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

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

Speech at SIIA

It was a privilege to be a speaker at the Software & Information Industry Association (SIIA) conference in New York on January 25. The subject of the speech was The Future of the Internet but I included an emphasis on impact to healthcare and publishing. The conference was attended by executives from the publishing and software industries. I do not know why the video was captured in five segments, but until I get a consolidated version, the links are below. The slides were on my iPad and the video doesn’t show the screen the audience was looking at. If you want to see the slides, they are here.

Part 1
Part 2
Part 3
Part 4
Part 5

Tags: future, health, Healthcare, hospital, internet, john patrick, medicine, music, publisher, siia, technology

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

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

Personal Health Records

Seems like everything is in the clouds or on the way to the clouds — our money, our music and pictures, our email, contacts and spreadsheets. What about our healthcare records?  Some say security is holding back electronic health records. I do not think so and I believe the vision is clear — that encrypted healthcare data that is authenticated and properly authorized for access will be safer than the millions of manilla folders currently guarding our sensitive information. Google.com/health made a bold move to provide a universal repository for storing health records. I was one of the early users and came to depend on it. When did I get the flu shot? What was my blood pressure at last year’s physical? What test results and medications are there?  All that and much more were provided for free by Google Health. Automatic updates were made by CVS, Medco, and Quest Diagnostics. Get a blood test and in a couple of days you can see a graph of how those results compared to the last time or to five years ago. A very nice service. The company announced last month that Google Health will be shut down permanently and all data will be deleted in 18 months.

Google says it’s shutting down the project because they got very little traction, but ReadWriteWeb reported in Google Health: Why It’s Ending & What It Means, that Google Health may have been ahead of its time and did a poor job reaching out to a now growing ecosystem of developers.  They urge that rather than shut it down, Google should put it on slow life support until the momentum builds. Many tech executives believe, as I do, that patient-centric cloud-based electronic health records are a huge opportunity. An executive acquaintance at Microsoft (yes, there is at least one person at Microsoft who will speak to me after the OS/2 wars), tells me that the company sees the opportunity as large and is committed to HealthVault, an offering similar to Google Health. Even though I am not a fan of Microsoft offerings, I decided to give it a try. Step one at healthvault.com was to login using your Windows Live credentials. That almost stopped me in my tracks, but then I remembered that I had actually setup a Windows Live account back in 2003 to try out some other offering and my account is still good. Exporting all my health data from Google was a couple of clicks and importing it to HealthVault was a bit more complicated but not bad. Now that I have all my health data in HealthVault, what can I do with it. So far, nothing.

At Google Health, you can look at graphs of all your blood tests, print out an immunization card for travel purposes, and other handy things. The HealthVault strategy is to use business partners for the applications; Microsoft just stores the data. They have quite a few partners who offer personal health records. I tried several of them and could not get any of them to work. My data is securely in Microsoft’s vault and nobody can get access to it, including me! You have to setup a unique HealthVault email address and cross-authenticate, and, and, and. I spent an hour at it and finally gave up. I am sure they will make it easier and one day when I don’t have a doctoral paper due, I will try again. Our future health will revolve around personalized medicine and it in turn will revolve around our personal health records (PHR). The key question is who will provide the PHR service for us.

It is early in the game and there are many possibilities. First movers will not necessarily be the winners. Having Google or Microsoft provide a PHR service has certain advantages but there are disadvantages. How about if your health insurance provider decides to not share information with one of the big guys? Why would they decide that? Maybe because they want to be your PHR provider. Then there is your hospital. This is a very logical provider for a PHR service in the cloud, but will they have the resource and skills to launch a user-friendly, scalable, secure cloud-based service? And if you move, will your data be able to move with you? And if you decide to go on a medical vacation to China to get a heart transplant, will your hospital allow the Chinese hospital to have access to your PHR? And there is CVS and Walgreen and Walmart. They may all want to be your PHR provider as an integrated service with their pharmacy operations. And then there is Merck and Pfizer et al. Some chronically ill patients depend on certain medications and the manufacturer will be motivated to provide a PHR service tailored to monitor, sell, and communicate about their drugs. WebMd and the many other e-health sites are logical providers based on the wealth of medical information they provide access to. And what role will the government play?

There are many hurdles. A key element is standards. The Internet works exactly the same in every part of the world because it is built on globally agreed to standards. Health records have standards too. A lot of them! I have written a lot over the years about certificate authorities for authentication on the Internet (see patrickWeb category on PKI). In theory, there could be a single central certificate authority that would issue digital signatures that could make Internet email much more secure. In theory. I participated in meetings in Washington 15 years ago on the subject. When there were a few of us in the room we made a lot of progress but when the vendors, agencies, the military, etc. weighed in the whole process fell of its own weight. Likewise one central provider of PHRs could have many advantages, but I don’t believe consensus could be reached on how to do it. I am betting on hospital systems and networks. They may not be able to provide national solutions but they certainly can provide regional solutions through use of their health information exchanges (HIE) and HIEs in turn will ultimately follow standards that will allow them to exchange data on a secure basis. Stay tuned. There will be many developments on this subject in the months ahead.

Tags: emr, Google Health, Healthcare, healthvault, hie, personal health record, phr, PKI

IBM at 100 – A Day of Nostalgia and Optimism

I was not exactly sure what to expect when I arrived at the world famous T. J. Watson Research Center at IBM last week. I have been there many times over the years but never to a birthday party. I walked in to the arrival tent where light refreshments were being served and the crowd of 350 invited guests began to build. One of the first people I saw was Allen Krowe. Allen had been CFO of IBM and then Vice Chairman of Texaco. I was his assistant back in 1981. I remember the day that he turned 50 years old and thinking that was very advanced. That was 30 years ago and NOW I am 15 years older than he was then. Then I saw Spike Beitzel. Spike had been a sales manager in Philadelphia for IBM’s insurance industry customers, the same position that I held some years later. Spike is a pilot, as was Allen, and many other senior IBM executives, including Thomas J. Watson, Jr. Spike is 83 and still flies his own airplane. It was nice to talk about aviation. It was a privilege to say hello to three IBM CEOs — John Akers, Lou Gerstner, and Sam Palmisano. There were four current and former heads of IBM Research there. One of them was Ralph Gomory. I am not sure how old Ralph is but he got his PhD in mathematics from Princeton in 1954. Whenb he retired from IBM in 1989 he became president of the Sloan Foundation. The pattern became clear — this was not just a birthday party for IBM; it was an alumni reunion for executives that worked for IBM over the past fifty years. Then I ran into the former heads of IBM Japn, IBM China, IBM Italy, IBM Brazil, and various other parts of IBM from around the world. Former Chairman Thomas J. Watson, Jr., said in 1957 that IBM “is a company of human beings, not machines; personalities, not products; people, not real estate.” That observation was true long before 1957 — and it remains so today. Although every IBMer makes a difference, there is a list of IBM Builders that were the pioneers who helped to fashion the IBM of the 21st century. Most of them were were among those in the tent; it was humbling to be in their midst and a thrill to shake their hands. Everyone had a smile on their face. It was a happy and nostalgic day that none of us will ever forget.

The main event took place in a really big tent. There were 2,000 members of IBM Research in attendance. During the opening ceremonies Sam Palmisano asked the thirty members of the Watson family in attendance to stand; everyone appreciated the heritage of the company. The family must have been proud to hear about Watson, the advanced Q&A system that triumphed at Jeopardy, and will surely change the way medicine is practiced as it transforms anecdotal medicine to personalized, evidence-based medicine. The program included some excellent videos about the past, present, and future of IBM. Senior VP Jon Iwata interviewed three journalists, Kevin Maney, Steve Hamm and Jeffrey O’Brien about the research they had done to write their new book about IBM called Making the World Work Better: The Ideas That Shaped a Century and a Company. I have known Kevin for quite a few years. When he quoted someone in his columns at USA Today, you always knew that he would not use information out of context. Steve Hamm wrote the story about my home when he was at BusinessWeek. He now works for IBM. It was an alumni event with journalists too! Another panel with Senior VP John Kelly focused on IBM research efforts around the world, in particular about IBM’s advanced work on environmental and healthcare initiatives. Sam and senior vice president and group executive for sales, marketing and strategy Ginni Rometty painted a rosy picture of IBM’s future.  IBM also cares about the future of others. As part of its Celebration of Service, 300,000 IBMers around the world — nearly three quarters of its global workforce — volunteeried in more than 5,000 projects in 120 countries, helping millions in need. Since the beginning of the year, IBMers, retirees and their families have donated more than 2.5 million hours of service to communities worldwide. A lot of conofidence was exuded that another 100 years of innovation and growth are underway.

Tags: akers, Aviation, beitzel, evidence based medicine, gerstner, gomory, Healthcare, IBM, IBM Research, kevin maney, krowe, palmisano, personalized medicine, research, rometty, steve hamm, supercomputing, watson, yorktown