HeathCamp Thoughts by @ekivemark

The future of Health is Mobile+ Kaiser Permanente now has a mobile optimized web site for 9M members.

2012-01-31T16:35:00.001-05:00

This afternoon I am joining Kaiser Permanente to learn about their Mobile App for members. Kaiser Permanente is a major forward thinking health care provider. It is great to see them embracing Mobile. I have being saying for a long time that the patient/member is often not at a computer when they are receiving service in the health care system. The device they do have to hand is typically their cell phone.

What is needed is a Mobile+ solution. A desktop based solution doesn't work in isolation, neither does a Mobile only solution. You can see this when you look at the emerging consumer wellness sensor market. The Bodymedia device has a website and a mobile application. But the two platforms aren't connected. The new Jawbone UP is a neat wristband but it only has an iOS app. That may be fine for on the go data entry but deeper analysis just cries out to work on a desktop browser. Fitbit remains my favorite tool for wellness. The immediacy of the on device readout is great. I don't need an app to get immediate feedback on my level of activity, the stairs I have climbed or the steps I have taken. However, the mobile app allows me to enter data and get a quick snapshot, as of the last sync event. If I go to the web browser on my laptop I can get an immediate update of anything entered in to the mobile app. It is this Mobile+ approach that health system developers need to embrace.

Mobile is not the panacea. It is a part of a complex puzzle. Patients/Members/Consumers will choose the access method that works for them, and that may change based upon their situation.

Anyway.... time for me to get off that little soap box. Let's take a look at what Kaiser Permanente has been up to...

So KP is launching a mobile app to support 9M members. This is a massive roll-out of a mobile health platform.

The major components of the App:

- Medical Record

- Pharmacy Center

- Appointment Center

- Message Center

- Location Finder

KP.org is now mobile-aware. If you sign on with your smartphone or tablet it will present a mobile friendly format.

The authentication for the app leverages the same mechanisms used for the standard web app.

The Medical Record on mobile gives access to:

- Allergies

- Reminders

- Health Summary

- Immunizations

- Ongoing health conditions

- Past visit history

- Test Results

Some of the most popular features are therefore available from a smartphone such as:

- Message Center

- Appointments

- Test Results

KP promises a two day turn around for messages but the typical practice is to provide a same day response.

15% of traffic is currently coming from mobile devices. This helped drive KP to produce a mobile friendly site.

The Mobile App is available on Android and iOS.

Bill Marsh: The transition to mobile is positively transforming the trusted relationship between patient and physician. Mobile amplifies the relationship in real time.

in Colorado 40% of support is currently delivered virtually. Mobile will expand this further.

HealthConnect is being tested on tablets and mobile devices. They are heading in that direction but it is not widely deployed yet.

@healthyThinker asked about use of lab results. Everything that is accessible online is also available on mobile.

The vast majority of routine tests are auto-released. Only those that are sensitive or regulated by state regulations not autoreleased.

Per @epatientdave "This is what everything should be in health care"

The mobile platform allows more accessible access to care. People are shifting away from using their desktop/laptops and switching to mobile.

Expect to see geo-location and other mobile specific services to be incorporated as the mobile platform is developed.

The truth is that the KP web site has always been accessible from a smartphone with a good browser (think iOS, Android or Palm). The latest development is to optimize the experience on mobile devices. This is obviously the first step to enhancing for mobile.

The plethora of standards for video are barriers to implementation. Then add in security to the mix. KP is already testing solutions. Facetime (form Apple) has already been identified as HIPAA compliant. Since Apple built Facetime using industry standard protocols we really need to see other developers producing cross platform versions of Facetime "clones". It would be great to have a Facetime on Windows and Linux devices.

KP is producing a family of mobile apps. The mobile optimized web site will launch the KP Locator app to help members find a local KP facility. Expect to see more apps join this family.

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Curing US HealthCare… Coding reform and payment reform go hand in hand

2012-01-29T12:54:00.001-05:00

This week I took part in the Care Innovations Summit in Washington DC. On Wednesday I was at the Kaiser Permanente Center For Total Health for a pre-Summit networking day. It was great to work with Danielle Cass and Ted Eytan from Kaiser to facilitate a day long event that I heard people describe as "The Best Networking Day. Ever"

The day was a mix of networking exercises, fireside chats with people that are shaping the future of health care and panel discussions that really made people think. If you get chance to spend time with Jack Cochran, MD, Executive Director, The Permanente Federation, Kaiser Permanente grab the opportunity. He has a life history that would make a great movie and his views on the future of health care and how to improve health are worth listening to and he takes his energy and relentlessly applies it to achieving that aim of better care.

Joe Smith, MD, PhD, Chief Medical and Science Officer, The West Wireless Health Institute is equally vocal about improving our health care system. While Joe didn't get on stage at the Summit itself, he was one various panel discussions at the pre-summit. You really need to listen to his ideas. West Wireless Health Institute is doing great things to promote new approaches to health care. Joe is one of the people shaping the future.

The themes that kept surfacing at the pre-networking event where two fold: Coding Reform and Payment reform. The two need to go hand in hand. As the industry is about to go through a transition that multiplies the number of CPT codes in use complexity is going to try to drive another nail in the coffin of transparency. We can't let this complexity win. If we are not careful we will become so focused on diagnosing exactly what is wrong with a patient that we will forget that it would have been better to have avoided the patient having to come in for a diagnosis in the first place.

If CPT Coding stays focused on minutely identifying an action or condition it risks missing the big picture and enabling preventative actions by physicians. Yet prevention is the big win in healthcare. It is something that has been lost in the Pay for Volume model that is the lot of the vast majority of US Health Care - with certain notable exceptions - like Kaiser Permanente.

When I look back at this week I wish Daniel Palistrant (of Sermo and Par8o) had been at the pre-networking event. His would have been an interesting voice to add to the discussion. He has a provocative article on his blog this week that complimented the CPT and Payment reform discussion. Check out his latest blog post:

"I Know Cancer When I See It"

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Here is the full Tweet Reach report for #CISummit - Provided by HealthCamp as a service to Health Innovators everywhere

2012-01-27T09:23:00.001-05:00

I was asked by someone at CMS if I could get a copy of the Tweets from the Care Innovations Summit (#CISummit). So here as a service to the Innovation Community is a copy of the report from TweetReach - both the old style report and the jazzy new version.

Old Style Report:

TweetReach_cisummit_or_hcidc_org-OldStyle.pdf Download this file

New Style Report:

TweetReach_cisummit_or_hcidc_org-NewStyle.pdf Download this file

If you want to show some love for this service you can always head over to HealthCa.mp and make a small token donation.

It was a great event and I am looking forward to a repeat next year. We should all thank West Wireless Health Institute and the Centers for Medicare & Medicaid Services for putting together a great event. Thanks should also go to Kaiser Permanente for working with West Wireless to host the pre-event networking day at the Kaiser Permanente Center For Total Health. The feedback we have had from that high energy event has been fantastic. I heard understated comments like: "Best Networking Event. Ever!" The only downside of the networking day was the complaint from people that they had heard great reports about the event but didn't hear about before hand so that they could take part.

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#CISummit Don Casey wraps up the summit

2012-01-26T17:53:00.001-05:00

Don Casey:

CMS gets very little positive feedback. They took a risk and engaged with a passionate audience.
Let's thank CMS for all their efforts.

1200 people at the event.

2400 people listened to web cast for extended periods.

Invest in putting the patient at the center - this is the path to better outcomes at lower cost.

Can we engineer a jailbreak for HealthCare. The question is how quickly.

Talk is cheap - what are you doing?

We need to take action quickly.

Westhealth Policy Center working on a fellowship program to create research with actionable outcomes.

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#CISummit - Key points and quotes - Part 2 adds memorable quotes from the afternoon session

2012-01-26T17:47:00.003-05:00

Don Casey: Don Casey says healthcare costs are 17.9% of the GDP and may reach north of 30% if left unchecked. This could cripple the economy.

Dr. Atul Gawande: Health Care (cost) is destroying the American Dream

We forget the bell curve of impact and cost. The two curves do not match. This gives us hope. We want the positive deviants.

HealthCare today is like driving a car with a speedo that tells what speed we were traveling 4 years ago. Data is the key!

Rick Gilfillan: "No one went to school to provide fragmented, expensive care"

@Todd_Park: Data is rocket fuel for innovation

@Todd_Park: There is no problem America can't innovate its way out of - apply the innovation mojo!

Dr. Brian Prestwich - The EMR of today is completely inadequate for the family doctor. They need to be connected. They need knowledge from the patient. They need population information for comparison. (Lots of applause)

Dr. Brian Prestwich: Make it simple to reduce the cognitive workload

David Kirchhoff - Obesity is a lifestyle issue. Difficult and messy.

Lonny Reisman: Technology is essential but not sufficient

Farzad Mostashari: Data as oxygen for innovators.

Aneesh: Has ONC just put forward the idea of OpenTable for Health Care?

After lunch:

Ken Coburn: No part of health system can stand apart. We need collaborative models.

Debbie James: Short term risk is short term thinking about costs

Will Shrank - Medication Non-Adherence - Americas other drug problem

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#CISummit - Wrap up in the Innovation Hot Tub

2012-01-26T17:47:00.001-05:00

5:15-
5:45pm

Fireside chat with Susan Dentzer

Editor-in-Chief, Health Affairs

Jonathan Blum

Deputy Administrator and Director for the Center of Medicare at the Centers for Medicare and Medicaid Services (CMS)

Cindy Mann

Deputy Administrator Director Centers for Medicare & Medicaid Services

Rick Gilfillan, MD

Director, Center for Medicare & Medicaid Innovation ("CMS Innovation Center")

Susan Dentzer suggests that a hot tub is a more appropriate metaphor since there is no fireplace.

Innovation is doing! Like cooking.

Payment is an important part of the innovation soup.

Secret sauce is Culture Change

Scaling for Culture is hard to do.

Technology and Data is key.

Data is an enabler and the rocket fuel of innovation.

Evidence is key.

We need to Share.

How do we move forward:

Jonathan Blum: What does it take to be a high performing doctor or technician.

Best practice audits to review top performing plans and learn what the secret sauce is. Then communicate this information to others to apply.

[ED:]Scaling Positive Change is the same challenge as patient medication adherence. We can package it like a pill but medication is not the only part to a cure. People have to want to get better. If providers don't buy in to new processes they will not perform at the same level as the top performers.

Rick Gilfillan: We (the Feds) don't have to build a new delivery system. The care services in their local communities will build what works.

[ED: The challenge is to provide the payment systems that enable innovative methods of care to be implemented.

Looking in the upcoming CMS Challenge for ideas that engage people/patients in these new models.

Cindy Mann: our doors are open . Come forward with ideas.

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#CISummit - Cancer Care.

2012-01-26T17:12:00.001-05:00

4:00-
5:15pm

Panel 3

Cancer: Journey Toward Better Health, Better Care and Lower Costs Case Study

Moderator: Simmi P. Singh

Senior Advisor, Health Innovation, Office of the Secretary, Department of Health and Human Services

Amy Abernethy, MD

Associate Professor, Division of Medical Oncology, Duke University School of Medicine and Medical Director of Oncology Quality, Outcomes and Patient-Centered Care in Duke University Health System

Amy Berman, RN

Program Officer, John A. Hartford Foundation

Jeffrey Elton, PhD

Co-Founder and Board Member, Kew Group, Inc.

Bruce Johnson, MD

Head of Thoracic Oncology, Dana Farber Cancer Institute

Chris Olivia, MD

Board Member, Eviti, Inc.

Simmi Singh

Cancer is 4th leading cause of death.

Cancer = uncontroled cell reproduction.

Bruce Johnson - Dana Faber Cancer Institute

- How the Human Genome project has influenced cancer treatment.

- The past decade - what have we learned

The human genome was sequenced at the cost of $1B.

We can now sequence an individuals genome for $1,000.

Lung cancer is the most common form of cancer death. (156,940 in 2011 in USA)

85% of patients die.

Using the lessons from genome research is allowing pills targeting specific sub sets of cancer. This replaces chemo therapy or infusion with a simple pill that works for longer.

Jeffrey elton - Kew Group

Personalized Oncology Management in the community.

Quality based reimbursement+ Molecular diagnostics + Clinical Research

This is precision medicine.

Chris Olivia - Eviti

50% of cancer diagnostics are wrong.

32-40% of treatments deviate from guidelines.

45% of patients don't take medications as prescribed.

Cancer has seen an explosion in data requirements to support cancer decision making.

Eviti can reduce approvals for treatment from days or weeks to 15m

Amy Abernathy - Duke University

Rapid Learning HealthCare - IOM in 2007 (but nothing happened.....)

Patient reported outcomes have been discarded as unreliable - how do we improve that so they can be relied upon.

Community oncologists are at the forefront of using patient reported outcomes.

Sequentially Link data connect disparate datasets.

Data needs to be re-purposable.

Amy Berman - Hartford Foundation

Talking about her story about the diagnosis of her inflammatory breast cancer.

The message is that we have to consider the patient and their quality of life.

Amy has chosen to not do the high cost, high impact procedures and instead preserve quality of life.

The patient needs to be able to make informed choices and the medical community needs to place value of the patients set of values.

The Discussion

20% of research pipeline in pharma and elsewhere is going in to oncology.

We spend $150-$200B on Cancer Treatment.

The increased specialization of cancer treatment raises issues in running clinical trials and treatment.

Chris Olivia gives a hats off to the work of CMS to unleash data and drive innovation to effect change.

BJ - we may need to come up with different method of practicing as we unravel the secrets of cancer in the genome. Let's hope our payment systems of the future don't prevent this adaptation.

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#CISummit Ignite Talks - Part 3

2012-01-26T16:09:00.001-05:00

3:45-
4:00pm

Ignite Talks: Rapid Fire Innovation Pitches

Facilitated by Joe McCannon

Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services (CMS)

Will Shrank, MD

Director, Rapid Cycle Evaluation Group, Centers for Medicare & Medicaid Services (CMS)

David Eddy MD, PhD

Co-Founder, Archimedes

Joe McCannon - Asked the question:

- Who would you most like to meet?

- What innovation has captured your imagination?

I know I want to learn more about the Allscripts challenge.

Will Shrank - Rapid Cycle Evaluation Group - CMS

Medication Non-Adherence - Americas other drug problem

$0.5T problem due to medication non-adherence.

No magic bullet. But....

Better education and communication

Pharmacists are potent communicators

Benefit design to remove payment barrier.

Simple reminders

Better labeling and packaging

HIT is the backbone of any adherence initiative. Social Networks are powerful tools.

Engage family and friends.

Tom Lee - One Medical Group

Entrepreneur behind epocraties

Redesigned primary care service at lower cost. Same day appointments. More time with patients.

Not a concierge model.

Ideas are cheap. It is putting them in to practice that takes effort.

There is waste in the system. First concentrate on internal waste. Started looking at support staff. Typical practice has 4.5 FTE's per MD.

But that depends on handling many, many patients.

Dropped it to 1.5 FTE per MD

Classic People - Process - Technology challenge.

Instituted email. - what a concept!

Simple systems. Email, web forms, simple EHR

Don't specialize

What was learned:

- The bar is low.

- Expectations are rising.

Creativity is thinking new things - Innovation is doing new things.

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#CISummit - Chronic Care Management - The discussion

2012-01-26T15:23:00.001-05:00

Atul Gawande leads a discussion on Chronic Care Management.

2:00-
3:30pm

Panel 2

Care Delivery/Chronic Disease Innovation Case Study

Moderator: Atul Gawande, MD, MPH

Surgeon, Writer, Public Health Researcher

Kenneth Coburn, MD, MPH

Chief Executive Officer and Medical Director, Health Quality Partners (HQP)

Alan Hoops

Chairman and Chief Executive Officer, WellPoint/CareMore

Debbie James

Vice President, Healthways Fitness Division, Healthways

Mary Naylor, PhD, RN

Professor in Gerontology, University of Pennsylvania School of Nursing

DJ: Complex model. Targeted messaging based on demographics.

Mail campaigns (majority of activity), phone calls. some clients they work with physicians. (Healthways client is the health plan or employer)

Fitness centers are trained to deal with seniors.

MN: Nurse "hold the family and patient's hand through the transition from hospital to home. This starts before release. Patients in hospital go from 24x7 care to 24x7 nothing upon release.

AH: The component pieces of care are nothing new. What is new - for Health Plans to be accountable. CareMore focuses on the 10-20% of patients that exceeds the PCP's ability to care for them.

So.... CareMore is an outsource model.

50% of chronic condition seniors admitted to hospital are either dead or readmitted within 12 months.

MN: Focus on medicare and dual eligibles, multiple chronic conditions, multiple acute service use. Work in hospital and with PCP's. Pick people up at a point of risk and support them to a point where they are no longer at risk.

DJ: beenfits seen in Year 1, benefits pay for all participants in Year 2.

KC: High risk groups has ROI in first year. Wider beneftis in 4.5 yrs. Once people ar ein the program they stay in and continue to benefit.

MN: TCM has a continued investment needed in systems and training. Hospitalized patients show an ROI within months.

AH: CareMore Model is a platform and patients are divided in to many sub-groups. Differing payback returns. CareMore looks for broken systems that enable 20-50% reduction in cost in a 6 month time frame.

Innovative models don't fit the regulations. Regulations are designed for the healthier 75% and not the sickest 25%.

MN: Our biggest barrier is us

KC: No part of health system can stand apart. We need collaborative models.

DJ: Short term risk is short term thinking about costs

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#CISummit Chronic Disease Management moderated by @atul_gawande

2012-01-26T14:42:00.001-05:00

2:00-
3:30pm

Panel 2

Care Delivery/Chronic Disease Innovation Case Study

Moderator: Atul Gawande, MD, MPH

Surgeon, Writer, Public Health Researcher

Kenneth Coburn, MD, MPH

Chief Executive Officer and Medical Director, Health Quality Partners (HQP)

Alan Hoops

Chairman and Chief Executive Officer, WellPoint/CareMore

Debbie James

Vice President, Healthways Fitness Division, Healthways

Mary Naylor, PhD, RN

Professor in Gerontology, University of Pennsylvania School of Nursing

How do we care for patients that normally slip through the net.

Debbie James - HealthWays

Physical Activity improves health. Silver Sneakers Fitness Program. Better health at lower cost for seniors.

46% of participants in the program have never been into a fitness center.

Engagement - get them there... keep there.

Access and Variety are important factors.

Need access (within 5 miles)

Create community - Social is important.

Customize programs for older adults. Make them comfortable and take away fear of the unknown.

Program leads to better health at lower costs.

23-37% lower cost for silver sneakers members.

9M Medicare Advantage and Medicare Supplement Program members have access to Silver Sneakers.

Ken Coburn - Health Quality Partners

Community-based care management.

Aim: improve health, independence and reduce suffering of chronically ill older adults.

Focus on preventive services.

Person-centered model. A long haul relationship.

Run in parallel with Primary Care Providers.

200 Performance measures used internally.

35 Nurse interventions.

"A High contact sport"

9 year program..

Looking for technology partners to develop program further.

Mary Naylor - U of Penn School of Nursing

The Transitional Care Model - A 20 year old model.

Nurses as hub of a care giving model.

A huge opportunity in community-based organizations to get seniors back on their feet.

We have know since 1999 that this program works Shame on US Health Care! Surely a lawyer is going to take a class action suit against the medical community.

Scale TCM across the system

Deploy TCM workforce

Improve and Sustain....

Data driven quality improvement.

Alan Hoops - CareMore

50% of members in special needs plans.

Address chronic diseases and conditions.

A platform that looks for system breakdowns and replace with something that works.

50% reduction in hospitalization amongst dialysis patients. Simply by placing case managers in the dialysis unit. Divert to appropriate care instead of defaulting to ER visits.

Chronic Care management

Episodic Care management

Predictive modeling and intervention

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#CISummit Joe McCannon introduces the next round of Ignite Talks

2012-01-26T14:06:00.001-05:00

1:45-
2:00pm

Ignite Talks: Rapid Fire Innovation Pitches

Facilitated by Joe McCannon

Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services (CMS)

Bob Masters

President and CEO, Commonwealth Care Alliance

Jennifer DeCubellis

Area Director, Hennepin Health

Tom X. Lee, MD

Chief Executive Officer, 1Life Healthcare and One Medical Group

Joe McCannon is based in the CMS Innovation Center and focuses on learning diffusion.

Bob Masters - Commonwealth Care Alliance

Based in MA.

Once in a generation opportunity to improve care for the most vulnerable - Dual Eligibles.

CCA focuses in MA on 3800 mostly home bound frail elders and 600 younger beneficiaries.

A lot of money spent but even more money saved.

How we care for the mentally ill is shameful.

75% are dual eligible. Average life expectancy is 53 years.

Implementing new Primary Care models.

Jennifer DeCubellis - Hennepin Health

A social disparities approach to healthcare reform.

Patient Centered Care where care is Coordinated.

Add Pharmacists to care teams. Reduce medications and side effects and increasing time for Doctors.

Mobile Crisis Home Visits. 24x7 crisis line.

32% of population are in unstable housing. Providing services for the homeless.

Housing support helps place individuals - this reduces hospital stays.

Interpreters help families navigate the system.

Vision care - don't overlook this. Imagine being able to read your prescriptions.

Dental Care has been attached to emergency departments - this reduces ER visits and prescription of pain medications.

Food Pantries help patients deal with upset stomachs that impact medicatin adherence.

This just shows that you have to treat the whole person and not the condition.

Tom Lee - 1Life HealthCare and One Medical Group

Guidelines as key to physician-patient decision making.

Evidence-based medicine is not enough.

Guidelines are too simplistic. They focus on one risk factor at a time.

We need to look at each individual and take into account all risk factors.

Calculate risks of all outcomes.

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A contagion of healthcare disruptors conspiring at #cisummit

2012-01-26T12:56:00.001-05:00

@aviars
@pjmachado
@davidrosenman
@susannahfox
@mindofandre
@ctorgan
@lygia

And @epatientdave ducked out or a minute.

Who else did I miss?

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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#CISummit - Key points and quotes part 1 - the morning sessions

2012-01-26T12:24:00.001-05:00

Don Casey: Don Casey says healthcare costs are 17.9% of the GDP and may reach north of 30% if left unchecked. This could cripple the economy.

Dr. Atul Gawande: Health Care (cost) is destroying the American Dream

We forget the bell curve of impact and cost. The two curves do not match. This gives us hope. We want the positive deviants.

HealthCare today is like driving a car with a speedo that tells what speed we were traveling 4 years ago. Data is the key!

Rick Gilfillan: "No one went to school to provide fragmented, expensive care"

@Todd_Park: Data is rocket fuel for innovation

@Todd_Park: There is no problem America can't innovate its way out of - apply the innovation mojo!

Dr. Brian Prestwich: Make it simple to reduce the cognitive workload

David Kirchhoff - Obesity is a lifestyle issue. Difficult and messy.

Lonny Reisman: Technology is essential but not sufficient

Farzad Mostashari: Data as oxygen for innovators.

Aneesh: Has ONC just put forward the idea of OpenTable for Health Care?

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#CISummit - More Ignite Talks

2012-01-26T12:23:00.001-05:00

12:15-
12:30pm

Ignite Talks: Prizes and Challenges

Facilitated by Aneesh Chopra

United States Chief Technology Officer, Assistant to the President and Associate Director for Technology, Office of Science & Technology Policy (OSTP)

Toby Samo, MD

Chief Medical Officer, Allscripts

Leigh Burchell

Vice President, Policy & Government Affairs, Allscripts

Michael Williams

Vice President of Primary Care, Pfizer

Suzanne Blaug

Head, Janssen Alzheimer Immunotherapy, a Janssen Pharmaceutical Company

Farzad Mostashari, MD, ScM

National Coordinator for Health Information Technology, Office of the National Coordinator for Health IT (ONC)

Toby Samo - Allscripts

Allscripts Million Hearts Clinical DEcision Support Challenge.

Fighting Cardiovascular Disease. $50,000 top prize.

CVD: $400B cost in direct and indirect costs in 2010.

Expand the use of clinical decision support.

Machine readable format that can be read by any EMR.

Michael Williams - Pfizer / Suzanne Blaug - Jansenn Alzheimer Immunotherapy

Over 13M people may have Alzheimers

12.5B unpaid Care hours

Dementia costs $1T per year.

Alzheimer cost is larger than Walmart's annual revenue.

Need:

1. Tools to detect early symptoms

2. Tools to monitor and track changes over time.

A devastating disease because symptoms go undetected.

Develop a simple cost effective, reliable high touch tool that can detect Alzheimers and track changes over time.

Enter data in to EMRs

Be user friendly.

www.alzheimerschallenge2012.com

Farzad Mostashari - ONC

Data as oxygen for Innovators.

Care Transitions Challenge #2 . Post-Discharge Follow-up Appointments.

More EMR adoption in last 2 years than in last 20 years. Adoption doubled.

BUT we need interoperability.

Meaningful use means you change outcomes

Quality Measurement BY providers NOT TO providers.

70% of rural PCPs work with a Regional Extension Center.

130,000 PCPs working with local non-profits to change care delivery.

Challenge #1 was around Transitions of Care.

Challenge #2 is a simple thing....

How to get a patient to have an appointment with their doctor after they leave hospital.

But it hides a lot of complexity.

The prize isn't money....

The prize is connection.... to communities that want to implement the solution.

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#CISummit Care Delivery Care Innovation - The discussion

2012-01-26T12:02:00.001-05:00

Care Delivery/Primary Care Innovation Case Study

Moderator: Mohit Kaushal, MD, MBA

Executive Vice President of Business Development and Chief Strategy Officer, West Wireless Health Institute

Christopher Chen, MD

Chief Executive Officer, ChenMed

Frank Ingari

President and Chief Executive Officer, Essence Healthcare

Brian Prestwich, MD

Assistant Professor of Family Medicine, Keck School of Medicine, University of Southern California

Lonny Reisman, MD

Chief Medical Officer, Aetna

David P Kirchhoff

President and Chief Executive Officer, Weight Watchers

2% incentive for Docs is a small number. Small number = small change.

FI: Aggregation to deal with scale. Episodes of care has issues with boundaries of care.

Capitation is the long term solution.

LR: A continuum of solutions for delivery solutions. starting from basic EMR implementation building to full risk management/share.

AETNA doing a lot of consultation that leads to development of payment models that work for the delivery system.

Orientation around the patient is an awakening. The solution to health is not in the doc's office or hospital

FI: The model today is a reactive patient presentment model. We need to flip the model so that the provider is reaching out before the patient presents.

CC: We need a cultural change for doctors. We should expect docs to help innovate.

BP: Risk-based registries are critical to population care. We need time to reflect on patient story and payment options to allow e-consults.

DK: Working with Cleveland Clinic, State of Oregon. We need to move to focus on prevention. eg. for avoiding diabetes. Alignment works. Patient, Payer, Provider

FI: Reducing obesity would have massive ROI for Medicare participants.

LR: Technology is essential but not sufficient. Support and incentives are a critical addition. More collaboration needed to achieve success.

CC: After a heart attack a patient has an average of 11 drugs to take. Put the drugs in their hand don't send them to a pharmacy. This removes one barrier.

BP: We need to help patients do workflow on their own life/health.

BP: The LA Innovation Corridor covers 11M people.

What would you do to help achieve the Triple Aim:

DK: Rewire the system so that incentives align with processes. We need proactive preventive care.

BP: HIT that supports the patient and population view. Dashboards that guide care. Take care of patients well and the risk takes care of itself.

CC: Scaling culture is hard. We need to rewire from transactions to outcomes.

FI: Use Meaningful Use Phase 2 /3 to be more open. Allow information to flow in AND out.

LR: We need to spend more time thinking about Health - Engagement and motivation. Patients don't automatically do what the doctor suggests.

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#CISummit: Frank Ingari - Essence Healthcare / Chris Chen of ChenMed / Brian Prestwich - Keck School of Med USC / Kirchhoff - @WeightWatchers

2012-01-26T11:25:00.001-05:00

10:45am-12:15pm

Panel 1

Care Delivery/Primary Care Innovation Case Study

Moderator: Mohit Kaushal, MD, MBA

Executive Vice President of Business Development and Chief Strategy Officer, West Wireless Health Institute

Christopher Chen, MD

Chief Executive Officer, ChenMed

Frank Ingari

President and Chief Executive Officer, Essence Healthcare

Brian Prestwich, MD

Assistant Professor of Family Medicine, Keck School of Medicine, University of Southern California

Lonny Reisman, MD

Chief Medical Officer, Aetna

David P Kirchhoff

President and Chief Executive Officer, Weight Watchers

Larry Ingari - Essence Healthcare

Reinvented insurer as logistics and evidence provider.

Eliminating acute episodes is not enough.

Medicare Advantage addresses flaws in original plans.

Essence provides data for free to their providers.

timely, accurate with continuous learning.

Detailed performance summaries.

Collaboration on benefit design referral and other policies.

Initiatives are driven by Care Management.

Christopher Chen - ChenMed

Another instance of a family of physicians discovering the experience of a patient.

No one accountable for care/results.

Principles:

1. Invest in patients upfront

focused on moderate to low income senior population (focus on a specific population)

2. Physician Culture - deliver outcomes and not procedures

3. Develop technology to achieve goals.

Design a one stop shop approach for a focused population.

Then you need to get access for the population. They provide transportation to/from the clinic.

Restrict panel size so patients can be seen monthly.

Technology is designed to support the doctor patient relationship.

Brian Prestwich - Keck School of Medicine - University of Southern California

The Greater LA Care Innovation Corridor.

Doctors need time. They need support.

Doctors need information.

The EMR of today is completely inadequate for the family doctor. They need to be connected. They need knowledge from the patient. They need population information for comparison.

Redesigning team-based care.

Redesigning the Physician work day.

Group care works for complex patient issues.

Figure out what you want to do

Fix the care model

Implement technology to support the care model.

Educate the patient to take better care of themselves.

Make it simple to reduce the cognitive workload

David Kirchhoff - Weight Watchers

Obesity is a lifestyle issue.

It is difficult and messy

The NHS in the UK works with Weight Watchers. Doctors can provide vouchers and refer patients to Weight Watchers.

12 Session course on PCP referral. 45 UKL at no cost to patient.

A Cambridge study showed PCP+Weight watchers program is twice as effective. Doctor creates sense of urgency. Weight Watchers delivers program and payer supports.

WW does 45,000 meetings per week globally (20k in USA)

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#CISummit Mohit Kaushal - Care Delivery/Primary Care Innovation Case Study

2012-01-26T10:59:00.001-05:00

10:45am-12:15pm

Panel 1

Care Delivery/Primary Care Innovation Case Study

Moderator: Mohit Kaushal, MD, MBA

Executive Vice President of Business Development and Chief Strategy Officer, West Wireless Health Institute

Christopher Chen, MD

Chief Executive Officer, ChenMed

Frank Ingari

President and Chief Executive Officer, Essence Healthcare

Brian Prestwich, MD

Assistant Professor of Family Medicine, Keck School of Medicine, University of Southern California

Lonny Reisman, MD

Chief Medical Officer, Aetna

David P Kirchhoff

President and Chief Executive Officer, Weight Watchers

Lonny Reisman - AETNA:

Tiered Networks as an emerging standard. Constrained networks (to ACO as most constrained) driving quality improvements.

AETNA is building HIT tools to power ACOs.

Sharing and Interoperability is important. ETNA has acquired Medicity to provide a Health Information Exchange.

Analytics are important.

We need precision of information. We need workflow tools to maximize performance.

AETNA has 3 models:

1. Enhanced Clinical capabilities

2. Population Management

3. White Label Payer

Eliminating co-pays for patients have demonstrated improvements in care. ie. reduce the patients barrier to care.

Free drugs after a heart attack led to only 51% compliance. This indicates that there is far more to be done in caring for the patient.

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#CISummit @aneeshChopra is up with Ignite Talks on prizes and Challenges (@DDDiabetes, @KP JandJ

2012-01-26T10:25:00.001-05:00

Aneesh Chopra: Rousing the crowd. Aneesh has to build on the @Todd_Park mojo.

Innovation will grow new industries and new businesses.

America Competes gives the government new tools to spark breakthrough ideas.

Ignite Talks on Prizes and Challenges

1. Dennis Urbaniak: Sanofi - Diabetes Challenge

Crowdsourcing Health

2012 Data Design Diabetes Innovation Challenge:

1. Crowdsource applications

2. Open Submission

3. Mentorship

4. Demo Day

5. Support

Tweet using @DDDiabetes

2. Johnson & Johnson / Janssen Healthcare

Janssen Connected Care Challenge.

Caring for a person who has been hospitalized is very challenging. Can we develop a tool or system to help people coordinate care.

1 in 3 people discharged don't see their physician inside 30 days.

This is a $15B problem. $12B is preventable!

How do you connect caretakers, medication, therapy, physician, hospital in a coordinated care plan.

The challenge is looking for approaches to improve connected care. Prizes range from $50,000 to $100,000.

www.janssenhealthcareinnovation.com

3. James Albino - White House / Michael Horberg - Kaiser Permanente.

Kaiser Permanente HIV Innovation Challenge

www.kp.org/hivchallenge

KP's systemic approach to HIV treatment leads the nation. mortality rates are much lower than national average. Their approach also eliminates the treatment disparities amongst disadvantaged communities.

KP is largest provider of integrated HIV care in the USA.

Get patients diagnosed, in to care and on a course of treatment leads to better outcomes and productive lives.

Multi-disiplinary care. using the EMR, coordinated treatment.

The challenge: join KP and benefit from their lessons learned. No cost access to the toolkit they have compiled.

Access to mentorship and treatment and care guidelines.

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#CISummit Rick Gilfillan, MD - Director CMS Innovation Center and @Todd_Park

2012-01-26T10:05:00.001-05:00

Rick Gilfillan - Director of CMS Innovation Center with Todd_Park, CTO and Entrepreneur in Residence at Health and Human Services.

The CMS Innovation Center Approach:

Is the Triple Aim possible?

Amongst diabetics: Treatment (insulin and blood strips) = $3600 per year v leg amputation for ulcerated foot = $50,000

A system that is good at providing "care fragments"

The Emergency Room is becoming the only viable place to get care for a growing population.

Achieving the three part aim:

1. Commitment:

2. Innovation

3. Spread the innovations with wide adoptions

Innovation approaches:

Medical Homes

Accountable Care Organizations

Bundled Payments

"No one went to school to provide fragmented, expensive care"

If something CMS Innovation Center tests something that can improve care with positive results then they can promote regulations to aodpt the new payment structures.

This provides the opportunity to move from pay for volume to pay for outcomes.

Multi-Payer Primary Care Practice

Federally Qualified Health Centers Medical Homes

Dual Eligible population: 9M have Medicare and Medicaid coverage.

Pioneer ACOs - 32 contracts to test ACO models reaching 87,000 medicare beneficiaries.

Diffusion and Scale:

- Innovation Advisors

- Million Hearts (could save 1M lives over 5 years)

- Partnership for Patients (focusing on patient safety and care transitions)

The Innovation Challenge: $1B of awards to demonstrate new methods of care.

A large portion of the audience are interested in this challenge which closes on Friday January 27th - Tomorrow!

Data is critical.

Todd Park now talks about how data will get to innovators.

CMS is embracing the power of Data Liberacion.

Data is rocket fuel for innovation

Strategic priority to unleash the power of CMS data to improve health care - while protecting patient privacy..

Blue Button - VA, Medicare beneficiaries can download their own personal health or claims record.

500,000 people have downloaded their data. Adoption is accelerating. This is expanding to private sector organizations.

Robert Wood Johnson have established bluebuttondata.org

Data for ACOs

Medicare Data Sharing for Performance Measurement - these reports will be made available to the general public.

www.healithindicators.gov

These are just the beginning. Improving accessibility and serviceability of data is a core service function for CMS.

There is no problem America can't innovate its way out of - apply the innovation mojo!

Rick Gilfillan: Now is the time to decide - adopt innovation. Change the way we think. It is not abstract. It is a real issue. Doing nothing is making the decision to standstill.

It is not easy. it is difficult. Remember the first rule of medicine: Do no harm.

CMS pledges to be a constructive force in this change.

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#CISummit - Dr. Atul Gawande - How do doctors get good?

2012-01-26T09:32:00.001-05:00

From the Care Innovations Summit:

Dr. Atul Gawande, Surgeon, Writer, Public Health Researcher.

How do Doctors get to be good at what they do?

In last 10 years an ordinary Family has seen a rise in pay of $23k but all but $85/month has gone to paying higher health care costs.

The same has been seen in MA in the education sector. Every penny of increased investment has been diverted to health care for teachers.

Health Care (cost) is destroying the American Dream

in 1937 (pre-penicillin days) Health Care was cheap and ineffective.Hospitalization's major benefit was food and warmth.

Since then we have discovered 13,600 diagnoses and 4,000 surgical procedures and 6,000 medications.

No other industry has to deliver on 13,600 product lines to every person in every community.

Our delivery methods have not significantly changed despite this explosion in diagnosis and treatment.

We trained and rewarded independent cowboys when we want pit crews for patients.

The medical community can't cope on their own. Clinicians are baffled by the cost discussion.

We forget the bell curve of impact and cost. The two curves do not match.
This is a sign of hope. If the curves matched we would be talking about rationing of care. But that is not the case.We need to identify the positive deviants. The most successful behave like systems and not independents.
Data is an under utilized resource in Health Care. Data is the window to answers.

HealthCare today is like driving a car with a speedo that tells what speed we were traveling 4 years ago.

The major illnesses of the 5% highest cost medicare beneficiaries in 2010:

Ischemic Heart failure 32% of all beneficiaries and 68% of high cost beneficiaries.

Airlines and Restaurants use Checklists.
Applying checklists to surgery can make a big impact. Average reduction in deaths was 47%. VA has adopted this approach. leading to 18% reduction in deaths.
Implementing Discoveries:

We have to deal with resistance.
We must change who we train, how we work together and how we get our jobs done.

Values:
1. Humility (we all make mistakes)
2. Discipline (Repeat practice)
3. Teamwork (More knowledge than we can handle alone)

We need to define what great performance and great care looks like and then design the payment system to support that outcome.

We are battling for the soul of American Medicine. The fundamental issue of this century.

In early 1900's Food was 40% of a family budget.
Government provided data. Weather, crop reports, prices etc.
Incentives: eg. Farmer cooperative banks.
Comparative Effectiveness studies. Cost effectiveness studies.

Intending to bend the cost curve they halved the cost within 20 years.

We face the same challenge in Health care today. This is a 20 year journey that starts by setting out to bend the cost curve.

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#CISummit - Marilyn Tavenner Acting Administrator - CMS

2012-01-26T09:04:00.001-05:00

Marilyn Tavenner talking about the work of CMS in support of the Triple Aims and the Innovation Center.

Two years since Affordable Care Act (ACA) went in to law.

ACA addresses:

- Insurance companies

- Higher Quality of Care

- Improved Access to Care

- Innovation

2010:

- Filled in the donut hole

- Created the high risk pool to serve high risk patients with pre-existing conditions.

- Children can't be blocked from coverage due to pre-existing conditions

- Medical Loss Ratio set at 80% (ie. 80% of premiums to go to care spending)

- Free health risk assessments /wellness visits.

By 2011: 22M on medicare have received at least one free service.

here to talk about 2012 and beyond.

In October hospitals will be paid based on quality of care.

- Coordinating care

- Improvements in Technology

- Changes in Delivery Systems

- Public Private Partnerships

Innovation Center:

- More than a dozen initiatives launched.

- Value not Volume and putting the patient at the center.

Don Berwick has been repeatedly acknowledge at Summit events as the master architect of the reengineering of CMS. He has been masterful in shaping the future in an entirely positive manner.

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#CISummit We have to work together to build a Health Economy that is built to last

2012-01-26T08:54:00.001-05:00

Live blogging from the Care Innovations Summit:

The Triple Aim:
- Better Care- Better Health
- Lower Cost

Susan Dentzer - Editor-in-Chief, Health Affairs is MC'ing the day.

Health is not (or should not be) a partisan issue.

Health is not red or blue - it is purple (Go Ravens! :))

Public and Private Sectors need to work hand in hand.

Disclaimer: CMS is not endorsing the West Wireless Institute or the participants at the summit.

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#CISummit Care Innovations Summit kicks off in Washington DC

2012-01-26T08:49:00.001-05:00

Today is the Care Innovations Summit at the Renaissance Grand in Washington DC. The event is organized by the Centers for Medicare and Medicaid Services, West Wireless Health Institute and Health Affairs.

This is a major gathering of Health Innovators.
Don Casey is introducing the day. We are looking forward to an exciting day with a number of fast paced ignite talks.

Gary and Mary West funded the West Wireless Health Institute with $100M to drive medical research.

This event is about "Jailbreaking" healthcare.

There must be a better way:

- How do we transform healthcare to deliver better care and better outcomes
- How do change healthcare
- How do we deliver health care at a price we can afford.

CMS pays for 35% of all US Health Care.

CMS wants to transform health care through innovation. The CMS Innovation Center is at the forefront of this change.

The Triple Aim:
- Better Care- Better Health
- Lower Cost

Start a revolution: Take 1 idea home and IMPLEMENT it!

The Challenge form Don Casey:

- 10 new business cards- 3 New Innovation Ideas

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#CISummit - the wrap-up of the pre-summit networking day.

2012-01-25T16:02:00.001-05:00

Congratulations to the team at Kaiser Permanente that hosted the pre-networking day at the Center for Total Health.

Nancy Taylor - appreciated the orchestration and time to network.

Joe Smith - It is time to jail break health care.

The key to quality improvement is not just a primary care job.

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#CISummit - Policy discussion towards Accountable Care - Payment reform at the heart of change

2012-01-25T15:52:00.001-05:00

Nancy Taylor - VP PUblic Policy and External Relations at the Permanente Federation
Jonathan Blum - Deputy Administrator and Director of CMS

One theme for the day is the need to change CPT Coding and Payment reform. People follow the money and until we pay for health and stop paying for sickness we will not see significant change.

Fee Schedules will remain important while they
72% of people in Medicare use fee for service. This is shrinking as people choose alternative private plans. Encouraging plans to think about wellness and managing care.

Shared Savings program - driven by need to create multiple pathways for people at different stages of development as an Accountable Care Organization (ACO) to participate.

The Pioneer track is created using CMS' innovation authority.

32 Pioneers have signed contracts. They will test different options including payment methodologies, including capitated payment models.

Track 1 has no downside risk for first 3 years.
Track 2 has up and down side risk.
Pioneers - a responsibility to teach the world what works.

Slow change from Fee for Service models.

Moving from Fee For Service needs additional capabilities such as Data Warehousing which is slowing adoption.

CMS has an advanced payment model that helps organizations make the change to alternate risk-based cost models.

Bundled payments and changes to hospital readmission payments will drive push to better care.

Pioneer applicants came from across the country and was not limited to high cost areas.

ACO program is not just about payment changes - but about care improvement. Also want to understand HOW the results were achieved. What works and how that can be incentivized through payment policy.

CMS is trying to understand best practices. Five Star Private Plans will be reviewed for best practice to understand how they achieve their rating and how those practices can be spread to other plans.

CMS has to be based on a shared savings model with re-baselining using processes that work.
Who do the savings belong to: the payer, physician or the patient?

Recent CBO review and report indicated that past CMS tests had mixed results in the area of care coordination. The old traditional model of reporting took too long. This prompted congress to approve a more dynamic process to test, review and disseminate results.
CMS sees a lot of interest in payment reform models. The volume of interest tells them that they must scale up quickly. Projects are based around the notion that they can be scaled.

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#CISummit - Chronic Disease Management

2012-01-25T14:52:00.001-05:00

NudgeRX - Virtual recovery guidance engine for post-op patients.

Being challenged to work further upstream in pre-op readiness.

Targeting 25-35% reduction in 30-90 days.

360Fresh - Addressing unplanned Readmission Rates.

Realtime analysis of medical records. Identify/track at risk patients.

The long tail of the patient population re-admissions.

Real-time review of medical records.

Predict readmissions.

Target at-risk patients for personalized care.

Passionate about transforming medical data in to improved quality of care.

Have analyzed over 25M patient visits.

7 Hills - Home Care

Necessity is the mother of invention. 1 in 10 hospitalizations can be prevented. The majority are medicare patients.

7 Hills does home visits for chronic medicare patients. Screen patients for risks of falls. Significantly reduce costs to medicare.

Falls are a $28B Cost for Medicare.

Struggling to obtain funding.

Prevent calls by increasing mobility. knock on effect on Hypertension and other conditions.

NudgeRx - Health Plans looking at elective surgery and nudging people away from surgery. Surgeons looking at nudging people towards elective surgery.

360Fresh - Business model is as an enterprise solution co-located with EMR platform in hospital systems. Hospitalists provides a dashboard report identifying their high risk patients.

CabinCreek - No show

Biscayne Institute of Health & Living - coordinated Health Care System.

Many physicians don't have resources to become a medical home.

presented by Marie DiCowden

The Advisory Board Company - Crimson Initiative

Danbury Hospital - a progressive hospital when it comes to patient engagement.

Crimson Continuum of Care:

- Physician friendly user interface.

- Severity adjusts in patient data.

- drill down to case level details.

- Time and risk adjusted.

Using Crimson to review and inflect clinical performance and unnecessary utilization.

Driving a Halo Effect across the hospital to affect savings.

The shift in culture to pay for value and away from pay for volume made the adoption of this system an opportunity to get ahead of the curve. It takes real leadership to bring physicians to the table to adopt.

Some doctors at the hospital have used the data to create a clinical center of excellence. The data demonstrated that savings can be achieved while maintaining or increasing the quality of outcomes.

data is based on claims data.

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#CISummit Hurdles to Better Care, Better Health at lower cost discussion

2012-01-25T13:19:00.001-05:00

A lunchtime panel addressing how to overcome the hurdles to achieving Better Care, Better Health at Lower Cost:

- Kelsey Gowin (Special Assistant to Richard J Gifilan, CMS Innovation Center
- Jack Cochran (Executive Director, Permanente Federation)
- Joseph Smith (Chief Medical and Science Officer, The West Wireless Health Institute)

The panel is moderated by Jean-Luc Neptune, Health 2.0.

West Wireless is focused on cost because it threatens our health system. It is an uncomfortable conversation.
Responsibility over cost does not automatically mean rationing. Technology has the opportunity to improve the cost picture. Ample room to do more at lower cost.

CMS - The Three Part aim has an implicit Patient Centric approach.

Health is not isolated. Health is part of a patient's overall life. It impacts their wealth. Over half of all personal bankruptcies are due to medical costs.

No single aim is the most important. We have disparities, shortages, all compounded by a severe recession and an explosion in baby boomers. We have to deal with all the issues - they are inter-related.

Joe Smith - Put health care on the same footing as every other technology-based industry.

In no other industry do you consume the product and after the fact find out what you received and what it cost.

Consumerism is a driving force emerging in Health Care.

CMS is excited by the level of response to challenges and innovation programs.
KP is excited by the move from good to excellent results in conjunction with the transition to Team-based delivery of service.

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#CISummit Bernadette Loftus KP and Patrick Conway CMO at CMS have a fireside chat

2012-01-25T10:47:00.001-05:00

Bernadette Loftus - Be relentless in driving improvement

How to improve quality:

Extract data and present and share it. Set numerical discreet goals.

It is not just a primary care job. The EMR prompts specialists to ensure follow ups happen - even outside their specialty.

Patrick Conway:

Acts as a clinical voice in CMS quality programs.

Set the goals and let people figure out the How.

How do you work on rapid cycle change (90 days)?

BL:

- First believe that you can make change happen.

- Line of sight accountability. Connect owners to action.

PC:

- Remove unnecessary regulation

- Focus on measures that matter to patients and clinicians

- Partnering to work with medicaid, CHIP and the exchanges. Act as a catalyst.

Physician Leadership - what is the role in Quality.

BL: Move the attitude to move the results. Be mindful and systematic.

What does success look like for CMS in 5 years?

The point of the innovation center is to test different models. Don't pre-suppose the answer.

Fostering delivery systems that offer high reliability in their change systems.

Move the vast majority of people in to "Systems of care"

How do you spread innovation?

BL: facilitate the conversation.

Reward the innovation

Innovation is also a process. Create innovation access points. - using Innovation Consultants in medical centers to give people an entry point for change.

Evidence-based medicine:

PC: Evidence should inform coverage decisions.

Cancer Screening approaches:

BL: Screening tests must be deliverable across a mass population.

Forward sweep - Watch for people on planned visits - what tests are they missing.

Clinical Workflow - Do all tests during appointments.

Back sweep - Look at those that missed testing

How can this group of participants help CMS?

PC: - do more of what is being done - faster!

We need to speed up the pace of change. Engage broad collaborations.

Collaborate and innovate.

Share.

Learn from best practice.

Keep in mind:

"What would you do if you knew you couldn't fail?"\

"What is best for the patient?"

How do we embed better care in the community?

- Move from volume to value reimbursement.

- Workforce redesign

Moving from Sick Care to Well Care

KP has moved from a primary care comprehensive testing (multi-phasic) approach to a connected network of physicians that can address their specialties and ensure that there are no gaps in testing and care. Patients can attend an appointment and have multiple specialist encounters in a single visit.

Move Faster:

Testing models quickly. Does it save money and does it scale.

The Next Generation of Patients

How do we educate people to establish their electronic health records and sharing their electronic records with researchers.

We need to develop the capability for shared decision making. Making sure their is real engagement.

What is CMS doing to change how Patients are engaged in the policy discussions?

PC: we need more patient engagement in clinical and policy arenas.

The patient needs to be the decision maker.

KP is putting more emphasis on the voice of the patient.

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#CISummit Mohit Kaushal and Joe Smith from WWHI

2012-01-25T09:26:00.001-05:00

Live blogging from #CISummit.

West Wireless Health Institute - is co-sponsoring the day.
Healthcare costs are rising at rate above every other metric in the US economy.
WWHI is driven to drive down the cost of health care. They are doing this through innovation and commercialization.

WWHI has opened a policy center. Policy can drive change.

"Most smart people work somewhere else" We need to collaborate. There is so much to be done.

Let's get stuff done!

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#CISummit @tedeytan introduces his boss - Jack Cochran for the networking day @kptotalhealth

2012-01-25T09:20:00.001-05:00

I am live blogging from the pre-summit day at the Kaiser Permanente Center For Total Health.

"Our greatest responsibility is to be good ancestors" - This is why we need to change HealthCare.

The USA faces tough challenges and tough choices and health care is a major part of the economy - running around 20% of GDP.

Too many families have had the fabric of their American Dream ripped apart. Health Care impacts both financially and socially.

Quality, safety, accessibility and affordability are still major issues.

The american people want fairness in health. Legislation is not the only answer. We need solutions.

"The role of patient is an involuntary act"

Small victories are not enough. We need to learn from each other. We need to leverage meaningful collaboration.

Take the enthusiasm and energy and use it as a platform to improve dramatically.

People want affordable access to safe care - when they need it.

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Preparing for the Health Care Innovations Summit, Washington DC 25-26/1/2012

2012-01-25T07:36:00.001-05:00

Tomorrow is the Health Care Innovations Summit in Washington, DC. The event is organized by the Centers for Medicare & Medicaid Services (CMS), West Wireless Health Institute and and Health Affairs. THe summit itself on January 26th is over subscribed and there is a packed agenda. Fortunately Kaiser Permanente is lending a hand and helping to make the day more productive for attendees. Today, Wednesday January 25th, Kaiser Permenanente's Center for Total Health is hosting a pre-event networking day and tomorrow the center hosts a viewing party for people that can't get to the Summit event at the Renaissance Hotel. You can still register for the viewing party here:

http://summitviewingliveatkp.eventbrite.com

Today I am working with Danielle Cass and Ted Eytan to facilitate the networking day. It is set to be both fun and informative. The objective of the day is to turbo charge the summit experience for participants, helping them to connect with others of like mind and to share innovation ideas. There are also some fascinating discussions organized throughout the day.

For those of you that watch my tweets, I know I have been lying low for a few weeks. But over the next few days I will be live tweeting and blogging from the summit - so watch out for a stream of blogs and tweets.

The reason for me lying low is that I have been working with Community Education Group (CEG) in Washington DC to help them submit a proposal for a CMS Health Innovation Award. CEG is a leader in HIV Education and Support and for 18 years has focused outreach to the disadvantaged communities in Washington DC. This has involved bringing together some amazing partners to implement an innovative community-based medical home for patients in disadvantaged communities living with life long chronic conditions. There will be more to come on this subject, including some exciting partnerships with some great organizations.

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Students demonstrate innovative iPad book page flip | TUAW - The Unofficial Apple Weblog

2012-01-24T10:30:00.001-05:00

One major complaint about reading an eBook is the experience; holding an iPad is just not the same as holding a book and thumbing through the pages. This complaint may lose some of its weight if the folks at the KAIST Institute of Information Technology Convergence can get their patented Smart E-Book Interface Prototype out of the lab and into the wild.
The interface uses the private Apple API for the page flip and turns it upside down and inside out. Not only do you get a beautiful page flip like the one in iBooks, you also get page flipping that lets you scan 20 or 30 pages at a time, multiple page flips that are controlled by the speed of your finger swipe, and a way to hold your thumb on one page and flip through the book with your fingers. You can see it in action in the video below to marvel at how the interface mimics the way most people flip the pages of a softcover book.
[Via Macgasm]

22 8 0 3

View Tags

Source:

via tuaw.com

Very cool animation.

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#ReginaHolliday asked me where my Walking Gallery Jacket has been...

2012-01-18T11:31:00.001-05:00

In May of this year Regina Holliday painted my favorite leather jacket. Since then my Jacket has been well travelled... Regina asked where it had been. So let's try to put together a list. Here goes....

May 2011:

@reginaholliday artwork hanging at Nottingham Contemporary #hcdc #thewalkinggallery

The WallaceSpace at St.Pancras, London for a UK mHealth brainstorming day

June 2011:

Washington DC Health Innovation Week, June 2011

The Press Conference at the Kaiser Permanente Center For Total Health

The Walking Gallery

HealthCampDC

Health Data Palooza at the National Institutes of Health

Washington DC Health 2.0 Developer Challenge

Health Informatics Pulse in Washington DC

Baltimore Wordpress Meetup

July 2011:

Washington DC Quantified Self Meetup

HealthCamp Florida

MoDevDC Meetup

MobiHealth DC Meetup

August 2011:

Health2STAT in Washington DC

Edelman Meetup in NYC

September 2011:

SocialHealth meetup in NYC

Putting the I in HealthIT ONC event in Washington DC

#DCTech Meetup

#SXSH in Philadelphia

EPatient Connections in Philadelphia

HealthCamPSFBAY

Health 2.0 Developers Challenge, San Francisco

Patients 2.0

In the making of the Rainbow Button Initiative Rap Video

Health 2.0 including being on stage with the ONC team

And being painted in to the Health 2.0 mural by @Lygeia Ricciardi

October 2011:

Ignite Baltimore

University of Maryland - Fall 2011 Health IT Research Summit

HealthCamp Oregon

Baltimore Tech Breakfast (multiple times over the course of the year)

Putting the IT in Transitions at ONC Session at KPCTH

#73Cents session at Kaiser Permanente Center For Total Health

TedXPennQuarter

MobiHealthDC

November 2011:

HealthCa.mp/LA

Presenting RainbowButton at Baltimore Tech Breakfast

Health2STAT impromptu Rainbow Button presentation

SocialChocolate at #KPCTH in Washington DC

December 2011:

mHealth Summit in Washington National Harbor

Baltimore Tech Breakfast

Yes, it has been a busy year and I am sure I have forgotten a few of the places where I have worn my RainbowButton HealthCamp jacket with pride.

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viktor hertz: honest logos

2012-01-08T15:25:00.001-05:00

via designboom.com

Excellent interpretation of Corporate Logos and images to tell the story behind the logo. Enjoy...

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Off to practice on the backside @skilibertymtn

2012-01-06T15:38:00.001-05:00

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Google+ Is Going To Mess Up The Internet

2012-01-04T23:36:00.001-05:00

I am fed up with Google+ on Mac OS X. If I try to assign someone following me to a circle I get the error that I have reached my daily limit. This is even if I haven't assigned anyone to a circle in days or even weeks. Adding to circles doesn't work on Mac Desktop browsers. It has rarely if ever worked, all they have done is change the error message.
If I can't assign people to a circle what use are circles? And without the ability to post to Google+ from other sites Google+ is an isolated island.

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via readwriteweb.com

From the ReadWrite Web Article: Google+ Is Going To Mess Up The Internet by Jon Mitchell http://www.readwriteweb.com/archives/google_is_going_to_mess_up_the_internet.php

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Seniors and health IT: A match made to avoid heaven! - All Things HIT

2012-01-04T09:32:00.001-05:00

Dec 30 2011 6:46PM GMT

Seniors and health IT: A match made to avoid heaven!

Posted by: Patrick Howard
Senior care, telemedicine, eRx, Senior Citizens League, Cost of care
Last week I wrote a ceremonious, empathetic, “Christmassy” blog about being reminded how effective ”no tech” methods can be in achieving better medical outcomes, increasing medication compliance, and so on and so forth. Well after reviewing the results of a most recent study by the Senior Citizens League, one of the largest nonpartisan seniors advocacy groups in the USA, based in Alexandria, Virginia, I’m back on the health IT soapbox.

The study reviewed how the financial concerns of senior citizens affect their behavior when it comes to visiting the physician’s office, taking their medications and approaching their end of life care. The study surveyed 1200 seniors and revealed the following:

50% of respondents postponed filling prescriptions

61% postponed visits to dentists, opticians, or hearing specialists

44% postponed filling prescriptions or chose to take a lower dosage than prescribed

44% are spending at least $300 per month on medical expenses

10% are spending at least $750 per month

I admit, the results weren’t that surprising. Anytime a person has less money and/or no health insurance, they will put off visiting the doctor, dentist, and even not-comply with their medication. What was astounding to me, however, was the metrics’s large percentages and the high out-of-pocket monthly cost (points four and five above). After reviewing the results, I couldn’t help but think about solutions that, not surprisingly, were in the health IT realm! How can e-prescribing systems with a generic pricing default reduce the cost of the prescription? How can a clinical decision support systems be used for prevention, possibly eliminating that office visit and/or prescription?  I thought about how we can use telehealth appointments, in lieu of physical office visits, and hence increasing visit compliance, as this would reduce their costs and is more convenient, especially for those in rural communities.  Seniors wouldn’t have to get dressed, get driven, and spend valuable gas dollars visiting the doctor office.

While I know this is utopian, our seniors definitely deserve these impactful technologies, especially towards the end of life.  The costs associated with care and the mere inconvenience of an office visit during the time when a person is the least mobile seems inhumane when these barrier-breaking technologies exist. Although there are some “no tech” solutions that could address theses concerns, such as lowering prices, this seem less likely than implementing the technologies. Yes, health care IT and seniors can truly be a match made to avoid heaven.
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via searchhealthit.techtarget.com

Seniors are not as averse to technology as we often believe. They are connecting with their grandkids on Facebook and using technology to stay in touch with family. This is something that kids and grandkids can encourage. Using technology with them can help them become comfortable with using that same technology to help maintain their health.

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Off to practice....

2011-12-30T08:44:00.001-05:00

Then taking my first children's session of the season at Ski Liberty

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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A big crowd for Baltimore #TechBreakfast @ETC in Canton

2011-12-28T09:22:00.001-05:00

This morning is the Baltimore Tech Breakfast at the Emerging Technology Center in Canton - Baltimore, MD.

We have a packed house for the Show and Tell.

The morning kicks off with a fellow Ski Instructor and developer, Shea Frederick, talking about:

Baltimore Open Data

Using the Socrata Open Data API - http://data.baltimorecity.gov. A couple of hundred datasets are available.

Examples of data sets:

- Employee Salaries

- Parking Citations

- Liquor Licenses

- Crime Reports

- Property Taxes

Files and Documents:

- Building Footprints

- Neighborhood Outlines

- Flood planes

- Street Centerlines

- Vacant Properties

The data api allows simple searches:

http://data.baltimorecity.gov/api

XML and JSON data is returned.

Get an API Key by registering. This allows access to complex searches.

The update frequency of the data depends on the datasets.

The City is receptive to suggestions for new data sets to add.

XML Fat - Content Management System

Matt Sax - Info AT XMLFAT {dot} com

http://www.xmlfat.com

A web-based XML-based Content Management System.

Target cost is less than $100/year.

- Data can be kept where you want it.

- Reformat to XML and re-format to present it.

uses. csv, xml or json as data sources.

No custom API needed for development.

Shared Code Repository. Developers of code and modules can be released as needed.

Very simple and powerful interface. The example of a calendar module uses a simple javascript variable to display a calendar. The system can reference widgets available on the Internet.

The CMS system can be extended via an API.

The target audience is web developers that understand javascript.

Primary engine is in C, originally in Perl. The CMS can run standalone as well as web-based.

Solar System Express

Vertically integrated hardware and software company focused on "New Space" which includes companies like Virgin Galactic.

Hardware and software solutions.

High performance development board.

They are developing a high performance Space Suit for use in Space Diving.

General Discussion Portion of the event - How are you promoting your business

ParkingPanda.com - the "AirBnB of parking"

LocalUP -EatBMore.com

- Flyers

- SEO

- Press - is free and creates recognition.

- Marketing people follow Press/Journalists on Twitter. Re-tweet them.

Gus Sentementes gets a shout out as a great local tech journalist.

Write a great pitch document for journalists to use.

Tech Cocktail is a great contact..

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The One Resolution You Need To Make In 2012 | Fast Company

2011-12-14T00:57:00.001-05:00

As the New Year approaches, many of us are thinking about our resolutions. What will we vow to do this coming year to be better--both at what we do for a living, and as members of the human race?
There’s only one resolution you need to make and keep. Do this one thing and you’ll be good to go for the year: Do what you say you are going to do, otherwise known as accountability. This one resolution can have any number of permutations:
If you say you are going to call, call.
Promise to send someone information? Send it.
Finish a job when you promised--or earlier--with quality work.
Let people know as soon as you can when you are running late for a meeting or won’t make it at all.
And, my personal favorite, make good on the promise "Let’s get together sometime." Make a note on your calendar in the near future to set something up. Or don’t say it at all.
Every goal begins with your own accountability, whether it is business success, losing weight, developing your personal brand--whatever your goals may be this coming year.
Start now. This very second. You’ll be ahead of most of the world, long before their hangovers have worn off on January 1, 2012.
Happy New Year!
Dayna Steele is a marketing strategist, success speaker and the author of the forthcoming book 101 Ways to Rock Your World: Everyday Activities for Success Every Day! Follow her on Twitter @daynasteele. Her resolution in 2012 is to break 100 on the front nine.
[Image: Flickr user C.M.]

via fastcompany.com

I will endeavor to follow up in 2012.....

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Seven Reasons to be Thankful for Health Reform this Holiday Season | The Health Care Blog

2011-12-13T21:45:00.001-05:00

dennis byron says:

December 12, 2011 at 2:04 pm

This post is inaccurate and/or misleading as it relates to Medicare so I would be careful with other “facts” cited. The editorial says:

“If you are 65 or older — (and eligible for Medicare) — seniors who are enrolled in Medicare Advantage plans (that’s Part C or the managed care part of Medicare) may have seen their premiums reduced this year. Some may even have access to ZERO premium health plans. Seniors also now receive free preventive treatments and a rebate of $500 if their drug coverage hits the “donut hole” in 2011.”

1. Everyone 65 or over — and some people under 65 — are “eligible” for Medicare. For almost everyone, Part A is free and Part B is $100 per month. The rare exceptions are:
– for Part A if you did not work enough SSA hours, it is not free (but you are still eligible to buy it)
– for Part B if you make over $85,000 a year your premiums go up

2. Many people on Parts B and D — not just some on Part C — saw their premiums decrease for 2012. And some saw them increase. ZERO-premium Part C plans have been around for years. None of the raises or decreases had any thing to do wth the 2010 Patient Protection and Affordable Care Act

3. There is no $500 rebate if your drug costs hit the donut hole in 2011 (or 2012). There are 50% discounts on expensive brandname drugs and much smaller discounts on generic drugs if you fall into the donut hole.

Reply

via thehealthcareblog.com

Too many people don't understand the benefits that are already accruing to people as a result of the Affordable Care Act. Most people think change doesn't come until 2014 but the removal of spending caps, access to pre-existing condition plans and the extension of coverage to kids up to age 26 have all made a difference for a growing number of people.

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Do we need to Search for a new Twitter power client? Tweetdeck downgrade has come to Mac App Store

2011-12-13T10:59:00.001-05:00

Earlier this year Twitter advised developers to stop building Twitter Clients. Since then Twitter entered in to a must-win battle with UberSocial for Tweetdeck and successfully acquired the premier professional Twitter client. I use it everyday on my Mac and iPhone. It is, or was a great twitter client.

In the past couple of weeks Twitter has released their new UI on the world and have also released a new Tweetdeck to the Mac App Store. The New Tweetdeck is a complete new product. It jettisons the AIR platform and implements a new UI where the only similarity with the old Tweetdeck seems to be the color scheme.

The new Mac Tweetdeck seems to require extra clicks to do anything. You can't scroll across multiple columns one at a time. They scroll in screenfuls. Try to direct message someone and you get a text box saying "Message twitterhandle" When you start typing the text disappears and you enter a larger text box with no nlue as to who you are direct messaging. If you get distracted by a phone call and come back to Tweetdeck you have no clue who you are responding to.

IT also looks like you can no longer link Tweetdeck to your LinkedIn account.

Translation - Gone.

Column filtering - Gone.

My advice is stick with the current AIR-based iteration of Tweetdeck. The new app makes a mockery of the Tweetdeck name. Twitter may not want people building new Twitter Clients but there is a significant "Professional" base of users that need more than a standard Twitter client and if Twitter is going to cripple Tweetdeck there is going to be a number of those pro users, myself included that will be looking for a cross-platform Professional Grade Twitter Client.

There are still Twitter clients out there like:

- Echofon

- Janetter

- Bottlenose

What is your favorite Twitter client that offers a similar multi-column format like Tweetdeck?

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Obamacare to the Rescue | The Health Care Blog

2011-12-11T18:45:00.001-05:00

By Spike Dolomite Ward

I want to apologize to President Obama. But first, some background.

I found out three weeks ago I have cancer. I’m 49 years old, have been married for almost 20 years and have two kids. My husband has his own small computer business, and I run a small nonprofit in the San Fernando Valley. I am also an artist. Money is tight, and we don’t spend it frivolously. We’re just ordinary, middle-class people, making an honest living, raising great kids and participating in our community, the kids’ schools and church.

We’re good people, and we work hard. But we haven’t been able to afford health insurance for more than two years. And now I have third-stage breast cancer and am facing months of expensive treatment.

To understand how such a thing could happen to a family like ours, I need to take you back nine years to when my husband got laid off from the entertainment company where he’d worked for 10 years. Until then, we had been insured through his work, with a first-rate plan. After he got laid off, we got to keep that health insurance for 18 months through COBRA, by paying $1,300 a month, which was a huge burden on an unemployed father and his family.

By the time the COBRA ran out, my husband had decided to go into business for himself, so we had to purchase our own insurance. That was fine for a while. Every year his business grew. But insurance premiums were steadily rising too. More than once, we switched carriers for a lower rate, only to have them raise rates significantly after a few months.

With the recession, both of our businesses took a huge hit — my husband’s income was cut in half, and the foundations that had supported my small nonprofit were going through their own tough times. We had to start using a home equity line of credit to pay for our health insurance premiums (which by that point cost as much as our monthly mortgage). When the bank capped our home equity line, we were forced to cash in my husband’s IRA. The time finally came when we had to make a choice between paying our mortgage or paying for health insurance. We chose to keep our house. We made a nerve-racking gamble, and we lost.

Not having insurance amplifies cancer stress. After the diagnosis, instead of focusing all of my energy on getting well, I was panicked about how we were going to pay for everything. I felt guilty and embarrassed about not being insured. When I went to the diagnostic center to pick up my first reports, I was sent to the financial department, where a woman sat me down to talk about resources for “cash patients” (a polite way of saying “uninsured”).

“I’m not a deadbeat,” I blurted out. “I’m a good person. I have two kids and a house!” The clerk was sympathetic, telling me how even though she worked in the healthcare field, she could barely afford insurance herself.

Although there have been a few people who judged us harshly, most people have been understanding about how this could happen to us. That’s given me the courage to “out” myself and my family in hopes that it will educate people who are still lucky enough to have health insurance and view people like my family as irresponsible. We’re not. What I want people to understand is that, if this could happen to us, it could happen to anybody.

If you are fortunate enough to still be employed and have insurance through your employers, you may feel insulated from the sufferings of people like me right now. But things can change abruptly. If you still have a good job with insurance, that doesn’t mean that you’re better than me, more deserving than me or smarter than me. It just means that you are luckier. And access to healthcare shouldn’t depend on luck.

Fortunately for me, I’ve been saved by the federal government’s Pre-existing Condition Insurance Plan, something I had never heard of before needing it. It’s part of President Obama’s healthcare plan, one of the things that has already kicked in, and it guarantees access to insurance for U.S. citizens with preexisting conditions who have been uninsured for at least six months. The application was short, the premiums are affordable, and I have found the people who work in the administration office to be quite compassionate (nothing like the people I have dealt with over the years at other insurance companies.) It’s not perfect, of course, and it still leaves many people in need out in the cold. But it’s a start, and for me it’s been a lifesaver — perhaps literally.

Which brings me to my apology. I was pretty mad at Obama before I learned about this new insurance plan. I had changed my registration from Democrat to Independent, and I had blacked out the top of the “h” on my Obama bumper sticker, so that it read, “Got nope” instead of “got hope.” I felt like he had let down the struggling middle class. My son and I had campaigned for him, but since he took office, we felt he had let us down.

So this is my public apology. I’m sorry I didn’t do enough of my own research to find out what promises the president has made good on. I’m sorry I didn’t realize that he really has stood up for me and my family, and for so many others like us. I’m getting a new bumper sticker to cover the one that says “Got nope.” It will say “ObamaCares.”

Spike Dolomite Ward is the founder and executive director of Arts in Education Aid Council, a nonprofit organization that is restoring the arts to public schools in the San Fernando Valley. This piece originally appeared in the L.A. Times.

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Filed Under: THCB, The Insider's Guide To Health Care
Tagged: Cancer Treatment, COBRA, health insurance premiums, Health Reform, Pre-existing Condition Insurance Plan Dec 8, 2011

via thehealthcareblog.com

This is just one example of the provisions in the Affordable Care Act that are set to make dramatic change for the everyday consumer - leveling the playing field in health care.

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It is the middle class that create jobs through Customer Demand… Trickledown economic ain't working #OWS

2011-12-10T14:17:00.001-05:00

There seem to be a number of stories bubbling up to refute the "Tax Cuts for the rich to create jobs" mantra we hear in congress every day.

The logic seems undeniable. When the 99% benefit through more disposable income demand in the economy grows and this creates job opportunities and companies grow to meet the demand. Companies do not invest in jobs if there is no demand to be met. The growth of the last couple of decades has been fueled by the middle classes using their disposable income. In many cases they engineered disposable income by cashing out on their house values which now leaves us with the debt overhang and underwater mortgages.

See the Business Insider article: Finally, A Rich American Destroys The Fiction That Rich People Create Jobs

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The grand central apple store is just simply amazing!

2011-12-09T18:10:00.001-05:00

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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Article: Official Google Mobile Blog: Google Currents is hot off the press

2011-12-09T09:25:00.001-05:00

Google Currents is above app. The ability to share is great but I am not sure about some design choices in the UI. You have to flip sideways to move from page to page in an article. This probably takes a design cue from traditional magazines but on an iPhone it means a constant flipping from page to page when the natural tendency is to want to scroll down the page with a flick of the finger.

I have also been comparing Currents to Flipboard. Flipboard's interface is simply gorgeous with delicate touches such as the page flapping that very simply suggests that you can flip the page up or down without cluttering valuable screen real estate with UI controls.

If you haven't tried it yet give Flipboard a spin.

Official Google Mobile Blog: Google Currents is hot off the press
http://googlemobile.blogspot.com/2011/12/google-currents-is-hot-off-press.html?m=1

(Sent from Flipboard)

Mark Scrimshire

B: http://ekive.blogspot.com

....Sent from my iPhone

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GigaOM: If you want to get consumerization right, get emotional

2011-12-09T08:48:00.001-05:00

Google has launched Currents, a Pinboard competitor. Here is one article that is worth reading. If you want to help your employees be productive then get passionate and embrace consumer technology.

This is a message that the healthcare industry should take to heart for both employees and customers.

If you want to get consumerization right, get emotional

If there’s one thing Claudia Kotcha will tell you about building apps that employees want to use, it’s to think about your employees really want. Kotc...

Source: http://goo.gl/mag/COi7b

Shared via Google Currents

Mark Scrimshire

B: http://ekive.blogspot.com

....Sent from my iPhone

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UP from Jawbone - Design flaw preventing charging?

2011-12-08T11:37:00.001-05:00

I recently received an UP from Jawbone. It is a neat device. However, I don't think it beats the simplicity and convenience of the FitBit.

I like the reminder vibration you can program in to the UP. However, I have found problems getting the UP to sync with the iPhone app. It repeatedly comes up with SYNC Failed.

After a week of use the UP needed charging. This means you need to use the provided USB cable that connects to the UP. So I got the cable out and attached it to my MacBook and left it to charge. After an hour. No change in the charge level of the App. You have to plug it in to your iPhone and sync in order to find the charge level.

I tried moving the USB Cable to another machine and left it to charge for 3 hours. No change. Hmmmm.

So I went on line. It seems I am not alone. There are a number of people with UP Charging issues.

I think I have found a reason.

I put the UP and the USB charging cable back on to my laptop and I was looking at the UP. There were no lights to indicate it was charging. so with my laptop on my lap I had the UP dangling. I pulled on the UP so that instead of being a circle it resembled more of a spiral. When the pressure was applied to put the UP in to a spiral shape the charging "flower" started glowing. I put my iphone on the UP so that it applied pressure to force the spiral shape and after 20 minutes I removed the UP and attached it to the iPhone and tried a sync. The normal sync failed but by going to change the activity alarm and then syncing I was able to get it to sync and it therefore told me the charging level upon completion of the sync.

Yes, by applying pressure to the UP to make it a spiral shape the device would charge. You see the flower glowing as it charges.

Applying the same pressuring strategy when syncing with the iPhone through the headphone socket does not appear to make a difference.

It looks like the people that are experiencing issues with UP charging that there is a design or assembly issue. There must be a loose internal connection. One that only works when the band is put under pressure in a spiral shape.

It looks like UP may need to recall the initial batch of devices and reissue with a revised design that is more reliable,

To finally address some of the questions I have seen form people diagnosing the charging problem. I wear the UP with the end up on top of my wrist. I have not lost the cap (many people apparently do lose the cap - it is easy to displace when you are charging the UP.

If you are having trouble charging the UP try an experiment and connect the UP to the charging cable and apply some pressure s that the UP forms a spiral . Let me know if you see the flower light up and start glowing as it charges. I find that putting my iphone in to the spiral applies sufficient pressure to keep the spiral shape and allow charging to happen.

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#MHS11 Wil Yu (@HlthInnovation) introduces Qualcomm CEO for last keynote

2011-12-07T10:15:00.001-05:00

This is a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

This is a live blog post, as such the notes are made in real time and posted with minimal editing. I am sharing these via Facebook, Twitter and my blog to help others get a snapshot of the activities at the conference. You can follow the tweet stream at #MHS11 or follow the mHealth Summit's twitter account @mhealthsummit.

Wil Yu (@HlthInnovation)introduces the last Keynote of #MHS11

Wednesday, December 7, 2011

9:30–10:00 AM — Morning Keynote

	Paul E. Jacobs, Ph.D. Chairman of the Board and CEO Qualcomm

	Sangita Reddy Executive Director, Operations Apollo Hospitals Group

Paul Jacobs:

More people use cell phones than toothbrushes (5.6B)

Smartphones out shipped PCs.

Next year the installed base of mobile phones will surpass PCs.

Mobile broadband has passed fixed broadband in 2010.

Consumers expect the amazing in mobile.

Mobile will see more lightweight instant on devices. The weight of accessories will also drop.

The Internet of Things - Everything will be connected - and it will be wireless.

The phone will be the personal mediator for the internet of things.

Chronic Disease is a critical issue. 300M chronic disease sufferers in North America and Europe.

By 2020 160M americans will be remotely monitored for a chronic disease

88% of physicians want patients to be able to self monitor at home.

Wireless enabled CRTs and ICDs halve mortality rate in clinical trials of 100,000 patients.

Qualcomm have announced QualcommLife and the 2Net platform.

$100M investment in wireless health.

Telcare, Alivecor, Duofertility, sotera, worksmartlabs.

We are entering the era of connected health. We need open connected health and not a bunch of walled gardens.

Next up....

Sangita Reddy

Giving thanks to those propelling change in health care.

We are now at base camp in the use of technology.

In India there are 870M mobile users.

Apollo Hospitals Group - a transformation of the organization that looks at the circle of life.

"India - Islands of excellence in an ocean of inadequacy."

Innovation is the key - Quality, Accessibility and Equity.

The hospital is the last stop and not the first. ie. preventative care.

Perfect timing for mHealth. Wireless Carriers are interested and engaged. "Two birds with one phone"

"Are we there Yet?"

Pricing model - one of most powerful levers for behavior change.

Complex stakeholder matrix - cooperate and not compete.

Lack of integrated services. Multiple Chronic diseases are common. We can't silo care.

How do we incentivize the doctor for change.

Biology - Bytes and Bandwidth. The 3 Bs of Change

Are we ready for 24x7 Ubiquitous Health Care.

mhealth deliver care and information to the point of action.

Bricks and Mortar and mHealth is not an absolute choice. Just like retail we need brick and click health care

The Health Ecosystem - Each of us will not be a passive recipient but rather an active partner

Directproject.org gets a shout out and BlueButton will be used by Apollo.

((tag: mHealth, mHealth Summit, Mobile))

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#MHS11 Day 3 - Discussion group - Diet and Physical activity

2011-12-07T09:12:00.001-05:00

a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

This is the last day of the conference. It is wet and dreary in Washington but the discussions are buzzing.

Great discussion around Diet and Physical Activity.

How can researchers get data.

Can we create a BlueButton file for Fitbit. Then add it to RainbowButton.com and allow researchers to have data donated to them.

Motivation - we need to think about design.

How do we engage the 85% that are not motivated - to engage in healthier practices.

Inter-disciplinary studies. We need usability, visualization, health promotion, User Experience etc.

I heard a plea for HealthCamp. Involve people from across disciplines in conferences. We have done that for three years with HealthCamp.

Create a database of measurement tools. Identify which are validated products and tools.

Just gave my mantra of:

"Health may be private, Exercise is solitary but wellness is social."

Two year olds can unlock an iphone and find their favorite videos or games - how do we harness that for wellness.

Food fights - socially healthy eating games.

Challenge your own assumptions about Obesity. All the motivation in the world will not make a difference if the options are not there.

Don't just think about the individual - think about their social networks. Look at the community. Look at policy.

Per Carol Torgan - @ctorgan - there is a national physical activity plan

Research mapping Seattle points to no linkage between food desserts and dietary intake.

Okay - yes I did pitch for HealthCa.mp as a venue for the brainstorming sessions that were suggested.

((tag: mHealth, mHealth Summit, Mobile))

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#mhs11 FDA regulations around medical devices and apps mHealth regulatory coalition recommendations

2011-12-06T16:33:00.001-05:00

Notes from mhealth summit.
Today if you connect to a medical device you are a medical device.
Now everything is connected.
Medical device data is:
Storage,
Conversion, transfer,
Display.
Not:
Active patient monitoring
Device control
Modify
Analyze
Mobile medical apps guidelines. Three tier pyramid.
1. Connects to a medical device
2. Transforms the mobile device I'm to a medical device
3. algorithm that output a patient specific result
It is not:
Medical text books
Providing clinicians with training
General health and wellness apps
Automate general office operations
Generic aids eg. Word processor
Electronic health records

Manage weight = wellness
Manage obesity = disease
Latter is medical device
The middle group that is undetermined:
- automate common medical knowledge
- self manage their disease
- automate common clinicians diagnostic ad treatment tasks
The mHealth regulatory coalition proposes changes to FDA proposed rules for mobile medical apps.
This is what FDA proposed:
Type A - aid in the use of parent device. Class 1 device
Type B - extends intended use - same level as parent device
type C - created a new intended use - bass on new risk.
Framework needed more clarity
Near term solution:
Type A - general purpose - unregulated Type B- not reasonably expected to directly affect safety and effectiveness - class 1
Type C - changes fundamental intended use- based on new risk
Type D - regulated products that are not toe a-c. Same as connected device.
We need new classification regulations. Need to clearly define categories.
Propose software modularization - use standard desin principles to create functional independence and reduce inherent risk of discrete modules.
Other agencies like FAA have embraced modularization for regulatory purposes.
Consider evolution of technology. Redefine fda's original manufacturer definition:
1. Mobile medical app manufacturer
2. Mobile platform manufacturer
In 1. The distributor is excluded. Eg. ITunes apps store.
In 2. Component manufacturers are excluded. Their platform is produced with no intended use.
Alternative:
Medical device manufacturers are exactly that.
Don't regulate distributor and component manufacturer categories.
MRC suggests: 1. Promoting investment and innovation
2. Clarify scope of FDA jurisdiction
3. Recognize current approach is an intrusion on the practice of medicine.
4. Recognize global nature and harmonization of regulation
5. Create an mHealth division in CDRH
6. Define regulatory state of EHR and HIE. 7. Consider CDS software software separately (clinical decision support)
Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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#mhs11 raj shah CEO of CTIS

2011-12-06T15:49:00.001-05:00

Raj is managing chronic care through mobile.

100M Americans have 1 chronic disease.
MHealth value proposition: comfort, clinical, collaborative, convenience.

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

Posted via email from ekivemark: pre-blogspot

#MHS11 Open Standards for mHealth Interoperability in Severely Resource-Constrained Environments

2011-12-06T15:23:00.001-05:00

This is a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

Session 5

2:15–3:15 PM

Open Standards for mHealth Interoperability in Severely Resource-Constrained Environments
Many of the world’s funders of mHealth programs are interested in seeing international standards adopted by tools providers in order to expand the reach of programs they are currently supporting. To identify and decide on the appropriate standards is one of the key focus areas for the funders and implementers of national scale mHealth deployments. NetHope is undertaking a study for PEPFAR on this topic and they are interested in using the findings to initiate a broader discussion with industry stakeholders. Preliminary documentation will be published on HealthUnbound.org for review prior to this panel discussion.

Moderator
Fredrik Winsnes Healthcare Working Group Lead NetHope	Alice Borrelli Director Intel	Michael Gehron PEPFAR HIS Coordinator Deapartment of State	Jonathan Jackson CEO Dimagi, Inc.	Derek Ritz Principal ecGroup Inc.

Good News / Bad News.

- Good: Projects are proliferating

- Bad: Projects do not interoperate

Discussion group on mhealth alliance web site. This session is to start a discussion.

NetHope doing a study for Department of State in the use of open standards.

Michael Gehron:

mHealth Apps are like piles of bottles of water rather than a reservoir

Info systems are developed as part of wider initiatives

Assistance is provided in an emergency setting that over rides long term needs.

Derek Ritz:

Deliverable: A design Specification onhow selected interoperability standards may be adopted.

NO NEW STANDARDS!

Leverage and extend artefacts from MNCH Framework and active projects.

Use Case Story defined business need. Processes were defined using UML.

Use cases based on maternity community care event in Africa - A real requirement from an active project.

Check out HUB on mHealth Alliance. Provide feedback to design team.

Jonathan Jackson:

Dimagi founded in 2002 at Harvard and MIT Media Lab. An Open Source software company.

Co-Developed national medical record system for Zambia Smartcare.

Co-founded: OpenROsa and JavaRosa, RapidSMS, CommCare, Coded in Country Initiative.

Tend to integrate more than interoperate.

See little demand for plug and play interoperability.

Little capacity to consume interoperability standards.

Better to focus on open and available data than standards

But... they still think standards are great.

Contracts should demand vendors provide one-click download of data.

Facebook and Twitter do not follow standards but they are massively consumed.

Alice Borrelli:

Personal Connected Health

www.continuaalliance.org

244 companies that have developed and adopted inter connected devices/systems.

40+ products certified.

Established 5 years ago and now starting to see solutions hit the market.

Personal Connected Healthcare can:

- reduce mortality: 35-56%

- hospitalization: -47%

- 6 day reduction in hospital stays

- 40-64% reduction in physician time performing checks.

Continua does not create standards.Depend on standards bodies to do so.

[This seems to be an odd statement since they are developing a standard for interoperability with EHR platforms.]

Singapore and Japan are adopting Continua as requirement for devices interoperating with national health record platforms.

Special pricing for non-profits and emerging market companies.

Generic interoperability can lead to us missing the problem. Trade-off between functionality and interoperability.

Confusion between interoperability and the ability for applications to work together. e.g. Google Maps, Twitter, Facebook APIs.

Point to Point strategies perish with scale.

Did this panel really address the issue of "Severely-resource constrained environments"

We need to make sure standards are Open and light weight. If not this will limit adoption in end user devices and increase their cost.

Simple, Lightweight, Open. That will make easy adoption. Simple on the Internet wins.

1 in 10 medical procedures result in an error that is medically adverse. Standards help us drive towards the levels seen in Aerospace and other high reliability industries.

((tag: mHealth, mHealth Summit, Mobile))

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#MHS11 Basic Building Blocks of mHealth - Role of Patient Education and Monitoring of their medical compliance

2011-12-06T14:20:00.001-05:00

This is a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

Day 2:

As patients better understand the use of applications for remote monitoring technologies, adoption of these applications may increase, bringing with it an increase in compliance. This panel discussion explores patient education in remote monitoring technologies, including education of specific disease states and how data is gathered and used.

Tuesday, December 6th
	11:15 AM–12:15 PM

Moderator

Michael O'Neil

Founder & CEO
GetWellNetwork

John de Souza
CEO
MedHelp International Inc.

Ryan McWhorter
President
Logistimo

Eric Schultz
CEO
QuantiaMD

mHealth is an opportunity to change the game in patient engagement.

Eric Schultz - CEO QuantiaMD

We need practical ambition. People have too many distractions. Lack of compliance comes from multiple sources.

Just more reminders don't work. You have to overcome the distractions. Media and life distractions, cognitive impairment.

Fight fire with Lorum Ipsum..... No wonder we lose.

mHealth services not apps - not download and forget.

Apps - 6% of apps are downloaded and still used after 4 weeks. There is an engagement issue.

Nurses and clinicians are a critical ally.

Educate them to be comfortable so they will prescribe the service/app to the patient.

Quantia's DAibetesIQ - described by iMedicalApps.com as Angry Birds: Diabetes Edition.

Ryan McWhorter - Logistimo

The intersection of patient and inventory management.

Logistimo works off-grid in remote locations. Doesn't mean disconnected. Use classic mobile phones plus the cloud (GPRS or SMS).

10,000 new HIV cases in Congo (due to rape)

PEP Kit needs to be received within a few days to be effective.

A project was developed to track episodes of rape, where a PEP Kit is located and whether a PEP Kit was administered.

Mobile Phones used to record data. Web used to manage.

Project is ready to go in January.

John de Souza - MedHelp

MedHelp - 12M monthly uniques.

longest established community.

Bring Data, Communities and Data together.

350 different communities.

mobile traffic is 30% of traffic. Set of mobile apps.

Can also pull data from devices (eg. Withings scale)

Able to aggregate data across the country.

People want to communicate with their doctors.

Doctors want an extract of PHR by specialty - addresses Doctor's liability concerns.

People don't care about data or devices - they care about their health.

Q & A Session

What business models will stick?

John de Souza - if you have a bad solution making it mobile just makes it a mobile bad solution.

You need to deliver real value. It needs to be compelling so you get continued use.

Employers need solutions.

In place contextual sponsorship is a viable business model.

Convenience in a model that scales is financially viable with a low cost payment model.

Will clinicians be comfortable operating in a sponsor model.

Clinicians are more concerned in finding a viable patient education solution that gets the patient out of the office and doesn't take them more effort to operate. It needs to have good value for patient and not run counter to care guidelines.

The danger in the USA is the slowness with which we move. We are and will be lagging what is happening in the rest of the world.

An unintended outcome is an increase in personal accountability. People are more engaged and motivated.

What are top 2 or 3 criteria to create a healthy angry birds:

1. Interoperability and integration of data

2. Health is not one dimensional

3. Don't make me work.

4. Speak to me in my own language. We need a simple vocabulary.

5. Fit the lifestyle

6. Use indirection - use other actions to infer data.

We don't want to care for our health - we want to enjoy our life.

What barriers would the panelists like to remove:

Logistimo:

1. Reduce the number of decision makers/voices in international projects. no clear lead

2. Simplification

3. understandable language

MedHelp;

1. FDA guidance

2. HIPAA (used as a barrier to sharing)

Quantia:

1. Misalignment of incentives. Healthcare is done to patients as a disengaged bystanders. Align to outcomes.

Major companies have challenges understanding where things are in the supply chain. These are same challenges for health care. Coke and Tobacco are leading on the cutting edge.

((tag: mHealth, mHealth Summit, Mobile))

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#MHS11 Basic Building Blocks of mHealth - Role of Patient Education and Monitoring of their medical compliance

2011-12-06T14:07:00.001-05:00

This is a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

Day 2:

Tuesday, December 6th
	11:15 AM–12:15 PM

Moderator

Michael O'Neil

Founder & CEO
GetWellNetwork

John de Souza
CEO
MedHelp International Inc.

Ryan McWhorter
President
Logistimo

Eric Schultz
CEO
QuantiaMD

mHealth is an opportunity to change the game in patient engagement.

Eric Schultz - CEO QuantiaMD

We need practical ambition. People have too many distractions. Lack of compliance comes from multiple sources.

Just more reminders don't work. You have to overcome the distractions. Media and life distractions, cognitive impairment.

Fight fire with Lorum Ipsum..... No wonder we lose.

mHealth services not apps - not download and forget.

Apps - 6% of apps are downloaded and still used after 4 weeks. There is an engagement issue.

Nurses and clinicians are a critical ally.

Educate them to be comfortable so they will prescribe the service/app to the patient.

Quantia's DAibetesIQ - described by iMedicalApps.com as Angry Birds: Diabetes Edition.

Ryan McWhorter - Logistimo

The intersection of patient and inventory management.

Logistimo works off-grid in remote locations. Doesn't mean disconnected. Use classic mobile phones plus the cloud (GPRS or SMS).

10,000 new HIV cases in Congo (due to rape)

PEP Kit needs to be received within a few days to be effective.

A project was developed to track episodes of rape, where a PEP Kit is located and whether a PEP Kit was administered.

Mobile Phones used to record data. Web used to manage.

Project is ready to go in January.

John de Souza - MedHelp

MedHelp - 12M monthly uniques.

longest established community.

Bring Data, Communities and Data together.

350 different communities.

mobile traffic is 30% of traffic. Set of mobile apps.

Can also pull data from devices (eg. Withings scale)

Able to aggregate data across the country.

People want to communicate with their doctors.

Doctors want an extract of PHR by specialty - addresses Doctor's liability concerns.

People don't care about data or devices - they care about their health.

Q & A Session

What business models will stick?

John de Souza - if you have a bad solution making it mobile just makes it a mobile bad solution.

You need to deliver real value. It needs to be compelling so you get continued use.

Employers need solutions.

In place contextual sponsorship is a viable business model.

Convenience in a model that scales is financially viable with a low cost payment model.

Will clinicians be comfortable operating in a sponsor model.

The danger in the USA is the slowness with which we move. We are and will be lagging what is happening in the rest of the world.

An unintended outcome is an increase in personal accountability. People are more engaged and motivated.

What are top 2 or 3 criteria to create a healthy angry birds:

1. Interoperability and integration of data

2. Health is not one dimensional

3. Don't make me work.

4. Speak to me in my own language. We need a simple vocabulary.

5. Fit the lifestyle

6. Use indirection - use other actions to infer data.

We don't want to care for our health - we want to enjoy our life.

What barriers would the panelists like to remove:

Logistimo:

1. Reduce the number of decision makers/voices in international projects. no clear lead

2. Simplification

3. understandable language

MedHelp;

1. FDA guidance

2. HIPAA (used as a barrier to sharing)

Quantia:

1. Misalignment of incentives. Healthcare is done to patients as a disengaged bystanders. Align to outcomes.

Major companies have challenges understanding where things are in the supply chain. These are same challenges for health care. Coke and Tobacco are leading on the cutting edge.

((tag: mHealth, mHealth Summit, Mobile))

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#mhs11 intel uses the BUT model

2011-12-06T12:50:00.001-05:00

Intel: Business
Usage
Technology

Human centered design

Change management - teach business process change

Payment reform with value over volume

We don't want reimbursement for devices. Allow care to take place in least restrictive place possible consistent with quality outcomes.

Focus on people and workflow.

Clinic is not the only place that care can occur.

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

Posted via email from ekivemark: pre-blogspot

#MHS11 Day 2 Keynotes.

2011-12-06T11:03:00.001-05:00

This is a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

The day 2 Keynotes:

Tuesday, December 6, 2011

9:30–10:00 AM — Morning Keynote

	John Stratton EVP & COO Verizon Wireless

	Dr. Regina M. Benjamin Surgeon General of the United States U.S. Department of Health & Human Services

Verizon's Stratton tells us we spent $1.1T on Chronic Disease in 2010 & cost $2.2T by 2020-12% of GDP & 7 of 10 deaths

John Stratton points to the banks. Redefining customer relationship and reduced cost. HealthCare and Education are the last stand outs for change.

The Verizon approach to Digital Care Solutions:

- Mobile Clinicians

- Digital Care Management

- Virtual Care

- Independent Living

All built on 4G LTE.

Home based telemedicine is promising: 20% reduction in hospitalizations. 70% increased days between visits.

Mainly based on fixed wired line solutions. This needs to go mobile to give additional flexibility.

Leverage mobility and the cloud to transform chronic care management.

Building a scalable cloud-based digital care management platform.

I wonder how open Verizon's care management platform will be?

Integrate best of breed connected medical devices to track health goals. Personalized care plans integrated in to daily life via all major smartphones.

I am wondering if Personalized Care Management is just the next consumer lock-in strategy?

Launching Mid-2012 focused around key chronic diseases. So they must be looking at providers buying smartphones for members. Or they will push consumers to switch to Verizon.

Verizon is partnering with Duke University: UPMC and Wellpoint in various pilots..

Verizon is pushing for reimbursement advocacy - allow mobile health tools to be charged for.

Good to push for inter-state credentialling to unleash telemedicine applications.

It will be interesting to compare AT&T's mHealth strategy to Verizon's. I suspect Verizon is further ahead in presenting a coherent mhealth strategy.

Next Up Dr. Regina Benjamin

The National Prevention Strategy.

Good health extends beyond health care. Change the way we think about health. An integrated approach that includes housing, food, road safety. preventive health services, empowered people and eliminate disparities.

Increase the number of americans who are healthy at every stage of life.

Prevention needs to be profitable and joyful.

Be more positive. Tell people what they CAN DO. - Stepping out with the Surgeon General.

60 second Surgeon General Dance Break. - Let's encourage Radio stations to help people get active - e.g by dancing.

There is now a Surgeon General App Challenge -

1.Physical Activity

2. Healthy Eating

3. Integrated Health

Something easy and simple to use. Open until December 30th. Checkout SurgeonGeneral.gov.

The final word: Remember to take your flu shot.

((tag: mHealth, mHealth Summit, Mobile))

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#MHS11 day 2 starts with discussion groups: EHR and mHealth

2011-12-06T09:02:00.001-05:00

This is a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

This is the start of day 2. I am attending one of the discussion groups ( http://www.mhealthsummit.org/program_morning.php ):

EHR and MHealth

Moderator: Abdul Shaikh, NCI

There are about 35 people with a diverse background attended this session.

We have the following representation:

- National Institutes of Health

- National Cancer Institute

- Consultants

- Academia

- Integrated Health Systems

- Software companies

- Mobile Startup companies

- Device Manufacturers

- Consultants

- NGOs

- Social Media

- Digital Agencies

- Physicians

- eHealth Government Initiative

- Europe

- Africa

- North America

Fascinating discussion that touched on #RainbowButton initiative and Rainbowbutton.com and use of BlueButton data.

We need to be able to convert BlueButton data to a structured format for interoperability.

We need to capture Observations of Daily Living including patient preferences. These are not currently included in EHRs

Look at ONC and FDA for guidance on security guidance.

Who is doing anything on security toolkits for phones: Good and Better are two companies.

At a chip set level there are AES Encryption tools for phones. For transmission HTTPS is widely used for banking.

We should get government to declare our health data as an organ that we can donate upon our death. This just requires a redefinition of the scope of the organ donation clause when people apply for or renew their drivers license.

DirectProject.org got a shout out because people want to know how to move data between EMRs

GreenCDA - Simplified format for expressing data in CCR or C32. Progressing through standards process.

HDATA - Standard for transfer - RESTful.

((tag: mHealth, mHealth Summit, Mobile))

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#MHS11 ONC Town Hall Meeting on Consumer Engagement - Led by @Lygeia

2011-12-05T18:01:00.001-05:00

This is a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

http://www.mhealthsummit.org/program_special_onc.php

Special Session:

ONC TownHall Meeting on Consumer Engagement

Monday, December 5, 2011, 4:30–6:00 PM

Overview: Join Lygeia Ricciardi, Senior Advisor for Consumer e-Health at the Office of the National Coordinator for Health IT, and other members of ONC’s new Consumer e-Health program for a TownHall meeting to learn more about their strategy to boost consumer engagement in health via information technology.
ONC is making an unprecedented push toward promoting consumer access to and use of health information to better manage health and health care. Learn about the strategies and initiatives of this new program---the first-ever of its kind in the federal government. Additionally, find out how your organization can participate in a pledge program that offers a variety of benefits, including:

An opportunity to help shape ONC’s consumer engagement strategy
A forum to elevate issues and provide input on policy barriers/challenges that the federal government could help address
Access to a community of peers to exchange best practices
Input into the development of tools to educate and engage consumers
Opportunities to network and partner with consumer organizations, provider organizations, and other stakeholder groups that share a similar vision

Lygeia Ricciardi leads the Office of the National Coordinator's Town Hall session on Consumer Engagement.

1/3 of US Population is engaged in Health. 1/3 not engaged and 1/3 in the middle.

We want people to have EFFECTIVE engagement. ie. When it matters.

Technology and Community changes are driving change. mHealth is part of that change.

ONC's role is to act as a catalyst for change.

ONC Strategic Approach

1. Access

2. Action

3. Attitude

Get access to information . Support the creation of tools and services that help consumers take actions. Attitude is about changing expectations.

1. Access to Information - The Pledge for Consumer Engagement in Health. Data Providers and Non-Data Holders.

HealthCamp Foundation has taken the Non-Data Holder Pledge.

More than 200 organizations have taken the pledge. This provides access to personal health information for more than 100 Million Americans.

Lygeia asked me to explain why HealthCa.mp Foundation took the Non-Data Holder Pledge. We have to put the Patient at the center.

Fight Disassociated Patient Syndrome (Fight DPS!)

ONC is also involved with challenge.gov and is putting up incentives and prizes to entrepreneurs to improve care transitions.

"Putting the I in Health IT"

ONC is looking for interesting and inspiring stories for people getting engaged in their care.

Crowd sourced video contest and animated film to help create awareness around health care engagement.

ONC will use online media to develop a series of messages:

1. Healthcare is getting an upgrade via IT (build awareness)

2. Choose a provider who uses Health IT for your convenience and safety.

3. Get a copy of your own health info and check to make sure it is right.

4. Use e-health tools to engage in your health.

Frontier Issues:

1. Integration of patient generated data in to EHR's/Clinical Care

2. Use of Social media for Health

3. Enabling proxy access to personal data

4. Integrating information about costs and quality with clinical info to help consumers understand context of their decisions.

((tag: mHealth, mHealth Summit, Mobile))

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#mhs11 The impact of cloud computing and online solutions on mHealth

2011-12-05T16:24:00.001-05:00

This is a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

Session 3

3:15–4:15 PM

The Impact of Cloud Computing and *Online Solutions on mHealth
Taking mHealth solutions to scale is an inevitable consequence of successful deployments. As public and private entities seek ways to optimize mHealth to help control costs and improve access to tools, information, and resources, they are are exploring the promise of cloud computing services. Organizations in highly regulated sectors such as healthcare must be prioritize security and other cloud issues when considering cloud computing solutions and online storage tools. This session approaches the mHealth cloud computing from a variety of perspectives including defining need, deployment, and evaluation.

Moderator

Halle Tecco

Founder & Managing Director
Rock Health

Jesse Coleman
mHeallth Project Manager
BC Centre for Disease Control

Nadine Levick
Founder/Research Dir.
EMS Safety Foundation

Mehul Shah
EVP & CEO
CTIS, Inc.

Flaura Winston
Scientific Dirc. Professor
The Children's Hospital of Philadelphia / University of Pennsylvania

Nadine Levick - iRescu

300,000 out of hospital cardiac arrests per year. Less than 25% receive CPR.

Developing a CPR/AED multimedia two-way support management system using smartphones.

Develop an App that avoids using medical jargon to teach use of AED.

Using Crowd sourcing to supplement database of AEDs.

Jesse Coleman - mHealth Content Management

Using a Content Management System to target Health Text messaging.

mHealth Content Management System -

Ruby on Rails Platform

PHP Interface

SQL Database

Secure Web Interface

Mehul Shah - CEO of CTIS. Inc.

Current health trends is that 50% of US Population will have at least one chronic condition by 2025.

Innovative Intervention.

((tag: mHealth, mHealth Summit, Mobile))

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#MHS11 Medical Grade Wireless Testing: Accelerating Deployment in Health Care Settings through Test Environments

2011-12-05T15:08:00.001-05:00

This is a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

http://www.mhealthsummit.org/program_track_policy_2.php

Medical Grade Wireless Testing: Accelerating Deployment in Healthcare Settings through Test Environments
Test beds play a promising role in advancing wireless innovation. To be successful, supportive policies and coordinated activity are needed across the private sector and government. Help shape the path forward.

Moderator

Gregory S. Walton

CIO
El Camino Hospital

Anura Fernando
Research Engineer
Underwriters Laboratories

David Hoglund
President
Integra Systems, Inc.

Ira Keltz
Deputy Chief - OET
FCC

Chris Riha
Clinical Engineer
Carilion Clinic

Medical Grade usually means expensive.

Proprietary networks in health care are dead. The move is to use the IT Wired and Wireless Infrastructure.

But IT don't want the liability and risk of having medical devices on their IT network.

The typical Wireless LAN in a hospital has not been designed for medical device use.

Computing has entered every area in which we function: medicine, home, work...

((tag: mHealth, mHealth Summit, Mobile))

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#MHS11 MHealthSummit Startup Health

2011-12-05T13:34:00.001-05:00

This is a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

StartUp Health: Bridging the Gap between Health & Wellness Entrepreneurs, Payers and Providers

http://www.mhealthsummit.org/program_special_startup.php

A panel moderated by: Steven Krein, Co-founder of StartUp Health

Peter Levin - CTO and Senior Advisor to the Secretary of Dept of Veteran Affairs - Promoter of the BlueButton

Don Casey, CEO of West Wireless Health Institute & former Worldwide Chairman for Johnson & Johnson's comprehensive care group and member of the Company's Executive committee

Stephen Ondra, MD - Senior Policy Adviser of Health Affairs, Dept of Veteran Affairs.

BlueButton - What does it mean to Entrepreneurs.

Outcomes, Cost and Control model. BlueButton improves access, compliance. Real benefit is as a catalyst to move to patient centered care.

BlueButton is simple formatted Text File. (ASCII).

At the VA it tracks 17 items in a health record, including self-entered data. Now they are starting to include data from VISTA - The VA's EMR.

http://www.VA.GOV/Bluebutton

Two ideas that utilize the BlueButton File:

- Help physicians deliver information to patients

- Help patients manage their own care.

There is of course RainbowButton.com to allow data donation anonymously.

Don Casey thinks there is a market for an app to find physicians that accept blue button data.

Did you know that over 500,000 people have downloaded their BlueButton data from the VA and with adoption by United Health and Aetna the market in private health care markets puts BlueButton access at over 17M.

Q: Is EMR Adoption taking up more time for doctors.

A: Yes - Doctors often hate the technology. They don't hate what it is trying to achieve.

They want products that help their patients, fit their workflow and help them be more efficient.

West Wireless Health development preferences:

- Diagnostics

- Analysis

- Devices

Q: How do get doctors to the table to participate in the change process.

A: we need to align incentives. It is starting to happen. Switch from fee for service to pay for performance and no reimbursement for readmission within 30 days are having a radical impact.

Billions being invested in EMRs. Most are not developed for workflow improvement but for billing management. The transition from revenue cycle management to clinical outcomes will force a radical change.

1. What problem are you solving

2. Who will pay for the solution

3. Is there something unique about your offering

4. How will this lower the cost of health care

Who pays:

18% of US Population managed by capitated health plans. (Kaiser, Geinsinger)

Large Self Insured: IBM, Exxon etc.

High Deductible Self-Directed Health Plans

We need to be more be more sophisticated in how you approach health care and mHealth:

- Clinical Applications

- Revenue and Workflow management

- Health Care industry (Pharma etc)

- Health and Wellness (Consumer wellness and prevention)

$1B of innovation money

Beacon Communities

$19B to be spent over next several years.

((tag: mhealth, mhealth summit, mobile))

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#mhs11 super session - value proposition of mHealth

2011-12-05T11:26:00.001-05:00

The initial drive will come from payers - the government, employers and insurers.

To really transform we need to engage consumers to manage their own vitality.

The move from fee for service to pay for quality. CMS ha changed hospital systems approach to quality due to payment reform.

A lot of development going in to home based monitoring. People recover better at home. Also least regulated.

Technical and regulatory obstacles:

- security because we need to share actionable information
- how to manage medical liability for large databases.

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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#MHS11 Mhealth Summit - the keynotes

2011-12-05T10:47:00.001-05:00

This is a live blog post from the mHealth Summit. The summit is taking place from December 5-7th at the Gaylord National Convention Center, National Harbor, MD.

Monday, December 5, 2011

9:45–10:15 AM — Opening Keynote

	Kathleen Sebelius Secretary U.S. Department of Health and Human Services

	Eric J. Topol, M.D. Vice Chairman West Wireless Health Institute

First the introductions:

Scott Campbell - Exec Director & CEO - Foundation for the National Institutes of Health kicks off the Summit.

Around 3,000 attendees in 2011 growing 25% from last year.

We need to learn from the mFinance community - they are further along in developing solutions than Health Care.

Rosemary Nelson - mHIMSS Taskforce Chair of HIMSS. mHIMSS is the mobile offshoot of HIMSS.

Patricia Mecheal, Ph D. - Executive Director - mHealth Alliance -- focusing internationally on the poor, disadvantaged and vulnerable communities.

Robert Kaplan, Director - OBSSR - National Institutes of Health

Now on to the key notes….

Kathleen Sibelius - Secretary, US Dept of Health and Human Services (who has her talk on her iPad)

Almost every American has a cell phone and smartphones represent more than 50% of cell phones. The iTunes store alone has 12,000 apps related to health.

What is exciting is the rate of innovation in an area (Health Care) which has been traditionally sedentary.

When innovation is slow so is improvement.

Rapidly rising health care costs are imposing increasing burdens on families, employers and Government.

We need information. Incomplete information about patients. Information Deficit is being addressed through the push for Health IT.

Office based doctors have grown in EMR use from 17% to 34% in less than two years.

Mobile Health is the next logical extension. Cellphones are an incredible tool for engaging consumers in our own health.

iTriage and Pillbox gets a shout out as innovative solutions to help patients and providers.

What can the Administration do to promote innovation. The Government role is to provide research. Act as a catalyst.

Adoption of EMRs had not changed in many years to the Recovery Act set out to - set Standards for interoperable systems, Create Regional Extension Centers help small practices adopt, Health Information Exchanges to help interoperability.

Recognized that it wasn't good enough to just dump paper in to electronic form. Meaningful Use emerged from this. We can now measure progress.

Government data was locked up and difficult to obtain. HealthData.gov was created to make the data accessible.

Shining a spotlight on health problems. 1 in 5 students in college report some sexual assault during their college years. Why not use technology to protect themselves. Apps Against Abuse: Circle of 6 and onWatch were the winners.

TXT4Health from InfieldHealth also got a shout out.

Innovations are being per sued around Care Transitions to reduce hospital readmissions.

Challenge 1: Support all innovations in Health Care - not just mhealth solutions.

Challenge 2: Help consumers understand that applications and data for consumers are safe and privacy is maintained.

We are heading for a future where we each take care of our health.

There are major opportunities to export technology as developing countries grow.

Scott Ratzan, MD, MPA - VP - Global Health - Johnson & Johnson

TXT4BABY - 71% of people getting text messages are seeking advice from physicians.

TXT4BABY is expanding to Russia.

0.5M babies die in first year of life. We need to change that.

Only 10 years ago less then half the wor;d's population had ever made a phone call. Today over 5B people in a 7B world population now own a cellphone.

Eric Topol, MD - West Wireless Health - The Creative Destruction of Medicine

@EricTopol

Kairos - The supreme - most opportune moment in history.

Digital World and the Medical Cocoon. They are starting to converge.

We are now talking about "Digitizing Man".

We have a new species - Homo Distractus

Joseph Schumpeter - Creative Destruction - now being applied to medicine.

Johns Hopkins has announced it is closing it's medical library and going digital. This is the harbinger of change.

Eric gave a number of examples from FitBit

AliveCor was demoed with the new Credit Card reader that can do ECG on your iPhone.

Skin Scan can snap a skin lesion and have it diagnosed remotely.

CellScope converts a cellphone to a microscope.

We are moving to a lab on a chip.

EyeNetra.com for Refractive Assessment in eye tests.

Sensimed - Triggerfish monitors eye pressure.

Qualcomm has announced 2net - a wireless health ecosystem

The Steve Jobs Autobiography looking at the future thought the biggest innovation of 21st century will be the intersection of medicine and technology.

We are entering the era of genomics sequencing. Eric demonstrated a handheld DNA Sequencer that could assess whether a patient would respond to Plavix.

The stethoscope is an icon of medicine. Why listen to a heart when you can see an ultrasound image using a portable scanner

There is now a technology to detect cracks in an artery. Using nano technology. Embedded nano sensors

Eric has an ebook on "The Creative Destruction of Medicine"

((tag: mHealth, mHealth Summit, Mobile))

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#MHS11 At the mHealth Summit at the National Harbor outside Washington DC

2011-12-05T07:48:00.001-05:00

This week is the mHealth Summit which is being held at the Gaylord National Convention Center, National Harbor, MD. Around 3,000 people are expected to descend on National Harbor to attend the mHealth Summit. I am joining the throngs to catch up on the latest developments in mHealth

The pre-conference meetup last night brought together a sizable crowd. Many old faces and a lot of new people - all doing interesting things in the mHealth field.

I will be blogging from the conference and visiting the exhibition floor and reporting over the next couple of days. Watch out for a stream of blog posts and tweets over the next few days.

((tag: mhealth, mhealth summit))

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GooglePlus Frustrations

2011-12-04T21:58:00.001-05:00

Google Plus has improved their error messages when adding people to circles. Now I am told I have reached my daily limit for adding to circles.

http://www.google.com/support/plus/bin/answer.py?hl=en&answer=1733011&p=circl...

It appears I am allowed to add <1 people to my circles each day. I will have to try again tomorrow.....

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Is @klout losing credibility? Their scores are all over the place. 51 is the new 49!

2011-12-03T10:22:00.001-05:00

A few months ago Klout revamped their scoring. Some people were winners, others losers. I admit. ! was one of the losers with my Klout score dropping by more than 17 points.

Over the past two days my Klout score had been rising. This could easily be explained by my increased activity in Social Media. I have been through a quiet spell as I have been doing some development work and learning Python/Django for work on RainbowButton.com.

Today I logged in to Klout and got a warning message that my Klout Score had dropped by two points in the past day - back to 49 from a recent high of 51. Yet my score still showed as 51 (in the chart it shows as 50.70 but the chart shows it back down to 48 point something.

We understand that Klout is still in beta but credibility is an important factor to be maintained. If Klout is tweaking their algorithms they should let us know. If they have dropped or added data feeds that might be the cause - in which case let us know.

The more Klout scores bounce around the less credibility they have.

I understand that Klout needs to keep secret how they calculate their score, otherwise people will game the system but there is also a need to balance that with enabling Klout's user base to identify a level of cause and effect for the actions they take in Social Media.

((tag: klout, social media))

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@TechCrunch article - Internet Bandwidth a time-based issue and not a capacity issue

2011-11-30T18:27:00.001-05:00

TechCrunch has a great post about the impact of bandwidth caps for Internet use. The post, which links to an expensive report is available here:

Another Study Shows Data Caps Are Likely Ineffective, Address Wrong Problem

The Internet Capacity problem is just like the electric energy problem. In the UK customers could install a meter for cheap rate power to charge up storage radiators.

These ran overnight when there was plenty of power available and then gave out heat during the day. As pointed out in the Techcrunch article, we need to deal with the peak capacity issue and simple bandwidth caps exacerbate rather than alleviate the problem.

If "cheap rate" bandwidth became popular it might trigger some interesting developments. Imagine an "Internet Storage Radiator" that could go on to the Internet each evening when bandwidth was plentiful and download and cache popular content. This could be based on the browsing patterns of the people typically using the family or small business network. Then with some intelligent proxy serving the pre-loaded content could be served from the "Storage Radiator" with the live Internet connection only being used for real-time content.

With the falling cost of compute power and storage this type of service could be an affordable option. Imagine if the storage radiator would refresh your video queue amd download and store likely new content which would then be available on demand - without taxing the your network connection. This could be an interesting proposition for Netflix since they currently represent probably around 30% of peak time Internet usage.

Netflix could turn the tide of bad sentiment for their brand through caching

Imagine if Netflix offered a low cost storage hub that you could attach to your network router that cached popular content and offered this in conjunction with a low cost "cached movie plan". This could be refreshed overnight based upon a member's queue selections. This could reduce/redistribute network demand and reduce peak demand on their architecture and content delivery network. They might even negotiate more favorable transmission charges with ISPs for this off-peak content transmission.

I can see how Netflix could easily implement the use of this cached content.

There are plenty of opportunities for innovation in this space. We can come up with better solutions that address the real problem - peak hour demand versus network capacity.

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My #RainbowButton Initiative presentation ( http://2.healthca.mp/s3cylR ) to Baltimore Tech Breakfast this morning

2011-11-30T12:42:00.001-05:00

Today I was at the Baltimore Tech Breakfast (11.30.2011).

I was presenting the work that Alan Viars and I have done since we won a prize at the Health 2.0 Developer's Challenge in San Francisco.

Rainbow Button aims to build a market place for the donation of health data under the consumer's control.

Here is the Presentation:

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Baltimore Tech Breakfast - Presenting #RainbowButton Initiaitive

2011-11-30T11:20:00.001-05:00

The regular Baltimore Tech Breakfast took place today at the Emerging Technology Center in Canton, Baltimore. The event is growing in popularity. A strong turnout today (Nov 30, 2011)

The show and tell session kicked off with Bullhorn (@bullhornmobile). A free iPhone / Android App.

Allow people to ask and answer questions locally.

The app was launched at the Baltimore Grand Prix. People downloading the app at the event were using it to ask questions relevant to the event. Like where is the best happy hour, where is the best view of the race.

The app can be branded. The team is looking at applications for Universities. e.g. Ask a question on campus.

Voting and Game Mechanics are being built in to the app for the next iteration (end of 2011).

PowerHouse Webcasting

Components:

- Live Web Casting (including video)

- Live Management tool (multiple producers)

- Archive/Synchronizer (sync audio and slides)

Impressive cross platform secure webcasting tool

This seems to bring together a number of tools:

- YouTube

- CoveritLive

- Slideshare/Slidecast

- Livestream/UStream

Aiming at corporate clients.

Provide:

- On demand (bandwidth based charging)

- Live (subscription - per user)

- Portal

Currently in private Alpha development.

- Consumers don't need to download any components/drivers. Content producers do need to download.

Q&A - How do we find talent?

- Local Tech Events

- Employee referrals (smart people tend to know smart people)

- Craigslist (cheap and a lot of techies seem to check out craigslist)

- Make yourself interesting by sharing a lot. The good people will find you.

- LinkedIn

"Development is a creative discipline rather than an engineering discipline - technologies come and go"

"The act of building improves the ability to build"

If you outsource overseas - eg. via odesk then be very specific in your request.

Have a series of related questions ready to ask that are relevant to your project. This helps to ensure the response is not just an automated response.

Develop a relationship. Test with short simple projects.

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@mikearrington - Inspiring Lifestyle change - Being Less Fat « Uncrunched

2011-11-22T10:38:00.001-05:00

Liz Welch at Inc. Magazine interviewed me in 2010 as part of her regular “The Way I Work” series. I had just moved to Seattle as part of my overall goal of (occasionally) detaching myself Silicon Valley.

In the article I talk about my erratic sleep patterns and my overall weight gain – some 50 pounds since I started TechCrunch in 2005.

In the year since I visited a sleep center and began focusing on getting enough sleep at regular hours. After a year of that my life has changed dramatically for the better. But the weight just kept creeping up. In the late summer 2011 I was a good 70 pounds heavier than I was when I started TechCrunch. And probably 90 pounds over my ideal weight.

Basically, I’m fat.

Being fat sucks. I’m not talking about the way I look. I’ve always been fairly comfortable in my own skin. But there are a whole bevy of health issues that fat people have to deal with. You don’t live as long as you should, and your quality of life is diminished substantially.

I’m trying to take control of this issue in my own way, and for the last several weeks I’ve been experimenting with a complete shift in lifestyle. So far, so good. And since a lot of people in our world deal are dealing with weight gain and health issues resulting from sitting in front of a computer for 16 hours a day, I thought I’d share.

The lightbulb went off in my head as I was reading Neal Stephenson’s new book Reamde (buy it here). In the book a character works at his computer from a treadmill, stationary bike or elliptical machine.

That prompted me to research “treadmill desks” and read about people’s experiences with them. Some people can’t stick with it, but a lot do. And the benefits are staggering. You’ll burn an extra 150 calories or so per hour. Most people say that they’re significantly more alert during the day, and they sleep much better at night.

So I jumped in. I elected not to buy a $5,000 unit (there are a couple out there), and building one myself seemed like too much trouble. Instead I bought a “TrekDesk” on Amazon and a cheap treadmill. I’ve been walking at 1.5 mph for 7-8 hours a day on average over the last few weeks. Some days I’m logging over 15 miles walking.

That’s not all though. I’m also using a Withings wifi scale to track my weight, and I’ve shared it with friends so they can keep an eye on it. The scale itself works great. The software is terrible but it does the job.

The final product I’m using is a Jawbone Up device. It’s a pedometer (very handy), it tracks sleep and it has a vibrating alarm feature to wake me up – much like the Lark device that I love so much. The only complaint I have about the Jawbone Up is that it doesn’t track steps very well on a treadmill with my hands up at a keyboard. But from what I can tell all pedometers seem to have this problem.

Things are just getting started. But the fact that I’m sleeping properly and have revamped my diet with my doctor, combined with actually walking miles and miles a day, has already had a profoundly positive effect on me.

I’ll update in a couple of months with any progress. If all goes well, in a year or two my body may have forgiven me for the TechCrunch years. We’ll see.

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via uncrunched.com

Inspiring post from @MikeArrington about how he has changed his lifestyle in order to be healthier and lose excess weight.

We are rooting for you Mike!

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CPT_Advanced_Custom_Fields_Meetup | SlideRocket, Online Presentation Tools

2011-11-22T10:30:00.001-05:00

via portal.sliderocket.com

You can do some cool things with Advanced Custom Fields and Post Types in Wordpress. Here is Marjorie Roswell's presentation from Monday's Baltimore Wordpress Meetup Group.

http://www.meetup.com/The-Baltimore-WordPress-Group/events/40446932/?a=ed1_l6

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Education-Specific HTML to Be Submitted to Search Engines Soon

2011-11-22T09:39:00.001-05:00

The LRMI 0.5 spec lets publishers communicate in a page's HTML things like the competencies taught, the competencies required, the type of educational materials and the typical age range of intended users for anything educational published online. Time required for completion, degree of interactivity and a small number of other ways of describing educational content are included in the spec.

Active participants working to figure out how to construct LRMI and how to integrate it into Schema.org include people from small non-profits like open curriculum community Curriki, corporate education technology giant Pearson, international information standards group Dublin Core and intellectual property law group Creative Commons, among others.

Participants debate on the official mailing list over new terminology, balancing concerns like coherence with Schema.org, ease of input by people who will enter metadata to go with resources being published online and specificity gained or lost by the way that metadata fields are named and framed.

While some semantic technologies are able to assert categorization from the top down, whether content publishers participate or not, it seems likely that the kind of data that will be communicated in LRMI will require informed participation by the producers of the content themselves. Requiring participation in categorization could pose a challenge to hopes the spec will gain meaningful adoption.

The LRMI effort doesn't seem well-known yet outside its own ranks, either; the official website has almost no inbound links indexed by Google yet and none of the education technology blogs we track here at ReadWriteWeb have mentioned LRMI yet. The project was just announced last month though and in the education market, a month isn't a very long time.

LRMI isn't alone though, either. Nathan Angell, a Board Director at the collaborative open education software community Sakai Foundation and a Product Manager at rSmart, calls LRMI "another welcome intervention in growing list of data specifications for education."

"These days we have access to an unbelievable number of learning resources--both open and proprietary--but it's still hard to find the right ones, quality resources, suited to your needs, when you need them.
"For example, in the Sakai community, we have built a new platform--the Open Academic Environment--that helps people create and tag learning materials, and most importantly, share them openly by default.

"With the LRMI specification, we can help people tag their materials with exactly the right information that will make them easy for others to find and use...and even better, we can augment the suggested content widgets we already have in place to discover resources in the moment that match the very specific needs of a particular educator or student."

Angell, who isn't associated with LRMI in particular, sees data specifications like this as potential game changers. Those suggested content widgets are really shorthand for computation that can begin at a higher level of abstraction if the hard work of content categorization and description has already been done in a standardized way. That means education technology providers, search engines and others don't have to invest time and energy into understanding educational resources online - they can begin with a pre-existing understanding of that content and then offer higher-level features and services on top of already-organized information.

"LRMI helps set the stage for the hive mind that will help our children's children learn faster and better than we ever thought possible," Angel says. "In comparison, school today will look like drawing pictures in the dirt with a stick."

See Also

Learn AI in Largest Google+ Hangout Tomorrow

jQuery's New Project Will Fight for Every Developer Lost in the Web Standards Pit of Despair

Bringing Scalability to the Classrooms of the Himalayas

BenchPrep Opens Test-Prep Courses to Wikipedia, YouTube Content

via readwriteweb.com

HealthCare needs to think this way too. Work with the major search engines to introduce a metadata standard for health information.

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Baltimore Wordpress Meetup Group - Custom Post Types/Advanced Custom Fields

2011-11-21T23:11:00.001-05:00

I am at the Baltimore Wordpress Meetup Group. The topic is Custom Post Type and Advanced Custom Fields.

Here is the intro for the session:

Create your own edit screens. Choose from multiple field types. Learn straightforward API functions for use in your themes. Attach custom fields to custom post types. Yay! CMS* made easy. (*CMS= Content Management System). Presenter: Marjorie Roswell

Standard Post Types:

- Posts

- Pages

- Media

- Revisions

- Navigation Menu Items

Custom Post types allow you to extend these basic post types to meet your own needs.

The Plug in can be found here: http://wordpress.org/extend/plugins/custom-post-type-ui/

Advanced Custom Fields:

This is a newer plugin. http://wordpress.org/extend/plugins/advanced-custom-fields/

Documentation can be found here: http://plugins.elliotcondon.com/advanced-custom-fields/documentation/

Create a field group before creating custom fields for the group. Otherwise they may not save.

Display custom fields:

- Custom Post Type Archives handles by theme's archive.php

- Override this for particular post type in archive-{post-type}.php

Two key entries from the API are used to build a print layout for the archive view. These are:

<?php get_field('{field name}') : ?>

<?php the-field('{field description}') : ?>

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6 things to know about Occupy Healthcare | Healthcare IT News

2011-11-18T15:08:00.001-05:00

Occupy Wall Street is everywhere and anywhere you turn, and although demands are unclear, the movement has garnered unprecedented support across the country. But one offspring of Occupy Wall Street has failed to gain the same coverage, despite its united efforts and clear demands: Occupy Healthcare.

According to the site OccupyHealthcare.net, “Healthcare is a morass of competing interests, and a majority of those competing interests are committed to maintaining the status quo. Make no mistake, there is a cacophony, and this cacophony is made up of the voices telling you that change in healthcare is impossible. They are wrong.”

Whether you agree with the movement or not, knowledge is power, which is why we rounded up six things to know about the Occupy Healthcare movement:

1. It has clear principles. Unlike the Occupy Wall Street movement, Occupy Healthcare has managed to create a set of clear, guiding principles, making it easier to identify the goals of the movement and its beliefs. The site recently proposed the following:

We believe healthcare is a right for all.

We believe the healthcare system, as it currently stands, is too costly and ineffective.

We believe that we should create a system that works to meet the needs of a person and community as a whole.

We believe patients, families, and communities should be at the center of all healthcare.

We believe that a truly effective, person-centered healthcare system should be built on prevention and wellness rather than illness and disease and that addressing social determinants of health is an integral component of improving health.

We believe monetary incentives should be tied to better outcomes and improved health, with increased rewards for improving the health of those most vulnerable among us.

2. Supporters recognize American healthcare isn’t the best in the world. On the site KevinMD.com, Mark Ryan, MD, explained why the healthcare system is in dire need of change. He argues that “contrary to the common wisdom,” the American healthcare system isn’t the best in the world. In a series of points defending his stance, he points to a World Health Organization analysis that ranks the U.S. healthcare system 37^th. Additionally, the United States ranks 39^th in infant mortality, 43^rd for adult female mortality, and 42^nd for adult male mortality. “We rank last among seven developed Western-style democracies in U.S. healthcare performance,” Ryan wrote. “Our healthcare spending per capita is 50 percent greater than the next highest nation’s, and our healthcare spending in the U.S. is increasing faster than most other nations’.” Lastly, Ryan added, according to a recently released report from the Commonwealth Fund, the United States scored 64 out of 100 points, lagging behind other developed nations. “Americans pay much more per person to support a healthcare system that does not function very well at all,” Ryan concluded. “[It] provides inadequate and unequal care for far too many people, and that leaves nearly 50 million Americans without health insurance. These are indicators of a system with significant, fundamental dysfunction.”

Continued on the next page.

via healthcareitnews.com

Great summary of #OccupyHealthCare.

Put the patient at the center!

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#RainbowButton at #Health2STAT Supporting @Todd_Park and team with Data Liberacion through Data Donation #patients20

2011-11-18T14:43:00.001-05:00

Last night I headed down to Bethesda for the regular #Health2STAT event hosted by Aquilent and a group of fellow sponsors.

I was looking forward to hearing David Hale (@lostonroute66) talk about his personal history and the impact of personal genome testing on his life and a journey of discovery.

The evening had some great talks lined up and the theme of the evening for me became "Information is the best Rx for better health." Whether it is insights gained from an analysis of our personal genome, text messages that get us to think about a healthier lifestyle, or vide messages received when we leave the Emergency Department or hospital. Relevant, timely and personalized information can have a major positive impact on our health and on our recovery from an incident or health issue.

I was looking forward to a relaxing evening meeting the great friends in the DC/Baltimore Health Community. There are so many innovators and thought leaders and Health 2.0 STAT is a great, lively forum for us all to get together.

I arrived early and discovered that a number of presenters had dropped out, whether as a result of flight cancellations or other commitments. The host, Mike Tock asked me if I could step in and do an impromptu 5 minute presentation. Fortunately I had my laptop in the car and I had just gone through a series of updates to RainbowButton.com with my "partner in crime", Alan Viars (@aviars). So with about 20 minutes to prepare I put together a quick presentation before going on as the first presenter!

David Hale, a agent provocateur extraordinaire, caught me presenting:

http://lockerz.com/s/157067921

Yes - I successfully managed to create a presentation and live demo in less than 20 minutes and then presented and performed the demo in five minutes. Using www.RainbowButton.com is really meant to be that simple you can upload and de-personalize your BlueButton file in a couple of minutes.

David also caught me creating the presentation at Health 2.0 STAT:

http://lockerz.com/s/157065312

For those that couldn't be there here is the presentation. I have uploaded to Slideshare:

I am also experimenting with iWork.com and sharing Keynote. So you can check out the presentation there too:

http://public.iwork.com/document/?a=p63197994&d=RainbowButton-Health2STAT.key

((tags: rainbowbutton, health2.0, bluebutton))

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@lostonroute66 #health2stat

2011-11-17T19:22:00.001-05:00

David was a steal for $25!

When you don't know your medical history personal genomics it is an amazing resource.

Yet Maryland prevents genome testing because insurers are concerned if consumers know more than the insurers.

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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Health eworks - david mathison md #health2stat

2011-11-17T19:16:00.001-05:00

Health E works streams relevant video messages to patients at discharge from ER or hospital. "Mobile video prescriptions"

This addresses hospital readmissions

NIH supported to look at reducing ER re-admissions.

Implemented in southwest DC

68% have smartphones. Hispanic population are heavy users of smartphones.

The videos are traceable - unlike paper prescriptions or paper literature.

>50% view videos

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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The text big thing in wellness Crosby + kaiser Permanente #health2stat @crosbymarketing

2011-11-17T19:11:00.001-05:00

Crosby marketing and Kaiser Permanente Using text to attract federal employees through wellness initiatives.

Developed a program - mobile wellness coach

Daily wellness tip via text message. A weekly theme. Health tip
Joke Recipe
Inspiring quote
Interactive question

Text keyword via short code to opt in

Very low opt out rate

Health texting works!
People are comfortable with it
Focus on content
Widest reach
Plenty of success stories

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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@miketock kicks off #health2stat

2011-11-17T18:55:00.001-05:00

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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More Americans than not want health law repeal: poll

2011-11-17T09:17:00.001-05:00

A recent poll suggests that 47% of Americans want the affordable Carre act repealed.

Yet the majority also believe that there should be healthcare for all. If ACA is repealed do Americans really want:
- older kids in a family denied coverage on their family policy if they are over 18 but under age 26?
- insurance companies to be able to refuse coverage because of a pre-existing condition?

I believe that the insurance exchanges that are being established under ACA will drive a shift that puts more Americans in direct charge of their health care insurance and see a reduction in directly sponsored employer based health plans. This will be a positive development for the better health insurers since individuals are more likely to stay with a plan they like and will cease to be "shopped around" by their employers as they seek better deals every couple of years. With more longevity to a health plan contract the plans will have an incentive to focus on real prevention rather than remedial care. Just look at the average member relationship at Kaiser Permanente versus other insurers. I don't have the stats to hand but believe you would see the KP member staying for 10+ years whereas your typical employer sponsored plan moves insurer every couple of years.

The Affordable Care Act can no doubt be improved upon but that is no reason to throw it out or cripple it. We have already seen a massive surge in innovation in healthcare which I believe is all resulting from the health reform initiatives.

More Americans than not want health law repeal: poll Read it online: http://mobile.reuters.com/article/idUSTRE7AF1BD20111116?irpc=932 Sent via TweetDeck (http://tweetdeck.com)

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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HeathCamp Thoughts by @ekivemark

The future of Health is Mobile+ Kaiser Permanente now has a mobile optimized web site for 9M members.

Curing US HealthCare… Coding reform and payment reform go hand in hand

"I Know Cancer When I See It"

Here is the full Tweet Reach report for #CISummit - Provided by HealthCamp as a service to Health Innovators everywhere

#CISummit Don Casey wraps up the summit

#CISummit - Key points and quotes - Part 2 adds memorable quotes from the afternoon session

#CISummit - Wrap up in the Innovation Hot Tub

5:15-5:45pm

Fireside chat with Susan Dentzer

Jonathan Blum

Cindy Mann

Rick Gilfillan, MD

#CISummit - Cancer Care.

4:00-5:15pm

Panel 3

Cancer: Journey Toward Better Health, Better Care and Lower Costs Case Study

Moderator: Simmi P. Singh

Amy Abernethy, MD

Amy Berman, RN

Jeffrey Elton, PhD

Bruce Johnson, MD

Chris Olivia, MD

#CISummit Ignite Talks - Part 3

3:45-4:00pm

Ignite Talks: Rapid Fire Innovation Pitches

Facilitated by Joe McCannon

Will Shrank, MD

David Eddy MD, PhD

#CISummit - Chronic Care Management - The discussion

2:00-3:30pm

Panel 2

Care Delivery/Chronic Disease Innovation Case Study

Moderator: Atul Gawande, MD, MPH

Kenneth Coburn, MD, MPH

Alan Hoops

Debbie James

Mary Naylor, PhD, RN

#CISummit Chronic Disease Management moderated by @atul_gawande

2:00-3:30pm

Panel 2

Care Delivery/Chronic Disease Innovation Case Study

Moderator: Atul Gawande, MD, MPH

Kenneth Coburn, MD, MPH

Alan Hoops

Debbie James

Mary Naylor, PhD, RN

#CISummit Joe McCannon introduces the next round of Ignite Talks

1:45-2:00pm

Ignite Talks: Rapid Fire Innovation Pitches

Facilitated by Joe McCannon

Bob Masters

Jennifer DeCubellis

Tom X. Lee, MD

A contagion of healthcare disruptors conspiring at #cisummit

#CISummit - Key points and quotes part 1 - the morning sessions

#CISummit - More Ignite Talks

12:15-12:30pm

Ignite Talks: Prizes and Challenges

Facilitated by Aneesh Chopra

Toby Samo, MD

Leigh Burchell

Michael Williams

Suzanne Blaug

Farzad Mostashari, MD, ScM

#CISummit Care Delivery Care Innovation - The discussion

Care Delivery/Primary Care Innovation Case Study

Moderator: Mohit Kaushal, MD, MBA

Christopher Chen, MD

Frank Ingari

Brian Prestwich, MD

Lonny Reisman, MD

David P Kirchhoff

#CISummit: Frank Ingari - Essence Healthcare / Chris Chen of ChenMed / Brian Prestwich - Keck School of Med USC / Kirchhoff - @WeightWatchers

10:45am-12:15pm

Panel 1

Care Delivery/Primary Care Innovation Case Study

Moderator: Mohit Kaushal, MD, MBA

Christopher Chen, MD

Frank Ingari

5:15-
5:45pm

4:00-
5:15pm

3:45-
4:00pm

2:00-
3:30pm

2:00-
3:30pm

1:45-
2:00pm

12:15-
12:30pm