Imagine taking care of 15 patients a day. And you've never met them before. And coordinating care among three shifts of nurses, labs and specialists. That is the plight of the hospitalist.
HealthIT 1.0 has failed them. Patient histories from multiple sites of care? Disparate PAC systems, care coordination? Medication reconciliation? There are bits and pieces but no system does it all.
Instead the 1.0 vendors try to bolt on new functionality to very old legacy systems. Epic is based on MUMPS that was developed in 1967. And they are the leaders.
The next generation 2.0 vendors will disrupt the establishment by focusing exclusively on the physician / care providers and the patient. And we're seeing examples of this from outfits like Doximity, Practice Fusion, Hello Health and Image32.
A friend of mine asked me this week about how I started out as a developer. Did I go to school for it?
The short answer is no. I taught myself initially because it helped me do my job better. In the early 80's I worked at US Gypsum building plants. Curing drywall takes a lot of energy and some plants were coal fired. Depending on where the coal was mined it had different BTU's, sulfur pollution and cost.
We had to calculate how many tons of coals from which sources to meet minimum BTU, maximum sulfur and at the least cost. This was an optimization model with 18 variables. A lot of paper, calculus and a slide rule.
Then came the TRS-80 Radio Shack computer. We could write a program in Basic that would do all the calculations in 2 seconds. Around the same time the NASA project manager for Skylab
came to work
for us and taught me how to do project management using a computer. I was hooked and went back to school for an MBA with a focus on computer systems.
Since then I've always believed that whatever you wanted to do, you could figure out a way to make it easier with software. I have not been disappointed.
Twice this year I've talked to two companies who have the same challenge: After a decade of getting to $20-$50M in sales , senior management has been tasked by the board to "GET BIG NOW".
I have noticed the same strategy by both companies:
Hire a lot of people
Use the word "Cloud" or "Mobile" in their new strategy
Move to a larger building
After a decade in business they both have a lot of creaky Microsoft based legacy software and a decent sized installed base. In reality, they have two paths to growth:
Suck up the existing market through acquisition and consolidation.
Leverage their knowledge base to create new products / services to accelerate growth.
Acquisition may get you through the first couple of years, but you need to be planning for the long view after that. Once you own 60% of the market, then what?
Even if you do that you eventually end up at option 2: Leverage your knowledge and customer base. Doc Searls called it "the because effect":
The because effect is a kind of jujitsu. While other people look to make money with something, you're finding ways of making money because of something.
Kathy Sierra has this great video: "Building the minimum Badass User". While you may be a fan of techniques such as Pragmatic Marketing, that only improves what you are already doing. By focusing on how to make users be really great at their jobs will give you new ways to refocus your products and services to new uses.
Meaningful use stage II is requiring a certain percentage of patients to be able to view their patient health information. At HIMSS in New Orleans there was a lot of conversation about this. And many vendors talking about their solutions. InteliChart is a good example of these portals. What happens if a patient goes to different doctors? Different portals. And most of the security is username + password. Not much 2-factor authentication in place.
Then layer in the requirements for the Health Information Exchanges. Each patient needs to be perfectly matched to every EMR where their records reside. Name + date of birth does not work so well if you are John Smith or Maria Garcia. And who has access to these records? And how does the patient know? Again, many vendors have their unique solutions requiring everyone to sign up for their particular system.
These systems are being built bass-ackwards. Here's a novel concept: Have the patients in control of their own identities and they decide when and where other people (or their surrogate like their primary care physician) can access their information. And the patient knows everytime who accessed what information and for what purpose.
Universal identity cards will work as well as a social security number. They won't. Instead, patient supply their own credentials and each entity verifies if they indeed trust that that patient is who they say they are. Can this be done programmaticly? Yes and it's not that hard.
Look at project VRM: http://blogs.law.harvard.edu/vrm/2013/03/09/the-vrm-perspective/ http://cyber.law.harvard.edu/research/projectvrm
Create a personal private cloud for each patient. Then create an oAuth service that each provider entity and HIE can connect. The trick here is that all authentication and access flows through the individual patient's personal cloud. Use a certificate authority to create irrefutable credentials and use for 2 factor authentication (added bonus - public /private key encryption)
I especially like the part where it detects if you are running an iPad or iPhone. It then enables finger swipes. A side benefit is you are forced to simplify the content of your presentation so you can view it on a smart phone.
Just before Thanksgiving I was floored by sciatica. I started taking a lot of ibuprofen to reduce the inflammation. By Friday I was able to get off the floor and go see the doctor who prescribed prednisone to further calm the inflammation. No x-rays.
A lot of my friends suggested I get an x-ray and MRI study. Very expensive and since there is only a low 30% success rate for surgery, that would be a waste of time and money. The following week I got a script for physical therapy. So I went to "Wasatch Physical Therapy at Kimball Junction" (what a name...) on my crutches.
One big advantage of living in Utah is we have the best orthopedic practices in the country. With all the outdoor sports here, that is a focus. It's not "let's relieve the pain" it's "Let's get you back on the mountain." Which is why Tiger Woods came here for knee surgery.
Brandon immediately did an assessment and determined it was a bulging disk on the L4. He put me on a treatment plan for 3 times a week. Based on my condition he prescribed various exercises. Dani took over after a couple of weeks.
The hour routine started off with heat and electrical stimulation while laying on a roller bed. Then Lexi or Brittany would use localized ultrasound on my back. Then a lower back massage.
Early on Brittany was able to pinpoint the exact location of bulging disk through localized pressure. After the massage Dani would work with me for the rest of the hour on spinal manipulation and
After the session they would instruct me as to the different excercises I needed to do during the week based on my prognosis. In 8 weeks I went from pain and crutches to powder skiing and no pain.
So dump the MRI and get yourself to Physical Therapy. Only if you don't respond to their treatment will they send you back to the doctor for x-rays or an MRI.
Eight weeks of PT was far cheaper then 1 MRI. And wouldn't you rather be better or just have some pictures?
Just got a notice from Comcast that they are dropping all analog signals. I'm not surprised. There is only so much bandwidth and I suspect Comcast is increasing their 3D line up. So goodbye analog.
If you have an old(er) TV like a CRT you will no longer be able to plug the coax into the back. You will need their box. Being generous, you can hook up 3 for free. Then it's $2 per set.
Some of you may have the "occasional" TV in the garage or the guest bedroom. What to do? If it's a newer TV you can still get the normal network HD channels (I checked with Comcast). Or perhaps this is a good time to head over to your local big box store and pick up a convertor over the air box for about $50. Just plug in an antenna (remember those?) and you can get all of the network stations for free.
This may be a good time to evaluate what you are paying. Maybe all you need is high speed Internet and the basic channels (comes with HD). Then used the money saved for Hulu or another service.
While working with a new startup, it is easy to get lost in the weeds. The first major milestone is cash flow break-even. This is when income meets expenses. It's math, when (number of customers x contribution margin) = expenses.
I have figured out the four essential R's:
Right Product: Did you build something that people will actually buy?
Right Pricing: Is value in the customers eyes greater than their total costs?
Right People: Are there enough customers to buy your product and will they know about it?
Right Margins: Can your business model support your expenses and be profitable?
Metrics are key. You have assumptions, how do you test and monitor them? And remember that whenever you think you have the right answers, be prepared to change because everything changes.
Yesterday our plane broke and since I would miss my connection they kindly rebooked me on a flight this morning. It was a very long night and I missed the flight. 30 minutes later I tried to rebook with an agent (still can't figure out the new website). We spent an hour on the phone trying to figure out how to do it.
Turns out someone reprinted my boarding pass and used it to board the flight. As me. Since according to the system I was on the plane, it wouldn't let me rebook the flight. Sounds like an episode of Homeland.