Patient-centered Medical Home

The health care system of today is based on an entitlement-oriented fee for services model. Providers feel entitled to be reimbursed for the services they provide. The more services they provide, the more reimbursement they receive. The payers–both government and insurance companies–have not yet provided sufficient incentive to providers to shift the focus to health instead of treatment. A new model is emerging rapidly that will cause a shift to an accountability-oriented fee for value model. The intention of the new model is to increase quality and patient safety and improve outcomes while reducing cost.

A major systemic change to the health care model is arising because of the shift from volume to value. The change is the emergence of the patient-centered medical home (PCMH). The home in PCMH is not a place; it is a concept. The concept is for the primary care physician to coordinate the care of a population of people and recommend the care that is needed to keep that population healthy. Dr. Paul Grundy at IBM describes the primary care physician’s role as the “systems integrator”.  Under the PCMH, the primary care physician will focus on health instead of treatments and will use a full range of procedures and providers to achieve improved health including alternative medicine, home health care, follow-up calls to ensure medication compliance, and follow-up appointments to monitor progress. IBM is encouraging the use of email communications between doctors and patients to supplement the standard waiting room interval before being able to ask the doctor a question. The focus on health is more likely to keep patients out of the hospital where costs are significantly higher. Dr. Grundy has been aggressively pushing on the PCMH concept for more than five years and for obvious reasons–IBM has hundreds of thousands of employees and pays the bill for a lot of health care.  A healthier workforce is good for employees and shareholders alike. If you want to get some further insight about the PCMH, I highly recommend listening to a 21 minute video of Dr. Grundy’s recent talk.

Tags: health care, Healthcare, ibm health care, patient centered medical home, pcmh

The Future of the Internet

The following story was published in the April 2012 issue of  Sun and Surf Magazine

The Future of the Internet
By John R. Patrick

The future of the Internet in our lives is very positive but we are only about 10% of the way there. Of all the things that could be done online that would save us time and simplify our lives, only 10% of them are there. Travel and banking web sites are getting better, but we are still at the early stages of what is possible. Consider retail e-commerce. Although there has been continuous and steady growth of retail e-commerce, it still represents just 5% of total retail sales. Why isn’t it 25% or more? Much is written about that here at patrickWeb but the short version is that there are still a lot of lame web sites. “Click here for the location of our nearest dealer where you can visit” or “call to get a price on the product you just found” or “Click here to download this form, fill it out, and fax it to us”. It is no wonder that Amazon captured 28% of all online sales in the fourth quarter of 2011. One company out of 4 million retailers got more than a quarter of all the sales. Have you ever heard a friend complain about poor customer service at Amazon? They walk in the customer’s shoes and deliver a terrific experience. Most of the rest of the e-businesses in the world have a long way to go. And in the physical world, there are the ubiquitous clipboards at doctor offices where we take a pen and provide a lot of information that they already have.

The changes in Internet technology have been continuous for decades and there is no end in sight. For the past fifteen years, I have been writing about the evolution of the Internet by describing developments in seven key areas: Fast, Always On, Everywhere, Natural, Intelligent, Easy, and Trusted. In the following paragraphs, I will hit the highlights of some of the more important trends and developments.

Fast
Broadband in the U.S. is not a pretty story compared to other parts of the world. We are second after China in the number of broadband users, but 28th in the world in the number of broadband users as a percentage of our population. The problem is that there are too many lobbyists, and the FCC is a political organization. The new FCC head is a very smart guy with technology and business experience. He totally gets it. The only problem is that AT&T, Comcast, and Verizon have more lawyers than the FCC does. Meanwhile France is offering 100 megabit access for $90 per month and rolling out WiFi throughout the country. Thanks to the telco lobby, many states have banned the offering of WiFi by municipal entities. Every citizen in Greenland has Internet access. We have 31,000 post offices.

Always On
WiFi is part of the fabric of the world. The big shift is the streaming of data — not just tweets, but data from *things* — bridges, toll booths, traffic lights, buildings, cars, iPhones, Androids, handheld GPS devices, weather instruments, and health monitoring devices attached to people. The growth in creation of data is staggering. Of all the data in the world, 90% of it was created in the last two years. YouTube receives 60 hours of new video every hour – an hour every minute. Wikipedia has 4 million articles and 8,000 editors. Hospital physicians will soon be adjusting the drip rate on infusion pumps in the hospital from their office based on real-time data from the patient. WiFi-enabled infusion pumps will enable hospital administrators to know where the pumps are (they never have enough of them) and which ones need maintenance.

Everywhere
There are one billion computers (including tablets), one billion cars, 1.5 billion televisions, and 2 billion Internet users. Small numbers compared to cell phones — 5.2 billion paid subscribers. The Internet used to be where your PC is, but now the Internet is where you are.  Most of the cell phones are dumb but soon most of them will be smart and they will all have Internet access. The mobile web is unfolding and is taking part in creating data by streaming data to the Cloud and then consuming data by streaming it from the Cloud. When you take a picture on your iPhone, it goes into the photostream and from there to iCloud and from there to all of your other devices and, if you choose, to the devices of your friends and family.

Natural
Social networking has become fundamental to all aspects of our economy and society. Integration of social networking with a full range of web applications will evolve to become the primary means of finding jobs, finding employees, finding business partners, and collaborating on projects. The emerging issue is that many people, especially young ones, are a bit liberal with sharing their every movement — what they are eating, listening to, where they are headed, their current latitude and longitude, and where they slept last night. They are not thinking that some day they may run for office or interview for a job. A new protocol will emerge to enable people to “erase” things they placed on the Internet. The Europeans may legislate it. OpenSocial is an important new standard that will enable social media apps that work across all of the social media sites.

Intelligent
The Semantic Web is the next big turn of the crank for the evolution of the World Wide Web. Most web pages have links but do not have context. The words on the web page do not necessarily mean anything — but they could. For example, if a web page said “Join us for a concert by The Eagles at Kimmel Center in Philadelphia next Tuesday” that set of words could have a lot of context. Clicking on it could add the concert to your calendar, knowing what “next Tuesday” means. It would also know exactly where the Kimmel Center is and provide a map. The Eagles is a performing group that performs a particular genre and your music player would receive a list of suggestions of music they have recorded or links to live concerts under way at the moment and make recommendations about their music to your friends. This is the tip of the iceberg. The semantic web will lead us to a point where most of the interactions of web pages will be between computers, not between computers and people. The biggest growth of intelligence is occurring in the field of analytics. Exabytes of data are being stored. A byte is 8 bits (a bit is a zero or a 1) and represents one character. An exabyte is a 1 followed by 18 zeroes! Business Intelligence and analytics are poised to enable new insight into the mounds of data – “Big Data” — that are being accumulated. Analytics will enable businesses to make sense of the explosion of data, develop digital models of their business, and continuously adapt it to what is going on. IBM’s Watson successfully challenged humans on the Jeopardy Show, but what is more interesting is the ability for a primary care physician to call and get a recommendation based on patient symptoms and measurements they describe to Watson. Within a couple of seconds Watson technology will be able to review all available medical information in the world and make a useful suggestion.

Easy
Technology is not the easiest thing at times. There are many dimensions to “easy” but one good example is the Nintendo Wii. At a local senior center, members find the Wii to be their exercise coach. It is not just for kids! The iPhone and iPad have shown how easy it can be to get applications on a handheld computer. Amazon has done the same with the Kindle. Most companies still don’t get the idea that the Internet is about power to the people. If you can’t make it simple, people won’t buy it. Cloud computing has become the mainstay for me and for millions. The ease, convenience, and reliability of the Cloud is compelling. Add Dropbox to your laptop and your iPad and your iPhone and you have a completely replicated set of data – all of your data at your disposal wherever you are and with whatever device you may be using. How about the future of TV? Three of the most common remotes — BlueRay, Cable box, and TV — include 151 buttons. Even a savvy child could not possibly master this impossible user interface. Boxee TV has produced a good model of the future of TV – think of it like TV Guide on the web — but I suspect that an upcoming Apple TV will be what finally provides the needed regime change.

Trusted
This is the big one. Can we trust the Internet? Security technology is available to achieve much higher levels of security than is presently deployed both at enterprise and consumer levels. It is a constant battle and requires significant budgets and a lot of talented people to maintain the needed security. The equally important issue is privacy. The good news is that there are some good technology solutions available to help us control access to our Internet habits. The bad news is that politicians have gotten interested in the subject. Banks have our personal information and they are using it. Healthcare insurers have more information about our health than our doctors do. Nevertheless, there is much to be optimistic about when it comes to electronic medical records. Perhaps 25% of doctors and hospitals use them but they are not easily interchangeable and accessible. This will change over the next few years as the government adds dollar incentives to make it happen. The result will be better quality of care, better outcomes, and fewer errors. And, fewer clipboards.

In January, I gave a talk about the Future of the Internet and Healthcare at the SIIA Conference in New York. The slides and a video of the presentation can be found here.

About the author

John R. Patrick (john@patrickweb.com) is president of Attitude LLC and former vice president of Internet technology at IBM. Mr. Patrick was a founding member of the World Wide Web Consortium at MIT in 1994 and of the Global Internet Project. He is a fellow of the Institute of Electrical and Electronic Engineers and a member of the American College of Healthcare Executives.  He is a director of Knovel Corporation, WebMediaBrands, Inc., and Western Connecticut Health Network. He is the author of Net Attitude: What It Is, How to Get It, and Why Your Company Can’t Survive Without It (Perseus, 2001).

About SUN and SURF

SUN and SURF Magazine is published quarterly and mailed to all property owners in Hammock Dunes in Palm Coast, Florida. The magazine currently has a circulation of approximately 1,000.

Tags: analytics, big data, cardionet, corventis, IBM, internet, Internet Technology, ipad, patientslikeme, social media, telemonitoring

My Doctoral Journey – Part 4

I really appreciate the support from my friends and family for my decision 17 months ago to begin the doctoral journey. I promised periodic updates and that is the purpose of this posting. I have now completed 27 credits of coursework out of the rquired 62 — approxmiately 43%. I completed a course in health care marketing in January and am now taking a course in health care economics. In December, I attended a second residency in Atlanta. The third residency will be in October. It will be an important step as it is the launching point from which I will be able to submit a proposal for my research study and dissertation.

The goal that every doctoral student shares is to successfully complete a dissertation as the final step in earning their degree. Some say that at least half of doctoral learners never complete their dissertation because of the incredible detail required to get a research topic developed and approved for research. A typical dissertation is 200-300 pages in length. Some consider the process more than challenging – a friend of mine told me he had an ABD degree – all but dissertation. A visit to Amazon and you can find a lot of books on how to “survive” a dissertation. I still remember the meeting with the academic review committee when I had to defend my masters thesis forty years ago. It seemed challenging at the time, but I can now see that it was nothing compared to what lies ahead for the doctoral dissertation.

I have completed a concept paper, which is the precursor to a proposal for a quantitative research study that I have in mind. The study relates to the cost of care and lives lost due to congestive heart failure (CHF). My mother passed away from CHF a few years ago and I learned a lot about the disease during her final months. As a member of the board at Western Connecticut Health Network, I can also see the impact from a hospital point of view. The concept paper is eleven pages long. Following are a few excerpts from the paper to share a few of the things I am considering.

Chronic heart failure (CHF) is the leading cause of hospitalizations and readmissions for the elderly, and accounts for a large share of developed countries’ healthcare expenditures. Although CHF is a condition for which hospitalization is often avoidable, nearly 20% of Medicare patients discharged from hospitals are readmitted within 30 days at a cost to Medicare of $15 billion annually.

The problem is that the frequent readmission of CHF patients to the hospital has a negative impact on the patient and the hospital. For the patient, it results in a reduced quality of life and a negative impact to their psychosocial and financial condition. For the hospital, it means using extra capacity for care while facing the risk of not receiving reimbursement for the associated cost. The purpose of my proposed quantitative research study will be is to answer the question of whether home-based telemonitoring with coordinated care could improve mortality and reduce hospital readmissions for patients with CHF.

Experimental research attempts to identify cause-and-effect relationships between variables by conducting a controlled experiment. The proposed research method I am considering would use a randomized controlled experiment in which patients are randomly allocated into two groups; one that receives pharmacological treatment with coordinated care (control group) and the other, which receives pharmacological treatment with telemonitoring and coordinated care (enhanced care group).

Telemonitoring makes it possible to gather daily data from patients in a consistent and automated manner. A wireless gateway device similar in size to a cellular telephone can automatically capture data from other wireless devises such as a weight scale, a blood pressure cuff, and a pulse oximeter to measure pulse and the level of oxygen in the blood (oxygenation). Since my last update, I have discovered several companies that have interesting technology for monitoring. These include cardionet.com and corventis.com. Around-the-clock access to a patient portal could display patient data and enable caregivers to respond proactively to the patient. For example, if the data from telemonitoring shows a sudden increase in the patient’s weight, a nurse might make a dietary suggestion or obtain authorization to make a change in medications.

There have been a number of similar studies but none have shown a significant benefit from telemonitoring. The research I have in mind would be focused on whether the right combination of healthcare delivery and technology can improve outcomes. The result could be improved quality of life for patients and, if the care plans are implemented in a cost-effective way, reduced financial risk for hospitals and the ability to invest more in their community healthcare mission.

I will have a further report on the proposal in a few months. In the meantime, I will be continuing with more course work. Since the program began one year ago, I have written 47 papers. Many more to come and then the big one! If everything goes right, I could be just a little less than two years from completion.

Index of stories about My Doctoral Journey

Tags: chf, dissertation, doctorate, e-learning, hospital, scholar, telemonitoring

Medicare – Part 4

I have now been on Medicare for 18 months. Fortunately, I have not required significant clinical services and therefore do not have a lot of experience with the financial impact of Medicare. The medical insurance part of Medicare costs between $99.90 per month and $369.10 per month (per person), depending on your income. The poliiticians imply that everybody pays the same for Medicare and it is time for people to pay their fair share. I do not know what would be considered fair, but a range of X to more than 3X is non-trivial. If you want to understand the Medicare premiums in detail, good luck — it is really complicated. Every time I decide to dig into it and understand it, I run out of time and give up. I did have occasion to go to an urgent care center in Florida in January. I contracted a bad case of rhinosinusitis (perhaps from grandchildren, perhaps from inadequate hand washing during the holiday travels) and needed some health care. It took a couple of weeks to get back to normal and then a couple more to get the claims detail from United Health, which is the supplemental medical insurance I get through IBM. It is coordinated with Medicare. In theory, whatever Medicare does not pay goes to the supplemental insurer for consideration. How this works is as clear as mud. Here is what my claim detail from United Health showed for my visit to the doctor at the urgent care center.

Not to worry. The footnote to the claim detail clears this up (right!).

This Plan Determines Benefits Once Medicare Makes Payment. If Medicare Pays Less Than This Plan’s Benefit, This Plan Will Consider The Difference. This Plan’s Allowable Benefits Are Based On The Medicare Approved Amount If The Physician Or Provider Accepted Medicare’s Assignment Or On The Limiting Charge If They Did Not Accept The Assignment. The Patient Is Responsible For The Difference Between The Allowable Amount And The Total Amount Paid By Both Plans. The Patient Must Pay Any Applicable Plan Deductibles And Copays Before This Plan Can Pay Any Benefits. Medicare payment was applied in the amount of $28.02

There was no co-pay, and if there is a deductible, it would seem that I would have to pay something. What exactly went to whom is a mystery to me. I am sure it is a mystery to our political leaders also. Medicare encourages preventative examinations and tests. That is a good thing, but if I followed all that are recommended, I would 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 entitlement 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” and it will begin the shift from a volume-based system to a value-based system. This is a good thing, and regardless of the 2012 political outomces, I do not see the shift changing.

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 will make my sinusitis claim detail seem trivial.

One thing is for sure and that is that the current model of care 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, health, Healthcare, medical insurance, medicare, sinusitis, wheel chair, wheelchair

Genesys XVIII

The 18th Annual Genesys Partners Venture Dinner — Gen XVIII– Monday night at the Union League Club in New York attracted more than 100 venture capitalists, investors, journalists, entrepreneurs, and industry executives. As always, Jim Kollegger — CEO of Genesys Partners and one of the pioneers of the information industry — was an elegant master of ceremonies. He introduced the various sponsors, next day panelists for the SIIA Conference, several startup CEO’s, and a few of us who have been around the block a few times, each to make some comments.

Like a broken record, I offered the normal upbeat view of the future of the Internet but prefaced my remarks by asserting that we are only 10% of the way there. In other words, of all the things that could be done on the Internet that would save us time and make our lives better, only 10% of them are there. It may sound low but consider retail e-commerce. Although there has been continuous and steady growth of retail e-commerce it still represents just 4% of total retail (as of the end of October). Why isn’t it 25% or more? Much is written about that here at patrickWeb but the short version is that there are still a lot of lame web sites. “Click here for the location of our nearest dealer where you can visit” or “call to buy the product you just found” or “Click here to download this form and fax it to us”. And of course there are the ubiquitous clipboards at doctor offices where we take a pen and provide a lot of information information that they already have.

I described one man’s view of the evolution of the Internet including the seven characteristics below. This parsed way of looking at the Internet has served me well for quite a few years. The things going on under each area continuously change and Jim asks me once a year to do a thumbnail sketch of my latest thinking.

Fast
Broadband in the U.S. is not a pretty story compared to other parts of the world. We are second after China in number of broadband users, but 28th in the world in number of broadband users as a percentage of our population. The problem is that there are too many lobbyists and the FCC is a political organization. The new FCC head is a very smart guy with venture and business experience. He totally gets it. The only problem is that AT&T, Comcast, and Verizon have more lawyers than he does. Meanwhile France is offering 100 megabit access for $90 per month and WiFi throughout the country. Thanks to the telco lobby, many states have banned the offering of WiFi by municipal entities. Every citizen in Greenland has Internet access. We have 31,000 post offices.

Always On

WiFi is part of the fabric of the world. The big shift is streaming of data — not just tweets, but data from *things*. Bridges, toll booths, traffic lights, buildings, cars, and health monitoring devices attached to people. Hospital physicians will soon be adjusting the drip rate on infusion pumps in the hospital from their office based on real-time data from the patient. The WiFi infusion pumps enable hospital administrators to know where the pumps are (they never have enough of them) and which ones need maintenance. The creation of data is staggering. Of all the data in the world, 90% of it was created in the last two years. YouTube receives 60 hours of new video every hour. Wikipedia has 4 million articles and 8,000 editors.

Everywhere
There are one billion computers (including tablets), one billion cars, 1.5 billion televisions, and 2 billion Internet users. Small numbers compared to cell phones — 5.2 billion paid subscribers. The Internet used to be where your PC is, now it is where you are.  Most of the cell phones are dumb but soon most of them will be smart and they will all have Internet access. The mobile web is unfolding and is taking part in creating data in addition to consuming it through streaming. When you take a picture on your iPhone, it goes into the photostream and from there to iCloud and from there to all of your other devices.  

Natural
Social networking has become fundamental to all aspects of our economy and society. Integration of social networking with a full range of web applications will evolve to become the primary means of collaboration. The emerging issue is that many people are a bit liberal with sharing their every movement — what they are eating, listening to, where they are headed, their current latitude and longitude, and where they slept last night. They are not thinking that some day they may run for office or interview for a job. OpenSocial is an important new standard that will enable social media apps that work across all of the social media sites. The Europeans may legislate it, but regardless, a capability is needed to be able to remove things from the social media.

Intelligent
The Semantic Web is the next big turn of the crank but the crank is moving slowly. Most web pages have links but do not have context. In other words the words on the page do not necessarily mean anything — but they could. If a web page said “Join us for a concert by The Eagles at Kimmel Center in Philadelphia next Tuesday” that set of words could have a lot of context. Clicking on it could add the concert to your calendar, knowing what “next Tuesday” means. It would also know exactly where the Kimmel Center is and that The Eagles is a performing group that performs a particular genre and your music player would receive a list of suggestions of music they have recorded or links to live concerts under way at the moment. This is the tip of the iceberg. The semantic web will lead us to a point where most of the interactions of web pages will be between computers not between computers and people. The biggest growth of intelligence is occurring in the field of analytics. Exabytes of data are being stored. Analytics will enable businesses to make sense of it, model their business and continuously adapt to what is going on. IBM’s Watson took on humans on the Jeopardy Show, but what is more interesting is the ability for a primary care physician to call and get a recomendation based on patient data they describe to Watson. Within a couple of seconds Watson will be able to review all medical information in the world and make a useful suggestion. Business Intelligence and analytics are poised to enable new insight into the mounds of data that are being accumulated.

Easy
Technology isn’t the easiest thing at times. There are many dimensions to “easy” but one good example is the Nintendo Wii. At a local senior center, members find the Wii to be their exercise coach. It is not just for kids! The iPhone and iPad have shown how easy it can be to get applications on a handheld computer. Amazon has done the same with the Kindle. Most companies still don’t get the idea that the Internet is about power to the people. If you can’t make it simple, people won’t buy it. Cloud computing has become the mainstay for me and for millions. The convenience and reliability of the clouds is compelling. Add Dropbox and you have a completely replicated set of data, wherever you are and with whatever device you may be using. How about TV? Three remotes — BlueRay, Cable box, and TV — include 151 buttons. Even a savvy child could not possibly master this impossible user interface. Boxee TV has produced a good model of the future of TV, but I suspect that an upcoming Apple TV will be what finally provides the needed regime change.

Trusted
This is the big one. Will we trust the Internet? Security technology is available to achieve much higher levels of security than presently deployed both at enterprise and consumer levels. It is a constant battle and requires significant budgets and a lot of talented people to maintain the needed security. The bigger issue will be privacy. (Stay tuned for the Firefox “do not track” feature). Banks have our personal information and they are using it. Healthcare insurers have more information about our health than our doctors do. Nevertheless, there is much to be optimistic about when it comes to electronic medical records. Perhaps 25% of doctors and hospitals use them but they are not easily interchangeable and accessible. This will change over the next few years as the government adds dollar incentives to make it happen. The result will be better quality of care, better outcomes, and fewer errors. And, fewer clipboards.

On Wednesday I gave a talk about the Future of the Internet and Healthcare at the SIIA Conference. The presentation can be found here.

Other patrickWeb conference related stories

Tags: broadband, fcc, future, health, health care, Healthcare, IBM, internet, ipad, iPhone, jeopardy, john patrick, Mobile, opera, siia, social media, supercomputer, union league, WiFi

Big Data

The storage capacities of laptop and desktop computers has been growing rapidly, but the growth may not be fast enough. According to IBM, we create 2.5 quintillion bytes of data every day. Perhaps quintillions of bytes are not meaningful to most of us, but it is the growth rate that is staggering — 90% of all the data in the world has been created in the last two years. Where does all the data come from? Data comes from everywhere: from sensors used to gather climate information, physiological readings taken 1,000 times per second from a patient, posts to social media sites, digital pictures and videos posted online, transaction records of online purchases, and cell phone GPS coordinates to name just a few. Collectively, the phenomenon is called “big data”. (See  IBM Big data and information integration for smarter computing).

Note: Data is plural. The singular term is datum. Should we say data is or data are? There are many views on which is right.

 IBM describes big data as spanning three dimensions: Variety, Velocity and Volume.  Variety refers to the fact that big data extends beyond structured data like we might find in a spread sheet. It includes unstructured data such as text documents, email, audio and video recordings, click streams from the web, log files that record financial and business transactions, and much more. Velocity of data refers to the fact that data can be time-sensitive such as bid and ask data in a financial market or physiological data that affect the lives of patients. In these cases, historical data is interesting but real-time data is critical. The third parameter is volume. IBM says that big data comes in one size: large. Organizations are flooded with data — terabytes, petabytes, or even yottabytes.

Big data is a challenge in various technical ways, but more importantly, it is an opportunity to find insight in new and emerging types of data and to answer questions that, in the past, were not possible to analyze effectively. Data that has been hidden can be surfaced and acted upon. The result can be a more agile organization or in the case of health care, better outcomes for patients.  Picture a hospital neonatal environment where a plethora of medical monitors connected to babies are used to alert hospital staff to potential health problems before patients develop clinical signs of infection or other issues. There are breakthroughs on the horizon for how this will be done. Today the instrumentation generates huge amounts of information — up to 1,000 readings per second — which is summarized into one reading every 30 to 60 minutes. The information is stored for up to 72 hours and is then discarded. If the stream of data could be captured, stored and analyzed in real-time there could be a huge opportunity to improve the quality of care for special-care babies.

The Hospital for Sick Children in Ontario, Canada developed such a vision and is acted on it. Dr. Carolyn McGregor, Canada research chair in health informatics at the University of Ontario Institute of Technology visited researchers at the IBM T. J. Watson Research Center who are working on a new stream-computing platform to support healthcare analytics. A three-way collaboration was established, with each group bringing a unique perspective — the hospital focus on patient care, the university’s ideas for using the data stream, and IBM providing the advanced analysis software and information technology expertise needed to turn the vision into reality. The result of the collaboration was Project Artemis which pairs IBM scientists with clinicians and`researchers to explore how emerging technologies can solve real-world business problems, in this case developing a highly flexible platform that aims to help physicians make better, faster decisions regarding patient care for a wide range of conditions. At the Children’s hospital the focus is real-time detection of the onset of nosocomial infection (often called hospital-acquired infection). Regulatory, ethical, privacy, and safety issues were addressed and then two infant beds were instrumented and connected to the system for data collection. The team then created an algorithm that deciphered the streaming data. By establishing the impact of moving a baby or changing its diaper, those things can be filtered out to help spot the telltale signs of nosocomial infection.

Dr. Andrew James, staff neonatologist, at the Hospital for Sick Children is optimistic that as they learn more they will be able to account for variations in individual patients and eventually be able to integrate data inputs such as lab results and observational notes. In the future, any condition that can be detected through subtle changes in the underlying data streams can be the target of the system’s early-warning capabilities. It is likely that sensors attached to or even implanted in the body will allow monitoring of important conditions from home or anywhere. Big data has the potential to improve the health of patients whever they may be.

Other healthcare-related stories on patrickWeb

Tags: analytics, big data, health, Healthcare, hospital, IBM, monitoring, neonatal

BioEverything – Part 3

In 1963 there were two tracks that an electrical engineering student at Lehigh University could choose from — electronics or power. Electronics was about solid state devices such as transistors. (The Intel 4-bit 4004, now four decades old, was not to come until 1971). The “power” track was mostly about electric motors and power generation. There was no computer science program, but the university had recently acquired a GE 225 which occupied a good part of the basement floor of Packard Laboratory. Nearly every department at Lehigh began to include computer programming as part of their curricula. Some departments evolved toward strong computer orientation more rapidly than others but eventually computer science and computer engineering became formal programs of their own.

Fast forward forty years and you can see a very similar evolution occurring with regard to bioengineering. Initially “bio” was a special interest area that spread roots from the biology department into various engineering disciplines. Bioengineering has already become a structured curriculum for students interested in the intersection between engineering and biological sciences. The bioengineering faculty at Lehigh is drawn from several departments in the college of engineering and applied science and the college of arts and sciences. Bioengineering combines engineering principles with the life sciences. There are three tracks available to students. Biopharmaceutical engineering encompasses biochemistry and chemical engineering. Bioelectronics/biophotonics focuses on applications of electrical engineering and physics in bioengineering such as signal processing, biosensors, and biochips. Cell and tissue engineering straddles the fields of molecular and cell biology, materials science, mechanical and electrical engineering and encompasses biomaterials and biomechanics. Studies range from cells and tissue to organs and systems. Sound a bit different than transistors and electric motors?

I think many of us have certain things in mind when we hear the word engineering. Perhaps we think of electronic circuits, chemical interactions, structural designs, or automotive and aeronautical endeavors. The first two stories in resolve leaves a different impression. The first article was “Measuring the stiffness of a single living cell”, a story about how changes in the mechanical properties of biological cells may be a major contributing factor to the development of bone, kidney, and vascular disease. The second story was “Mending a wounded heart”, a story about how heart attacks can cause extensive scarring of the cardiac muscle tissue and how inadequate structural remodeling can be supplemented with an implanted cardiac patch composed of heart muscle cells grown on a porous polymer scaffold. A third story talks about the mechanics of  proteins — how protein molecules are made from a linear chain of amino acids that fold into a 3-D globular form. The bottom line is that engineering is not what it used to be! Engineers still design bridges and circuits but now bio-engineers are working at the molecular level to improve the quality of life by by redesigning parts of the human being and designing new components to take the place of those in our body that may have worn out.

The exciting part of all this is that engineering students with “bio” in their pedigree have a much broadened career potential including healthcare, biomedical, pharmaceutical, biomaterials, and medicine. A  new professional master’s degree program in healthcare systems engineering (HSE) in the Department of Industrial & Systems Engineering (ISE) designed to prepare graduate students for engineering and management careers in healthcare and health related products and services companies. The increasing complexity of delivering health care with high quality and positive patient outcomes requires professionals who are trained to think in terms of systems. The Institute of Medicine and the National Academy of Engineering have urged the healthcare field to embrace systems engineering as a way to deliver safe, effective, timely, patient-centered, and efficient.

Lehigh’s Healthcare Systems Engineering program has developed relationships with Mayo Clinic, Lehigh Valley Health Network, Geisinger Health System, Saint Luke’s Health System, Memorial Sloan-Kettering Cancer Center, Merck, and Cigna Healthcare. There are already 18 graduate students enrolled in the new HSE program and many more expressing interest.

Even more exciting is the possibility for those of us who started out back in the days of the transistors and motors and now have aging bodies that some day we will benefit from bio-engineered “components”. The implantable pacemaker was just the beginning. Bioengineering graduates will be developing pacemakers for the brain, cochlear implants for hearing deficiencies, artificial cartilage for our knees, devices to enable the blind to see, and cures for today’s incurable diseases. At some point a nanotechnology “cocktail” will bring nanobots to our internal systems to replace faulty cells with newly engineered ones. Just like computers have become ubiquitous, it is clear that bio-everything is on the horizon. Bioethics will become a larger concern but it is clear that the trend toward The Singularity is underway.

Tags: bio, bio-engineering, bioengineering, engineering, lehigh, singularity

iPhone 4S Bluetooth Advantage

I continue to believe that the iPhone 4S is much better than what some in the media panned. Peter Svensson at the Sidney Morning Herald did an excellent job of reporting about a little-noticed feature that makes the 4S unique among smartphones (See iPhone 4S first phone for low-power Bluetooth). The updated Bluetooth feature enables the iPhone 4S to communicate with a new class of wireless devices not previously in the mix — for example, watches and heart-rate monitors.

Bluetooth has been around since 1994. I use it to connect my iPhone to the audio and phone system in my car and to connect a keyboard to the iPad 2. What is new about the Bluetooth chip in the 4S is that it can support connecting to devices that use much less power than has been the case. The new ultra-low power chip uses so little power that it is found in devices that are powered by a “button cell” battery like what is found in watches and which can last for years.

The industry group behind Bluetooth said these small devices will be labeled “Bluetooth Smart.” Devices such as the iPhone 4S that support the new standard will be labeled “Bluetooth Smart Ready.”

Casio announced that it will introduce a Bluetooth Smart watch in December that will be able to link to a smartphone and alert the wearer to incoming emails and text messages by beeping and vibrating. Sony Ericsson had a watch five years ago that did the same thing, but it weighed nearly half a pound because of its big battery.

The possibilities in healthcare are exciting. Nordic Semiconductor, a Norwegian company, said that one of its Bluetooth Smart chips will be used in a belt that monitors heart rate and relays it to a smartphone. Other possibilities include glucose sensors for diabetics and sensors that can tell if a chronically ill person has fallen or had a significant change in posture. Home health monitoring is entering a phase of innovation that has the potential to improve quality of life and reduce the cost of healthcare. Stay tuned!

EMRs — The Time is Now

Electronic medical records (EMRs) are on the way, and not any too soon. The government is offering large incentives to healthcare providers to start using EMRs and for those who skip the incentive, there will be penalties to follow. Whatever you may think of the EMR, it is at our doorstep. I am not making a political statement about this – to me it is common sense and a technological imperative that will reduce costs, enhance healthcare quality, and improve patient safety. A reader sent me an account of what he and his family experienced two weeks ago and, with his permission, I am sharing this true story because I think it is one of millions of examples that justify the move to EMRs.

The reader is from California and I will call him Frank for purposes of this post. Frank’s 15-year-old son Alex was scheduled for non-emergency pulmonary valve replacement surgery on Friday afternoon. He was born with a number of congenital heart defects and had open-heart surgery at 30 days old 15 years ago. A recent MRI showed his pulmonary valve to be leaking extensively so it was recommended it be replaced with a new adult-sized pig valve. Before leaving for the hospital Friday morning, Frank received a phone call saying that Alex had been bumped from the schedule due to a critical newborn with heart problems.

Although Frank understood the bump, Alex took it extremely hard. As the day wore on, he got more and more upset and stressed out. Around 9 PM he mentioned that he was having shortness of breath and was having pains around his heart. Since he had a full pre-op earlier that week, Frank’s immediate thoughts were that this was a combination of extreme stress and possibly indigestion, but he decided to take Alex to the local hospital emergency room (ER). Once there, clinicians checked Alex’s vital signs and ran an EKG. The ER doctor did a quick echocardiogram. After reviewing the test results, the ER Doctor asked if Frank had any historical EKG’s so that a comparison could be made to Alex’s abnormal EKG.

Around 11 PM Frank signed the paperwork to authorize a search for the EKG — the nursing staff started calling hospitals where Alex had been a patient to see if they could obtain EKG data. They hit a brick wall. The large hospital where Alex had the pre-op wanted to help but had no access to data. A call to the cardiology specialist’s office got a recording — they were closed.

As Frank reflected on the data void, he realized that he can download an obscure piece of music from multiple sources on the web, but in spite of valiant efforts, he could not get a copy of Alex’s EKG. Isn’t it a collection of ones and zeroes, just like music? Although it was a stressful weekend for Frank, Alex began to feel better and was able to go back to school the next day.

On Saturday morning Frank did an extensive web search, and found that Medic Alert provides emergency information to caregivers if a physician sends them data. This is a great service, but shouldn’t it be an automatic by-product of healthcare by any caregiver? From Frank’s perspective, having access to someone’s past EKG could either save a life, prevent misdiagnosis or save time and money. To Frank, it seems like a basic for anyone with an affected child or if they themselves have a potentially serious ailment. Frank’s perception is that EKGs for the most part are still “paper driven” and nobody is thinking about getting them on the web as a standard practice.

Alex has a new surgery date in early November. Hopefully, Alex will be feeling better, and with the surgery delay he should get to finish his soccer season.

It is time for healthcare to catch up to banking, e-shopping, e-music, YouTube, and social networking. What could be more important that the health of our families? Privacy is a valid and important concern, but it can and is being addressed as part of the rollout of EMR systems.

Alex’s privacy was intact – his EKG results were in a manila folder somewhere – private, secure, and unavailable when needed.

Tags: cardiac, ekg, emr, health care, Healthcare, heart, heart surgery, phr, surgery

DEMO in Santa Clara – 2011

Demo has always been my favorite conference, and this past week in Santa Clara proved valuable once again. I believe this was the twenty-first year I have attended Demo. The Demo conference allows entrepreneurs to show off new gadgets, software, hardware and business ideas and enables the press, analysts, investors, key influencers and technology enthusiasts to assess what they see. The product introductions that take place reveal key technology trends over the coming 12 to 18 months. There were excellent speakers, as always. Take a look at the list.

Eighty companies were launched in two days. I view Demo as a barometer of what lies ahead and each year I comment not just on the companies but on the key trends I observed. Last year it was mobile, social media, and cloud. This year it was mobile, cloud, social media, and HTML5. There are now 5 billion cell phones in use around the world. In the U.S., 96% of people have one, and half of them are now smartphones. That is a big shift and it validates that the moible Internet is here. Cloud computing was as clear as a bell. Nobody wants to buy an application that requires having a server, as has been required in the past. Everything is in the cloud. Dropbox continues to be the best way to get an understanding of what cloud means. If you don’t have Dropbox yet, I highly recommend it. Social media is here to stay and most of the startups were offering some new way to exploit it — collaborative shopping and sharing content continue to loom large. The biggest shift is HTML5. I try to keep technical jargon out of patrickWeb, so sorry for the technical term. HTML is what makes the Web work. It is a protocol that makes Web pages accessible and useful. What is new is that HTML5 takes the Web to a much higher level than before. It means that a Web page can now be much more intelligent and, most importantly, the page can be truly cross-platform. That means that a page can be rendered on your PC, Mac, iPhone, Android, Tv, or anything that uses a standards-based browser. It is going to revolutionize the Web. To get a taste of this, get the Amazon Cloud Reader. HTML5 also means that–once fully adopted–you will never see a message that says “You need the latest version of Flash” or “You need the latest Real player” or “You need the latest Windows Media Player”. Audio and video will be able to be embedded in any page and enjoyed on any device. I love it!

Only six of the 80 companies were of special interest to me, although all of them were interesting. Three of them were related to healthcare. Here is my list — the links from them will tell you more. You can get a complete rundown on all 80 at the Demo Alumni Page.

LumoBack has a bandaid-like patch that you put on your back and it sends data to your iPhone about your posture.
Oh my meds provides a way to keep a track of a lot of meds in one convenient place–even if they were fulfilled at multiple pharmacies–and provides a lot of useful information about the medications.
SenseAide monitors what is going on at the residence of a senior. If the door has not opened for a long period of time or there is a fall, a call to a wall-mounted video phone is placed and automatically answered so a caregiver can ask if everything is ok.
Iconfinder has a slick model for selecting an image for use in your blog or website.
Upverter is a cloud-based electronic design tool. It breaks a lot of new ground and it is quite impressive what it can do without any desktop software.
Zirtu Virtual desktop takes virtualization to a new level. It does not virtualize the operating system — just all the desktop apps. It provides a virtual desktop even if the network connection is lost.

See the rest at demo.com, or better yet, head out to Silicon Valley in April for DemoSpring2012 and see the next batch of startups.

Tags: ethanol, find a doctor, health care, Healthcare, mac, vmware, windows