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  • “to feel and be felt” Ze Frank on designing for happiness

    Posted on April 24th, 2012 admin Comments

    I saw a post today on Swiss Miss the great design blog, which made my day. Ze Frank is coming back! And that bit of exciting news reminded me of this gem:

    In his 2010 TED talk (warning, some adult language), Ze Frank talks about his experience running a popular blog and a video series. But that doesn’t begin to describe what Ze Frank’s world was. Fans will remember his posts and videos as so much more just than a blog.

    Ze Frank’s gift is one of designing for happiness.

    In the TED Talk, Frank says the most fundemental thing we can do is to “feel and be felt”. In essence, all of his work was about spinning things – existing works, people’s concerns, negitive emotions – into something positive. His daily video posts were ways to rapid prototype the outcomes of his ideas. If that’s not the essence of experience design, I don’t know what is.

  • Socioeconomic factors and health outcomes in Virginia

    Posted on April 24th, 2012 admin Comments


    The quality of healthcare matters and it is one of the more difficult things for a consumer/patient to gauge. We can tell if a consumer product is cheaply made, or if a dining experience is sub par. It is harder to observe, research, quantify and compair the quality of healthcare. For most Americans, unless it is a major procedure, or requires services offered at a specialty location, we probably stick close to home. But what if the quality of care close to home is vastly different than even a few hours away?

    Another very interesting angle is to consider is if variations in outcomes and quality are not simply in the hands of the provider, but also influenced by socioeconomic factors. Do you have access to high quality food and can you afford it? Do you have access to health education and do you have the means to follow the recommendations? Do work conditions in manufacturing-dominated areas contribute to health issues that aren’t as prevalent in professional areas?

    This week, the Robert Wood Johnson Foundation released an interactive tool for exploring health outcomes by geographic area. In Virginia, there are some pretty clear relationships between positive health outcomes and medican household income. I’ve not reviewed enough data to suggest any causalities. For instance, are better care facilities found in more populated areas and therefor those areas have better outcomes? Regardless, the relationship between low income and poor health outcomes is worthy of discussion; particularly as our country continues the debate over national health reform.

    RWJF Map:

    New York Times Economic Samples from 2005-2009:

    In this case, the colors are inverse. The upper map shows positive health outcomes in white and light green. For instance, Nelson (NE) and Albemarle  (AE) counties. The lower map shows higher household incomes in dark green. For instance: Fredricksburg and Charlottesville metropolitan areas.

    The relationship is a little more clear if we look at county by county:

    Rank Health Income
    1 Fairfax City of Calls Church
    2 Arlington Arlington
    3 Loudoun City of Alexandria
    4 Albemarle Fairfax
    5 York Loudoun
    6 Alexandria City of Fairfax
    7 James City James City County
    8 Clarke Goochland County
    9 Powhatan Albemarle
    10 Mathews Fauquier

    source: Health – RWJF, Income – Wikipedia

    To be absolutely clear, this is not a scientific study. There are likely many other factors which should be considered including population density, density of qualified healthcare providers, etc. We need to also think about other things that go hand-in-hand with economic disparity. For instance, areas of low income are traditionally associated with fewer healthy options for food and are sometimes classified as food deserts. Areas of high income tend to also have better education, which has a well studied cause and effect relationship to positive health outcomes.

    My point in sharing this comparison is simply to call attention to the large variation in health outcomes, even in a single state and to raise the question of socioeconomic factors, as well as variations in clinical quality, as a contributing factor. What do you think?

  • From Mayo: Building a Process to Accept Feedback from your Social Media Audience

    Posted on April 24th, 2012 admin Comments

    Note: I’m not writing much on this site about healthcare and social media lately. However, over on Mayo Clinic’s Center for Social Media I contributed a piece on social health strategy. One of my concerns about any business which uses social media is how they will manage feedback. It’s easy to setup a facebook page, but it’s another thing entirely to connect all the right processess and people within the company to help address feedback from fans and friends. Yet, without that process, your social strategy can fall flat on its face if audiences don’t think you can help them with anything other than marketing info.

    You can download a pdf of the article here.


  • For some healthcare players, innovation is already a priority

    Posted on April 24th, 2012 admin Comments

    Lately, I’ve been writing about innovation and design thinking in healthcare. I often make general observations about the industry like innovation is rare in the delivery of care or we need to learn how to use design thinking. While they may be present as buzz words, largely I stand by the assertion that they are rarely deeply integrated into the culture of most health systems. But there are some standout exceptions and I’d be remiss if I didn’t highlight the places where innovation is part of the culture.

    • Kaiser’s Garfield Center for Innovation – Kaiser’s center was among the first of its kind in healthcare. The Garfield center was established out of work the health system did in collaboration with IDEO. A team of clinicians was tasked with redesigning nursing units and the processes around them. On the heels of a successful redesign, the team formed the center to become a source of new ideas for the system as well as internal consultants. Kaiser’s innovation center is profiled in Tim Brown’s Harvard Business Review case study on Design Thinking.
    • Mayo Clinic Center of Innovation – Mayo’s center builds on the Mayo brother’s early idea of patient-centered care. The Center occupies a large glass workspace in the lobby of Mayo’s Rochester location, giving it both prominence and literal transparency.
    • United Healthcare’s Innovation Team - United is a large commercial payor with roots in the provider world. United has a VP of Innovation who, along with his team, is responsible for promoting design thinking across the organization. United has also started offering innovation consulting to providers through its process improvement program.

    This is by no means an exhaustive list. You can probably name some other health systems or industry players with innovation and design teams. We have a ways to go before empathetic design becomes widely adopted in the industry. But it is important recognize that innovation is already a priority in some organizations.

  • Want to build the health delivery system of the future? Just think like Mick Jagger.

    Posted on April 24th, 2012 admin Comments

    This post orignally appeared on the Stanford Medicine X blog, you can find it in it’s entirety there. 

    Pick a classic rock band. Go ahead, I’ll wait. You’re thinking of The Rolling Stones aren’t you? No? Well you are now. When we think about band like the Stones, we often describe them as iconic. The Stones had a unique sound, didn’t they? Seeing them live was a unique experience (or so I’m told). The reality is The Rolling Stones were total copycats.

    So why do we love watching Mick strut back and forth singing Honky Tonk Woman? Innovation!

    Want to read more? Check out the full post on the Stanford Medicine X blog.

    Quite shy, Keith Richards spent his formative years alone, listening to and mimicking American blues and jazz artists. Richards was enamored with Chicago blues artists like Muddy Waters (who later become an icon of delta blues). He also had a fondness for rock-n-roll star Chuck Berry. He spotted a guy toting American blues records under his arm, while walking between classes in college, and recognized him as an estranged primary school classmate, Mick Jagger. The two, along with a crew of supporting characters, began booking gigs based on their reputation for covering American R&B tunes. [1]

    When they began to pen original tunes, two of their bandmates quit, in protest over the duo’s love for Chuck Berry’s style. Undaunted, Jagger and Richards focused on incorporating Berry’s love of casual guitar riffs and Chicago blues-style lyrics into everything they wrote. Today, when we listen to classic, defining tunes like Give Me Shelter, what we are really hearing is innovation. [2]

    The Stones in 1965

    Jagger and Richards took something existing and built on it to create something new. And that’s what innovation is.

    Innovation is about seeing trends and ideas in other spaces and applying your expertise and creativity to them to iterate and create something new. It is a skill which can be learned and cultivated.

    Oddly, we rarely see innovation in the process of delivering care. Certainly, there have been advances in medicine, techniques and devices, yet largely the delivery process has remained unchanged. Perhaps that’s because it is easy to confuse innovation with invention. Totally new ideas, the kind which come out of the blue, are lightening strikes compared to the frequent, iterative nature of innovation. For that reason, it is much easier to practice innovation than many suspect. Don’t believe me?

    Think of an iconic 21st century consumer electronics design. Go ahead, I’ll wait. You’re thinking of the iPod aren’t you? Darn it! Well, you are now. You’re imagining the simple, white, elegant design; totally new, totally unlike other MP3 players with their ugly buttons and clunky shapes. Right?

    T3 Pocket transistor radio | Dieter Rams | Braun

    See the resemblance to Dieter Ram’s design for Braun’s T3 1960′s transistor radio? Here is the essence of innovation. Just like Richards, inspired to noodle bluesy riffs by Chuck Berry, created something iterative and new, Apple’s Jony Ive looked at an elegantly designed radio and thought how does this inspire us? Shameless? Hardly. Steve Jobs often quoted Pablo Picasso, “bad artists copy. Great artists steal.”

    Stanford’s MedX is all about taking a queue from Richards and Apple. Innovation is easy, but it does require practice. Stanford’s MedX conference has an emphasis on inspiring innovation thinking. Michael Graves, renowned architect and designer, will headline the event, discussing his experience as a patient. Graves is outspoken about the need for innovation thinking in delivery of care. Beyond Graves, the entire event will use innovation as a theme to inspire the next iterations on care delivery.

    Want to get started practicing innovation? Here’s a simple example:

    Think about a company that revolutionized a drink commodity into a retail and lifestyle juggernaut in the last 20 years. Really, I don’t mind waiting. You’re thinking of Starbucks aren’t you? I knew it! We’re together on this, you and me. What are some attributes of the Starbucks model?

    • Inviting spaces – ever notice how Starbucks’ shops have big, over-sized, comfy furniture as well as hard surfaces? Sometimes we want to sit and chat. Other times, we need to get work done.
    • Rent-a-space – Ever thought of a Starbucks as your out-of-town office when traveling? Wifi, power, a desk…it’s perfect. That cup of coffee you bought effectively paid your rent on the space.
    • Adopt-a-style – Like the Starbucks experience? Why not buy a porcelain mug designed after their paper coffee cup? You can also pick up cards with iTunes links to the mellow coffee house vibes they play. Grab a bag of beans and you are on your way to recreating the baristia experience at home. Cha-ching!

    Now, think about the process of delivering health care. See any similarities? It’s ok if they don’t jump off the screen. But really think about it. Channel your inner Mick Jagger. What can Starbucks inspire about how we deliver care? Is it a retail model, or branding effort, or customer experience design? What about a new layout for a clinic, or walk in model? I don’t know, but I bet you can pull an Apple and build on Starbucks’ ideas to create something entirely new.

    Innovation doesn’t mean creating a new idea from scratch. Rather, innovation is a learnable skill which is all about observing existing trends, ideas, processes and technologies and applying your own iteration on them to create something entirely new. After all, remember what the artist Bansky said:

    Banksy v Picasso Bad artists imitate Great artists steal



  • Milk’s Oink – a model for rapid development in healthcare

    Posted on April 24th, 2012 admin Comments

    Last week, tech startup Milk, inc shuttered its first and only app, Oink. Stop laughing. Those are the real names. Ok, only in the tech world, right? Jokes aside, deciding to pull the plug on a major project is not easy. Kevin Rose, Milk’s founder, and the team have stated they are committed to rapid, agile development. It’s an idea we could learn from in healthcare.

    The company’s explanation was: “We started Milk Inc. (the company behind Oink) to rapidly build and test out new ideas. Oink was our first test and, in preparing to move onto the next project, we’ve decided to shut it down to help focus our efforts.” – via All Things D

    Easy to say, hard to do

    The trend of rapid development is gaining traction in tech startups. The basic idea is to continually innovate on products and services – they may never reach a finished state. In some instances, like Milk’s, the products may yeild some success, but fail to fully meet expectations. In that case, developers look at lessons learned from the project and move the successful parts into new projects, leaving the failed peices on the cutting room floor. Continue what works, abandon what doesnt.

    If the idea of abandoning projects mid-stream sounds challenging, it is. Teams have to ask themselves many questions such as when is the right time to pull the plug? How do we define success vs failure? What are the parts to keep and what should we leave behind? Perhaps that’s why tech pundants have lauded Rose and team for their decision to stop Oinc.

    Hey, clearly it worked out for them:

    Google today confirmed the news we brought you yesterday: Kevin Rose and some of the team from his mobile app incubator Milk will be joining the company. – Via All Things D

    Like most established industries, healthcare is steeped in tradition. One of the challenges of our tradition is a cautious approach to change. Largely, and justifibly, that’s because rapid change in the practice of medicine has high risks, and we don’t want to take risks with peoples lives. But there are some places within healthcare where rapid develipment and risk taking makes sense.

    The professional side of healthcare – administration, business development, IT, marketing, management, etc – has historically taken clues from the medical tradition: slow, calculated decisions based on evidence, research, detailed financial plans, etc.

    In adopting a rapid development model, professional teams could reduce some of the ramp up time for projects by getting comfortable with failure and change. Not every idea is a home run, sometimes it’s just about getting on base. If the idea has some merit, take the positives and apply them to the next iteration.

    Practicing rapid development

    In the last few weeks, I’ve had an opportunity to explore rapid development. A team approached me with a clever idea. (It really doesn’t matter what team or what their was. Names have been changed to protect the innocent, you get it.) As the innovation guy, it’s my job to help them incubate and pilot the idea. So we tried it.

    A few days in to the pilot, we hit snags. Part of the process stalled, dependant on another team and other processess. Pretty soon we had a massive reply-all thread going on email and enough differing opinions to make Congress jealous. (I’m here all night, tip your waitress, try the veal).

    We were at a crossroads – stall the project, build a larger team and try and compermise on the orignal idea, or rapidly develop the idea into something else. We chose the later.

    We did a quick assessment of the orignal idea and looked at the parts we felt worked well. We then discontinued the pilot in its current form. We let the other participants know and told them why and what our next steps were. Right away, we started a new pilot, plan b. Since we had building blocks from the successful parts of the first pilot, we were able to drop those processess and tools into place right away. We again communicated with the larger team.

    To pharaphrase:
    "Hey, were’t not perfect, but with your help and support we’ll continue to refine this process. Thanks for your patience. Instead of A B and C, would you please start using X Y and Z?"

    So far, the team has gone along with us. We understand they will eventually reach a point of change fatigue. To mitigate that risk, we know we cannot be in a state of rapid development forever. However, if we can use the tactic to keep the important parts of the orignal idea moving while we develop a stable process, then it will be a success overall.

    What about you – have you practiced some sort of rapid development in healthcare? What are your tips and lessons learned? How have you learned to accept partial success along with partial failure? Does rapid development differ from basic project management skills?

  • Designing for happiness

    Posted on April 24th, 2012 admin Comments

    I have the privledge of conduting new employee orentation for my health system. There is an excersize I ask the new hires to go through which I’ll share with you here.

    Take a few moments and think about something in your life you cannot imagine being without….something where you think I don’t remember how I got along without XYZ… It can be a thing, or a place, or even a person.

    What did you think of?

    9 out of 10 new hires usually shout out “my iPhone”.

    Sure, some folks reply with non-consumer answers such as my family, my children, or my last vacation. But for the ones who say it is their phone, what makes it such a compelling device, why could they not live without it? What they often tell me is it’s just magic, it just works. Apple’s marketing department would be happy with that response. I believe its just magical is a proxy for it was designed well.

    Over the weekend I had the chance to re-watch one of my favorite documentaries, Objectified. Objectified is director Gary Hustwit’s homage to industral design and designers. The film moves from vignettes of iconic design to narritaves of personal insight from famous designers. It is a wonderful film and part of a trillogy where Hustwit focuses on asthetics and design.

    In healthcare, we often think about design in a few very narrow contexts. We think about the archatecture of new buildings. Sometimes we think about the shape and styling of medical devices. Yet, that’s not how designers see the world. As Jony Ive, head of design for Apple, puts it: “it’s part of the curse of what we do… think about how everything we encounter is designed.”

    In Objectified, Erwan Bouroullec, of the designers says the goal of design about creating an enviroment where people feel good.

    Isn’t that sort of also the goal of a hospital or doctor’s clinic? Don’t doctors start practing medicine because it feels good to take care of people? Don’t we go to the doctor because we want to feel good?

    Regrettably, so many of our processess for delivering care were designed by consensus, rather than with a goal of creating an eivnroment where people feel good.

    A few months ago I wrote a post about designing for experience where I suggested many processess are designed by consensus, or created through committees which often involve compromise for political agreement or to avoid conflict.

    Try my new hire exercise again only this time think about an object or process which makes you feel frustrated or challenged when you interact with it.

    My guess is whatever that thing is, it was probably not well-designed. It may be the result of design through consensus or it may simply not have been designed with attention to user experience or detail.

    Now, more than ever healthcare needs to begin to apply design thinking to its processes and services. Design thinking has two major benefits: first it builds things which are in empathetic towards the user. Secondly, as Bouroullec says, it makes people feel good.

    Davin Stowell, a principal designer at SmartDesign discussess working with OXO, the kitchenwares company on their vegitable peeler. Stowell says it’s not as important to understand how the average person who use the vegetable peeler. What matters is the extreme usecase – the person with arthirtis in his example. “When you design for extremes, the middle takes care of itself…” says Dan Formosa, also of SmartDesign.

    Healthcare has an opportunity to embrace its extreme users too.

    Examples most certinally include those who identify as ePatients. ePatients want to participate in the development and implementation of their treatment plans. They often lament a lack of access to their clinical data, or even access to their physicans using modern things like text messaging or skype.

    We might also look at other extemes for inspiration. What can a “frequent flier” in the ER tell us about processess in the emergency room? What can the single, working mother with three kids tell us about process in the familiy medicine clinic?

    These users are all around us, yet for some reason, we fail to consider them when designing care delivery processess and services. Instead, we design for the middle, creating average offerings rather than standout offerings.

    There are competitive advantages to good design. It gets more people in the door. There are also imporant humanistic aspects. If good design really does create an enviroment that makes us happy, doesn’t healthcare have an obligation to design things well?

    It is not my intent to judge our entire industry unfavorably. Good design can be as ambigious as the term itself. If it were easy, every phone manufactureer would have invented the iPhone years ago, right?

    Still, there are ways to learn and practice design thinking:

    • Watch Objectified – pretty good place to start. It’s on Netflix for streaming. Listen to the designers talk about the objects they’ve designed and apply their terms and language to processess and experiences in healthcare.
    • Be empathatic – Empathy might be the single most important skill for anyone working in healthcare. Practice by thinking "Today, I’m not a provider or administrator. Today, I’m the patient walking in these doors for the first time. What do I see? Riff on the idea, always challenging yourself to put yourself in the patient’s shoes. How would a patient use this service? What would a patient think of this cafeteria food?
    • Embrace extreme usecases – Identify the extreme users of your services and observe their behaviour and listen to their communications. What can you learn from them? Are your waiting room seats uncomfortable for the elderly? Do ePatients with smartphones portend the future for the entire next generation of patients? What processess would you develop or change based on the answers?
    • Engage designers – OXO didn’t re-invent the vegitable peeler on their own. They worked with SmartDesign. Healthcare providers can find local or nationally renound tallent. Sure, it comes at a cost, but think of a well designed offering as a compeitive advange. You’d pay a reasonable price for a consultant who could help you grow marketshare, right?

    By the way, healthcare device manufacturers and supply vendors are no strangers to working with designers. IDEO and SmartDesign have both worked with vendors on items such as:

    • Cardinal Health Endura Scrubs

      Many hospital workers complain about the baggy, pajama-like, and unprofessional look of traditional ‘scrubs’. Furthermore, over 70% of hospital employees are women, yet they are forced to adapt to clothing that was designed for an XL-sized man. The Endura Performance Apparel Scrubs is a line of cost-effective high performance scrubs that we designed as true unisex wear with benefits for women and men alike. They are a vast improvement on their predecessors because of design innovations such as collars that don’t blouse open to over-expose females…

    • Ethicon Endo-Surgery Generator

      Equipment in the operating room environment can be complex and intimidating, prompting the need for intuitive technology solutions that help OR nurses focus more on patient care. The new EES Generator combines advanced technology, multifunctionality, and intuitive touch screen simplicity into one compact, easy-to-operate unit.

    • Lifeport Kidney Transport System

      The LifePort Kidney Transporter provides a new high-tech alternative to the conventional method of organ storage and transportation—a cooler filled with ice.

    • Finally, here’s IDEO’s Tim Brown at the 2009 TEDmed event on Designing Healthcare
  • Quant Self gaining popularity in other circles

    Posted on April 24th, 2012 admin Comments

    I’m continuing to see references to self quantification appear outside of the niche world of quantified self devotees. This week on the TWiT podcast network, two of Leo Laporte’s shows featured conversations about capturing, measuring and analyzing data about our own health.

    Now, certainly these two shows represent niche communities and interests of their own. TWiG focuses on cloud computer, social networking and Google. Security Now is about, you guessed it, security. What I find particularly exciting is both shows feature discussions about using personal health devices without knowing the term quantified self, suggesting the ideas of self quantification are creeping into other areas; the long tail is beginning to widen.

    On Episode 138 of This Week in Google, the hosts discussed the Nike Fuelband device. Nike’s Fuelband wrist-worn gadget made a splashy debute at this year South By South West, selling out via their pop-up store. The Fuelband, which is often compaired to the defunct Jawbone Up, is very similar to the FitBit (which I still think is the best device in the space – love mine!).

    Here is a link to the exact position of the discussion on the Fuelband.

    Host Jeff Jarvis describes, these devices as “the internet of things, and things tend to be you…”  At last year’s Stanford Med 2.0 event, Dr. Bryan Vartabedian  described personal health devices as An API into the patient.” An API – application programmer’s interface – is a term in computer programming and hardware which references a programmer’s ability to connect with another program or device. The point Dr. V and Mr. Jarvis are marking is that quantified self devices give users and providers access to retime data about health and actives, without needing a lagging lab test or resource-intensive diagnostic study.

    On episode 344 of the wonderfully nerdy Security Now podcast, host Steve Gibson discusses his penchant for “conducting experiments on [himself].” In 2009, Mr. Gibson, usually focused on technology security, released a special hour long discussion on his studies of vitamin D. This week, he briefly mentions an expriment he conducted on eliminating most carbohydrates from his diet.

    Editorial note – I’ve discovered in my own move to a mostly vegan diet, there many differing opinions on what constitutes the perfect diet and just as many studies to back them up. That said, I’m not sure I completely agree every part of his food-related discussion with host Leo Laporte. Nevertheless, Mr. Gibson has an almost obsessive habit of regular blood draws and lab tests.

    You and watch their discussion on dietary changes and how they affected his lab results here.

    Security Now 344: Your Questions, Steve’s Answers #139 – YouTube.

  • Healthcare’s digital divide: consumers vs providers

    Posted on April 24th, 2012 admin Comments

    Last week, I wrote about embracing niche use cases, or what is known as the long tail. I referenced a William Gibson quote: The future is here…it’s just not evenly distributed. 

    If we are defining the future as processess, ideas, or technologies which sound far fetched to most, but in actuality exist in niche areas, then there is another way to consider their distribution. These processess, ideas or technologies can be widely accepted by some groups but still dismissed as “the future” by others. Consider mobile health technology.

    According to the Pew American Life Project, nearly half of US adults have smart phones. Float Mobile Learning suggests there are 186 phones for every hospital bed in the US. They also suggest health apps is the 3rd fastest growing area on Apple’s App Store. In 2011, South by South West, the popular interactive and music festival in Austin added a healthcare track. This year, the Health Track drew thousands, including big brand names like Qualcom, Cisco, and more.

    But wait, there’s more.

    I created my own infographic… actually, it’s part of a slide deck I use internally from which I’ve stripped the branding and strategy parts. Still, it shows how online and mobile health have tipped, and for consumers, are no longer niche areas.

    See the trend here? If 80% of US Adults (including 56% of seniors) are going online for health information, can we really say the distribution is uneven?

    The Digital Divide

    There is a term, the digital divide which speaks to the rift between those with internet access and/or tech skills, and those without. Examples include the elderly and underserved communities, though there are certainly exceptions in those demographics.

    There is another digital divide. When we consider the relatively wide adoption of online and mobile health ideas, processess and technologies, there is still a group for whom this is the future…it’s out of reach, or not part of the plan: provider organizations.

    Here, the future is evenly distributed among the general population, but very sporadically adopted by providers.

    I’m not pointing fingers. This isn’t easy stuff. 80% of doctors may have smart phones, according to Float, but how many are also advanced programers and IT gurus? And should we expect them to be? Nor should we expect them to expend their precious margins – believe me, they aren’t as high as pop culture would suggest – on developing a state-of-the-art application.

    Nevertheless, I suggest there are ways for providers and health systems to start embracing the future:

    • Use what is already available - if you have an EMR with a patient portal, then encourage patients to upload data from health apps. Likely, it will start as CSV attachments which will not immediately be discrete data. Nevertheless, it is engaging for patients, helpful to providers and forward thinking.
    • Share your expertise online - 80% of US adults want health information online, be part of filling the vacuum. When I give talks to clinical folks this is the point I stress the most. There is a powerful difference between hearing your local doctor’s reaction to a new study and reading a national, disembodied by line on a national news site. Be the local expert!
    • Partner – if the idea of building your own app, accepting patient data, or starting a youtube channel is daunting, find someone who can help. This is part of a consumer’s decision making process, how savvy, available and with it is my doc or health system? Would you fly an airline that didn’t let you book online or bank with a bank that didn’t have online banking?
    • Embrace cost reduction – If you are a primary care provider, do you really want to ask people to wait in your waiting room for 40 minutes to see you for 10 to get a refill on allergy meds? Building a process for reimbursable eVisits isn’t nearly as hard as it sounds. Patients want them. We can FaceTime or Skype around the world, but not our doctors? How’s that for uneven distribution?
    • Self-scheduling - finally, in the no-brainer category, nearly all airline tickets are booked online. OpenTable dominates dinner reservations via the web and mobile app. Why does it take a 10 minute call to get a doctor’s appointment at a horrible time on a day that doesn’t work for me?
    One thing is clear, if we consider the uneven distribution of mHealth in terms of consumer vs provider, the idea is already mainstream for a huge segment of the market. With prospects like that, it doesn’t take much to find gold. Embracing online tools and mHealth is going to be a major differentiator for providers and health systems who get on the band wagon early.

    Mobile Medicine & Mobile Health Care: Float Mobile Learning.


  • the future [of medicine] is already here

    Posted on April 24th, 2012 admin Comments

    The future is here…it’s just not evenly distributed. 

    Or so goes the original quote from science fiction author William Gibson.

    That’s also the line the Alternative Futures group used in describe their futuristic model of primary care.

    Challenges abound

    We hear about the challenges facing healthcare from every angle; and it’s not just those of us intrenched in the industry who are talking about them. Last week, the Washington Post’s Ezra Klein published a story titled: Why an MRI Costs $1,080 in America and $280 in France.

     There is a simple reason health care in the United States costs more than it does anywhere else: The prices are higher. That may sound obvious. But it is, in fact, key to understanding one of the most pressing problems facing our economy. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive.

    It is not all about high costs either. The American Medical Association predicts the US will have a shortage of over 91,000 physicians by 2020. JAMA illustrates the point by suggesting primary care doctors will need to double their patient panel size from 2,000 patients to 4,000.

    But there is a plan, right?

    There are no shortage of plans or experts to talk about them. CMS has announced initial payments to ACO pioneers will come this sparing. The Patient Centered Medical Home model is gaining popularity. Payors are also chiming in, at HIMMS conference, Aetna’s CEO hinted at major changes to the commercial insurance industry:

    Aetna CEO Mark Bertolini caused quite a stir when he said at a Las Vegas conference a few days ago that the insurance industry as we know it is, for all practical purposes, a dinosaur on the verge of extinction.

    Bertolini ticked off a number of reasons why providing basic health insurance to Americans was no longer viable — changes in demographics and the economy and, of course, health care reform at both the state and federal levels. What he did not say was that the standard operating practices of the industry were simply not sustainable and actually contributed more to the demise of the business model than any external factors.

    The future is here

    In their white paper, Primary Care 2025: A Scenario Exploration, Alternative Futures explores four scenarios around primary care in the US. They lay out cases which range from status quo to, what the author’s suggest, is a futuristic model.

    I Am My Own Medical Home A different “surprisingly successful” future for primary care that bifurcates between advanced, effective, efficient,cost-competitive, integrated delivery systems and sophisticated and personalized self-care, supported by advanced knowledge technologies that allow people to take over many functions of primary care for themselves.

    More important were the disruptive technologies that developed throughout the 2010s that put more and more control of health and health care into the hands of patients. New smartphone “apps” monitored a person’s diet, physical activity, and sleep patterns, and collected this data in personal health records (PHRs). New biomonitoring devices that measured blood pressure, blood chemistry, and even blood flow noise within the body could alert people to changes in their health. Lab tests conducted by the device at home, or sent by mail to a lab, provided a low-cost alternative to similar services previously provided in formal health care settings. Social networks, both in large population platforms like Facebook and Google, and in targeted networks like PatientsLikeMe, helped to formalize and extend the informal relationships that had always provided a large share of people’s health-related information.

    These things aren’t futuristic. They aren’t imaginary, pie in the sky, would-be-nice-to-have things. They exist today. It’s what Gibson means about the future being here, just not evenly distributed. Because these tools and their users, known as quant selfers, are not mainstream – or at least in the boardrooms of provider organizations, they are often discounted as fringe; unevenly distributed among the population of “normal patients.”

    Addressing the minority tastes

    Chris Anderson, editor of Wired Magazine speaks about niche groups whose interests he calls minority tastes. The thing about niche interests, Anderson calls out, is we all have them. They are likely some of our favorite things – a fringe band, a campy TV show, a strange food. They are the unique things that make us…us.

    Anderson has written about catering to minority tastes in The Long Tail. Graphically, if you were to measure the interest in a product or service, there has traditionally been a drop off point; a point when the market is saturated with users or the producer has hit their capacity to supply the thing. Anderson speaks about record sales. There was a point where a stores shelves could only hold so many CDs, so store owners had to chose which albums to carry. Once buyers had purchased the top selling albums, the curve dropped off.

    In the digital age – we can all agree, that future is  here and evenly distributed, right? – these things have unlimited capacity. There is no feasible capacity limit for the number of tunes Apple can sell on iTunes or videos Netflix can deliver via streaming. So, there is no reason to limit the availability of the store’s supply and there is no limit on the customer’s interests.

    Wikipedia: example of a Long Tail Graph

    Rather than dropping off, the distribution just spreads out over a larger range of a more shallow audience or smaller production.

    Clear as mud?

    In healthcare, we often wait for things to tip. For example, we need a market size to be substantially large enough to warrant building a new MRI center, otherwise, the curve dropps off too soon and we don’t make enough to support it. There is also that ever-nagging fear of the unknown, or new things. Look at EMR adoption.

    Those constraints don’t apply for embracing virtualized care, quantified self models, and medical management. Why? Well, the future is here. We know people are using FitBits, the Zeo Sleep Manager, iPhone glucometers, and blood pressure cuffs. We don’t have to wait for them to tip into a larger market segment.

    #Fitblog chat on twitter shows passionate people with collective interests in the long tail.

    How do we do it? Here are several lost cost, high impact ways:

    • Engage ePatients – ePatients are patients who actively seek to participate in medicine. Think about hosting an ePatient speaker for a board meeting or design session. ePatients are the ticket to understanding the long tail in healthcare. They have niche interests and are not evenly distributed, but they want access to data and electronic communication with providers and understand the value of holistic relationships as well as retail models. They represent the future, and they are here.
    • Embrace Quant Selfers – encourage those interested to upload data through an EMR patient portal. It doesn’t require any effort, but it could provide a world of returns (on health)
    • Build online patient support communities – facilitate spaces for patients to engage with each other, and form support and knowledge groups.
    • Engage with patients online, on the sites they use, in a way that adds value. This cannot be overstated. Marketing messages via social media, while they may provide incremental volume, do very little to affect the health of your followers. The meaningful use of social media in healthcare starts with focusing on outcomes.
    • Share data – Publish data on case volumes and quality. Hey, CMS has made their claims set public, what do you have to lose?


    Below, Chris Anderson speaks about the long tail: