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Martin Sizemore

Enterprise Architect with specialized skills in Enterprise Application Integration (EAI) and Service Oriented Architecture (SOA). Consultant and a trusted advisor to Chief Executive Officers, COOs, CIOs and senior managers for global multi-national companies and healthcare organizations. Deep industry experience as a consultant in manufacturing, healthcare and financial services industries. Broad knowledge of IBM hardware and software offerings with numerous certifications and recognitions from IBM including On-Demand Computing and SOA Advisor. Experienced with Microsoft general software products and architecture, including Sharepoint and SQL Server. Deep technical skills in system integration, system and software selection, data architecture, data warehousing and infrastructure design including virtualization.

Homepage http://www.perficient.com

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Business Gamification in Healthcare: What are 3 practical uses?

by on April 23rd, 2012

In the months after Perficient published a whitepaper on Gamification, the interest from our readers has been gratifying and it seems to be time for a follow-up to that interest.  Business gamification is the use of game mechanics and user interfaces in business software.  What are the practical uses of gamification in a healthcare workplace?  Here is a fresh look beyond the well-known fitness and wellness applications:

  1. Agile project management for implementing EMRs
  2. Training staff on new documentation requirements for ICD-10
  3. Maintaining a high level of commitment to quality measures and patient safety

Agile project management

Most healthcare organizations are in the grip of too many projects and desperately need a way to streamline project management and keep project team members highly engaged.  If that is your situation, then check out www.redcrittertracker.com and their Agile Project Management that uses badges, rewards leaderboards and real-time Twitter feeds to drive a “what’s next” methodology.  This innovative software uses gaming elements including fifty unique badges that can be unlocked by meeting project goals and deadlines.  Completing key milestones in a project can earn a participant Reward Points that can be cashed in for gift cards or lunches with executives.  Red Critter Tracker uses a drag and drop user interface that should improve project management updates as well.  Red Critter has been developed for multiple team management, traditional time tracking and effort estimation and real-time team messaging.  Most EMR implementations that span multiple institutions need easy to use and yet powerful project management tool that can coordinate communications in a simple To Do style view.

Staff Training on ICD-10 Documentation

Forbes recently named Badgeville (www.badgeville.com) “America’s Most Promising Company.”  Badgeville views gamification as a modern business strategy that uses proven techniques from social gaming to measure and influence behavior. They believe their techniques can be applied across virtually any user experience where increasing specific behaviors add value to a business or organization. Using advanced gamification techniques, such as levels, missions, and tracks, Badgeville clients experience 20 to more than 200 increases in key business objectives.  Their “Behavior Platform” appears to be just what the doctor ordered for the big cultural shift required in tougher documentation standards required to justify ICD-10 codes used for billing in healthcare.  The mission would be to meet or exceed the required standards and language for ICD-10 for each key medical procedure and gamification could manage the improvement through levels for key medical professionals.  The game elements could make the learning process more interesting, possibly playful and morale-boosting rather than intrusive for already busy people. (more…)

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Is it time for Open Source in Healthcare?

by on March 29th, 2012

From time to time, it is a good idea to re-evaluate potential IT architectures especially with the cost reduction pressures in healthcare IT.  The growth in maturity of several key players in the open source software arena is gaining the attention and respect of healthcare IT decision-makers and worth evaluation as a lower cost alternative.  The ability to set-up a complete top to bottom architectural stack is getting very close to a reality in open source and the only challenge will be an organization that will be able to integrate that open source stack.  What are these maturing key components of an open source stack for healthcare?  Here are the candidates from the bottom of the stack to the top: Mirth for HL7 integration, Drools for a business rules engine, Mule for SOA, Pentaho for business intelligence, and Liferay for portal.

Mirth for HL7 message integration

Starting with the integration layer, Mirth Connect has developed into the cost effective alternative at a time when commercial HL7 integration engines are charging by the number of interfaces and driving up costs.  Mirth is specifically designed from the ground up for healthcare HL7 message integration and provides the necessary tools for developing, testing, deploying, and monitoring interfaces.  Mirth products address one of the most difficult problems in healthcare – interoperability. With some hospitals using nearly 200 applications each, the applications integration challenges can be complex and numerous.  Mirth is a comprehensive integration solution that can handle the work to transform and route healthcare data, and here is the real plus – because it is open source, a healthcare organization can share and reuse your interfaces with other organizations.

One key new offering from Mirth is Mirth Appliances.  The Mirth Appliance provides a ready-to-run healthcare messaging platform that is stable, secure, and scalable. With the need to create Health Information Exchanges at many larger healthcare organizations, the Mirth Appliance installed at each individual hospital or large physician practice can make interoperability more affordable with full commercial support and a simple management control panel. There are no per-interface fees or per-message charges on a Mirth Appliance to assist in keeping down IT costs.

Drools for a Business Rules Engine

To assist in transforming healthcare messages and support business rules is the open source product called “Drools.”  No, it isn’t about leaking saliva, but is a fast maturing business rules engine at a time when healthcare needs to separate business logic from reams of old legacy source code, especially to meet changing performance measurements or calculating metrics for Meaningful Use.  According to Wikipedia, Drools is a business rule management system (BRMS) with a forward chaining inference based rules engine, more correctly known as a production rule system, using an enhanced implementation of the Rete algorithm. The Drools business rules engine supports the JSR-94 standard for its business rule engine and enterprise framework for the construction, maintenance, and enforcement of business policies in an organization, application, or service. Drools is a key component for implementing a flexible Service Oriented Architecture (SOA). JBoss Rules is the commercial version of the open source Drools project.

The key improvement in maturity of this open source business rules engine is the addition of a business rules manager called Drools Guvnor which is a centralized repository for creating knowledge bases.  In addition, Drools Fusion provides for complex event processing including time-based decision-making, also a key need for healthcare environments.  One example of the use of a Drools business rules engine would be a clinical event monitoring system to provide proactive alerts when messages indicate a need for human intervention in a business process.

Mule for a Service Oriented Architecture

While all of the major commercial software vendors have SOA offerings, the cost to install, implement and maintain SOA environments is out of reach for a typical healthcare IT budget.  A fast growing community is implementing the open source SOA Enterprise Service Bus product called Mule from Mulesoft.  Mule is used for SOA by many of the Fortune 500 companies and is a real alternative for cash-strapped healthcare IT needing to move to a message-based architecture. Mule ESB is a lightweight Java-based enterprise service bus (ESB) and integration platform that allows developers to connect applications together quickly and easily, enabling them to exchange data. Mule ESB enables easy integration of existing systems, regardless of the different technologies that the applications use, including JMS, Web Services, JDBC, HTTP, and more. Combined with the Mirth Appliance, Mule is capable of supporting the HIE needs of a healthcare integrated delivery network. Mule is also a strong SOA alternative to the current state of hub and spoke, single point of failure, integration engines used in healthcare today.

Mule has excellent scalability for large healthcare organizations with complex enterprise integration needs. Mule’s stage event-driven architecture (SEDA) makes it highly scalable and a major airline processes over 10,000 business transactions per second with Mule while H&R Block uses 13,000 Mule servers to support their highly distributed SOA environment.  Clearly, this open source solution has matured and gained widespread acceptance, but Mulesoft isn’t resting on its success and is developing a SOA repository management solution for its Enterprise version.

Pentaho for Business Intelligence

With the very high level of interest in business intelligence and performance metrics in healthcare due to Meaningful Use and Accountable Care, the next open source stack component to review is Pentaho.  What is interesting about Pentaho is how they describe themselves: “Pentaho was born out of the desire to achieve positive, disruptive change in the business analytics market, dominated by bureaucratic mega vendors offering eye-wateringly expensive heavy-weight products built on outdated technology platforms, and who had become focused on integration with the rest of their enterprise application suites – at the expense of innovation of their BI capabilities.”  The maturity level of Pentaho is demonstrated by their recent inclusion as a strong vendor with the richest functionality and most extensive integration with Hadoop for big data by Forrester.

Pentaho as an open source solution has compelling capabilities for the healthcare environment.  One of the more important ones is that Pentaho provides the option to take data in-memory to speed up your analytics. For quick near real-time analytics for clinical decision-making, this feature is important. The challenge with other BI solution sets is that they may require a customer to bring all data in memory before analysis resulting in memory challenges on the hardware platform. Pentaho supports capabilities to manage in-memory analytics with very large data sets.

Pentaho is a BI solution that can also provide persistent caching for improving the speed of advanced analytics.  A typical healthcare organization will not want to load reference data and prime the cache every time the analytics server restarts. This may take a long time depending on the size of the data set, creating significant delays in making the system available to end users. Reference data and some master data loaded in memory or persistent cache can really speed queries in a healthcare setting, especially with by facility or physician views of detailed information.  Pentaho uses a distributive caching system to scale out and distributes the queries to a pool of shared memory for meeting concurrency requirements and avoiding cache bottlenecks.

Liferay for the Portal

Last, but definitely not least, is the open source portal software called Liferay.  Liferay has matured in recent years to become a complete portal solution that includes:

  •  • Content & Document Management with Microsoft Office® integration
  •  • Web Publishing and Shared Workspaces
  •  • Enterprise Collaboration
  •  • Social Networking and Mash-ups
  •  • Enterprise Portals and Identity Management

For healthcare, portals are the key information delivery mechanism including patient portals, physician portals, intranets and project management portals.  Liferay is an independent portal vendor that doesn’t insist on controlling the architectural stack of architectural components in order to work. For large healthcare organizations with thousands of employees, Liferay has strength in developing self-service portals that include knowledge sharing workspaces and Web 2.0 capabilities.

Consider Integrating the Stack

In summary, the big building blocks of an open source architecture are available today and are reaching a level of maturity that is worthy of consideration by large healthcare organizations.  It is important to note that open source software is not free and requires staff commitment to succeed, generally with good to excellent Java skills.  The commercial versions of the open source products are usually well documented and have excellent product support.

One key aspect of these open source products is that they are excellent for developing proof of concept (POC) projects before committing to purchasing the full commercial versions. This POC approach can allow for testing not only the functionality of these architectural components but evaluating them in your existing IT environments. If your IT team hasn’t taken a recent look at open source, you might be surprised at what big organizations are adopting it and how much money it could save your organization.

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Meeting the Challenge of Managing Population Health

by on February 22nd, 2012

In the closing weeks before the Christmas holiday, I made a whirlwind tour of several large integrated delivery networks (IDNs) in search of the newest Holy Grail in healthcare: Managing Population Health.  The race to Accountable Care Organizations and Shared Savings performance contracts has resulted in a new level of enterprise data integration never imagined by most provider organizations.  The idea of combining claims data, from CMS or third party health insurers, with their internal clinical information systems was capturing their attention as they pondered managing the health of their served populations.   A key concept began to emerge that Population Health Management is multidisciplinary by definition – each stakeholder in the ACO would require customized information to play an effective role and, most importantly, an effective population health management strategy requires data from a variety of sources that need to be integrated for analysis.

Just as healthcare organizations began to grapple with the famous integration of in-patient and out-patients for meaningful use, accountable care and managing re-admissions, along comes Shared Savings performance contracts.  The need to have timely data to “course adjust” quality measures, referral patterns and perform risk stratification put a whole new twist on business intelligence efforts of overworked decision support teams.  The ability to ingest claims data from the new partners in the performance contracts posed challenges to data integration.  The ability to track performance metrics to manage the new emphasis on health and wellness as against traditional metrics treating illness called for more sophisticated data acquisition from points of care and aggregation of data to determine gaps in care.

The challenge is simple: time!  The demand for the ability to manage healthcare enterprise information for accountable care is not just now, but NOW!  Healthcare administrators need immediate enterprise data warehouses to integrate claims data, data from acute and ambulatory settings and flexibility to add new data sources as the reach of accountable care organizations expand into skilled nursing and other healthcare services.  The solution is three-fold:

  1. Health Information Exchanges – to bridge the interoperability gap between care settings
  2. New Healthcare Integrated Data Models that encompass both traditional payer and provider information together
  3. Enterprise Information Management Frameworks – yes, frameworks for building the data warehouse of today that can be flexible and extensible for tomorrow

There are many single point clinical data warehouse solutions in the marketplace at a time when that approach will only lead to more complexity.  The practical solution is not one that only analyzes claims a dozen ways or another that only has the view of the EMR data.  The best solution is going to be an independent and, here’s the key, integrated view of the data.  The enterprise information framework will encompass the entire life cycle of data and provide a means of solving the data integration problem of the moment for performance based contracts but then grow in the future to allow analysis of the unstructured data that healthcare professionals value.

Finally, healthcare organizations striving to manage population health need to discuss the performance metrics that really matter to their organization.  The choice of the right metrics that move stakeholders to the correct decision points to achieve the goals is crucial.  With hundreds of performance metrics available it will be vital to focus on the ones that when addressed yield the best results.  In the race to manage the health of a served population – doctor know thyself.

Are you interested in discussing the management of Population Health and related tools further? Visit us in Booth 1274 on the HIMSS show floor!

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HIMSS 12: Wrestling the Unstructured Data Beast

by on February 21st, 2012

We live in a period of time in healthcare where there is enormous pressure to analyze and compete based on the information buried in IT systems. The volume of healthcare data swells by a staggering 35 per cent per year. Worse than the volume is the fact that 80% of stored health information today consists of unstructured data such as physician notes and discharge summaries, email and satisfaction surveys, reference journals, possibly even text messages or social media.  This unstructured data is stored inconsistently and is generally incomplete and overly difficult to access.  The solution to wrestling the unstructured data beast and domesticating it is available today and comes from a “Watson ready” offering from IBM.  This powerful IBM Content and Predictive Analytics (ICPA) for healthcare solutions enhances clinical and operational decision making by analyzing both unstructured and structured data in context against past, present and future scenarios.

Using ICPA, healthcare organizations can delve into their own patient diagnostic and treatment records, clinical policies, medical literature and other sources of qualified information in ways they never thought possible.  One key example is the work currently underway at Texas-based Seton Healthcare to help increase the survival rate of congestive heart failure (CHF) patients.  Studies have shown that proactive treatment of CHF patients can help prevent the readmission rates on those types of patients.  Seton Healthcare is using the Content and Predictive Analytics solution to analyze patient data to determine the high-risk patients who would benefit from interventions.  The project mines the unstructured data of patient records, developing predictive models to determine the potential for readmissions, applying that knowledge then to improve outcomes and reduce costs.  With the increased pressure to reduce readmissions and costs, this predictive analytics approach is very timely for the proactive healthcare organization.

The impressive idea behind this solution is combining key technologies and pre-integrating them to reduce the time-to-value for deploying the specific application.  One of the key components of the solution besides IBM Content Analytics and SPSS Modeler is a healthcare solution accelerator (HSA – as if we need more acronyms).  HSA harnesses the natural-language processing powers of Watson to extract medical facts and build structured relationships through pre-built annotators for advanced text analytics.  The exciting aspect of this accelerator is its ability to identify trends, patterns, deviations, and anomalies in data.  HSA can expand predictive analytic capabilities beyond traditional modeling and scoring to predict outcomes!  A physician could analyze a large group of patient treatment and outcomes records, along with recent medical literature or research guidance, then apply it to his or her own patient records to develop a highly personalized treatment plan.  This solution has the power to be a game changer for chronic conditions, the identification and treatment of cancer or managing at-risk populations in general.  ICPA has the potential to allow large, sophisticated healthcare organizations to extend world-class treatment options to small towns and remote locations – a big win for telehealth.

The applications for this combination of content analytics and predictive modeling are extensive including a favorite headache for most healthcare teams called manual chart abstraction.  The average hospital can spend hundreds of thousands of dollars a year and tie up valuable nursing resources reading charts to complete medical records, prepare them for billing and summarize statistical quality data. This solution, coupled with modern paper scanning optical character recognition software, could also radically improve the quality and volume of valuable information hidden in paper records for analysis and, most importantly, predicting outcomes.  Many physicians will tell you that the most valuable part of a medical record is the notes and IBM is providing the capability to prove it.

The best secret is last: IBM has a Jumpstart program to help a healthcare organization develop a strategy for implementing this solution and selecting a best path-to-value for a rapid return on investment.  It doesn’t take a hardware system the size of the supercomputer that won on TV either, reasonable Power7 systems that are tailored for complex analytics of unstructured data and the compute intensive needs for predictive analytics.  To summarize, your healthcare organization does not have to wait for Watson technology to come to you, the future is here now and ready to address your demand for predictive analytics and outcome management.

Would you like to learn more about Predictive Analytics and its capabilities? Come discuss it with us in Booth 1274 at the HIMSS show! 

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What “Angry Birds” teaches us about Mobile Apps

by on January 31st, 2012

Once upon a time, when you took a stroll down the aisle of an airplane in mid-flight, you would see lots of people playing solitaire on their Windows laptops.  Today, you see many, many more people engaged in intense concentration on game of “Angry Birds.”  Angry Birds is an addictive, fun, easy to play game that, in my humble opinion, teaches some important concepts that are applicable to building successful mobile applications, especially for healthcare.

One of the questions that I get asked frequently about mobile healthcare applications is “What can we do to make physicians, patients, or plan members ‘lock in’ to our organization?”  When I hear this question I immediately think of the concept of stickiness. The concept of the stickiness factor comes from Malcolm Gladwell’s book called The Tipping Point and it is explained as an approximation of churn – the secret sauce that helps an organization understand their customer’s lifetime value and maximize revenues.  According to Gladwell, there is a simple way to package information that under the right circumstances can make it irresistible; all you have to do is find it.  One of the clever ways that Angry Birds gets this stickiness factor is to package the game play for easy starts and stops.  One round only takes a few minutes – win or lose.  The game player can start and finish a game while waiting on their lunch to heat in the microwave.  The take-away is that user experience makes a big difference in stickiness to keep them coming back.

The second thing to learn from Angry Birds is the power of incorporating social media into the experience. The ability to share game results with friends, brag on success of the various levels of difficulty and share the experience is another key strategy.  Focus groups and opinion leaders, called mavens by Gladwell, within your target demographic are powerful ways to learn how to influence key members of society that, in turn, influence the masses.  Feedback from the fanboys to improve on the mobile experience is key – listen, improve and repeat.  Angry Birds quickly adapted in the early days to add more interesting birds, tougher forts and more challenging levels.

The third key concept that Angry Birds taught us is to treat the mobile application as a platform.  Platform is a term that is often used incorrectly, but in this instance, a platform is defined as a series of components or modules that can be extended over time.  A demonstration of the platform concept was Angry Birds Seasons.  The original Angry Birds platform was extended using themes – holiday themes in this second version of the game.  One of the key principles of a platform is the idea that what the end user had learned so far transfers to the new game – no big learning curve for something new.  The ability to extend the application without forcing the user to start over with new skills is critical to the successful of a mobile application, and maybe any application.

Finally, my favorite lesson from Angry Birds: Allow people to fail, fail fast and start over easily.  How often have you used a mobile application that the slightest error was a massive set back sometimes meaning you lose all of your hard work.  All mobile apps should have the Angry Bird big counter-clockwise “do over” icon.  People will make mistakes, struggle with mobile applications and suffer from learning curves.  A great mobile application will make it easy to fail, fail fast and start over on the right track.  And you thought it was only an addictive game…

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It’s Time to Get Real…

by on January 4th, 2012

…Real-time analytics, that is.

One of the challenges in healthcare today is the lag in time for the acquisition, storage, analysis and delivery of data back to the physician or other healthcare provider for decision-making.  The majority of transactional information about a patient that is produced on reports or presented in terms of business intelligence is simply “old” or retrospective and, as such, limits its usefulness for decision-making.  The average reporting solution attached to the modern EMR software typically batches up information every 24 hours and makes it available for reporting and analysis.  In many healthcare decision-making settings like an Emergency Department, this data lag is frustrating and potentially dangerous from a patient safety point of view.  It’s not that EMR solutions can’t immediately reproduce the collected data quickly, but to analyze the data and present actionable information to a medical professional, the data lag for real business intelligence limits its return on investment and ongoing use.

The Challenge

The problem is simple – we need to perform complex real-time analytics on data, both structured and unstructured, that is in motion.    The ability to continuously analyze data, especially in healthcare, could make the famous “life and death” difference.  Let’s take a basic example.  Today, there are mobile devices that can stream electronic data like an EKG while you are in the ambulance headed to the ER.  The challenge is combining the real-time information fed from the telemetry with your existing electronic health record, filtering out extraneous data and presenting the key facts to the physician and the support team for decisions and preparation when you arrive.  This issue is especially true in modern trauma units where minutes count and integration of real-time data, especially lab results, is critical.  Instead of the doctor scanning all of the values for ones that are out of range, the real-time solution would highlight the out of range values and possibly recommend alternatives to address them.

(more…)

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Replay and Slides! ACO = HIE + Analytics: Managing Population Health

by on November 14th, 2011

Last Thursday I spoke in a webinar entitledACO = HIE + Analytics: Managing Population Health with Information Exchange and Analytics”.  You can view the slides below, and you can view a full recast of the webinar here: http://www.perficient.com/webinars/

Let me know what you think!

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Will ACOs Produce Accountable Patients?

by on November 2nd, 2011

I had the privilege of attending the Connected Health Symposium 2011 in Boston on October 20-21.  One of great ideas from that Symposium was to debate the key topics in healthcare today including the idea of Accountable Care Organizations and their ability to drive quality up and costs down.  At the heart of that idea is whether or not ACOs will produce more accountable patients.  This topic was debated by Timothy Ferris, MD, Medical Director, Mass. General Physicians Organization, Jonathan Gruber, PhD, Professor of Economics, MIT and Dana Safran, ScD, Senior Vice President, BCBSMA.  As you might imagine, Dr. Ferris took the negative point of view arguing that ACOs won’t produce accountable patients due to the need for new incentives.  Dr. Safran took the affirmative argument that ACOs would produce accountable patients by reducing fragmentation and chaos in the healthcare system.  Dr. Gruber, the economist, argued that the only way to change patient behavior was to use price signals, i.e. a higher cost burden.  Dr. Gruber noted that “patients hate paying when they go to the doctor” and that was the only way to produce accountable patients.

Dr. Ferris: ACO Will Not Produce Accountable Patients

It was not surprising to see that Dr. Ferris was pessimistic about producing accountable patients.  He felt that three systemic items must change:

  1. Access to care, the design of care and the measurement of care.  Dr. Ferris felt strongly that a mechanism for virtual visits must be created with both patient and physician portals to improve access to healthcare information and lower the cost of patient and physician interactions. 
  2. He wanted more from electronic health record systems to improve the decision making process and ease computerized physician order entry. 
  3. Most importantly, Dr. Ferris argued that measurements and reporting were keys to improving accountable patients including quality metrics, clinical outcomes and patient satisfaction.  He concluded that benchmarking, variance reporting and dashboards were improvements required to improve patient care.

Dr. Safran: ACO Will Increase Accountability

Dr. Dana Safran of BCBS of Massachusetts was positive that ACOs would increase accountability across the entire continuum of care including patients.  She noted that the chaos and fragmentation of healthcare industry must be addressed by aligning clinical and financial incentives to make accountable care organizations work.  Dr. Safran fielded a question from the floor about whether payers have enough interest to address the accountable patient due to “churn” or the turnover of patients covered over a longer period of time.  Her response was that “payers have a large incentive to look for effectiveness in the long term despite churn.” Dr. Safran went on to note that one of the challenges of accountable care was that “doctors are responsible for delivering less to patients.”  This statement provoked an immediate reaction from the physicians in the audience and Dr. Ferris.  One emergency room physician reacted that capitation didn’t work in the 90s and it won’t work now.  Another doctor pointed out that reimbursements today are too low to attract primary care physicians.

But what do the patients think?

Clearly, it was a lively debate with the doctors arguing to retain the current fee for service status quo and the economist/healthcare payer arguing that things must change.  One startling fact that Dr. Jonathan Gruber noted was that a middle class family income went up by $28,000 in the last 10 years but due to increased healthcare costs, they only pocketed $93. Clearly, employees are facing higher cost sharing but this fact drove the point home.  In the course of this debate, no one argued that we didn’t need to get control of healthcare costs and that those costs were a drag on the current economy.

The only voice missing in the debate was the patient.  Several of the folks on social media noted the absence and discussed that need in the future.  I’m curious what regular folks think about this issue – what is needed to get you to be more accountable about your health? What incentive really motives you?

Want to learn more about managing population health under new reimbursement models?  Register for our upcoming ACO webinar and you will be entered to win one of two Perficient client badges to the February HIMSS Conference in Las Vegas!

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Connected Health Symposium 2011: Living in the Clouds

by on October 21st, 2011

In the book As The Future Catches You, Juan Enriquez notes that “in a knowledge economy, you can work at your desk, in your home, in a hotel, or in a plane.”  As a person that operates in just that manner, there are real concerns not about just the connectivity to accomplish that mode of working but the idea of where my work desktop really should be located. Is it time to move beyond carrying around all of my software applications, personal data files and move into the cloud? The real question is whether or not I would have more security and confidence with my ability to work anywhere without the challenges of managing my personal laptop.

The question is more than just an experiment with living on the Internet.  When I consider my reliance on my laptop and the upcoming revolution of browser-based or tablet operating systems, it is time to formulate an opinion on the timing and the nature of the move. Last week, Apple rolled out iCloud as part of their iOS 5 upgrade. As I began to use it, there was a quick realization that this technology is really a game changer. We talk a lot about cloud as a part of future solutions in healthcare, but when you personally use it, the idea becomes more concrete.

In a simple experiment, I setup the iCloud to synchronize my contacts from Outlook running on my Windows laptop to my iPhone and iPad.  To make it more interesting, I changed my photo on my personal contact record, not a data field.  Instantly, and without cables or iTunes sync, my new contact photo appeared on my iPhone and iPad simultaneously – wirelessly and through the cloud.  I created a new contact on the iPhone and it appeared in Outlook.  The idea that we could apply this technology to really synchronize patient information from acute to ambulatory settings seemed very much closer and more possible.  I realize that we have to address privacy and security concerns to make cloud technology work in healthcare, but my iCloud experience is fueling big dreams about what is possible.

The cloud provides the instant on, always available information that healthcare professionals have to crave.  Many of them are constantly on the go, unable to sit at a single desk to interact with an IT system. The ability to work untethered but with up to date, accurate information should be more than a dream at this point, but table stakes in a life and death game. It isn’t surprising that there is a high adoption rate of smart phones by medical professionals – they need the technology to cope with daily work demands. The access to secure, managed patient information via mobile platforms and served up by the cloud will soon be expected, thanks to this demonstration by iCloud.

If the heart of accountable care is managing the transitions of patients from one healthcare setting to another safely and accurately, then we need to stop talking about interoperability and make it happen with cloud technology.  Let’s take an important lesson from Steve Jobs: Dream Big!

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Connected Health 2011: Sending Your Avatar to the Doctor Instead of You

by on October 20th, 2011

The rapidly shifting role of patients within the care model has resulted in demand for easier access to healthcare professionals.  Innovations in social media and collaborative technologies provide healthcare organizations with the ability to disperse information quickly and appeal to individuals who are seeking cost-effective healthcare services, especially in remote or rural communities.  There are plenty of opportunities to learn more about this topic at the Connected Health Symposium with events like, “Improving Patient Engagement and Medication Adherence Through Health System Innovation” and “The Age of Compassionate Computing.”

One innovation in collaborative technologies was featured in AARP magazine the other day (yes, I qualify) in an article titled “Medical Treatment in a Virtual World.”  It was a fascinating article about an experimental program to advise patients in Second Life, a website where doctors and patients appear as avatars, 3-D representations that communicate with each other.  The big news is that developers say it is the first time a virtual world application has been aimed to actually deliver health care. The goal of this use of the application is not to help people with acute problems, like an asthma attack, but about treating non-life-threatening chronic conditions that make up a large part of healthcare costs such as diabetes and arthritis.

In Second Life, patients create avatars before visiting the virtual treatment center which is open only by invitation.  People interact both individually and in groups with a doctor.  Through group sessions, people can anonymously learn from experiences, comments and questions of other patients according to Reza Shaker, M.D., gastroenterologist and professor at the Medical College of Wisconsin in Milwaukee. This approach could be very successful because my experience is that people enjoy this type of anonymity of group sessions for learning and that this approach of using avatars could encourage participation in chronic care management.  Using an avatar could help people be more honest about their current situation including glucose readings, compliance with treatment plans or pain assessments.

Another place that avatars are popular is on the Nintendo Wii gaming platform and they are called a Mii.  When the Wii Fit platform evaluates your weight, BMI and level of physical fitness for your Mii then it adjusts your appearance to match your demographics.  It is interesting that you don’t feel as offended if the application makes you look overweight but instead feel motivated to make your avatar look “normal.”  Is it possible that the avatar is the key to dropping our normal human façade that prevents honest communication with medical professionals?  What are your thoughts?  Is the idea that it is easier to assess your situation honestly as an avatar?

Avatars and the Real World of Health IT

As we consider methods for chronic care management, especially outreach to individuals in isolated or remote environments, it seems logical that we would tap the Internet to connect and collaborate.  The next step might logically be to integrate personal health information including remote device readings (glucose meters, blood pressure cuffs) to their avatar to provide the feedback loop for better medical advice and monitoring.  Another idea would be to use avatars for educating people on their medical conditions and how to avoid complications.

The potential for a virtual medical clinic has great value for non-life-threatening conditions in remote or rural medicine as well.  Tracking pain levels or wellness after medical treatments could be more personal and immediate through this novel approach.  Do you think people would respond well to this approach? Is it the next big idea for innovation in healthcare?