Health Care Reform and Health 2.0

Last night I attended the Health 2.0 Meet up in Silver spring, MD. It was a great event organized by David Blackburn of Aquilent. There was a sizeable crowd - the organizers had to turn down last minute requests to attend.

It was great to see David Hale talking about the evolution of PillBox at the National Institutes of Health. After seeing PillBox at HealthCampDc last year it has matured nicely.

Marie-Michelle Strah gave a fascinating talk about the use of Tele-Health by the US Armed Forces in the Mental Health field.

I had also been asked to present. My presentation can be found on Slideshare:

Its About Health Participation

View more presentations from Mark Scrimshire.

SocialWeb at Web 2.0 Expo

What has been happening with Data Portability on the Social Web. ie. OpenID, OAuth, etc.

The workshop is being run by @chrismessina, @daveman692 and @jsmarr

I will twitter comments from this session using the tag #w2e_sw

If you want to build new and innovative services you don't want to frustrate your users by asking for a bunch of account related data. If the data is out there go and get it. Don't Re-Key!

You need standards to enable mashups. Alternatively, you need consistent formats.

If standards exist - use them!

http://www.oxyweb.co.uk/blog produced a world map of popular social networks. This struck me as a great parallel to the HealthCare world with incompatible/competing health care players.

Functional sites, like Friendfeed, Twitter, last.fm and Dopplr represent specialist services. They have the opportunity to create combined value but they need a social graph to create this.

Facebook solved this for many, as long as developers were prepared to live inside facebook.

Activity streams are an emerging standard. No logo yet.

XMPP is not that popular yet, although it is one of the pipes that Twitter implemented and search.twitter.com leveraged.

Partuza is an Open Social - social Network site that uses Apache Shindig.

Pinax is a platform for rapidly developing websites using social tools such as IM, chat,

The emerging theme is "Connect"

Facebook Connect, OpenSocial Connect.

New building blocks:

• Who you are
• Who you know
• What's going on

These are aspects of the social ecosystem. These create the virtual circle of sharing/knowing.

The anatomy of "Connect":

• Profile (id, accounts profiles)
• Relationships (friends, followers)
• Content
• Activity
• Goal (search and discovery)

Most sites are building on the Open Stack:

• MySpace
• Yahoo
• Google
• Plaxo
• Microsoft

Supporting:

• OpenID
• XRDS-Simple
• OAuth
• PortableContacts
• OpenSocial

Facebook is different but is matching these standards.

Why do this?:

- Why do people have to:

• Create a new account on every service
• Re-create their profile
• Give away their password to every site that asks
• Re-discover their friends
• re-friend their friends
• Learn new ways to share and communicate

Why do developers have to?:

• Deal with forgotten passwords
• create another profile form
• Support every new service API that emerges
• Force members to invite everyone they know
• Implement and unsafe method to import contacts
• Create widgets for incompatible social networks
• Manually interpret feeds for activity streams

Industry trends:

• User control of data
• User centric web services
• Locatin based services
• Real time content delivery ubiquitous connectivity
• Interoperable app platforms
• content aggregation and syndication
• increasing quantities of data to work with
• democratization of digital media creation tools

How do customers benefit:

MySpace has built login with OpenID and OAuth to compete with Facebook Connect.

OpenID popup extension is being developed to simplify the user interface, ala facebook connect.

The emerging issue is that once an item has been made "public" on a social network it can't be withdrawn. If you withdraw an item it may still exist in other places that were connected to the original publishing location.

Demos:

• Eventbox

Now for the technical stuff:

OpenID Demo:

Mapquest (owned by AOL). You can sign in to mapquest with OpenID.

In 2009 there are over 30,000 sites that let you login with OpenID (Relying sites). Growth from 20,000 in August 2008 and 10,000 in Jan 2008. (source: http://blog.janrain.com)

Implementing OpenID as a relying party (ie. accept OpenID)

Internally you need to map one or more openIDs to an internal account.

The OpenID User experience

Directed Identity is emerging as one solution to avoid need for users to know URLs.

At least there aren't too many major providers so the button option is still feasible.

Once people have become known to a site it is possible to tailor re-sign in based upon where a user has come from. eg. If they arrive from Gmail then assume a gmail account.

Personal Discovery standard is emerging, driven by EU demands.

The browser knows who you are so this may be a way to simplify login. This moves away from web sites trying to guess which accounts you use.

The Popup extension is emerging as a technique. The challenge is to avoid spoofing. People don't look at the URL bar.

Remember - you can use email address as an indicator of which OpenId providers to support.

Different sites have different account preferences. This leads to sites supporting multiple standards. eg. OpenID + facebook. At least supporting OpenId means you automatically support Yahoo, AOL, Google, MySpace and other popular sites.

Microformats are also important.

Microformats enable webpages to be an API.

Semantic information can be embedded in a page. Some of the oldest standards are hCard (vCard in HTML)

Use CSS classes to markup and style the data. Very simple way to markup information in existing web pages.

This is ideal for database driven sites because you can edit one output web page and apply a microformat to every database record that is displayed through that web page.

Twitter supports hCard and includes the rel=me setting. If you want your blog to be the top search result on your name in Google then add this value to your blog. Simply add rel="me" to a relevant link on your blog.

Discovery

The more you publish the more you need a way to identify what you are publishing as yours. Our desktop is moving out in to the cloud.

Identity enables discovery. XRDS-Simple "the name is more complex than the concept"

XRDS - defines services.

eg. OpenID, PortableContacts

eg. OpenID points to one service. PortableContacts points to Plaxo.

WordPress OpenID plugin supports creating XRDS file.

XRDS-Simple can be used for a personal discovery or for sites to publish their service endpoints

LRDD - Link-based Resource Descriptor Discovery (emerging work)

Authorization

Authorization is important so you don't have to make data public to make it portable.

Will OAuth work in a mobile mode? Yes!

iPhone example is FlightTrack Pro works with Tripit. The iPhone app uses OAuth and Safari to authorize the app on Tripit.com.

OAuth is a protocol for developing password-less APIs.

Plaxo was recently bought by Comcast. Comcast saw a 92% success rate with login using OpenID in collaboration with Google.

The Plaxo-Google connection uses a hybrid. They do the OpenID dance and also handle the OAuth token acquisition at the same time. They also collect and notify user on the basic information that will be used. eg. name and email address.

The Comcast-Google test worked so well that the business folks at Comcast wouldn't let them turn the experiment off!

OAuth can be used asynchronously to allow one user to give permission to someone else to gain access to their information. eg. Dave allows Chris to see his phone number in his contact record.

Relationships and Contacts

Rather than have to support writing to address book APIs for each major service they instead implement a standard protocol. That is PortableContacts. This builds on OAuth and vCard standards.

GMail now supports Portable Contacts. ie. No Google specific code is required to use information from the Google Addressbook.

OpenSocial REST People Protocol is now PortableContact compatible.

vCardDav compatibility is coming with IETF.

Linking Accounts

The XFN Microformat is being used to link accounts and services.

Add a Rel=Me link to connect pages on services..

You can also use Rel=Contact to identify friends.

Google's Social Graph API does this in a simple form. A demo is available.

Activity Streams

Activity Streams are in the realm of "LifeStreaming"

Friendfeed support approximately 59 services. Each was hand coded by Friendfeed.

Activity Streams is about creating a protocol that can be leveraged across sites.

Social Discovery. eg. Plaxo Pulse, LinkedIn network updates, Facebook status updates.

Messaging: Twitter, Yammer, Eventbox (desktop app)

Brand/Personal Monitoring: GetSatisfaction's Overheard searching Twitter.

Primitives: Active, Verb, Object

Actor, Verb Object (context)

Build on Standards

Use ATOM for lists. (aka feeds)

Activity Stream is using a derivation of ATOM to share streams.

Activity Streams is targeted to go in to OpenSocial.

Check out http://activitystrea.ms for the latest info.

Gadgets and OpenSocial

Allow applications to be added tomultiple sites. Write a gadget once and allow in to run on multiple sites. Over 700M users acorss multiple sites support OpenSocial from Myspace to Plaxo to Ning oor Orkut etc.

Shindig is an Apache incubator project for gadgets in OpenSocial.

You can also build OpenSocial apps in the Google AppEngine.

This standard simplifies Engineering integratin and allows developers to focus on PRODUCT integration - ie. How to fit in to the target environment. eg. Ning is different from MySpace.

Next Steps - Homework:

1. Markup existing Data

2. Stop leaking passwords

3. Support OpenID and OAuth

These tools are mature enough to enable simple integration across sites and business partners.

Check out theSocialWeb.tv for the latest news in the space.

The Health Session at Social Media Club DC is a sell out

Tomorrow, Wednesday February 7th, IQ Solutions in Rockville is hosting a Social Media Club session. The topic is "Engaging the Health World Through Social Media." I have been asked to take part on the panel that is being moderated by Alexandra Rampy (@SocialButterfly). It is a real pleasure to be participating alongside Healthcare blogger, Dr. Val Jones (@DrVal), Christian Olsen and Joel Selzer of Ozmosis.

This should be a great panel, an interactive discussion, with not a PowerPoint in sight.

I have been invited because of my role as "chief troublemaker" and change agent in the HealthCamp movement. With HealthCampDc happening on Friday February 27th and HealthCampPhila taking place a month later on Saturday March 28th, this is a great opportunity to spread the word about these events.

I hope that anyone following the event is inspired to sign up for a HealthCamp event and join in the discussion about the future of Healthcare.

For those not familiar with HealthCamp, these are barcamp-style events focused around HealthCare. Healthcare is a complex industry with many different specialists engaged in the delivery of services.

Privacy issues create complexity and often stifles innovation and experimentation in the industry. Privacy is a double-edged sword. We have to trust that our privacy will be protected. At the same time, if we happen to be the victim of serious medical conditions that affect our quality of life then sites like PatientsLikeMe demonstrate that we are willing to sacrifice some of our privacy in order to improve our quality of life.

Privacy issues will come to the fore with Personal Health Records. Fears of our most personal information being accessible without our consent will have to be balanced against the risk of receiving incompatible treatments due to an ignorance of the full range of medications we are taking.

It always strikes me as ironic that when it comes to Health Records it is us, the health consumer, that are the only people in the health equation that typically does not have access to our records.

As I have discussed in an earlier post I believe Personal Health Records will be adopted by the senior members of the population. This will be driven by the quality of life issue. Our seniors will take advantage of Remote Tele Health monitoring equipment that will feed the Personal Health Record and allow vital signs to be remotely monitored.   

How does Social Media come in to play in the Health Arena?

I expect to see Social network tools being adopted amongst doctors and others with common interests. However, the real revolution has to come with the Personal Health Record.

We are the one common denominator in the health delivery equation. As such, we need to encourage systems to be developed that reflect this fact. If this is to happen then the Health Care industry needs to recognize and adopt some of the standards that are enabling information to be controlled by individuals. OpenID, OAuth and microformats are just three examples of standards that have much to offer in the Health Care arena.

I look forward to discussing these issues at the February Social Media Club DC meeting. If you come to the event please come and say hello!

BarCampPhilly - an amazing vibe

I spent today at BarCamp Philly. You can check out the day through a number of routes. Try barcamphilly.org as the main site. Also do a search on twitter for the #bcphilly tag. The schedules are there on the barcamphilly.org site. The iphone app to track the schedule worked really well. Great work team! Is that software available for use at other events?

Roz (aka Stellargirl) and JPToto and others did a great job to organize a fantastic day at the University of the Arts in Philadelphia.

I ended up presenting a session on Data Portability in Health Care. The focus was on how to get consumer engagement. Let's drive a push for adoption of OpenID, OAuth and microformats from the consumer perspective. He have to take our health in to our own hands. There seems to be an increasing recognition that we need to address single sign-on and data portability in healthcare.

I talked with a number of great people like Mary Ann Geier and Phil Baumann. All are interested in Health Care issues. I know I have missed other names. If I did, please leave a comment below and register your interest on the subject of Health. The bottom line is that there is a real interest in launching a HealthCampPhilly. The HealthCamp movement is growing like crazy. We have HealthCampUK happening this coming Monday (November 10th). We have HealthCampMd, to be held at Stevenson University (formerly Villa Julie College) in January. HealthCampDc set for February at CareFirst in Washington DC. HealthCampWv courtesy of Bob Coffield happening in March 2009 in Charleston, WV. Last week HealthCampNash also got proposed for Spring 2009 in Nashville, TN. I am also looking at hosting a HealthCampBoston on April 24th, 2009 - alongside the Health 2.0 conference.

The momentum that is growing around HealthCamp just reflects the consumer dissatisfaction with the current state of HealthCare and the recognition that we, the consumer, can make a difference if we demand change.

At BarCampPhilly I also gave a couple of sessions on the use of JackBe's Presto platform. This is a mature Enterprise Mashup Platform that recently revamped it's development licensing. They now offer free perpetual development licenses. This is a great move to stimulate the developer community. The feedback I got on the platform was overwhelmingly positive. I would really like to see the JackBe platform at the Boston Health 2.0 conference providing demonstrations of how their platform can integrate information across disparate Health care sites. I definitely need to work on this as an idea.

A Mini HealthCampPA - Engaging consumers in HealthCare, DataPortability and all that

The discussion on HealthCamp related issues such as DataPortability was very stimulating. It took place at 11:00am in Room 1215. The issue was how we, as consumer, can drive the re-construction of the HealthCare system in a way that finally gives us access to the information about us - Our Personal Health Record.

Once again, just like last week at SocialDevCampEast, a good audience of highly engaged people participated. One of the most telling quotes came from one of the participants, geoff dimasi :

"I didn't realize I had so much to say on the subject [of healthcare]"

I need to reflect on those discussions but hope some of the attendees will add their comments to this blog. More later.

Off to BarCampPhilly this Saturday

BarCampPhilly is happening this weekend (Saturday November 8th). The event is sold out so it should be an awesome event.

I didn't get enough Geeking done this weekend at SocialDevCampEast so another top up session is in order. It also appears that there will be a few people attending that are interested in DataPortability and Health Care. I think I may well end up presenting a session on bringing Open Standards and Web 2.0 technology to Health Care. Will this count as a mini HealthCampPa? Let me know if you are:

a) attending

b) interested in participating in Health related sessions.

Attendees to BarCampPhilly have been given the opportunity to be featured on the BarCampPhilly.org site by answering the following questions:

• Who are you and what do you do?
• Why are you attending BarCamp Philly?
• If you were to lead a session, what would it be about?
• Tell us one random fact about yourself.
• Where can we find you? (url/twitter)

For What Its Worth, here are my bits and pieces.....

Who are you and what do you do?


My name is Mark Scrimshire and I am a troublemaker, troubleshooter, Internet strategist and blogger who has worked in and around IT for more years than I care to mention. By day, I have just taken on the responsibility for CareFirst BlueCross BlueShield's Web Strategy. This is at a particularly interesting time.
I also organize the HealthCamp series of events and am active in the Web 2.0 and Health 2.0 scenes. I am also a big proponent of the DataPortability movement.
In my past I have spent 18 months blogging for O'Reilly Media at AOL, producing a daily blog for AOL staff talking about the implications of Web 2.0 technology.

Why are you attending BarCamp Philly?

I am not a developer but I am a geek at heart. I really enjoy getting under the covers of technology and working out how it can be applied in new and interesting ways. I have attended a number of BarCamps and also run a series of HealthCamps. I really enjoy meeting and learning from passionate people. The energy at these events is just awesome.

If you were to lead a session, what would it be about?

As a big proponent of DataPortability I would like to lead a session talking about how this can and should be leveraged in the Health Care world. Via Twitter I have already been asked to take time at the event to give a de-brief on the happenings at the recent Health 2.0 Conference that took place in San Francisco in Mid October. So that my very well surface as a session if more people express an interest.

Tell us one random fact about yourself

My son (the UK jazz artist - Scrimshire - you can catch his random podcasts on his site) has challenged me to swim around a bunch of Greek Islands next year. I was daft enough to accept. You can follow my training on twitter using search.twitter.com.

Where can we find you?

You can find me on Twitter as ekivemark.That same name is often found on AIM and Skype too.I blog at http://ekive.blogspot.com.My profile can also be found on LinkedIn and elsewhere via Google.

Reflecting on a new world of Consumer-driven Health Care

I have been back from the Health 2.0 Conference and HealthCampSf for a week now. I also attended SocialDevCampEast this weekend and presented a session on Data Portability. That session was given from the perspective of how Data Portability can be applied to Health Care. I was encouraged by the turnout to the session. Microsoft's announcement this week of OpenID support, that helped push the number of compatible accounts over the 900 Million mark, certainly didn't hurt to put DataPortability in the spotlight!

This week we also enter in to a momentous election here in the USA. Whatever the result we are set to see major changes in Health Care in this country.

When I reflect back on the past couple of weeks and the transformation of Health Care it is becoming clear that the industry is set to switch from being a business-to-business market place to not just a business-to-consumer market place but potentially to a point where there is a complete inversion of the market place - becoming a Consumer-to-Business market place. There are two factors that seem to be driving this transformation:

Information is becoming more readily available to consumers. We are already seeing "invested" consumers embracing this. They are not only consuming information but generating their own content to add to the growth in knowledge and resources. Just look at innovative sites like PatientsLikeMe for an example of this. We are also seeing the next generation of systems for health care from companies like AmericanWell that will capture and share consumer ranking information as a by product of the transactions that they enable.

Making information available is just one aspect. The invested Health Consumer to date has typically been someone with a health condition that is not being adequately serviced by the traditional health care system. These consumers have embraced email lists, social networking, blogs, wikis and other simple tools to find each other and create ad hoc support groups.

The industry has tried to ignore these emerging patient support resources but that is becoming harder to do. These support groups are now being enabled by startups and we are seeing situations where these groups are able to organize and conduct clinical trials that are bigger than anything even major players have been able to organize.

Like it or not the industry is going to have to recognize the power of the invested consumer and the ranks of the invested consumer will continue to grow. The cost of health care is continuing to rise with no moderation in sight for the rate of increase. Employers and Health Plans are reacting to this by offering new products like Consumer Directed Health Plans. The impact of these plans is that the consumer can find themselves shouldering a greater share of health costs. This is triggering two things:

• A greater focus on Health and Wellness. It is more cost effective to encourage healthy lifestyles that aim to avoid consumers becoming patients.
• Consumers are moving from apathetic to engaged.

The rise in out of pocket expenses for consumers is set to drive changing behaviors where consumers will leverage the information available to them to take a more active role in managing their health because failing to do so can have a major impact upon their financial health.

Health Plans will be increasingly supportive of this transition. The current system focuses on managing claims. If Health Plans continue to focus on the point at which their members have become patients then they have lost the battle and must become resigned to continually rising costs. Switching to helping members lead a health life can avoid unnecessary claims and provide an opportunity to contain medical costs.

One of the themes that has kept surfacing through out the election period has been the idea that we, the people can make change happen. It is that idea that is behind the HealthCamp initiative. We don't have to wait for the industry to organize itself to solve some of the challenges. We can push for change. If we get the new wave of startups in the Health industry to adopt open standards, to leverage the interoperability work that is being done in the Social Networking world, then we create a platform for change.

Let's build on the shoulders of the great work that is being done in the Data Portability world. The Health Industry doesn't need to invent its own mechanisms for secure authentication and information sharing. It can leverage the de facto standards like OpenID and OAuth. If information exchange standards are not established let's build on the great work being done by people around microformats.

The message I present to anyone that will listen at CareFirst, where I work, or any other Health Insurance Provider, Hospital System or business partner in the industry is that we need to adopt the standards that are establishing themselves in the consumer space. Failure to do so will only serve to frustrate our customers, because the last thing they want is yet another user id and password to remember. This is especially true as we move in to a world of electronic health records. The health care industry has so many specialties that there will always be a wide variety of organizations that a consumer will need to interact with in the course of their care. Let's make it easier for our customers by allowing them to use services that they are already familiar with. Why can't a Yahoo, Google, AOL or MSN user use the same user id and password that they use everyday in order to access health information?

Yes we have to be cognizant of Data Privacy but we need to balance that with the needs of an increasingly engaged customer.

Promoting HealthCamp and DataPortability at SocialDevCampEast

This afternoon I led a session on DataPortability as it relates to HealthCare. The topic is expected to range over OpenId, OAuth, Microformats and other related projects.

This turned out to be a very lively discussion. PRivacy is a major concern but the idea is that there are a lot of developer eyeballs focused on standards like OpenID and OAuth that will address problems more quickly than with proprietary solutions.

This discussion will continue at the next HealthCamp.

OpenId closing in on the big One Billion

This week has been a busy week for OpenID. At the Microsoft Professional Developers Conference Microsoft announced that Live ID will be OpenID compliant. I am estimating that this will add about 380 million accounts to the approximately 500 million existing OpenID capable accounts courtesy of Yahoo, AOL, France Telecom and others. Google has been providing limited OpenID support but this week also announced their adoption of OpenID 2.0 support. Interestingly they are also moving to support OAuth. That is a big move.

It could be that the Google announcement is a knee jerk reaction to Microsoft's news. It seems that they are still developing some pieces of the service offering. What is interesting is that Google seems to have take a slightly different approach and some are claiming that they are breaking the OpenID standard. What they are doing is using the gmail email address as the key. This requires sites adopting OpenID to make changes. This is where the shouting is taking place. For an interesting assessment of the implications check out the Neosmart blog. They claim that Google is forking OpenID. Try to take this in your stride. Take a breath and scroll down to the comment left by David Recordon, one of the leading players in the world of OpenID. I have copied David's comments are here:

"Google is taking advantage of a feature in OpenID 2.0 known as "Directed Identity". This allows an OpenID 2.0 Relying Party to start the OpenID protocol flow using a known URL (Yahoo!'s ishttp://openid.yahoo.com/) to allow for "one click" style login dialogues. By performing discovery on this URL, using the XRDS XML format, the OpenID Provider advertises the OpenID Endpoint URL for the Relying Party to make a request against. Google is doing this correctly with the URL to perform discovery against being https://www.google.com/accounts/o8/id.

The piece that Google is currently doing differently is requiring pre-registration of each OpenID Relying Party before users can login to a given site. This does break the common deployment of OpenID on the web today, but Eric Sachs of Google has said on the OpenID mailing list (http://tinyurl.com/562mec) that this is temporary as they work to stabilize their OpenID Provider: "We just need to do the standard scaling, stability, translation quality, etc. evaluation to make sure there are no major problems. If we are lucky, that won't take much time. However it is more then likely that we will need to tweak things in our user interface to make it easier to understand, and unfortunately translating any such tweaks into 40+ languages takes awhile."

As for using email addresses as OpenIDs, this is something the OpenID community is talking about quite a bit right now; Google included."

I think it is clear, As Microsoft noted, OpenID is recognized as a maturing De Facto standard for authentication. The major Internet players are all supporting OpenID. Now it is time for enterprises to recognize the advantage of adopting a global De Facto Authentication standard. This was part of our discussion at Health 2.0 and HealthCampSf last week.

I have been pushing the idea of using OpenID and OAuth, and other elements embraced by the DataPortability initiative, across the Health Care industry. It is now time for the industry to take that leap of faith and make it happen.

HealthCampSf - more fascinating discussion and planning

A big thanks needs to go out to Manatt Health Solutions for providing the venue for HealthCampSf at the Manatt, Phelps and Phillips offices in the Embarcadero Center, San Francisco. The only downside to this venue is the distraction that the view from their 30th floor offices brings. The views over the bay are totally stunning! Check out my blog from the Health 2.0 Accelerator meeting that was held there earlier this week.

Happening the day after the high octane Heath 2.0 Conference, where even Dr. Ruth made an appearance, The event saw the effects of the party hangover.

HealthCamp took place both physically and virtually with people dialing in from across the country.

THe discussions ranged over a number of subjects.

• How to evolve the Health 2.0 Accelerator and the Health 2.0 Conference
• How to promote interoperability initiatives with the Health 2.0 Accelerator

During HealthCampSf the CEO and VP of Business Development from JanRain courtesy of an invitatin from Mike Kirkwood of Polka.com, joined in the sessions and presented the latest developments around OpenId. JanRain's OpenId tools have recently been adopted by Microsoft for use with HealthVault. JanRain have released a Software as a Service offering for OpenId and OAuth, RPX Plus and RPX Pro.

The objective of these products is to bring implementation of OpenId and OAuth down to a less than one day integration exercise.

This is great news. OpenId has over 500 million OpenID capable accounts globally and anything that simplifies the signup process, without sacrificing security is a positive move.

Some of the discussion that spun out of this OpenId and OAuth overview touched on creating an Health Information Interoperability Demonstrator. It was suggested that this could be run in conjunction with the Health 2.0 Conference.

The concept is to plan to bring together developers in the Health 2.0 space and over the course of one or two days to work together to create new health-centric mashups as demonstrators.

One of the things that came through in the Health 2.0 Conference is that the industry has moved on beyond simple health content aggregation and is now focusing on getting real work done and transactions processed. This is great progress, but it just served to drive home the realization that there is much more to be done and the real evolution is when these different applications, platforms and services can be connected together to create new services that can extend the reach and value of these Health 2.0 applications.

For example, how might PharmaSURVEYOR's drug interaction software be integrated with Intelecare's Medical Adherence platform to improve drug safety for patients.

The discussion with JanRain was invaluable. It demonstrated that OpenId and OAuth continue to evolve and provides practical single sign-on capabilities and secure information sharing mechanisms.

After the discussion I was even more convinced that the Health 2.0 Accelerator should leverage the work being done by DataPortability.org. Part of the role of the Health 2.0 Accelerator could be to act as a Health Industry Special Interest Group to promote Health Information interoperability.

Health Care is poised to go through massive transformation. It will increasingly become a consumer-driven industry. As that happens it is entirely logical that the industry should build upon and leverage the developments that are continuing at breakneck pace in the Social Networking world. Emerging standards such as Portable Contacts will grow to become underlying standards in healthcare. We do not need to re-invent the wheel.

Another area to leverage will be Microformats. These machine interpretable but human readable formats keep evolving. The Health 2.0 software sector needs to look at developing Health related formats to complement xisting formats such as Address cards (hCard), Calendars (hCalendar) and ratings (hReview).

Check out the wetpaint wiki site To find out more about HealthCamp. To find out about future events check out the BarCamp.org front page or the HealthCamp specific page.

Blog Action Day - Poverty and Health Care

Today (October 15th) is Blog Action Day. This year the issue that is front and center is Poverty. With working for a major US Health Care provider my thoughts turned to the issue of how to bring Health and Wellness to those that can't afford traditional health care plans.

Making Health Care accessible to those that need it will be a major challenge that we will have to work together to solve in the USA.

The Health Care system is broken and we have to work out how to put it back together in a way that helps us address this and other significant challenges.

The transformation of Health Care through Social Media, Open Standards and Web 2.0 technologies is the central theme of the series of HealthCamp unconferences I have been organizing. If you will be at the Health 2.0 Conference in San Francisco next week then look me up, I am helping the organizers there.

After the Conference I will be organizing a HealthCampSf event to take place on Friday October 24th. The venue is still being finalized but I am hoping to hold the event at the Courtyard Marriott San Francisco on 2nd street. The finalized details will be posted on the barcamp.org site.

I will also be attending the second SocialDevCampEast event on Saturday November 1st in Baltimore. The event is filling up fast and I plan to raise the Health Care issue as part of the Social Media conversation at that event. If you plan to be there drop me a line on twitter to ekivemark.

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This post is part of Blog Action Day 08 - Poverty

Geeking out at Web 2.0 Expo

I ducked out of the Finance 2.0 for Early Adopters session and dropped in on the Comet session.

Web Sockets in the HTML 5 specification supports bi-directional communication over a single socket.

With the HTML versin 5 spec the HTTP protocol can upgrade to WebSocket protocol enabling bi-directional flow between client and server over a single socket. This means it traverses firewalls easily and it eliminates the need for middleware components.

This was really just the warm up for me. The session I really wanted to see was Joseph Smarr, the Chief Platform Architect from Plaxo. He makes complex subjects clear and somehow manages to do that while talking at a rate of hundreds of words per minute. His talk is one of the last at the conference and addresses implementing the Open Web.

Joseph is going to talk about OpenID, OAuth, OpenSocial, PortableContacts and probably more. Plaxo has been on the forefront of the OpenWeb and portability of information, particularly address book information across the web. Their technology was attractive enough for them to be acquired by Comcast earlier this year for a rumored $150-170M. This talk will probably be similar to the one given to Google Developers back in May 2008.

This is a fast moving development space so it will be interesting to see how things have evolved since the first talk in April 2008 at the Web 2.0 Expo San Francisco.

Off we go......

"The Web is going social"

OpenI, Oauth, OpenSocial, Microformats.... Jabber is the forgotten standard that is a critical glue component around XMPP. Yes, the stream that Twitter keeps controlling.

"The Social Web of today is broken"

Each web site assumes they are the first to ever be social. Yet another silo gets created. Or they give up and become a widget inside Facebook.

Help is on the way....

New building blocks:

- Who I am

- Who I know

- What's going on

Who I am

Create a portable, durable online identity. On the web we pretend we have never met before. But that is changing.

OpenID

- Sign up with an existing account

- Link and share your profile data between sites.

This is a powerful building block. You can build a trusted connection that allows you to share information between the sites.

AOL, Yahoo and soon MySpace are OpenID providers. Google also does this for some of their properties.

You can consolidate your identity though microformats using

rel=me(XFN)

Only I can put a me link on my web pages.

Most sites that ask for your home url and they add rel=me links. This allows the Social Graph to be trawled.

The advantage for site owners is that you don't need to get members to upload photo, videos and other content. Yet it can still be available to you.

This is an open standard so you can build this content on your own web sites.

Build and maintain real relationships

Contact APIs

- Find people from your current address book

- leverage previously established relationships.

Web mail address books have been the best source of information up to now.

Google, Yahoo and others have implemented these contact apis so you don't need to reveal your userid and password.

OAuth

- Share private data between trusted sites.

This has been a big success in the last year. It is a standard way of granting access to another site.

The big advantage is that you can apply a scope to the access. It could limit the type of operations that are possible or the duration for which it is available.

Friends-List Portability

OAuth allows updating of your friends list. ie. Continuous discovery.

What's going on?

OpenSocial

- Build social apps that can run anywhere.

RSS/Atom

- Syndicate your activity to share with others

- A general mechanism to share updates. Couple with OAuth to limit access via a protected channel.

Jabber (XMPP)

- Real time update stream between sites.

This is an inherently federated protocol. It is a core part of Identi.ca and laconi.ca

GNIP is a middleware provider that is making this easy for service providers.

How is this evolving?

- Emerging Identity Providers. The big portals are adopting these standards to retain users.

- Content Aggregators. As the number of site grow then a middleman acting as a discovery engine will be useful.

- Social Graph Providers. Leveraging friends lists.

XRDS-Simple - A simple service directory document.

PortableContacts

This is a simple standard, similar to vCard and built on OpenSocial that enables the discovery of contact information. OpenSocial will integrate PortableContacts.

The Emerging Scenario is

OpenID to sign in.

Looks for X-XRDS-Location

XRDS-Simple to discover availablew APIs

WWW-Authenticate specifies OAuth

OAuth Discovery via XRDS provides OAuth endpoints.

After OAuth grants access users get a token that enables access.

This provides an end-to-end process for reaching a site and accessing contact information without requiring custom code to be developed for each site.

We are moving towards Write Once and Work.

While providers use different terms they support the same handshake:

- Facebook connect

- Myspace dataavailablity

- Yahoo Y!OS

- Google FriendConnect

- Plaxo Pulse

Facebook is the outlier - the only one not using standards. However they conceptualize the same way and could at somepoint swap out standards "under the hood."

Developers are advised to use the open stack. Once implemented it will be easy to adopt the same handshake process with Facebook.

Brady Forrest asked a great question: Usability with OpenID is an issue that "freaks out Grandmas"

The good point is that because the big players are using open standards the work they are now focusing on to improve usability will feed back in to the Open stack. Some good work is going on how to explain the process to users.

.

VRM and HealthCamp via Health 2.0 at BarCampRDU

I am writing and posting this from the Carolinian traveling down through Virginia to BarCampRDU in Raleigh, North Carolina. Oh, the wonders of modern technology.

In my last blog I weaved together some of the threads from Vendor Relationship Management and Health 2.0. This has been very much on my mind as preparations for HealthCampDc and HealthCampNy continue.

I have volunteered to talk about Health 2.0 and VRM at BarCampRDU. So, as I sat on the train I pulled together a few slides to illustrate the subject. I have uploaded them to Slideshare and am sharing it below.

Health 2.0- and Vendor Relationship Managmeent

view presentation (tags: 2.0 health healthcamp vrm)

Health, VRM and Open Source - Coming together at BarCampRDU

This coming weekend is the third BarCampRDU, which is being held at the Red Hat Campus in Raleigh. I am traveling down to the event to join 250 others in discussions revolving around Open Source.

So far the proposed sessions include Data Portability, The Semantic Web, Distributed Agile, Rails/Groovy and other developer focused topics. The growing list is here. I have proposed sessions on Vendor Relationship Management and Social Networking and Open Standards in Health Care - aka Health 2.0 - a prelude to the discussions at HealthCampDc and HealthCampNy at the Web 2.0 Expo Web2Open unconference.

Hopefully Doc Searls won't mind me leveraging some of the great ground laying that he and various colleagues have done in order to spread the word on VRM. I will probably start with the VRM Principles:

Principles

1. User control
2. Reduce, Reuse, Recycle (Don't Reinvent the Wheel)
3. Reciprocity & Everybody Wins
4. Leverage network effects
5. Relationships are more than transactions
6. Solve real-world problems

I should probably also steal some slides from Doc's great intro talk on the VRM Manifesto.

Building on the VRM subject I am hoping to get in to discussions about using the Higgins Identity framework to manage federated group access policies. That could be a fascinating discussion that we just barely scraped the surface of, as we touched on R-Cards at the VRM Workshop.

I see a convergence of VRM with Health Care as the consumer becomes more involved in their own health. As that happens scalability becomes critical and the simplicity of Open Standards such as OpenID and OAuth will come in to play to enable seamless, heterogeneous integration. If I understand the principles behind R-Cards and I-Cards correctly these provide a stepping stone to the Personal Data Store that exists for VRM. The pointer-based nature of R-Cards would allow existing islands of information to be leveraged under the direction of the consumer - the real data owner.

The more I think about all these threads emerging, the more I get excited about our ability to make change happen. This week's BarCampRDU is set to be another stimulating un-conference event which should set the scene for HealthCampDc on September 12th and HealthCampNy immediately the following week.

Stay tuned - or better still - sign up and join in making change happen! You can even buy the T-Shirt!

VRM retrospective - making adoption easy

The Vendor Relationship Management Workshop at Harvard this week has been an invigorating event.

During the event I blogged on a question that was on my mind:

"Where do I put all my VRM stuff? "

Some of my questions were answered in the final session on R-Cards.

R-Cards offer the potential for our "personal data store" to be aggregated from the personal data held by companies that we have done business with on the Internet. One thing does need to happen though. We need to establish a VRM data portability policy framework that can be adopted and followed by companies.

What are the elements of a VRM data portability policy?

The basic elements of a VRM data portability policy should include:

• Data retention agreement - How long will my data be retained for? For example - for the life of the relationship plus 30 days.
• Data reuse agreement - Will my data be used for purposes beyond the original transaction
• Data ownership agreement - What elements of the data belong to the vendor such as a Frequent Flyer number
• Data portability agreement - The data that is the subject of the agreement may be stored by the vendor, or it may be held by a data custodian in a Personal Data Store.
• Data access agreement - The data that is the subject, or a sub-set, of the agreement should be accessible to third parties that have been granted access by the user. For example, granting access to my shipping address information at Amazon by a third party vendor I have performed a transaction with.

What other elements are needed?

Enabling evolution of the Personal Data Store

With an agreement around VRM data portability we have the basic mechanism in place to create the VRM Personal Data Store from the information that is already held about us out on the Internet. The R-Card seems to provide a mechanism to enable this.

Embracing the Vendor

This approach is attractive to me because it offers an approach that embraces the vendor rather than excluding them. Forward thinking Internet companies like Google, Amazon and eBay could adopt this as a means of further cementing customer loyalty.

Because the approach acknowledges the existence of our personal data being held by vendors it is pragmatic and leverages the situation. The Personal Data Store and the online infrastructure in the cloud needed to support the Personal Data Store does not become an impediment to adoption. Instead the user adoption curve becomes very simple. If a user has a set of delivery, billing and other addresses they have established and maintained at Amazon or eBay they can begin to re-use them at other sites via R-Card pointers.

As Personal Data Stores become established users can gradually transition their information in to their Data Store seamlessly.

The critical point is that this all becomes a matter of user choice. Users are not forced to adopt the Personal Data Store in order to enter the world of VRM.

Shoot it down

I know this line of thinking needs further analysis but I felt it worth putting out for discussion. Feel free to comment.

VRM and the Personal Address Manager

This VRM Workshop session covered the concept of the Personal Address Manager.

The scene setting points covered:

• First Assumption - Privacy
• Differences from long running relationships
• - Mutual policy negotiation - pain-free
• - Default policy bucket
• - No identifier
• Easy to produce end of relationship artifacts
• Win-Win for customers and vendors
• - Removing barriers to exit is attractive.

A use case was examined: Single Stop Online Shopping

• With Address
• With Personal Delivery Service (eg. relationship wth UPS, Fedex etc.)
• With Vendor Delivery Service (eg. Vendors own delivery service that respects PAM token)
• With Address from Personal Address Manager

Is the "With Address" scenario a Personal Address Manager (PAM) case? However the PAM might be the place where user relationship policies are stored. "With Address" was eliminated as a policy statement by vendors.

The "with Delivery Service" was selected to analyze.

Roles:

• Shopper (S:)
• Merchant (M:)

Assumption:

• Policy Assurance and Warranty

Scenario:

Step 1.

S: Shop at a compliant store

M: Offer VRM ("use VRM" button on the web page)

Step 2.

S: Click "Use VRM"

M: Endpoint Request

Step 3.

S: VRM Discovery End point - ie. PAM Address pointer

M: Push to provision

Step 4.

S: Provision vendor

S: Give Vendor token (with policy)

M: Policy agreement

M: Use token to get address

M: Use Address

M: Delete

M: Confirmation of End of use

Side notes:

Initiatives are underway to build a policy framework. (SAML and WS-Policy?)

This was a complex discussion to develop the scenario. Edits to refine this discussion can be made on the VRM Workshop Wiki in the Personal Address Manager page.

Where do I put all my VRM stuff?

Today has been fascinating at the VRM Workshop. I held a session on Vendor Relationship Management (VRM) and Healthcare but wished I could be at some of the other concurrent sessions.

Health Care has some great use cases that can demonstrate the value of VRM.

After a stimulating dinner, in which conversations continued, it was time for a walk back to the hotel and a chance to contemplate some of the discussions of the day.

It struck me that there is one question I must ask tomorrow. First, some background for those of you not familiar with the concept of VRM, to set the scene.

VRM puts the consumer at the center of transactions whereas today we are often the outsiders. This is especially true in the health care sector where we often feel like the uninformed observer, yet we are the subject of the tests and treatment.

One of the discussions that came up today was about data portability. The efforts of the dataportability.org collective appears to be to enable data to move between different social media sites. This is different to VRM where it is considered that the consumer owns the information. This is not putting down the essential efforts of the dataportability.org group because VRM depends upon data portability to allow information to be moved from data custodians.

This does raise a significant question. Let's pre-suppose that we as consumers adopt VRM and it is another "cloud" service that we use.

What are the essential characteristics of our VRM data custodian? This is a logical and important question because the average user will not want to be bothered with the information management tasks that go with managing a critical information store.

• So how do we determine the level of trust offered by our VRM data custodian?
• Do we need different custodians for different types of data?
• Does our medical VRM information need to be stored with a HIPPAA certified entity?
• If we have multiple data custodians how is that different from today's situation?

Do we need a service mark for VRM data custodians? Could this be something that pushes forward the identity and data portability agenda's too?

If we could define the characteristics of a VRM data custodian then we could establish credentials and validation programs. The benefit of this approach might be to allow the existing established data stores, whether they are Google, Microsoft or other bricks and mortar vendors, to participate in VRM without shutting off the evolution to an ideal state. The credentials could enshrine the

Another benefit of this approach would be to allow some of the forward thinking organizations to participate in VRM more actively than would be the case if the essential data stores for VRM were outside their purview.

VRM and the Medical Home concept

During the opening remarks to the Workshop Doc Searls asked what areas within organizations might be most receptive to the adoption of Vendor Relationship Management (VRM)?

This question prompted this session. It struck me that the industry initiative in Health Care around the Medical Home concept might be Health Care's sweet spot.

Emerging issues in Health Care will help push the role of VRM. These include:

• The rise in the power of the consumer
• Public policy and the uninsured

In a conservative industry VRM might find a role as an enabler of the Medical Home. Medical Home is being promoted by the industry as a solution to improving the quality and efficiency with which care services are provided, particularly with respect to complex health issues.

The coach, advocate or practitioner that guides an individual through the maze of health care services can be considered a vendor partner of the patient. They can help pull together all of the relevant information to improve the efficiency and effectiveness of diagnostics and treatment.

During the discussion in the session a number of points emerged:

• Google is supporting Continuity of Care Record (CCR). They have also adopted Atom as the standard for sharing CCRs.

some of the participants are already working with solutions in this space:

• MedCommons.net
• Polka.com

Some of the conclusions from the session:

• Information is the bedrock on which Medical Home depends.
• The advocate or coach in a Medical Home program could be treated as "just another vendor" from a VRM perspective.
• The open standards of OpenID, OAuth, OpenSocial and other standards can be used to enable MedicalVRM.

OpenID and OAuth in the Medical Records world

Adrian Gropper of MedCommons presented this session: "The Enemy of Good is Better"

The realization is that the barriers to on-line medical records are not legal or technological. This leaves social acceptance as the primary barrier.

The concept behind this session is that people will use more sophisticated standards as a delaying tactic to avoid adoption.

Healthcare has so many aspects to it. A use case that addresses one specific situation may provide the starting point. But what is that use case?

Informed consent is a challenge in health care. How about a scenario where providers supplied medical information to the patient and they could use that information to seek second and third opinions may be via some type of marketplace.

Do we need a VRM logo that indicates an organizations willingness to provide information on a customers terms. ie. open document formats, openID support etc.

We worked through some use cases:

Information banking standards create trust through VRM via the Rel Button

• Patients Like Me could feature a RelButton on their site
• Employer sponsors medical VRM as an enabler of onsite clinics
• Doctors could feature a RelButton that the are open to assisting with informed consent or partnership with the patient in medical home
• Personal Genome: as poster child for VRM in Science - not healthcare
• Focus on the elderly or severely ill as early adopters
• Doctors could feature a RelButton on their sites that indicate that the are open to second opinions
  

VRM Agenda Making

Be Prepared to be Surprised. The Workshop is being based on Open Space principles. This is similar to the AgileCoachCamp I attended recently and the HealthCampMd meeting I ran recently.

I have volunteered to lead a session on

"VRM and HealthCare - Is Medical Home a stepping stone to VRM?"

1:00pm - 2:00pm in Room 202.

The first session I attended was Kevin Marks of Google talking about Open Social.

One of the emerging standards that seems to be an off shoot of Open social is Portable Contacts. that initiative is being worked on by Joseph Smarr (Chief Architect of Plaxo) and Chris Messina (aka FactoryJoe).