content elsewhere on the web, just like RSS works currently. AOL has the capability to build this infrastructure for personalized video channels. This could initially be delivered as an enhancement to exisitng AOL video services. Then it would be a case of promoting the service as an open approach that could be embedded in to set-top boxes, tivos, appleTVs and similar devices.
What do you think? Would you like to see personalized video feeds that you can deliver to the device of your choice? Share your thoughts. Leave a comment and join the conversation.
2007-04-11 - Wednesday
Video - channeling community
There is a great review of the online video industry that is worth checking out at Read/Write Web. What the article does is do a great job of categorizing the different sectors of the video industry. It identifies the main players in the following sectors:
- Video Sharing
- Intermediaries
- Video Search
- Video eCommerce
- Video Editing & Creation
- Rich Media Advertising
- P2P (Peer To Peer)
- Video Streaming
- Vlogosphere
Video is a hot sector and now that Apple are shipping the Apple TV the sector can only get hotter. Some time ago I wrote about the emergence of personalized programming. AppleTV/iPod smart playlists represent the first step in the personalized TV channel. Dave.TV is an interesting attempt to create personalized tv channels that can be embedded in a web page. The downside appears to be that your custom channel can only consist of content you have uploaded to your personal media locker.
May be there is an opportunity for Uncut Video in this emerging area. How easy would it be for Uncut Video to provide the ability for subscribers to define a series of tags, or search terms? Then take the results and allow them to be published as an RSS feed. The next step would be to provide the ability for a player to pick up one or more RSS feeds and play them with advertising integrated, may be pandora style. Subscribers should be able to pick up their own feeds, or those of other subscribers.
The possibilities for personalized channels is as broad as the imagination of the subscribers. Imagine parents creating video streams of fun and educational videos for their kids to watch. Colleges could create educational videos to supplement their course materials and students could pull together feeds for all of their subjects. The posibilities are limited by our imagination.
It would be cool if that output could be delivered podcast style. That would allow AOL content to be delivered to the living room via appleTV, or carried with you on an iPod.
Just a thought....
I know there are plenty of inventive people reading this blog. I am sure someone will hit the comment button and say "all you need to do is...." So go on, tell us how you would take AOL Video to the next level. Hit that comment button and share your ideas.
Friday, October 16, 2009
It's Friday and someone at Engadget is rocking with Photoshop
via engadget.com
Microsoft store opening October 22nd, insides revealed?
The article on Engadget has cleverly used the fast growing People of Walmart site to enhance the picture of a proposed Microsoft Store.
One question: have you ever seen a shopping cart in an Apple Store?
FSJ could have a field day with this!
Monday, October 12, 2009
Credibility in Health Care and the role of VRM (the VRooM Workshop)
Today was my first day back at work after an exciting trip to San Francisco for #HCSFBay and the Health 2.0 Conference. Today is also the kick off of the VRooM Workshop at Harvard hosted by Doc Searls.
The VRooM Workshop is the 2009 East Coast session of the Vendor Relationship Management initiative that was created by Doc Searls. I attended the 2008 Workshop and took part in a lot of very interesting discussions. Those discussions formed a clear link for me between VRM and Health Care.
VRM aims to put more power in the hands of the consumer. This is desperately needed in Health Care as we promote a Participatory model for Health Care and urge a move away from the paternalistic models that have persisted for many years.
One of the concepts I am hoping that VRM can consider is the issue of Portable Credibility or Portable Reputation. This is a concept that I surfaced last week at the Health 2.0 Conference.
In the Health Care industry it is a rare occurrence if the user-generated content in a Personal Health Record is considered as a trustworthy data source by medical professionals. Without that trust there is a continued discouragement against consumers maintaining their records.
At the recent Medicine 2.0 conference in Toronto the closing session on Ethics on line raised the question of liability for "Good Samaritans" providing online advice.
I see these issues as having a common thread. How do we trust a source?
At the same time we have existing platforms that have the potential to provide trust metrics to communities. The most familiar is eBay and Amazon that provide rankings for sellers. I believe there is an untapped resource amongst the Instant Message community. There are many online users that have maintained a screen name on one or more IM services and actively manage their identities. Their reputation is important. I am convinced that AOL missed an opportunity to create a Portable Reputation metric for their screen names on AIM. This is something that Google could possibly address with their deep metrics for Gmail and GoogleTalk users.
We need portable reputation so that we can allow others to assess the potential value and credibility of the information we provide.
I believe this could be invaluable in Health Care. Imagine if I am an engaged patient and I am consistently measuring critical physiological measures. If the accuracy and consistency of these measures could be assigned a recognizable metric then we open up the opportunity to save money and lives in Health Care.
As we move inevitably in to a world of online Personal Health Records we need to allow Consumer Observations of Daily Living to be added to the series of data sources used in diagnostics and care planning. Failure to address this need consigns us to continued aggressive medical price inflation.
Engaged patients frequently capturing real time data represents a massive untapped resource in health care. The experience with data collated by PatientLikeMe proves the value of this resource. A credibility/reliability metric that could be built over time through confirmations at interaction points with the medical community could provide a metric the medical professional could use when assessing the dependability of information.
Why should VRM look at this? Because the credibility metric is some thing that can apply to both sides. There is no reason that members of the medical community be measured as well. Just like eBay is able to measure buyers and sellers. A credibility/reputation metric could be just as useful to patients that are seeking out cutting edge research about life threatening conditions.
So yes, I hope the VRM workshop considers how we can evolve a Portable Reputation metric that can work for both sides of a transaction. I am sure the applications beyond Health Care are many. However, health care has challenges to solve now. Health Care reform is front and center in the public and government consciousness.
Developing Portable Reputation for Health Care is an important potential step in promoting the engagement of the patient in Participatory Medicine - as an equal.
Saturday, October 10, 2009
HealthCampSFBay (#hcsfbay) The movie
I was asked by a few people including @healthythinker to post the introductory movie I used at HealthCampSFBay. So here it is.
By the way - thanks to David Hale for the great panoramic view of the meeting in the round at #hcsfbay
I also want to thank @scrimshire for providing the great music behind the video.
HealthCampSFBay (#hcsfbay)
via flickr.com
Finally posted my photos and movies from HealthCampSFBay to Flickr
Thursday, October 08, 2009
#health2con Looking ahead
Matthew Holt wraps up by Looking Ahead with a panel that includes:
- Glenn Tullman, Allscripts
- David Kibbe, AAFP
- Johnathan Bush, athenahealth
David Kibbe:
Spent a lot of effort to get Docs to adopt EMRs
Those services are tied to the past.
Only 15% of physicians are using EMR technologies
The products are too expensive. Too difficult to implement
Trying to help the industry to re-invent EMRs
We shouldn't be talking about EHR's and Doctors.
We need to talk about Doctors, Patients and Consumers need to make better clinical decisions.
About to see an explosive growth in Platforms in the cloud to support Doctors and Patients.
Doctors Think in terms of Control, Power (and Money - JB)
The Vendors aren't going to certify the products that define Meaningful use. ie. CHIT is out.
Many Doctors are waiting. They want to know what they are going to have to spend.
Glenn Tullman:
How has EMR adoption gone so far?
Need vision (President has done that)
Need Standards
Need incentives (ARRA is doing that)
27% of sales as SAAS solution.
Healthcare is an information business
Need to focus on "Connected HealthCare"
Physicians don't care about technology.
They are interested in what makes them more effective.
100,000 Physicians in offices of less than 10 doctors.
Hospitals are going to become an important organizer amongst small physician groups.
CHIT will be the initial certifier
There are now 60 CHIT certified Vendors.
Believe the standards should be increased.
It shouldn't be about what should be done to qualify for Gov't funding. It should be about what is done to do right by the patient.
7k americans per year die from preventable medical errors.
Johnathan Bush:
"Software Enabled Service"
Let's put the service on the Internet.
(AthenaHealth has 2,000 physicians)
Hospitals will deliver EHR's for Doctors as a means to keep them tied to them.
35% of claims need to be resubmitted.
52% of what Docs order never come back to the chart.
Interoperability doesn't mean anything - interoperation means a lot.
Think Johnathan Bush is saying that CHIT has to focus on enabling interoperation.Less than that and we have disconnected islands
30% of independent doctors are throwing out EMRs. How does that add up when there is such low level of use.
[Me] I think Consumers will become the integration point. They will mashup what the entrenched system providers are not prepared to offer. Think Mint for Health...
Wednesday, October 07, 2009
#health2con More innovations in Health 2.0
Julie Murchison of the Health 2.0 Accelerator introduces: "Aging in Place:" is a reality. Remote care giving support is also a reality. Benay Dara Abrams, Kinnexxus Francis Kong, MedSimple Kinnexxus is connecting caregivers with Care Receiveers. ie. Kids and parents. MediSimple and Kinnexus have integrated. Kinnexxus has a kiosk solution. No keyboard. provides reminders and notifications to family. Elder can report weight and other numbers via the kiosk. Failure to do this can trigger a notification to the family member. Interesting example of how the caregiver can be prompted to compile information for the doctor in a call with the parent. The Kinnexxus portal also can feed medication and other numbers to the questionnaire and present that in an easily digestible form for the doctor. Eliza are no demonstrating their platform. Eliza has acquired Sprigley as a platform for recommendations. Voice completes internet access. Engagement through voice message increase likelihood of engagement via the web (2x - 4x)
#health2con Innovations in Health 2.0
Adam Bosworth opens up http://www.keas.com
Keas Thanks Quest Diagnostics and Healthwise for their support.
Keas, "Facebook for health".
What should you do, what did you do.
Personalized charting (including personalized interpretation and explanation)
Diabetes Mine:
"Know Your Numbers - Outlive your Diabetes"
Book by Richard Jackson, MD and Amy Tenderich
"Actionable Advice"
5 numbers that are critical for diabetes:
1. AIC
2. Blood Pressure
3. Lipids
4. Microalbumin
5. Eye Exam
Keas a platform for care plans.
#health2con - Accelerator UnPlatform
The Health 2.0 Accelerator
Showcasing innovation of intermingled applications.
Interoperable tools in the Health 2.0 Accelerator Tools Network
First up
Medikeeper provides a Personal Health Record with widgets of use to the member.
A tracker, A health risk assessment, a health savings widget from change healthcare, and alerts
Change:healthcare module demonstrates how to change money. Including scripts to make the switch of pharmacy and a map to display where to go.
CH has introduced an AskCH twitter client to allow people to ask personalized questions.
Sage is integrated from Change=:HealthCare to allow a consumer to book an appointment and link in to the Practice Management system of the provider.
Sage has linked to a health questionnaire provided by MedSimple.
MedSimple provides a health Questionnaire that is completed before the office visit. This allows the patient and doctor to focus on the issue rather than the paperwork and data collection.
Questionnaire arrives in PDF form. Sage supports CCR formats which will be a future enhancement in the integration.
Sage issues the e-prescription after a doctor's visit.
Data gets exported to Microsoft HealthVault.
Medikeeper pulls the information back from Microsoft HealthVault to update her medication details.
PharmaSurveyor is then used to work out drug interactions based on the data in the HealthVault records.
This is used to run a medications safety survey.
Interactions are not the only issue. Toxicity can add up and cause side effects.
In this example, although no side effects but she has been using a Polka application to track her drug usage.
@mikekirkwood is demonstrating the personal health platform.
Polka is a platform for capturing Observations of Daily Living. More than just drug usage.
Polka can include Over The Counter medications.
Embedded ReliefInsite.com in to iPhone and web platform.
PharmaSurveyor can also link in meds from Polka using HealthVault.
FirstDataBank was working behind the scenes. Their Mission "A World Free of Medication Error"
Check out the FDB NDDF+ and the Drug Code Lookup Service.
PharmaSurveyor can then be used to identify side effects, simulate alternatives for discussion with her doctor.
Amazing interoperability demo
Did Sage blow it with "What your doc allows you to see"???
Erik VonS Geeking out.
Bottoms up community work to use standards.
Open Framework for tools standards and patterns the Accelerator is evolving.
Marty Tannenbaum "You have just seen the future of HealthCare" Prediction, Personalization.
To get to the next level: What services can we add to this mix?
#health2con Launch!
Some interesting Features being launched.
Let's hope these can be easily integrated with other applications and platforms.
Interesting Beta from Livestrong.com Their MyPlate application is being enhanced for Diabetics. New Tools to help diabetics manage their diet.
BodiMojo - health promotion program for teens. Supported by a grant from NIH
Interesting use of UI - a Mood Cloud.
AccessDNA has some intersting UI around DNA SNIP data.
Also has DNA Classified. eg. Researchers can request snippets of DNA for research purposes. Users can submit profile that are open to offering DNA for research.
UnityMedical http://www.UnityMG.com
Nice mix of video and diagnosis plus pushed tailored content.
The voting was provided by http://www.polleverywhere.com and sponsored by Navinet.
Results:
1. Unity Medical
2. Remedy
3. BodiMojo
#health2con - And the User-Centered Winner is ...
LabCheck Plus Wins IDEO User-Centered Design Competition. Runner up was Phreesia.
#health2con Data Drives Decisions
Oracle are sponsoring, John Foster, VP Health Care introduces the panel.
Panel moderated by Indu Subaiya, Health 2.0Part 1 - Tools and platforms to support clinical decision-making by Doctors.
Panel:
- Rex Jakobovits, MyPACS.net/McKesson
- Lance Hill, Within3
Within3 is building online HC communities for professionals
MyPACS.net Radiological sharing tool
100,000 images. example images reducing error rates.
Lance H:
Taking the annual meeting process online and extending it to a 365 day experience.
Aiming to improve the learning experience for medical professionals
Rex J:
The flash based browser app had an accidental by-product in that sample images could be used for comparison to help with diagnosis.
- Convenience for radiologists is key. helps them be more efficient. Makes the solution attractive.
- Usage of your images on myPACS can count towards professional credits.
- MyPACS is international.
Large organizations using tools and platforms to help consumers make decisions
- Sanjay Koyani, US FDA
Social Media use to communicate on product recalls
Demonstration of use of YouTube, Twitter and other tools for product recalls.
13k followers on @FDARecalls
Partnered with CDC Health e-Cards
Will be launching interface via SMS Text messages.
"The FDA as a platform"
- Hugo Stephenson, iGuard
Providing product and safety info on prescription medications
Answers the question - "How Safe Are Your Meds?"
You no longer need to depend on the news. Instead you can have information customized to the individual.
The level of recalls is significant.
The reality is we have to get information out.
6 or more meds -= 50% chance of drug interaction
- John DeSouza, MedHelp
9M users on MedHelp. 400 condition specific sites.
Began as an "Ask the Doctor a Question"
Now switching around to user lens and monitoring readings.
How is democratization of clinical research process changing research
- Kristin Peck, Pfizer
- Alexandra Carmichael, CureTogether
- Jamie Haywood, PatientsLikeMe
- Amy DuRoss, Navigenics
- Sanjay Koyani, US FDA
Kristin Peck:
Putting Patients at the center. Let them decide.
Pfizer can't do it alone. Need industry standards.
Alexandra Carmichael:
CureTogether - information site for 300 conditions.
Jamie Haywood, PatientsLikeMe:
"Given my status what is the best possible outcome and how can I achieve that"
To much data in a system that punishes harshly for error
PatientsLikeMe is bringing the power and wisdom of the crowds to bear on critical health issues in a scarily powerful way.
Jamie Haywood: "Pharma is an information business that aims to understand the impact of chemicals on the human body"
CureTogether announce that they have identified a linkage between Migraine and Fibromyalgia based upon their user submitted data.
Navigenics focuses on clinical aspect of genome. ie. not Geneological.
Pfizer: Can gov't be more flexible on drug regulation now that there are tools that can gather info more quickly and effectively.
#health2con Data drives decisions - We need portable reputation
I came away from the Consumer Aggregator session having being prompted by Dr Danny Sands question.
I am convinced that we need a reputation engine that works across health platforms. This needs to include Patients. This can then enable Observations of Daily Living (ODL) in our Personal Health Records to be accepted by Providers in the evaluation of our health conditions and situations
#health2con - The consumer Aggregators
Introduced by Dr Danny Sands from Cisco and Beth Israel Deaconess.
Jane Sarasohn-Kahn (@healthythinker) Leads the panel with:
- Wayne Gattinella, WebMD
- Roni Zeiger, Google Health
- Bob Smoley, MD LiveCare
- David Cerino, Microsoft Health Solutions
35% of Americans use social networks online for health up from 27% last year
18% americans go online to use financial management of health.
Wayne:
Market is going Mobile and Global
Adoption assessments grown from 4% to 15%. Utilization is moving up quickly
Exciting uptake but still in the nascent stages.
Roni Z:
American Postal Union is now on Google Health
MD Live Care and Hello Health have integrated with Google Health
Search - continuing experiments
Google FluTrends- using search terms to determine spread of flu. Couple of engineers put in to practice a hypothesis that search predicts trends. They beat the CDC by 2 weeks.
Jane: People are doing more personalized searches How are the engines helping
Wayne:
Seeing people are more willing to share information online. WebMd collects 15 - 30 data points that are used to personalize information.
David C:
There is a value trade off that consumers make. Ask form information demands value to be returned.
We are now asking people to jump in to health care.
We need to get back to the basics like allowing appointments to be booked online (think http://www.zocdoc.com)
Roni Z:
Launched an experiment to ask people why they are searching on health related pages. Asking is it because they are ill.
This is huge.....
Microsoft HealthVault demonstration
Consumers tend to only use about 20% of an application.
MSN Health and Fitness - My HealthInfo
customizable application that links to HealthVault and is built in Silverlight. Widgets can be developed and added to the store.
Google Health Demonstration
MDLiveCare now linked to Google Health.
Enables live visits and data gets posted to Google Health . The interface is bi-directional so information from Google Health is available too.
WebMD demonstration
Demonstration of Mobile apps on iPhone.
- Symptom checker
- Drugs and Treatments
- First Aid Info
- Search WebMD
Mobile PHR App
includes:
- Health Directory
GPS used in search to narrow search
Jane: How are the Plans supporting the PHR Platform vendors?
Roni Z:
It's about the customers
38% of health plans provide PHRs but it is about adoption.
Wayne G:
Not about privacy and security. It is about utility.
David C:
Follow the money!
Question:
What is the difference between the PHRs
Microsoft - Utilization. HealthVault is not a PHR it is a platform.
Roni Z:
data portability is fundamental.
Google - providing excellent UI
Esther Dysan: What is business model? Will cost cutting impact Google Health
Roni Z: More Searches drive revenue for Google. They are incentivized to make search useful
David C: Health is a big vertical. One big network.
Dr Danny Sands: The Arms race - do we need to slow down. do we need to think - what are we doing to integrate the data feeds?
David C: - integrate the data that consumer wants. Need to explain the way that consumers understand
Wayne: We need to interpret highly nuanced data
[Me]: #health2con interpretation of highly nuanced data is a key competence challenge in Health 2.0
Roni: working at national level
eg. recommending unique prescription id.
Working on making more intuitive
Roni Z: it's all about the conversations - who understands participatory medicine?
#health2con - 3 CEO's and a President
Johnson & Johnson put out an amusing Social Media Video to lead off the session on 3 CEO's and a President.
Blogger v Reggae (Reggae being the Regulatorry Terminator)
Adam Bosworth, Keas interviewed by Carleen Hawn, HealthSpottr
Adam invented XML. He impacts our work every day. This RSS feed would not work without XML.
Talking about Keas. The idea was to get the people who understand health care so that they could apply their expertise and give personalized advice to people that need it.
This is about magnifying the impact of medical professionals. From seeing a few thousand people a year to scale up to enable helping 100,000+ people.
People are not living healthy lifestyles. We need to give tools to understand impacts.
Even when we know what to do - we don't do it.
Keas provides tools to Doctors to shift from episodic care to continuous care.
Carleen - How is Keas acquiring customers.
Quest Diagnostics have been a big supporter. Every Quest customer gets opportunity to sign up. Also support from Google Health and Microsoft HealthVault.
Carleen: Google or Microsoft - Which is likely to be more successful?
Competition is good. Both have amazing features. We need to make it more compelling to get people on line.
Carleen: What have you learned in building Keas?
- Be Humble
- Get it out early
- Learn from Customers
- Fix as fast as possible
Roy Schoenberg, American Well, interviewed by Thomas Goetz, Wired Magazine
TeleHealth is like the floying car except the Flying car only has to deal with gravity. Telehealth has to deal with the US Health Care system
AmericanWell is in Hawaii, Minnesota, and US Military.
Roy S: The driving force is Consumers
Online Care can change the system.
Washington is looking to change healthcare and this puts Amercian Well in a good position because the system is in operation and has scaled.
It is 2009 we do everything online - Health care needs to move that way.
We need to change the payment structure so Physicians get paid for doing more efficient things.
The system is such that Docs get sufficient payment to make change worthwhile.
Docs benefit because they can make themselves available on their own schedule. Bringing specialists in to the mix also allows Doctors to engage with Specialists in real time. That can bring enormous efficiencies to healthcare and convenience to Doctors and patients.
Chris Schroeder, HealthCentral interviewed by Elizabeth Cohen, CNN Chief Medical Correspondent
Elizabeth: HealthCentral looks like many other sites. How are you different?
Chris S:
Three things to distinguish:
1. Largest collection of disease and diagnostic information
2. Size and quality of Audience - 3000 health bloggers which are vetted, Expert patients that write. Great storytelling, great content.
3. Advertisers attracted to a sustainable model
The internet can aggregate effectively.
Health Central links to competitor sites where the best information is available. That brings huge credibility with the audience.
The profound stuff is when the Internet helps you get through everyday real life.
empathy, contact, resources.
HealthCare is not just science it is a more holistic experience.
Biggest mistake: Underestimating how nuanced Health Care is.
Alexandra Drane, Eliza interviewed by Chris Rauber, SF Business Times
Eliza has been around for 10 years.
Organizations use Eliza to support people's health objectives. To help people be healthier.
Natural Language engine that understands speech but that has to be married with an understanding of the objective and the consumer.
eg. Ask permission Be sensitive to time and environment
43% click through on emails. because permission was requested.
The competition is the couch and a Bacon double cheeseburger
Eliza didn't understand social networking - they therefore acquired a company that understood that.
#health2con Day 2 kicks off
Once again I will be live blogging and tweeting the event. Apologies to followers of @ekivemark for the high volume of tweets today.
It has been fabulous to spend time with many leading thinkers in the Health space such as @jensmccabe @epatientdave @healthythinker @2healthguru @john_chilmark @cascadia @cindythroop @swisshealth20 @mindofandre @sussanahfox @caparks @aviars
Gee... I can't keep track of all the names. But I am going to create a tweepml.org list and post it here.
Great conversations yesterday. It was a pleasure to meet Joan Osborne, Indu's Mother in Law. Also Paul Mayer of @voxiva. Plans are also bubbling up wondering how to organize a HealthCamp Paris. And Alexander (who came to HealthCampToronto) is here at HealthCampSFBay and the Conference and is thinking about HealthCampBerlin.
The Conference agenda kicks off. So watch out for the posts through out the day....
Tuesday, October 06, 2009
#health2con - Thoughts
145 doctors per 100,000 people in USA
In Africa it is 3 per 100,000 In Africa SMS text is making change happen. Essential healthcare services via cell phones. Giving phones to Community Health Workers. - pill counts
- follow up appointments http://www.hopephones.org to donate old mobile phones. 1 old Blackberry can be sold to pay for 5 low cost Nokia phones. Donate your old mobile phone!
In Africa it is 3 per 100,000 In Africa SMS text is making change happen. Essential healthcare services via cell phones. Giving phones to Community Health Workers. - pill counts
- follow up appointments http://www.hopephones.org to donate old mobile phones. 1 old Blackberry can be sold to pay for 5 low cost Nokia phones. Donate your old mobile phone!
#health2con - Can Health 2.0 make Healthcare more affordable
Live blogging from Health 2.0 Conference. Excuse the stream of consciousness. Interesting after having spent time at HealthCampToronto. Cost isn't the only focus. In Canada the issue would be Can Health 2.0 make Health Care more Accessible. Moderator: Michael Millenson, Health 2.0 Advisers Panelists:
- Al Waxman, Psilos
- Luke Mitchell, Harper's Magazine
- Maggie Mahar, The Century Foundation & Health Beat Blog
- JD Kleinke, JDK Online Health 2.0: 1. User Generated Health Care
2. Users connect to providers
3. Partnerships to reform delivery
4. Data drives decisions and discovery Al Waxman: Health 2.0 won't make health care more affordable. Just like the Internet didn't save the economy. The acid test - does an idea save money and/or improve quality. Maggie Mahar: (the author behind the book that triggered http://moneydrivenmedicine.org Health 2.0 won't save money unless we can persuade people that less health care is better care.
Skeptical about consumer driven medicine. We don't do a good job of managing our money so how will we deal with a more complicated subject - health care Luke Mitchell: Wrote article for Harper's on sending a civilian in to the health care system.
Discovery: a new project in the works for 10 years " An integrated network" Collect all the data, analyze and feed back to provide best practice health care. People with opinions make choices. This is what creates systems - they don't appear by magic. JDK:
Health 2.0 is about putting one stake in the ground to limit the number of variables. It is the democratization of health care information.
Behavior modification comes through availability of information. Health 2.0 may drive up costs in short term. in mid term costs drop through prevention. In long term costs rise due to longer life. [Me] Does this mean that we should just encourage people to party and die happy???? Al Waxman:
Our checking account belongs to us. Shouldn't our Health Record? Maggie M:
Maggie Mahar: Hospitals are dangerous places. Knowledgeable Patients avoid hospital 10% of death risk in the poor is from lack of access to health care
40% of death risk is due to lack of knowledge about implications of behavior. Given the 90%+ penetration of mobiles in the USA we can reach the poor in our communities. Al W:
There is a difference between Health Care System and Health Insurance JDK:
Health 2.0 can move away from waste and errors. We don't negotiate because there is no prive transparency. Mahar M:
Did you know 90% of people who smoke suffer at least one form of mental illness. Question: Can Health 2.0 help sharing across teams? Al W: Virtual Accountable Care Organization - Quality goes up and cost comes down. Chronic Disease management is a team sport. JDK: Optimistic about transparency of information Al W: Lowering admin costs is important and possible Maggie M: Use this technology so doctors can collaborate together and with the patient.
- Al Waxman, Psilos
- Luke Mitchell, Harper's Magazine
- Maggie Mahar, The Century Foundation & Health Beat Blog
- JD Kleinke, JDK Online Health 2.0: 1. User Generated Health Care
2. Users connect to providers
3. Partnerships to reform delivery
4. Data drives decisions and discovery Al Waxman: Health 2.0 won't make health care more affordable. Just like the Internet didn't save the economy. The acid test - does an idea save money and/or improve quality. Maggie Mahar: (the author behind the book that triggered http://moneydrivenmedicine.org Health 2.0 won't save money unless we can persuade people that less health care is better care.
Skeptical about consumer driven medicine. We don't do a good job of managing our money so how will we deal with a more complicated subject - health care Luke Mitchell: Wrote article for Harper's on sending a civilian in to the health care system.
Discovery: a new project in the works for 10 years " An integrated network" Collect all the data, analyze and feed back to provide best practice health care. People with opinions make choices. This is what creates systems - they don't appear by magic. JDK:
Health 2.0 is about putting one stake in the ground to limit the number of variables. It is the democratization of health care information.
Behavior modification comes through availability of information. Health 2.0 may drive up costs in short term. in mid term costs drop through prevention. In long term costs rise due to longer life. [Me] Does this mean that we should just encourage people to party and die happy???? Al Waxman:
Our checking account belongs to us. Shouldn't our Health Record? Maggie M:
Maggie Mahar: Hospitals are dangerous places. Knowledgeable Patients avoid hospital 10% of death risk in the poor is from lack of access to health care
40% of death risk is due to lack of knowledge about implications of behavior. Given the 90%+ penetration of mobiles in the USA we can reach the poor in our communities. Al W:
There is a difference between Health Care System and Health Insurance JDK:
Health 2.0 can move away from waste and errors. We don't negotiate because there is no prive transparency. Mahar M:
Did you know 90% of people who smoke suffer at least one form of mental illness. Question: Can Health 2.0 help sharing across teams? Al W: Virtual Accountable Care Organization - Quality goes up and cost comes down. Chronic Disease management is a team sport. JDK: Optimistic about transparency of information Al W: Lowering admin costs is important and possible Maggie M: Use this technology so doctors can collaborate together and with the patient.
#health2con - Health 2.0 confirms the vital role of HealthCamp
It has been a fascinating and frustrating day at the Health 2.0 conference. On the positive side the chance to catch up with contacts has been invaluable. Great conversations with more innovators.
On the down side the AT&T Wi-Fi is unusable. Thankfully my iPhone (2G) works and I can use my other phone as a 3G modem to get online. Posterous has been invaluable as a tool to write emails and get them posted to my blog.
The consensus is that tools for real patient engagement are still three years away but for the Payers that means we have to start planning to integrate these tools now.
The Health 2.0 Accelerator is a glimmer of light in all this. The members are working together, all be it slowly, to use open interfaces and apis. This is what we need if we are to follow the mantra of "use simple tools to do great things."
To move the needle on Patient engagement and empowerment we need to make it easy for the Patient to record their Observations of Daily Living and get those in to a portable personal health record. The next step is then to get the Phyicians to accept our content as VALID information.
I have said many times. The trend from 15 inaccurate readings taken by the patient are infinitely more valuable than one or two readings accurately taken by a health professional under stressful conditions for the patient. The Health Care industry needs to recognize that. Doing so will help us break the Catch-22 situation we are in. One fear seems to be that patients may "lie" in reporting the facts or readings. I firmly believe that the more times data is recorded the harder it becomes to fake the results. Therefore, if it is easy to collect user measured data the more data points will be collected and the more valuable the data becomes.
This conference has also confirmed the value of HealthCamp. On a number of occasions the message has come down from the Health 2.0 Conference stage that we need to get the conversation going between doctors, patients, payers, institutions, government and developers. That is exactly the purpose of HealthCamp. HealthCamp is designed to do that. It is a catalyst for ideas that can be incubated in the Health 2.0 Accelerator and then launched to the world via the Health 2.0 Conference.
#health2con - The power Patient Panel
Amy Tenderich, Diabetes Mine - Jen McCabe, Contagion Health
- Trisha Torrey, Every Patient's Advocate
- Gilles Frydman, ACCOR (@gfry)
- ePatientDave deBronkart, The new life of ePatient Dave
- Susannah Fox, Pew Internet Trisha Torrey - Why are the patients on their separate panel. Health 2.0 hasn't integrated the Patient. What hope do we have in healthcare if we don't practice what we preach.
@jensmccabe We make micro choices on a daily basis that add up to our life and lifestyle. No tools recognize and support that today. @gilles Health 2.0 is not about technology. The informed patient is the most under utilized capability in the Health Care System @jensmccabe - Caution: Build tools that support BUT DO NOT Require engagement @epatientdave - Health 2.0 tools not advancing as fast as iPhones and iPods. @epatientdave Empowerment is education and tools to allow independent action Question - how do we integrate patient groups in to health care. @susannahfox ProjectHealthDesign could only fund 5 of 100 submissions. Trisha Torrey - We need the success stories to encourage doctors. @jensmccabe we have to be able to have serious discussions. No action is a valid option. @gfry do we want patients to be integrated? Health Care Reform is guranteed to fail because Patients are not involved in reform
@jensmccabe Very interested in being paid for healthy behaviors rather than being paid to not be sick.
- Trisha Torrey, Every Patient's Advocate
- Gilles Frydman, ACCOR (@gfry)
- ePatientDave deBronkart, The new life of ePatient Dave
- Susannah Fox, Pew Internet Trisha Torrey - Why are the patients on their separate panel. Health 2.0 hasn't integrated the Patient. What hope do we have in healthcare if we don't practice what we preach.
@jensmccabe We make micro choices on a daily basis that add up to our life and lifestyle. No tools recognize and support that today. @gilles Health 2.0 is not about technology. The informed patient is the most under utilized capability in the Health Care System @jensmccabe - Caution: Build tools that support BUT DO NOT Require engagement @epatientdave - Health 2.0 tools not advancing as fast as iPhones and iPods. @epatientdave Empowerment is education and tools to allow independent action Question - how do we integrate patient groups in to health care. @susannahfox ProjectHealthDesign could only fund 5 of 100 submissions. Trisha Torrey - We need the success stories to encourage doctors. @jensmccabe we have to be able to have serious discussions. No action is a valid option. @gfry do we want patients to be integrated? Health Care Reform is guranteed to fail because Patients are not involved in reform
@jensmccabe Very interested in being paid for healthy behaviors rather than being paid to not be sick.
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