“Waiting for Godot” or why Apple’s rumoured tablet won’t transform health care today January 26, 2010
Posted by Hans in : Uncategorized , 2commentsIn a little over 24 hours, the technology world will be dissecting the announcements made by Apple at its special event. While everyone is expecting a tablet computer that will upend … something, I’ve been trying to hold my expectations in check. In my reading, I was surprised to come across an article titled “The Healthcare System: An Apple Tablet’s Biggest Opportunity” from ReadWriteWeb that Apple’s tablet could “transform our care delivery system in a major way”. While I am hopeful for a great product from Apple, I am skeptical that any single product could transform health care right now.
Even though the author does present valid points about why a tablet could be a great catalyst for adoption of mobile technologies in health care, he seems to forget some significant structural issues that need to be addressed.
1. Data definitions
Much to everyone’s chagrin, there still remains considerable work on developing standard data definitions. For example, I worked on a small project to develop a data dictionary to allow organizations to share information about lab results. When we started looking at the issue, there were no standard definitions used by organizations (often even within the same organization). We had to strike a working group to collect an inventory of definitions and then try to reconcile and agree upon definitions – all before getting approval from the clinicians. As such, much work still needs to be done to standardize definitions and then work needs to be done to link the systems.
2. Access and integration
Once the data definition issue has been addressed, getting access to information and integrating the information from different sources is the next big structural barrier that needs to be overcome. While a tablet is a great way to have information accessible at the point of care, significant work is required to get the data to a point where it is understandable and meaningful. The current legislation surrounding health data privacy and security often prevents novel ways to use the information because people can’t get access to it as the penalties can be severe.
3. Workflow, workflow, workflow
As much as a new tablet would be great, any potential solution has to overcome the issue of workflow issues. Clinicians are generally hesitant to try a new solutions because it doesn’t impact how they work in meaningful ways. Yes, a tablet could go a long way in making information readily available, but that’s only when the foundational issues have been addressed. The other systems and business processes need to be redesigned.
I’m a bit proponent of changing and transforming health care. I’m also a big proponent of utilizing new technologies when appropriate, but we can’t forget some basic principles:
- Technology is a tool. As a tool, IT only helps people do things faster and more easily – hopefully better. There are no magical qualities about a tablet that will solve the issues currently facing health care. When I was doing business process re-engineering work, my team had this principle of optimizing the existing system and then considering technological solutions to accelerate and magnify what was being done. This approach contradicted the CIO who once came in shouting “I have a solution! Now go find me a problem”.
- We need good leadership. If technology is only a tool, then how we use technology is the most important issue. Good, strong leadership will help organizations and people use technology appropriately. Nicholas Carr has done considerable research on how IT (and technology in general) is not a strategic advantage but that leadership is. This research is supported by the American Hospital Association’s Most Wired surveys which consistently find that the top performing hospitals also use technology well. It is a reflection of good leadership.
Finally, I think the author forgets that technology is not a panacea that will auto-magically solve all of the challenges clinicians face. A tablet that functions and looks like something on Star Trek would be both amazing and absolutely delightful. However, we are likely to be “waiting for Godot” for a while longer as health care is not yet ready for a magical tablet. Perhaps tomorrow…
Popularity: 13% [?]
iPhone as life-saver… January 20, 2010
Posted by Hans in : news , add a commentTalk about great press for the iPhone. A news report titled “Earthquake survivor calls iPhone a life saver” and reports how the man used the applications on his iPhone to treat himself and survive until he could be rescued.
I suspect that mobile applications for health will get a kickstart based on this type of news. However, I’ve always believed mobile health to be an increasingly important and growing area. I will write about this more when I write about my disruptive innovations for health care.
Popularity: 13% [?]
A small step towards adoption of health care IT… January 18, 2010
Posted by Hans in : news , add a commentIt’s nothing major, but reports like this seem to point toward a slow shift towards greater use of IT in health care. Getting neurosurgeons to use iPod touches to eliminate paper at a conference is just a small step. I predict that some will resist and be upset and i can’t really blame them. Reading academic papers, for some unknown reason, still seems easier on paper than it is on the screen.
What I do see, however, as a positive step is that this is an initiative being pushed by other physicians which will begin to change the social environment (a la social cognitive theory) to be more conducive toward using information technologies for health related purposes. There are still many stumbling blocks to be overcome within the actual work environment (i.e., hospitals and offices), but this is a positive step.
Popularity: 13% [?]
Disruptors of the decade – not the time for health care January 15, 2010
Posted by Hans in : Uncategorized , add a commentA recent blog post by Scott Anthony reported the results of a poll he ran to identify the “disruptors of the decade”. The results weren’t that surprising in terms of naming the companies from the technology and “emerging” categories. What was surprising to me were the companies in the established non high-technology companies category: Wal-Mart, Verizon, Dow Corning, General Electric, Goldman Sachs (?!), and Ford.
My initial thoughts as I read this post was “what about health care?”. Then, Anthony ends the post with a prediction about where the next disruptive titans will be. One of the categories was “health care, education, or cleantech”. Anthony states that “these three industries are screaming for disruptive innovation, and the innovators that deliver the disruptive goods are well position to create massive success stories”.
Part of the challenge with health care is how regulated this field is. As pointed out in Chrstensen’s book “Seeing what’s next: Using theories of innovation to predict industry change“, disruptive innovation is more challenging to take root in industries with high levels of regulation or legislative interference. In Canada, there is an unspoken rule that seems to discourage experimentation and as a result, innovation is stifled. Given how the US is mired in intense health care reform efforts, I don’t see much difference in the US.
I plan to follow-up on this with an updated list of potential disruptive innovations in health care. A few years ago, I wrote a series of posts on disruptive technologies in health care. I think it is time to revisit this issue and focus more on innovation rather than technologies.
Popularity: 15% [?]
The tablet revisited January 13, 2010
Posted by Hans in : Uncategorized , add a commentYesterday, I wrote about how Apple may potentially release a tablet with a few solutions for the health care market in mind. This blog post explores some possible uses for an Apple-based tablet.
The author reports:
It makes sense for Apple to test the waters in non-consumer markets where tablets have found some purchase in the past. The iPhone is making gains in enterprise, and is even used by many doctors because of the low cost and good design of a variety of medical database apps available on the device’s App Store.
Combining that kind of knowledge repository with a device that can replace a clipboard and act as a connected link to the hospital’s central database would obviously be something that might appeal to doctors. It would reduce the need for extraneous devices and trips back and forth from a central nursing station where information is collected and stored, and could conceivably lower wait times and increase patient turnover, an important concern in privatized health care.
I wonder if organizations will do any usability testing to determine if the handheld iPhone is preferred over a full-sized tablet depending on the role and function of the health professional. From my days working in the hospital, we had anecdotal evidence from staff that suggested that physicians preferred handheld smart-phones (like an iPhone) because they moved around the organization more. On the other hand, nurses seemed to prefer the full-sized tablet because they (generally) worked within a unit. Actually, what the nurses seemed to like best was to have touch-screens mounted on the wall so they could use their hands.
I would be interested to see if there is any data/evidence that examines this issue.
Popularity: 15% [?]
Is Apple Inc. making its first foray into the health care space? January 12, 2010
Posted by Hans in : Uncategorized , 1 comment so farAn interesting piece about Apple Inc. purportedly visiting Cedars-Sinai Hospital in California to gauge the interesting and application of tablet computers within health care settings. If true, then this would indicate the first (to the best of my knowledge) company sponsored move toward health care solutions for the company. Apple has traditionally focused on the desktop, education, and consumer electronics industries.
In the past, I wrote about what ehealth (and health care) can learn from Apple, Steve Jobs, and Macworld. Hopefully, Apple can live-up to the now famous Steve Jobs challenge of “changing the world” instead of making sugared water. Making iPhones, iPods, and other consumer electronics devices is great, but imagine what could happen if Apple were to come and challenge the existing players within the health care space…
Popularity: 14% [?]
OHA Health Achieve 2009 – Day 2 Exhibitor Floor January 7, 2010
Posted by Hans in : conferences & conventions , add a commentHad a chance to visit the exhibitor floor during the lunch break. Was great to see some interesting booths. No one booth stuck out in my mind, but there seemed to be a subdued sense of energy on the floor with quite a bit of networking going on.
A couple of shout-outs to friends, colleagues, and other good people:
- Oz Huner of NexJ Systems – My understanding is that NexJ works with health care organizations and regions help patients and providers to encourage health-conscious behaviours and promote wellness. I had a great demo of the software on Oz’s Blackberry. Pretty cool.
- Joe Cafazzo & Anjum Chapar, Human Factors @ Centre for Global eHealth Innovation – Great to see this very important work getting more interest from everyone in the health care sector. They were showing some footage from usability tests and it was just astounding at how bad "state of the art" technology is. If you don’t know about how human factors can affect health care, you really should learn more.
- Carlos Rizo & Neil Seeman, Innovation Cell – Had a chance to speak to them about some interesting projects they are working to catalogue patient experiences to find ways to improve the system.
I’m always interested in the different types of vendor booths. This year, there seemed to be fewer medical device vendors which was a bit disappointing. The big firms were there but not too many more. From my stroll through the aisles, the informatics/EHR section seems to be growing more and more.
The "green" health seems to be growing as well. What caught my attention was the number of organizations present who were involved in recruitment activities. The issue of health human resources continues to be an important issue.
Powered by Qumana
Popularity: 16% [?]
OHA Health Achieve 2009 – Day 2 Keynote: Michael Moore January 6, 2010
Posted by Hans in : conferences & conventions , add a commentToday’s keynote was Michael Moore the infamous director Sicko, Roger & Me, Bowling for Columbine, Farenheit 9/11, and most recently Capitalism: A Love Story. Here’s a running summary of the topics.
The session started off with a short clip from Sicko about his relatives purchasing health insurance at Sears for a short trip (couple of hours) to Michigan. The clip also profiled some additional Canadian stories from London, Ontario and London Health Sciences Centre. It was a very interesting introduction to his session. I think the clip hit a bit of a patriotic chord.
Moore talked about his experience running a show back in 1998, TV Nation, and a specific episode of a "health race" between Ft. Lauderdale, Toronto, and Havana, Cuba. The challenge was to treat a broken bone case and the participants were evaluated based on the time to treat and costs. Cuba ended up winning because in Toronto the hospital charged $10 for a set of crutches. Apparently, the NBC censor wouldn’t let the show air as is because it was "against policy" to allow Cuba to win. As such, Toronto/Canada won.
Next he talked about the current state of the health care debate in the US given the media bombardment over this issue. Apparently, some in the US portrays Canada as a "third world country with long line-ups and people dying in the street waiting for treatment". Moore offered anyone in the office to trade their OHIP card for his Director’s Guild health care plan card – no-one took him up on the offer even if the person can have the same "health card" as Steven Spielberg.
He then talked about the process of getting an appointment and seeing a physician in the US. Takes three weeks to get an appointment with the GP. First question – what’s your insurance? And then you wait. The physician’s office is fighting with the insurance companies to get reimbursed. Physicians, who Moore calls "Demoralized Doctor Dave" nets about $50,000/year after paying out expenses. After examining Moore, the doctor then leaves the exam room to check to see if they can refer the patient to a specialist.
Moore points out that something seriously wrong with US system. How is government health care so wrong when the government is supposedly "for the people by the people"? Sarcastically, Moore states that the US has government health insurance that isn’t Medicare or VA Health. The real government is the US health insurance companies who buy the laws.
According to Moore, medical bills are the #1 cause of bankruptcy and foreclosure. The sub-prime issue isn’t the #1 cause of foreclosure. The reason is that the health care industry punishes people when they get sick. One example is of a hospital hiring foreclosure companies to go after a person’s home to pay the bill. A Harvard study noted that 46,000 people die in the US because of lack of health insurance.
Moore then went to talk about a Bill Moyer episode with a a former Signa health insurance executive. The executive admitted that what health insurance companies tell you in the US is a lie about health care in Canada. Competing health insurance companies put aside our differences to discredit Sicko and the push for health care reform.
He then started an extended session of stating some startling facts:
- 14,000 will lose health insurance each day
- US spends more than any other country on health and yet is ranked 35 (Canada ranked #30)
- The Democrats bill is not a good bill. It will not fix the system. Health insurance companies windfall.
- Everone required to buy health insurance if their employer doesn’t provide but the insurance must be from a private company, not a public option. The private options have with little cost controls.
- The Bill only covers 2% of population for the public option
- Health insurance companies are projected to make an additional $70B per year and yet 13M people will still not have health insurance
- Drug companies got a side-deal to stay out of the fight by reducing costs by $8B in the first year. However, drugs will cost $10B more this year in preparation for next year
- A New York Times report over the weekend analyzed the speeches and found 20 of the democrat speeches and 22 republican speeches were virtually identical to one another. Speeches were written by health care lobbyists (Genetech).
- Moore’s local representative, Bart Stupack, held up the health reform bill to prohibit inclusion of plans that offer abortion
- 50M people in the US do not have adequate access to food, 17M struggle to for food on a daily basis
Then, Moore started talking about some of the causes of the issues in the US:
- In Detroit, 70% of high school students drop out
- There are 40M functional illiterates in US (only 4th grade reading level)
- Therefore, it is very easy to persuade people based on ads becasue population is ingorant and uneducated
- What kind of country would do this to itself? What kind of country would "attack" itself?
- Education is such a low priority in the US
- 3 of 4 children would not be able to join the army because they are not fit enough (i.e., overweight and out of shape)
He then shared an interesting story of how he plays a game called "Stump the Canadian" when he speaks in the US to illustrate a point. He’ll ask for the "smartest" American in the crowd (someone who gets As) to come-up and also the "dumbest" Canadian (someone who got Cs). Inevitably after a series of questions, the Americans know very little about Canada or the US whereas the Canadian knows more about the US. As a punishment, Moore makes the American sing the Canadian national anthem.
Moore then pointed out some challenges and issues for Canada. In addition to being ranked 30th for quality of health care, the social safety net in Canada has been cut and is eroding. This all started when Mulroney had his "weird threesome with Reagon and Thatcher" [LMAO!] and got out a big pair of scissors and cut the social safety net. Subsequent governments have continued this trend. As a result, Canada has seen the following "American" characteristics:
- Move to more private clinics for the privileged
- Moore: What’s going on here? What’s happening to you? Why do you love to be like us?
- If you allow this privatization to continue, the result will create two Canadas with money being the factor
Moore pointed out that the core Canadian principle is: "We’re all in the same boat and we all sink or swim together". Canada needs to preserve this idea and principle. Shouldn’t allow doctors to be in the public and private program. Parliament can make any law it wants to do the right thing. Moore ended with a few points:
- How would Canada feel if people died without any health care coverage?
- Canada needs to nip this in the bud now
- Americans admire Canadians because you don’t have a desire to kill each other. Even though Canada has a higher per capita gun rate than the US, the violence is so much lower. Why?
- If Canadians want to see how a private, American style health system works, all you need to do is look across the river to see how a "two country" system works
- Canada is a true friend to the US because it isn’t afraid to tell a friend they are full of sh*t. The best example is when Canada wouldn’t participate in invasion of Iraq
- Canada realized that you can’t fix the problem with guns in Afganistan. People need to solve their own problems
- Moore: Please help America – America needs to become more like Canada
- Why? Canada does things a little differently
- Canada has problems
- Dental is treated like a luxury but it’s so necessary. Dental care is critical and is the precursor to many other health issues.
- The viscious cycle starts by cutting the simple but critical thing?
He then went on to address the elephant in the room: How do we pay for this?
- Stop supporting US ventures
- Make the wealthy pay
- Counteract the US, disinformation advertising about Canada’s "socialist medicine"
- We need to share resources. Americans need to change their attitudes. An article by Toronto Star columnist, Linda McQuaig is (unfortunately true): Americans would rather die than share.
- It is amazing how much power and control corporate America has over things – a study by a university (didn’t catch the institution) concluded that the message of both Democrats and Republicans is virtually the same as both sides receive money from the pharmaceutical and insurance industries.
Question & Answer session
- How do you stay optimistic about the country you love? Not a cynic. Not all is lost. People are good at the core. As long as we live in a democracy there is hope. Even though the wealthiest 1% who have more than the bottom 95% combined, the rich only have 1% of the vote. People will rise up. We are capable of pushing past and doing the right thing to consider another possibility. I’m tired after 20 years of doing this. Last film was most personal and hard to make
- Frank McKenna advised increasing private share of health care because of efficiency – saddened to hear that. Private sector has annihilated the economy. The profit motive has ruined the US. More crises to come all fueled by profit. Why would you ever attach the word "profit" with health? This is absurd. If the government isn’t doing its job. You fund it. You put in new politicians but you don’t throw the baby out by politicians making the wrong decisions. Americans and private sector will try to drag Canada down the road. Moore: People in the future will think that profit + health is insane and judge us accordingly.
- Thoughts on government as a general insurer – yes. It should. Health is necessary as a right and a security issue. Need a healthy nation to protect itself.
- Middle America and tea party protests – Part of it is ignorance enforced by the media. Much of this is funded by wealthy corporate interests. Not many tea party protests, but they are very loud. Very good at manipulating the hurting and the fearful. The problem is that the millions are not engaged politically.
- Post-secondary education not funded beyond undergraduate – average college graduate in US leave college with $30-50k in debt. Once you’re in debt, that’s when they have you. US is spending $4B/week to support Iraq
- Why can’t we have a system that meets both private needs and public? Because it goes away from the concept of solidarity. Wait times speak volumes about you that you are willing to endure the crap you do to ensure that everyone has coverage
- Religous right and Jesus – The religious right hijacked Jesus. Corporate and religious right got married in convenience and hijacked Jesus. What would Jesus do today – didn’t he say to take care of the least and most vulnerable?
Very entertaining, passionate, and enjoyable. It turned into a bit of a love-fest for the Canadian system, but I think his main message was clear – private health care does not work. I will definitely have to watch Sicko.
Powered by Qumana
Popularity: 14% [?]
