#apple - Think about it - iPod Touch to get a camera at next refresh for FaceTime?

After reviewing the Steve Jobs key note speech from the Apple WWDC event last week I got to thinking about one statement that Steve made.

When Steve demoed Facetime he stated two things:

1. In 2010 FaceTime would be wifi only
2. In 2010 Apple would ship 10's of Millions of FaceTime equipped devices.

My only conclusion is that the iPod Touch will get a facelift in the traditional September/October refresh for the winter buying season. Apple is gearing up to build approximately 3M iPhone 4's each month. That would be approximately 18M phones.
The iPod Touch will run iOS4 and therefore the only thing it is missing is the mic and camera. Given that the last design refresh had space for a camera it is highly likely Apple will have sorted out the issues and can include at least a front facing video camera to enable FaceTime. Including this capability in the iPodTouch will let Apple comfortably reach their "10's of millions" target. It no doubt means that the iPad will get the camera treatment for the next design refresh in 2011.

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Health 2.0 should stay in Washington

Lygeia Ricciardi has a great post on the Health Care Blog today. She sums up the recent Health 2.0 Goes to Washington Conference.

I agree with Lygeia. This needs to become a regular event in order to extend the reach of the conversation to the Law and Policy makers on Capitol Hill.

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Back on the grid with Clearwire

At work our network is heavily filtered. To add to that I have been bounced from the guest network. This explains why I have been "off the grid" so much in the last six months. It has been like having an arm permanently tied behind my back. The river of information that normally flows to me through my Social Media connections had dwindled to the occasional dribble.

With the imminent launch of the iPhone 4 I had held off finding an alternative solution and had been muddling through by using a Blackberry Storm via Bluetooth and Verizon's network in order to get online to Social Media and Video sites. The connection kept dropping out and throughput wasn't great.

Living in Baltimore I had seen that Xohm, the now defunct Sprint-Nextel 4G network had launched a year ago as a test zone in our area. Sprint passed Xohm off to Clearwire and the new sign ups in Baltimore were suspended. All that changed last week. Now Clearwire is signing up people in Baltimore and Washington DC again.

So why not wait for the iPhone 4? 

That's simple - AT&T changed the rules. In their quest to suck more money out of their under performing network AT&T changed the unlimited (really a 5GB/month plan) to a 200MB or 2GB per month plan. I fail to see how it will save their network. It is obviously more a ploy to dip deeper in  to subscriber's pockets before they lose their Exclusivity deal on the wonder phone (see my earlier post). 

With AT&T changing the rules and on top of turning a 5GB plan in to a 2GB plan, they are also releasing (finally) the tethering option. This will cost an extra $20/month but you get no extra download capacity for your $20/month. Instead, you are paying extra for the privilege of using up your smaller data plan more quickly.

So AT&T - I don't want your tethering plan. I may move to the iPhone 4 but I don't want to loose the data plan I have been on for the past 3 years. 

So Hello Clearwire!  Once I found they were opening up to new subscribers I purchased a 4G USB Modem for my Mac. There is no data cap on the plan. Unlimited is unlimited. What's more for $40/month I have 6MB download and 1MB upload with no cap on usage. This is all on a month-to-month plan with no contract and no extortionate Early Termination Fee. Take that AT&T.

I ordered the modem yesterday and within 24 hours it was delivered in to my hands. The installation on the Mac is trivial. A flash drive contains the installation software (for Mac and Windows). Once the Connection Manager software was installed I updated my Network Preferences (The installation had set everything up) and I hit connect. I was prompted to Fill in a couple of account screens at clear.com within a couple of minutes I was happily surfing around the Internet at speeds that put the Verizon CDMA network to shame. In fact it even seemed faster than my company network!

When I got home I ran a speed test to compare Clearwire to Verizon FIOS. Yes, FIOS is faster but it is also more expensive (about 50% more per month)

Here are the snapshots from the speed test:

Clearwire:  
View on screencast.com »

FIOS: 
View on screencast.com »

All in all, it was a trouble free sign up process and an absolutely painless installation. The resulting browsing experience is great. Probably faster than DSL and I was only getting about 75% signal strength. 

The downside is that 4G WiMax from Clearwire is limited to a small, but growing number of markets. If you have coverage in your city and spend most of your time out and about in that city then it is an excellent and cost effective solution. If you travel more widely the 4G modem solution is not going to be what you want. If I find a need to travel I will probably upgrade to the 4G+ modem that offers 4G WiMax and 3G coverage via Sprint. This would add $15/month to the service cost - which is still competitive. While on 3G you would have a 5GB bandwidth cap each month. 

The combined 4G/3G solution is more cost effective than the major carriers offer and does not require a contract. The only downside is that drivers for Mac OS X are not currently available for the  4G/3G modem. Let's hoping that is fixed soon, otherwise Mac OS X users would need to get a portable cradlepoint wireless router (also sold as the ClearSpot).

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#Health2con - Wrapping up @boltyboy with Esther Dysan and others.

Realtime notes from #Health2con

Esther Dysan: 

"It is not the Government's job to be enough."  It is up to all of us. 

Will Yu - Director of Innovations at ONC

Focusing on Communication and Collaboration.

Applied Research.

Chris Schroeder - HealthCentral

If you deliver something Bigger, Faster, Easier, Better, more beautiful and someone will find a way to pay for that.

Health 2.0 and government initiatives are about breaking down Opaque

New technologies are enabling new behaviors. Most Americans have never really interacted with their personal health record.

Think how long it took to adopt online banking.

Esther:

We need to turn this in to motivation for individuals.

When people go online. they don't go online to consume messages. They go online for attention.

Will Yu:

Incentives within Personal Health Management - assumes you can incentivize change.

How do you create motivation. How do you create engagement. e.g. wikipedia, Linus, Open Source (HealthCamp!!!)

Chris:

Is is about creating connection. That creates powerful emotional drive.

Is there enough push from Patient Activism to drive change.

What inspires Chris is the empowered patient.  Internet Connections creating social groups gives the individual courage. We are not alone!

Esther: 

The market is segmented. Businesses need to make money. They need revenue. 

People are different. They are driven by other things and become role models.

The role models create data that allows the accountable to make changes.

Will: 

Health 2.0'ers are becoming more savvy and sophisticated.

Harvard - BJ Fogg looking at Micro-choices.

Now the wrap up from Indu and Matthew:

Personal Health Records - It's about the ethos of the PHR.

The Health 2.0 community is more sophisticated and is more focused on how to engage.

One sector can't do it alone.

Join in the Health 2.0 Challenge

http://www.health2challenge.org

Health Innovation Week in San Francisco October 3-10.

The Conference wrapped up with a video on the use of Health 2.0 and Web 2.0 technologies that show how these tools were used in the Haiti Earthquake disaster. This video was hosted by Roni Zeiger of Google.

- iPhones to document health records and treatments

- SMS short code to coordinate information 4636

- Crowdflower a micro-task platform

- Google

Google - provided a resource matching solution. 

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#Health2con - Josh Seidman with Regina Holliday, Ted Eytan and Jon White

Real time notes from #Health2Con

Josh Seideman - Office of Provider Adoption Support - Office of National Coordinator - with a great panel at #Health2Con.

Regina Holliday  - What should we do to engage consumers in Meaningful use. 

73 cents per page and 21 days to get a paper record. 

Without being able to see the document, as a patient, there is no meaningful use.

How can we get Patient generated data in to the Electronic Record.

Patients verbal recall is poor. Giving verbal information with no written backup is problematic. We want to be able to review and this leads to better informed patients and better care.

Jon White - AHRQ.

Health 2.0 can provide access to any information and make it available to the patient. Why shouldn't we make it available.

Is it convenient to use. Is the provider engaged?  Quality is not just for the doctors. It is for everybody.

AHRQ - "Questions Are The Answer" 

Getting people individualized information is critical. Ask people what is useful to them. Health IT can make a difference when there is a feedback loop.

Ted Eytan - Kaiser Permanente Federation

People want to share information. This is a major change in the last 4 years. The littlest may make the slightest change to improve things. 

When patients get access it causes patients to ask questions.

Patients forget 50-80% of information by time they get home. 

Kaiser has 3.1M people on PHRs.

They have 6.1M la results online.

Physicians now want to turn up the volume and get closer to their patients. 

Getting good results importing Blood Pressure data from Microsoft Healthvault.

"We didn't know how intelligent our patients are until we started interacting with them online"

Comment from a Physician in the audience. 

The Patient owns the record. The physician guides with the structure of the record.  

The Industry has the ownership issue upside down. The Doctor doesn't/ shouldn't own the record. The Patient owns it and decides who it is shared with.

Good Doctors know that patients can have information and work with their Patients.

Jamie Haywood

Laid out a challenge to the Federal Agencies.

The Feds think Health 2.0 is here to save the Feds by doing stuff with their data.

Jamie's call was to change what we pay for.

Make a Market that entrepreneurs can benefit if they come up with innovative solutions.

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#health2con - Aneesh Chopra's Keynote

Real time notes from #Health2con - Health 2.0 goes to Washington

Culture Gap between Consumers and Government.

Apple - There's an App for that
Federal Government - There's a Form for that

The President's Strategy for American Innovation - A long term platform for growth and jobs

Invest in building blocks of American Innovation Cloud computing and Mobile

Promote Competitive Markets that spur productive entrepreneurship

Catalyze Breakthroughs for National Priorities.

Infrastructure:- National Broadband plan
- Beta Block R&D Initiative to connect neighbors. Deliver 1GB to the poorest homes. Case Western University.
How would this impact - Energy Sustainability, Graduation rates, Chronic disease and Safety?

Wireless Health App.
- Text4baby campaign. Now approaching 50,000 subscribers since February (Voxiva application)

Text BABY to 511411. No charge for SMS messages for 2 years

Commercialize University Research and Spinoff Health IT.
Commerce Dept i6 Challenge to find next University-Based Startup.
Proposals due June 15th and Winners announced September 30th.

New OMB guidance to enable departments use rewards to stimulate change.

USDA inspiring games developers to promote games for better health for kids.

Open Collaborations to catalyze breakthroughs in Applicaitons and data Exchange.
- NHIN Direct Project. - A set of policies, standards and basic web services for the safe transmission of health information.

- SHARP Grantee - SMArt Apps - A health App to support substitutable apps. - Aligned with Modular certification for "Meaningful use"

Open Government Ecosystem.
HHS.gov launches with CHDI. HHS.gov/open

Every Federal Department has detailed their commitment to openness and transparency. Go to Dept/Open eg. http://hhs.gov/open

Bing.com has released Hospital Quality Satisfaction Data from Government Hospital Comparison Data.

Health 2.0 and the Health 2.0 Accelerator have established the http://www.health2challenge.org

June 2nd through October 3rd - 10th 2010. A developer challenge. Code-a-thon, and team competitions to build applications to improve personal and community health.

Use newly opened government data sets + lightweight tools.

Annesh also introduced an $80M competition: VAi2 Industry Innovation Competition to spur Game Changers.

Telehealth,
Patient preferred dialysis
e.g applying for Hearing Aid takes 160 days.
Looking for Private Sector ideas to contribute to 10,000 ideas already proposed by VA Employees to improve services to Veterans.

DARPA Network Challenge for 40th anniversary of the Internet

The DARPA Red balloon challenge.
In 2 days MIT put together 5,000 team members via Social Media.It took 9 hours to find the 10 balloons.

The team took this via the UN to e-Democracy to address hunger.

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#Health2Con - Modular Meaningful use

Farzai Mostafari substituting for David Bluementhal, from the ONC.

Modular Meaningful use. Got 1500 physicians in NYC to adopt Electronic Health Records.

Addressed How the ONC makes decisions.

5 Principles:
1. Put the patient at the center (hooray!!!) Doesn't have to be via an EHR but ARRA encourages that.
2. What is it all for? Where are we trying to get - improving health care. It is not about the technology. It is about what we accomplish with the technology. Technology agnostic. Focus on outcomes. e.g Meaningful Use - meant to capture everything that connects technology to outcomes. Demonstrate what is possible with technology in short order - Be flexible in how you get there.
3. Foster Innovation - This gets us to what we can't currently imagine. Use the market. e.g R&D investment - platform innovations program. Standards - Some things more specific. Getting tough on the vocabulary but where the market is less settled - tread lightly. On Security - define it functionally rather than being specific. Don't freeze out the market with out dated standards.
4. Don't freeze out the little guy. Small practices need help. They will need help changing workflows. Delivering patient summaries. Patient reminders. Deploying Regional Extension Centers to help with this. Modular certification for meaningful use. Enable best of breed solutions to be connected together.
5. Monitor and adapt. Be evidence based. Understand what is happening on the ground. Monitor. This will provide critical input to evolution of meaningful use.

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#health2con Health 2.0 in the physicians office

After a morning volunteering in the Exhibit hall I now get to sit and blog about the afternoon conference sessions at #Health2Con - "Health 2.0 goes to Washington"

The issue to start the afternoon - Can Health 2.0 improve EHR adoption.

This session will showcase:

-  Practicefusion and their web-based platform.

- VisionTree systems

- Alere and their PCMH platform (formerly RND Networks)

- RelayHealth

- Myca and their Hello Health / MycaHub platform.

Ryan Howard - PracticeFusion 40,000 physicians - 20 sign-ups per day. Free solution that enables Docs to win the $40,000 stimulus incentive.

 Web-based product. Covers all admin and clinical aspects of running a doctors office.

\

Enables rapid creation of chart notes. Same day registration.

Integrated PHR, ePrescribing, Quest and Labcorp Lab integration.

Advertising supported. de-identified data is available as a data driven service.

Hello Health - MycaHub. Launched at Health 2.0 Boston in Spring 2009.

Dr. Gordon Moore - Hello Health University.

Hello Health and Agile Health. The Blues Plans investment fund have invested in MycaHub.  

The business model is all cash based around Urgent, Primary and Online Care. Hello Health takes a percentage of practice revenue.

Practices are going "off the grid" and going beyond meaningful use in interacting with patients.

Terry Douglas - RelayHealth

Connecting everyone in the health care community. Enhancing the relationships.

Providing communication beyond the practice. Messages can include the patient e.g in the referral process.

Patients can log in to portal and see the same information that the physician sees.

RelayHealth seeing hospital systems reaching out to the community. Relay Health also acts as a Health Information Exchange in an area. 

Martin Pellinat - VisionTree Systems

HL7 import to create patient record. Patient Portal provides tasks such as visit records. Messaging with provider.

Similar to RelayHealth.

Patient centred team work is the key element of the system.

Geoff Hyatt - Alere

125M americans see 7 doctors per year. How do we coordinate that care?

Alere provides a PCMH platform.

The Care plan can enable seeing enhanced messages such as observations that can be interpreted.

Simple traffic light indicators of care gaps and exceptions in a disease registry/care plan.

The Care Gap and Care Plan shows what the patient and staff need to do.

All members of the Care Team can see the data. Care Team is more than just physicians. It can include any care giver (eg. spouse)

ReachMyDoctor is the patient facing patient portal where Patients receive Care Gap alerts  and secure messages as well as being able to review their Health Record and request appointments..

Team work is a key element.

Jeff Livingston is a practicing MacArthur OBGYN.

He was introduced to Social Media through his daughter and MySpace.

He uses Facebook. 

His practice web site has a blog and information about the physicians. There are podcasts which teenagers download through iTunes to download and listen to before a visit.

Patients are asking for more information with their lab results. They are therefore adding generic video segments on Youtube that are bundled with  the lab results. 

There is no real reason why the connection between the patient and physician can't be technology enabled. Jeff Livingston shows how low cost, consumer social tools can make a massive impact in improving interaction and engagements with patients.

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#health2con Things to see in the exhibit hall

I am here at the #health2con "Health 2.0 Goes to Washington" conference at the Ronald Reagan International Trade Center in Washington DC. Matthew and Indu have done a great job with their Health 12.0 Conference team to bring Health 2.0 to the attention of the Feds. 

I have volunteered for the event and am working the Exhibit hall. There is plenty worth seeing:

Kaiser Permanente is here and have some of the best freebies. Pick up a pen, a hand sanitizer or a stress relief toy.

Practice Fusion is worth looking at. They offer a free (ad supported) web-based practice management system for Physicians that is backed by Salesforce.com.

huMETRIX is here with an interesting portable Health Information Exchange: U-BeWell. Check out their nifty little flash card that can connect you or your physician to your Health Information in the cloud. They also have a smartphone version of this application.

Vitality is here with Glowcaps is a fascinating device. A replacement prescription bottle cap. It glows and chirps to remind you to take your meds. It will also send a weekly email to a family member. This is a great way of increasing medication adherence. If you have an independent elder relative this is also a great way to ensure that they are in fact taking their meds on a regular basis.

PharmaSurveyor is now SurveyorHealth. This Health 2.0 Accelerator company is doing fascinating things looking at Medication Risk Maps. They are one of the leading companies looking at adding value to data found in our Personal Health Records. If you are taking multiple medications, including over the counter medications then their tools can help you assess the risk of drug interactions and enable alternative drug regimes to be identified that lower overall risks for the patient.

ICYou is here recording interviews. They have been at most Health 2.0 Conferences and have a massive library of Health related content.

myca/ HelloHealth is also here with their integrated web-based practice management system. Hello Health is the business model and MycaHub is the software platform that powers the business model. Building on social media and modern communication tools this integrated platform enables physicians to interact with their patients in new and more efficient ways by leveraging social media.

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Calling B$ on the new AT&T data plans to sting #iphone upgraders

This week AT&T announced a new pricing structure for their data plans as a step towards fixing their network "challenges."

Let's take a look at these changes.

The original "Unlimited" data plan for iPhones was $20 for the first generation iPhone. This rose to $30 per month for the 3G and 3GS phones. One thing to remember is that "Unlimited" is unlimited in the sense of You can use up to 5GB of data each month. When you look at most US wireless carriers their plans are capped at 5GB.

As of June 7th, when Steve Jobs is widely expected to announce a new generation iPhone at the Apple World Wide Developers Conference, AT&T ushers in a new set of pricing plans.

iPhone users will have two plans to choose from:

• DataPlus
• DataPro

DataPlus

The DataPlus plan offers 200MB of data/month for $15. If you go over this limit each additional 200MB costs a further $15.

DataPro

The DataPro plan gives you 2GB of data per month for $25. If you burst through this cap each additional 1GB costs a further $10.

Tethering

We know tethering is coming in iPhone OS4. AT&T will charge you $20 to add tethering to your account. They are not giving you any extra data for this. They are just charging you $20 extra to use what you have already bought.

Will this really fix the AT&T network?

AT&T is justifying the changes saying that 65% of their customers use less than 200MB per month and 98% use less than 2GB per month. If this is the case then the price change will do nothing to alleviate the network congestion and is all about extracting extra revenue for customers through overage charges. Also note that unlike the carryover of voice minutes that AT&T offers, there is no carry over if you under use your data plan but you will get charged if you go even one byte over your monthly capacity.

This is perfectly timed by AT&T to extract extra revenue. The new iPhone is going to offer new features like Video chat that will consume extra bandwidth. Yet the AT&T reps will be able to show you your historical use of data, if you are upgrading and convince you that you currently come within one of their plans. But watch out for the surprise when you start experimenting with all those wizz bang new features on your brand spanking new iPhone!

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Watching the live feeds from #D8

I am reading the live feeds from the Steve Jobs Keynote session at D8 All Things Digital conference.

Cnet have provided a coveritlive feed (http://www.coveritlive.com/index.php?option=com_altcaster&task=siteviewaltcast&altcast_code=0f485f189e)

Meanwhile Engadget are also doing a great job with pictures and liveblog coverage.

Some thoughts from the coverage:

- Rupert Murdoch looked out of touch reading his speech from a crumpled set of papers. 

- Walt Mossberg asked about the future of the iPad and betrayed his PC centric view of the world. The iPad is different. Asking if a faster processor is needed for video editing and other content creation tasks misses the point of the iPad. The iPad is a window in to the cloud. As we see more services delivered in to the cloud the iPad will act as the UI in to the cloud. When that happens the dependence on local processing is diminished. What becomes more important is the network. It is a faster network that will really unleash new services and content creation and editing possibilities on the iPad and the iPhone.

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