Thanks for stopping by. My name is John Patrick and Attitude LLC is the name of my company. My activities include writing, speaking, and board service. I am fortunate to have quite a few affiliations and I get to work with people from whom I am constantly learning. Prior to “e-tirement”, I was vice president of Internet Technology at IBM Corporation. Nearly everything I have ever said or written is here at patrickWeb or in my book, Net Attitude. The patrickWeb blog contains more than 1,000 posts. I hope you enjoy reading some of them. Get the email version of patrickWeb if you prefer. Find me on Facebook. Follow me on twitter. You can also find me in Wikipedia.

Happy Birthday GPS

Twelve years ago geocaching suddenly became useful to citizens. Prior to May 2, 2000, the GPS satellite network had a “feature” called Selective Availability that provided an intentional degradation of the GPS signal so that only the military could use it with accuracy.  When President Clinton signed an order to permanently turn off the feature, civilian GPS devices instantly became 10 times more accurate. The first geocache was placed in the state of Oregon the next day. It was hidden in the U.S. state of Oregon on May 3, 2000. As of today, there are more than 1.7 million active geocaches and more than 5 million geocachers worldwide. There are quite a few postings here in patrickWeb about geocaching, and the homepage for geocaching is here. It is a great sport for young and old.

Tags: geocache, geocaching, gps, hiking, selective availability

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

E-Books From Your Local Library

Libraries are trying their best to make borrowing e-books convenient, but publishers are not making it easy. See E-Books Are Easier to Borrow, Just Be Prepared to Wait. The New York Times story said that e-book borrowing is preceded by e-book waiting. I decided to take a look a virtual visit to the library in Ridgefield, CT and see for myself. I logged on to the library site and clicked on the button for downloading eMedia. The library has 1,730 e-books, but only 347 of them are available. This is what the New York Times writer meant by borrowing being preceeded by waiting. The library had just one copy of most of the e-books I looked at, and since that copy was presently loaned out, I would have to click the waiting list button and get in line to borrow the book when it is returned. The library has one copy of The Pillars of the Earth, by Ken Follett, and there are eight patrons on the waiting list to borrow it (there are dozens of patrons waiting for some books). I selected an available book and clicked to add it to my list. I proceeded to checkout, logged in with my library card number, selected a seven-day lending period (you can choose up to 14 days), and then clicked “Get for Kindle”. I was then redirected to the Amazon site where I clicked “Get Library Book” and the book downloaded to my Kindle just as if I had purchased it from Amazon. The whole process is pretty slick, easy to follow, and efficient. So what is the problem? There are several.

Why isn’t the digital inventory infinite? The library knows how many patrons it has and how many books they read per year. They could estimate how many will be e-books and establish a budget to cover the purchase of X copies for lending. I suspect the answer is that publishers don’t want to do it that way. They want to sell books the same way they have always sold books. One book at a time at a retail price. They are not about to have the book business be like the music business. Or, so they think. The other problem is the mechanics of borrowing the e-book. The process is easy for a Kindle with some publishers following the process I described. With Ken Follett’s books, however, his publisher requires that you connect your Kindle to your PC with a USB cable and then download the book. “Due to publisher restrictions, this book in the Kindle format cannot be delivered wirelessly and must be downloaded and transferred via USB.” Note that it is a publisher restriction, not a hardware or software restriction. You can click another link for instructions on How to transfer Kindle books to Kindle devices via USB.

Kindle is not the only kind of e-book, of course. Some books are in the Adobe ePub format and others are in Adobe PDF format. Each requires a different download and installation of software. The convenience of borrowing an e-book ranges from a few clicks and wireless transfer to your Kindle to a hassle of plugging your Kindle into a PC with a cable to several variations in between. Everywhere you turn, you can see content publishers clinging to the past. In my doctoral courses, the e-book textbooks we use can only be opened with Adobe Acrobat (not Preview on the Mac) and they can not be saved or transferred to an iPad, in other words e-books that can not be read on an e-reader.

Publiishers are clearly struggling to find the right model. They had made progress with the Apple deal, but then the governmnet said it was an illegal approach. Three of the five publsihers involved have agreed to revert to the model Amazon has been advocating — letting the retailer set whatever price they want. We are a long way from getting to a free market where consumers can get what they are willing to pay for. A new book arrives on the scene but you can’t get it on your Kindle until you get in line and wait. A new movie is available, but only if you go to the theatre. You spend $125 for a textbook fee, but you can’t read the book on your iPad. The good news is that there are many entrepreneurs circling the wagons, creating innovative new devices and services. The publishers can slow down progress, but they can’t stop it.

Tags: books, e-book, ebook, ipad, Kindle, publishers

How to Empty Your Inbox

I got a call from Claire Suddath at Bloomberg Businessweek a few weeks ago. She told me about their upcoming second annual “How To” special issue.  We talked quite a bit about the history of email and various approaches to manage it. By necessity, the story had to be edited down quite a bit to fit the available space. (The nice thing about the Web is that space is unlimited. See my original story that caught Claire’s eye below).  My little story is called “How to Empty Your Inbox” and it appears here.  The “How To” special issue includes 55 stories from “CEOs, tech visionaries, U.S. senators, an NFL referee, an artist, and, for good measure, an 11-year-old and a 106-year-old”.  The guest contributors shared a lot of interesting perspectives, and Businessweek did a nice job pulling it all together. The stories can be found here.  

Since I wrote the story last December, I have become more and more dependent on Boomerang.  Whenever I send anyone an email to which I hope for a reply, I click the check box  to have Boomerang send the email back to me if I don’t get a reply to it in X hours or days or weeks, depending on the timeliness needed. Whenever I receive board materials to read, I boomerang them back to me the night before the meeting or the morning of a train or plane ride to the meeting. When an email arrives that I really want to read but don’t have time to at the moment, I boomerang it back to me when I think I will have time. I have numerous periodic emails that I send to myself but where I click the “Send Later” button and have Boomerang send it to me on a specific date or once a month, quarterly, or annually. Boomerang is more than an email manager — it helps you manage your tasks and workflow. 

Original story about Boomerang as published on patrickWeb on December 3, 2011

I wish I had a dollar for every task management application I have used over the last few decades. There are many good ones, but the task manager that consistently works for me–and that I always end up relying on the most–is email. It is not true for everyone, but for me, an email in the inbox is a call to action. If there are more than a handfull of emails in my inbox, I do not feel I am in control of my life. When I have answered an email or taken some action based on that email and I then delete the email, I feel I have accomplished something. When the inbox is empty I feel very good — I have things under control. The problem is that on many days, getting to an empty state for the inbox is just not in the cards. Enter Boomerang!

Boomerang for Gmail is a browser plugin (for Firefox or Chrome) that I have found to be a great productivity tool. It is not a task manager, per se, but it greatly enhances my ability to get to the empty inbox state. If I receive an email invitation to attend an event and the RSVP date is two weeks from now and I don’t have time at the moment to consider it — Boomerang! I click the boomerang button and select “return to my inbox in 4 days”. You can click on choices such as in an hour, four hours, tomorrow morning, tomorrow afternoon, in a week, in a month, or at 3PM on March 14, 2013. A couple of clicks and the email is out of your inbox — but it will be back at a time when you are ready to deal with it. You can also send yourself an email and click the boomerang button to have it sent to you every Saturrning as a reminder to put out the trash. I have one email that comes to my inbox on the first of every month to remind me to update a Google Doc that I maintain as a log with my business use car mileage. Another one on the 15th of the month reminds me to update my steps database from my pedometer. If I am really busy when one of those mails arrives, no problem, just click the boomerang button and have it come back to you in a day or two or next week.

Boomerang also helps with workflow. For example, I may  read the news on the iPad with Pulp and see a story that I think would be of interest to others.  I hit the share button in Pulp and it sends me an email with the story link. I see the email later but I am not ready to write a story just yet — Boomerang! A couple of clicks and the email comes back to me Saturday morning. Another very powerful feature helps with follow-up. You can send someone an email requesting something and select a boomerang option to have the email return to you in four days if there has not been a reply to your email. A few clicks and you get a follow-up system. Boomerange also works with the iPad and iPhone. Maybe something better will come along, but for now, Boomerang for Gmail is helping me organize things the way I want and allowing me to stay on top of things and keep a feeling of being in control.  If you overuse it and everything gets boomeranged and nothing ever gets done, well then you have other problems that technology can’t solve!

Tags: bloomberg, boomerang, businessweek, e-mail, email, inbox, john patrick, productivity, task, task manager

OS/2 Celebrates 25 Years

Harry McCracken’s story (see 25 Years of IBM’s OS/2: The Strange Days and Surprising Afterlife of a Legendary Operating System) about OS/2 brought back a lot of memories. Seeing my picture in PC World magazine made me feel old — who is that young man? Bill Gates and I were both wearing purple shirts, but that was the only thing we had in common. OS/2 was a great product, but it failed in the end for many reasons that Harry described. From my perspective, the main thing that could have upped the odds for OS/2 would have been if we had tightly integrated the IBM hardware, software, and services that IBM had at the time. Unfortunately, there was a feeling of independence in the various divisions of the company; the PC Company, the Personal Sofware Products Division of which I was the vice president for marketing, the IBM Global Network, the amazing National Service Division of which I earlier was vice president for service business, the various industry vertical and marketing organizations of IBM, and the financial resources to put it all together.

But, we did not put it all together. The Apple iPad and Mac are successful because Apple put it all together so that “it just works”. IBM had a similar potential with OS/2. Three researchers developed a Web browser called the Web Explorer. It was the best Web browser at the time. The ThinkPad had just been introduced a year earlier. IBM was the only vendor that could offer a PC with an operating system, a suite of Internet tools for surfing, email, and news reading, plus the IBM Global Network — all bundled on a ThinkPad. That was 1994 and IBM had it all and no other vendor was even close. Unfortunately, IBM, at the time, wanted each division to stand on its own. The PC division believed they could sell more PCs if they put Windows on them instead of OS/2. The OS/2 team wanted to make their software work with all the industry software, but the Lotus division wanted just their products on the PC. The industry vertical groups wanted to sell whatever kind of PC the customer wanted, IBM or others. The service division wanted to service any brand and give-up the exclusivity of great IBM service. While Apple had one brand, IBM had multiple brands, each with its own advertising agency, that did not leverage the strength of one of the greatest brands of all times — IBM.  When Lou Gerstner took control, the company came back together again, but unfortunately, it was too late for OS/2. If you like technology history, read Harry’s story. He did a great job in pulling it together. In my basement, I have a collection of OS/2 hats on the wall. My grandchildren ask me, “Pop-pop, what is OS/2?”

Tags: IBM, IBM Global Network, IGN, internet, john patrick, os/2, ThinkPad, Web Explorer

Back from Florida

The weather was so nice, it was difficult to leave and come home. I feel very fortunate to have been able to spend a bit more time in Florida this winter. Thanks to FaceTime, Skype, Polycom, iMessage, email, and the web, it was easy to participate in board meetings remotely. I was even able to chair a hospital quality committee meeting remotely, thanks to the high quality PolyCom video-conferencing system they have. My current doctoral course is in health care economics. One of the team assignments required a teleconference. There were four of us in diverse locations; Ottawa, Baltimore, Florida, and Jordan. If two of the students were in Canada and the Middle East, it didn’t matter that I was in Florida instead of home in Connecticut. We were all just a few hundred milliseconds apart.

Before leaving Florida, I decided to try out the new iPhoto app on the iPad3. It goes beyond the photos app that comes with the iPad. In addition to taking advantage of the greatly enhanced retina screen, the iPhoto app has a new feature called Journals. In addition to viewing your albums, events, faces, and places, you can create journals. A journal is a web page that can include pictures from your albums plus special add-ins from the app including a calendar icon representing the date you took the pictures, a map showing where you took them, and a weather icon showing what the weather was like when you took the picture or alternatively what the weather there is now. You can also add quotations and text boxes. See March in Florida for a page I created as a first try. The pictures can be edited, touched up, brightened, manipulated with effects, air-brushed, and arranged in a collage — all with your fingers. You then save the journal to a glass shelf and it is uploaded to iCloud where you can share it with friends, family, or the public. A home page shows all your shelves with the journals lined up on them in date sequence. In effect, journals gives you the ability to create a web site at iCloud with no traditional design tools. Just your iPad and your fingers.  This is classic Apple making things easy — it just works. But, it is not perfect.

iCloud can be slow in accepting your upload. The shelves on the iPad include a favorites shelf but that shelf does not appear on the homepage at iCloud. The six journals I created are not in date sequence as they are supposed to be. The iPhoto app does not sync with your iPhoto app on the Mac or your photos on a PC. The iPhoto pictures sync to the photos app on the iPad, not the new iPhoto app on the iPad. Syncing is one-way. If you delete or edit a picture or add a new one in one of your iPhoto albums on the iPad, it does not sync to iPhoto on the Mac or on your PC. There are a few things that need polish but you can see the vision coming through. Take a picture with your iPhone or iPad and the picture automatically goes to your photostream at iCloud. iCloud then pushes the picture down to all your other devices. You can then create journals and share them via iCloud. Facebook, Google, flickr, and others have nice ways to store and share photos, but journals are now offering an alternative that includes content creation for anyone with some imagination and an iPad. Take a look at patrickweb.com/iphotojournals and let me know what you think. As usual, I confess to not being a good photographer nor artistically creative.

Tags: albums, apple, events, ipad, iphotos, journals, mac, photos, pictures

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

iPad Evolution of Resolution

Today was the day so many of us knew would bring forth the next iPad from Apple. In some respects, it is just another iPad, but I am quite impressed with the technical specifications that have been announced. I can’t wait to get my hands on it! This may be the turning point for many new users of the iPad who previously were content with their desktop or laptop computer. I am a firm believer in the “post PC” era as described by Tim Cook in today’s brilliant keynote (watch the video here).

What to do with my current iPad? That answer is the same as what I had done with the iPad 1, iPhone, iPhone 3G, and iPhone 4. Gazelle.com has a very nice model for how to manage the transition of technology. They provide a guaranteed price and offer a very simple process to ship a product to them and receive a market-based payment for it. I especially like the feature that gives you get an extra 5% if you accept the payment in the form of a credit at Amazon.com. I will be receiving $304.50 for the iPad. It may be possible to do better on eBay but the convenience of Gazelle wins the day.

The price of the current iPad may drop fairly quickly as people get attracted to purchasing the newer technology. When will the rapid introduction of new products obsoleting predecessor products that still seem like new? The answer is not any time soon. The pace of technology is rapid and increasing. Consumers are the beneficiary and of course, it has made Apple the most valued company in the world.

The big picture is the transition to tablets. Today I read that a hospital in Canada has purchased 4,000 iPads for their physicians. There are so many applications where you have to “go to” your PC or laptop. With a mobile device such as the iPad or iPhone or any other of the rash of wannabes in the market, the Internet and the applications are where you are, not where your PC is. The updating of records of a patient in a hospital used to be by a chart on a clipboard filled out by the nurse. Much of that has moved to the PC or the laptop on a cart in the hall, or in some cases down the hall, not very close to the patient. The iPad can be with the nurse or physician and not only provide a way to enter the data, but also a way to show an x-ray with amazing clarity to the patient or a 3D model of their muscle and bone system enabling the physician to explain exactly what may be wrong and what will be done to correct it. The resolution of the new iPad is quite amazing and exceeds the ability of the human eye to discern pixels. The iPad displays 3.1 million of them — more than your HD TV. I can not imagine being a physician and not having one of the new iPads.

The laptop and desktop will not disappear because they are still quite useful for those who create information as opposed to those who consume information. Consuming information from a mobile device has changed the world and how we interact with information already — and we are still at the beginning. But someone has to create this content and most of that creation will be done on laptops and desktops as long as typing is involved. How long will that be the case? Talking to Siri on your iPhone is the beginning. Typing may become a thing of the past, but of course art work still requires paint and brushes — or does it? The WSJ reviewed a wide range of new styluses available for use with the iPad (Sketching Out a Future for the Stylus). The world is becoming digital at an increasing pace.

Tags: art, digital, Healthcare, ipad, iPhone, media, nurse, paint, paint brush, physician, radiology, siri, stylus

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

Expedited Deception

Last week I received a very official looking envelope in the mail. It came from PO Box 757, Chanhassen, MN 55317. Both sides of the envelope were emblazoned with labels including something for everyone -  “ExpeditedDelivery GRAM”, “Package Tracking Number 80495100562″, “Extremely Urent”, “Recipient please hand deliver to addressee”, “Expedited – Not available to all locations”, “Special Notes on Enclosure”, “Time sensitive material”, “Materials Inspected”, “Recipient Name Confirmed”, “Postage Paid”, “Address of Recipient Confirmed”, “Delivery Date Verified”, “Service – Expedited”, “Weight 1 oz”, “Zone – 4″, “Sender authorizes the delivery of this shipment without obtaining a release signature and shall indemnify and hold harmless the shipper from any claims resulting therefrom”, “Release Signature – KC”, “Revision date 1/96″, “Format 196″, “Printed in U.S.A.” The envelope contained everything except the identity of who had sent it. Can you believe it? I did not make this up. I actually received the envelope described. It was obvious that someone was desperate to deceive the recipient to open the envelope. Who was it from? SiriusXM Satellite Radio. What was the extremely urgent matter being brought to my attention? “There’s never been a better time to be a SiriusXM Satellite Radio subscriber. Reactivate your XMradio today with this Special Offer!” I respect aggressive marketing when it is of high-integrity. This sham from XMSirius had no integrity. Fraud might be slightly strong, but at a minimum their mailing is based on deceipt — trying to trick the recipient to open the envelope. If the mailing was intended to be humorous that would be ok — if they had added their name to it.

If you read financial commentary about SIRI (the stock symbol for XMSirius, coincidentally the name of the new voice recognition software in the iPhone 4S), you find the word “desperate” used quite often. Seeking Alpha said that the SiriusXM 2012 subscriber outlook fell short of Wall Street’s consensus estimates. It also noted that the low subscriber number was just one of several disappointing subscriber measurements (see the full story – SiriusXM And Slowing Subscriber Growth). The conversion rate – the percentage of OEM trial subscribers that become self pay subscribers – is expected to show no improvement in 2012 and the self-pay monthly churn (the cancellation rate for subscribers that had previously chosen to pay for the service) is projected at 2.1%. These are most likely two of the primary drivers behind the company’s relatively low forecast of 1.3 million net additional new subscribers in 2012.

Meanwhile, Pandora seems to be gaining subscribers rapidly. PaidContent.org reported that Pandora had 94 million registered users as of their IPO filing in May, of whom 34 million are considered “active” users. That’s up from 53 million users registered and 18 million “active” in the same quarter last year. The listening numbers are even more impressive — Pandora played 1.6 billion hours of music in the quarter ending April 30, compared with 700 million hours the prior year. See New Numbers From Pandora Show Big Growth But No Profits for more details. It is not just CDs, newspapers, and video that is being impacted by the Internet — add satellites to the list.

Tags: disintermediation, internet, music, satellite, sirius, xm