Kindle 3

The new Kindle 3 — “Smaller, Faster, Cheaper“” — arrived on Friday morning, a few days earlier than Amazon had promised. I would say that the new device will assure Amazon’s lead for some time. It is really fantastic. I had no complaints with the Kindle 2 — in fact I love it — but the new one has a nicer feel to it. The slightly smaller size allows you to truly read “one handed”. The power switch was moved to the bottom from the top and I find that much more convenient. The new color seems more with the times. A few other button changes but overall it is pretty much a refined version of the Kindle 2 which was a refined version of the Kindle 1. I am sure we won’t have to wait a year for the Kindle 4.

The Kindle 3′s new no glare screen has increased gray-scale contrast — it is clear as a bell and it loves the summer sun. The battery life is supposed to be one month. The migration from Kindle 2 to Kindle 3 was trivial. Took the new device out of the box, plugged it in, and turned it on. I clicked “register” and gave it my Amazon account id and password. I also gave it the SSID of my Wireless Access Point here at the Lake and that was it. In seconds I was reading the book that I had started on the Kindle 2 (and read parts of on the iPhone 4 and the Kindle app on the iPad).

I still love the iPad but when it comes to reading  books the Kindle is hands down better and with the Kindle 3 that advantage will be multiplied. The new Kindle comes in two flavors: one with WiFi for $139 and one with WiFi and 3G for $189. For most of us the WiFi model is more than adequate. If you are going on a trip you can download your favorite newspaper plus a book or two or more using your home WiFi and you are set. You don’t really need 3G for other applications because the Kindle doesn’t have other applications! That is what your iPad is for.

The magazine, book, and newspaper publishers still haven’t figured out what to do about the rapid adoption of e-readers. The iPad is great for reading news, but which news source is best to read?  The New York Times has the worst model. They offer a dozen stories and plan to charge if you want more. The Wall Street Journal charges $3.99 per week for their news on the iPad but if you want to read a WSJ story on the web or your iPhone they want you to take out another subscription. Wired and Time want you to pay $5 per issue of their magazines.  I believe people will be willing to pay for good content but nobody yet has the right model. I have experimented with quite a few news “readers” that display the RSS feeds of just about all publishers. I currently like NewsRack the best. None of the news readers are perfect but they are all getting better.

Meanwhile the Kindle DX has found a temporary home on eBay. The auction began Friday evening and already has 13 watchers and eight bids. The Kindle DX has been in use for airport and approach charts on the airplane but is no longer needed now that the pilots have iPads. This is a good example of where a “multi-purpose” device is better. There are many applications that are very handy in the cockpit and the iPad becomes an EFB (electronic flight bag). Hopefully, the pilots are not reading books while flying!

Tags: amazon, author, Aviation, efb, electronic flight bag, ipad, Kindle, kindle 3, kindle 4, publisher, WiFi

Medicare – Part 3

I have not had any clinical experience with Medicare to write about  (fortunately) so that will have to wait. Much to my surprise, however, I did receive a birthday greeting!

Dear JOHN R PATRICK

Happy Birthday from Medicare! We wish you well in the upcoming year. Our records show you are currently up-to-date on your preventive services. (Not sure what records they have) Congratulations on using Medicare to help you stay healthy. We will send you emails in the future as you become eligible for other Medicare preventive services. So you can plan and schedule your appointments, the following calendar shows the services that you may be eligible for over the next twelve months….

The email went on to recommend specific preventive examinations that I would be eligible for by month of the upcoming year. “To see a schedule of the services you are eligible for, visit www.MyMedicare.gov and select the “My Preventive Services” tab. Or, talk to your doctor for more information. Remember, Medicare is your partner in health.  Sincerely, Centers for Medicare & Medicaid Services”.

If I pursue all of the preventative examinations and tests that are recommended I will be a very busy person. Is there such a thing as too much care? Should care be “rationed”? These terms easily become highly emotional in both clinical and political terms.  Some say that Americans have too big of an “appetite” for healthcare services and there is a tug of war going on between the payers, the providers, the patients, and the politicians over what care should be provided. The answer is not more care or less care but more effective care. The model of paying for more visits, tests, and procedures is what has to change. An emerging new model to address this is called the “Accountable Care Organization“.

An ACO relies on close hospital partnerships, collaborative alignment with physicians, robust information technology infrastructure and operational expense management While the federal government is studying various models, the healthcare industry is moving toward the ACO model which  relies on the partnerships between healthcare providers to reduce healthcare costs while maintaining or improving quality of care. Successful ACOs will be rewarded financially, providing additional resources to invest in technology, jobs and other improvements in the delivery of care. The concept of the ACO is to have money flow to the ACO to keep patients healthy and have the money be allocated among the various providers — primary care physicians, specialists, laboratories, imaging centers, etc. Needless to say the method of allocation may be complex and contentious but over time the results could be quite positive for everyone.

One thing is for sure and that is that the current model is badly broken and unaffordable. When a 92 year old patient has an indication that a colonoscopy should be performed — knowing that surgery will not be performed regardless of the outcome of the examination — who is benefiting from the expenditure? When an elderly person is incapacitated and a wheelchair can dramatically improve their quality of life then it is a good investment by Medicare. When a person is grossly overweight because they enjoy Krispy Kreme doughnuts does the spending of millions of dollars on TV advertising to entice that person to get a Medicare-paid “free” sporty electric wheelchair, is that effective or might diet and exercise combined with visits to various members of the ACO be a better investment for Medicare? I think we all know the answer. Be on the lookout for the term ACO. We will be reading much more about this in the local and national news.

Tags: accountable care organization, aco, colonoscopy, Healthcare, wheel chair, wheelchair

Smarter Cardio Care

More than 25% of deaths in the United States are caused by heart disease. There are many statistics on the subject but to me the stunning one is that between 1,500 and 2,000 people die of heart disease every day. Most people would assume that heart disease is the leading cause of death for men but many are surprised to learn that it is also the number cause of death for women.  In fact, half of the deaths due to heart disease in 2006 were women. In 2010, heart disease will cost the United States $316.4 billion including the cost of health care services, medications, and lost productivity. In China the numbers are even bigger and this is why Beijing Goodwill and IBM have launched a joint effort to improve detection of cardiovascular diseases.

Although great strides have been made in the understanding and treatment of heart disease, there is much more that can be done. We all learned that the heart is a pump. If NASA had a pump that was experiencing difficulties it would put the pump in a lab, connect it to various sensors and testers and study it until the issue was resolved or the pump replaced.  In some cases a similar regimen is followed with humans but in most cases the analysis of a heart is done on a much more distributed basis. A primary care physician may look at a routine electrocardiogram done in the office. If anything in the ECG looks suspicious, you may be referred to a cardiologist for further examination. A second ECG is likely to be obtained. The specialist may have you wear a holter for a week or so. A cardiac stress ECG may also be requested. If some special testing is required you may be sent to the hospital. Then back to the cardiologist who does his or her best to integrate all the data and determine what is going on.

The model I described is not ideal. Part of the problem is that the reimbursement model provides an incentive for more visits and more tests. Physicians are not paid to cure you — they are paid to see you, to test you, to see you again, to re-test you, etc. Part of the problem is that the data is distributed among multiple technologies and locations. That is the problem that IBM and Beijing Goodwill are working on.

The joint project will launch an all-in-one electronic cardiogram management system in China. The idea is to achieve smarter healthcare by helping hospitals analyze real-time patient information generated from electrocardiography (ECG) examinations thereby getting better insight and a better ability to detect cardiovascular diseases with more accuracy.   The project will also empower doctors with mobile devices to monitor heart patients rather than wait until a holter is returned and a report is created from the data it contains. Physicians will be able to review test results from a single databank of centralized ECG information available to them anywhere.

Doctors will now be able to retrieve patient’s current and past cardiogram data, medical reports, and relevant scientific research. The integrated analytics tools of the system will automate the examination and diagnosis of results in real time, helping physicians increase the speed and accuracy of their diagnosis. As a result of this high-level of integration, the system will help hospitals to diagnose more effectively, eliminate human errors, reduce cost, optimize resources, and enhance research and educational capabilities.

IBM is investing heavily in Healthcare Industry Solutions Labs in Beijing and around the world and hiring doctors to work with IBM researchers to speed the evolution from anecdotal medicine to smarter information based medicine. There is a lot to be said for the laying on of the hands and comforting words of a physician but to make great strides in reducing the loss of life from curable diseases and conditions, we need to supplement emotion with more integrated data and collaboration in the healthcare model. With the efforts of IBM and many other technology companies focused on healthcare in partnership with providers and payers, I believe we will see tremendous progress in this regard over the next few years. We have many reasons to be optimistic.

Tags: analytics, cardio, cardiovascular, china, ecg, Healthcare, healthcare it, healthcare solutions, holter, hospital, IBM

Grand Canyon

Until this week I thought the Grand Canyon was a unique place in Arizona. The Grand Canyon there is the giant for sure — 277 miles  long, up to 18 miles wide and over a mile deep — but now I have learned about another Grand Canyon — in Pennsylvania. The motorcycle trip started out in cloudy weather but within the first hour we encountered rain — not just a few sprinkles but a steady downpour. By the time we reached downtown  historic Tunkhannock the streets were flooded. We found a place to park and went into Twigs Restaurant and Cafe.

I was anxious to check the radar at wunderground.com on the iPhone 4 to see where the storm lines were so I asked the hostess if they had WiFi. Oh, yes we do she proudly announced. Great, what is the SSID? You mean the password? No I mean the name of your wireless access point. Oh, just use “twigs”. Is that with a capital T or lower case? It doesn’t matter. Excuse me, but it does matter. No problem I will try both. Neither worked. Excuse me, is that with one g or two? Just one. Sorry but neither work. Sorry, said the hostess. The owner knows but he isn’t here. Maybe someone else knows? The hostess returned and said it was Twigs1. Nope. No, you need two T’s. I tried TTwigs and Ttwigs, and ttwigs. None worked. The bartender said it is TwigsTwigs1. I tried with and without the 1 but had no luck. The hostess said she had confirmed with the owner that it was correct so if it doesn’t work then you have to contact WiFi! If that doesn’t work try your Internet Service Provider. I explained that the name was set in a little box right there in Twigs and that it was up to them what name they gave it and seems strange that they would want to make it so hard for their customers to use. I finally gave up. At least the food was good. Looking out the window at the downpour and the four of us suited up in our rain gear and headed out into the torrents of rain.

The next hundred miles was more of the same. We could tell that the scenic U.S. Route 6 — more than 3,000 miles long extending from Provincetown, Massachusetts to Bishop, California — offered some great views of the hills and valleys. The stretch of Route 6 we were traveling along the 444 mile long Susquehanna River was beautiful but unfortunately we were not going to witness that on this day and we also needed to keep very focused on the road in front of us. The 175 mile adventure ended in Wellsboro, Pennsylvania, a small town of 3,500 people but with a disproportionate number of shops and restaurants to accommodate the tourists who come there to see the Grand Canyon of PA.

First steps for my brother and I and our wives were to check in to the motel, get our motorcycles parked, get a hot shower, and get our rain gear spread out to dry. The  motel WiFi was simple and fast and the iPad was great for checking email, the day’s market activities, and the news and weather — no longer a need to travel with a heavy laptop.  We headed out with umbrellas to Timeless Destination, a fine Italian restaurant a few blocks from the motel. The food was great and just for grins, I asked if they had WiFi. Oh yes but only the manager knows the password and he isn’t in today! I still stand by my deciiion to have gotten the iPad and the new Kindle (coming in a couple of weeks) with no 3GS, just WiFi. WiFi may not be ubiquitous but it is getting there — with a few exceptions in north central Pennsylvania.

After eggs and potatoes at the Wellsboro Diner in the center of town (did not bother asking about WiFi),  it was time to head out west on Route 660 to Grand Canyon. We gambled that we would not need our rain gear and although the weather was not picture perfect we did escape all but a few sprinkles for the day. A short ten mile ride through the hills and valleys brought us to the end of 660 and to the scenic overlook on the east ridge of the canyon in the 160,000 acre park in the Tioga State Forest. I haven’t been to the Grand Canyon in Arizona since I was a child so I can’t compare accurately but the Grand Canyon PA was quite impressive. Also known as Pine Creek Gorge, the Grand Canyon of Pennsylvania is situated along Pine Creek. The Canyon begins near Wellsboro along Route 6 and continues for approximately 47 miles. The maximum depth of the canyon is 1,450 feet and the distance from rim to rim is approximately 4,000 feet. It is worth seeing and with more time it affords some excellent hiking.

The ride back to the Lake gave us the chance to see the scenic overlooks that we had missed during the prior rainy day. Near Towanda in Asylum Township along the banks of the Susquehanna we saw an historical marking that states, “Marie Antoinette Scenic View, 2000 feet”.  Turns out that in 1793, during the French Revolution several French loyalists fled France and the French island of Santo Domingo (present-day Haiti) to escape persecution and death for their loyalty to King Louis XVI and Queen Marie Antoinette. They landed on the shores of Philadelphia where some prominent Philadelphians agreed to finance their stay in Pennsylvania. 1,600 acres in Northeastern Pennsylvania were purchased and given to the refugees.  The loyalists traveled up the Susquehanna River to a pristine area in the valley. They had found their safe harbor and named it Asylum. (During the Reign of Terror, at the height of the French Revolution, Louis XVI was deposed and the royal family was imprisoned. Nine months after her husband’s execution, Marie Antoinette was tried, convicted of treason, and executed by guillotine in October 1793.

We stopped in Towanda for lunch. The main street was similar to many towns along Route 6 including it’s own Opera House dated 1886 which is now a hardware store. Unfortunately, the business landscape of rural Pennsylvania and New York reveals many closed retailers and manufacturers. The primary place you see thriving buildings with full parking lots are at schools, hospitals, medical labs and clinics, senior citizen living centers, and various government buildings. I have been fortunate to have traveled to many countries around the world but there is much more to see within a day’s motorcycle ride in the northeast part of America.

Tags: french revolution, grand canyon, grand canyon pa, marie antoinette, motorcycle, rain, route 6, towanda, trike, tunkhannock, wellsboro, WiFi

Smarter Healthcare

We have a long way to go but things are accelerating in the world of healthcare. Thanks to improved technology and enlightened healthcare administrators, information technology investments are being deployed at a rapid pace and adoption by caregivers is growing. I am especially pleased to see IBM jumping into this arena and leveraging its considerable resources and talents. Not that it is a new area for IBM. A year after I joined the company in 1967 three IBMers saw a big opportunity to provide mainframe outsourcing for hospitals and left to form Shared Medical Systems. SMS went on to become a $billion company with more than 7,500 employees. It was subsequently acquired by Siemens which is one of today’s leading solution providers in healthcare. IBM was a partner and supplier to SMS and is today a strategic partner with Siemens. IBM’s focus has shifted dramatically over the last half-decade. In addition to providing servers, storage, and software, IBM provides highly advanced services. It has supplemented it’s legions of PhD’s in physics, math, and engineering with medical doctors, nurses, and others with clinical experience. The strategy to assist in the transformation to a “smarter planet” approach for healthcare is to engage in deep partnerships in areas that can have high impact. A couple of current examples follow.

IBM and the University of Pittsburgh Medical Center (UPMC) are teaming up to bring “smarter” hospital rooms to patients. The system, created by UPMC three years ago, features a system to automatically organize and prioritize the work of nurses and other caregivers.  The IBM SmartRoom uses ultrasound tags to identify health care workers as they walk into a patient’s room, displaying the person’s identity and role on a wall-mounted monitor visible to patients. It also automatically provides various physician, clinician and support staff with the relevant real-time patient information pulled from the electronic medical record, including allergies, vital signs, test results and medications that are due on their monitor. The system also evaluates tasks for each patient and helps determine which tasks should be completed in which order to most effectively and safely provide care needed by the patient. It also alerts the appropriate caregiver by mobile device or when they walk into a patient’s room. Unexpected interruptions — from new physician orders to lengthy discussions with a patient’s family — are factored into the dynamically changing priority list. Using a simple touchscreen interface on a monitor in the patient’s room, a nurse or aide can document the completion of tasks in just a few seconds. The SmartRoom provides real-time links to key clinical systems, including pharmacy and lab services. Patient email, testing schedules, education and other features are also offered through the SmartRoom technology.

In the electronic medical record arena IBM and ActiveHealth Management, an Aetna subsidiary, have announced the Collaborative Care Solution — a low cost, cloud computing based subscription service that gives medical practices, hospitals and states collaborative and analytics technologies for their accountable care and medical home efforts. (These two new approaches are fundamental to the reshaping of how healthcare will be delivered in the months and years ahead). Sharp Community Medical Group in San Diego announced that it will use the new solution. The Sharp network includes over 200 primary care physicians and over 500 specialists who care for more than 165,000 patients in   San Diego county.

The IBM cloud computing approach combines information from electronic medical records, claims, medication and lab data with ActiveHealth’s advanced analytics software so care can be coordinated among teams of physicians, nurses, nurse practitioners, aides, therapists and pharmacists. Additionally, the solution provides advanced analytics that help physicians, or entire healthcare organizations, measure their performance against national or hospital quality standards. The solution can also show trends in how patients are responding to treatment for chronic asthma, or adhering to drug regimens and automatically alert doctors to conflicting or missed prescriptions.

John Jenrette, M.D., CEO for Sharp Community Medical Group says, “This is going to revolutionize how we practice medicine. Instead of digging into volumes of paper to coordinate services, we’re going to have that information available at our fingertips. It’s going to make us all more efficient.” Using Collaborative Care, hospitals and medical practices will be able to connect, analyze and share a wide range of clinical and administrative data from disparate systems and sources via a regional health information exchange. The system will automate the measurement, tracking and reporting of clinical quality performance at the patient and practice level using the Active CareTeam, and it will improve patient care through the use of evidence-based, clinical decision support powered by the ActiveHealth CareEngine. The by-product will be a transformation of practices that will assist them in achieving the goals needed to achieve Patient Centered Medical Home status and become Accountable Care Organizations. There are also a range of tools to engage patients in their own care. The Collaborative Care Solution analyzes multiple patient data sources to give doctors actionable decision support on their desktop – highlighting gaps in care, clinical research or potential drug interactions. It also helps doctors see trends in patient populations, for example by showing among 2,000 patients how many have uncontrolled diabetes, or how many women haven’t had their mammography screening, a snapshot they haven’t been able to see before. All of these things combined move us one step further away from anecdotal medicine toward information based medicine. The result will be better outcomes at lower cost.

Tags: accountable care, aco, active careteam, activehealth, careEngine, Healthcare, hospital, medical home, patient centered medical home, patient centric, smart room, upmc

Tanglewood by Trike

It was a special treat to be able to enjoy a nice 375 mile motorcycle trip along with a memorable concert at Tanglewood. The ride from the lakehouse in Pennsylvania to Lenox, Massachusetts took us on mostly state and county roads in the state of New York. We took Route 6 through Milford, PA to Port Jervis, NY and then up route 209 along the historic Delaware and Hudson Canal to Kingston, across the Hudson and then on numerous back roads to Massachusetts, through West Stockbridge and into Berkshire County to Lenox, the summer home of the Boston Symphony Orchestra. After checking in at the Inn we headed for Tanglewood.

The first concert at Tanglewood was in 1936 and since then a substantial organization and support structure has grown up around the beautiful facility. The capacity is 24,000. Not sure how many were there last night but probably close to the limit. Although the main gate was closed to cars when we arrived the police happily motioned us in. Most big events are very courteous to motorcyclists. They save some choice parking areas that are not big enough for cars but perfect for bikes (or trikes). Most people bring wagons with their folded chairs and tables and dinner. Some make quite an elaborate evening out of the free seats on the lawn and embellish their wines and dinners with candles and even candelabras.

The theme of the concert was to honor the 30th anniversary at Tanglewood of composer John Williams. Williams is more famous than most of us probably realize. He has composed many of the most recognizable film scores in history, including Jaws, the Star Wars films, Superman, the Indiana Jones films, E.T. the Extra-Terrestrial, Hook, Jurassic Park, Schindler’s List, Home Alone, and three Harry Potter films.

The star studded evening included the Boston Symphony Orchestra, the Boston Pops Orchestra, and the Tanglewood Music Center Orchestra. Keith Lockhart, Stefan Asbury, and John Williams all conducted (see stories about my own conducting experiences). The program included selections from Superman, JFK, Seven for Luck, and Harry Potter. As a bonus there was music from the film score of Memoirs of a Geisha conducted by Williams and with an incredible solo performance by Yo-Yo Ma. Ma never ceases to delight and amaze audiences. His first performance was at age five and at age seven he performed for Presidents John F. Kennedy and Dwight D. Eisenhower. As if the program was not already over the top, nearby resident James Taylor appeared to sing and honor Williams. The evening concluded with Williams conducting Tchaikovsky’s 1812 Overture. There was a fireworks display while the thousands of attendees filed out. For us it was a short three mile ride on the trike back to the Inn.

Today’s ride was mostly backtracking from yesterday but with a few detours to take a slow ride through the main streets of Stockbridge and Woodstock.

Tags: boston pops, boston symphony orchestra, bso, delaware and hudson, hudson, hudson river, james taylor, john williams, keith lockhart, kingston, lenox, motorcycle, route 209, stockbridge, tanglewood, trike, woodstock, yo-yo ma