2,061 Days in the Making

Wow!

It has been 365 days since my last post on xchangehealth and so much has happened. I have been so focused on things at MINES that I haven’t been very active on Twitter or my blog so it’s probably about time for an update and a little taste of things to come at MINES.

As of July 3rd, 2017, MINES is now using a fully-CRM-based Electronic Health Record (EHR) system for patient management. I can’t even begin to explain how big of a deal this is for us, but to suffice it to say that there aren’t many others out there. Why is this so uncommon? Because rather than using the billing method to determine how to organize our records, we use the relationships that people actually have in their lives as our core operating assumption.

If that doesn’t make sense to you, let me put it another way: this was the result of over 5.6 years of planning, designing, and testing (several cycles, in fact) to create a system that would allow for this schema to be viable for a long-term records solution while minimally impacting daily operations and creating the opportunity for further development down the road.

“So what does that “down the road” really look like,” you might ask. I’d be happy to provide some examples!

Create your own (EH)Record!

Beginning in 2018, our clients will be able to submit all of the necessary information to get a referral for sessions and manage their own authorizations and provider interactions.

New provider value scores!

Our patient satisfaction data will be tied directly to patient and provider records, allowing real-time data regarding patient satisfaction for future referrals.

More in-depth reporting for HR!

Beginning in 2018, a new utilization report will be released for HR that provides greater insight into problems at the worksite and what interventions might help improve the operations of the company.

Better workflow for patient management!

Using the functionality that business development has been using for years means being able to apply the workflow of communication and client management to patient coordination.

Deeper insights into how patients actually work with their peers!

As early as 2019 we’ll see the implementation of a social media connection opportunity for those looking to leverage their social networks to improve their therapeutic performance. We’ll also be leveraging the growing relationship data to provide a basis for Social Network Analysis, giving us the opportunity to engage in a population health model at worksites.

A REAL app for an EAP!

Many EAPs have released limited versions of their website and/or online content, which is a start, but the app we will be releasing will allow clients to manage their account, see their appointments, share notes with their provider, and potentially launch an ad hoc telemedicine session.

The end of the traditional therapy model!

MINES will also be launching a new program model for purchase by employers to move away from the traditional “1-some number of sessions” model, allowing employees to call, video, text as they please. This allows for the EAP to work even more proactively with clients and to tailor clinical response to the particular need.

The team at MINES has been exceptionally open and excited about this critical difference in our record structure, and while we opened with a few glitches (as to be expected with any software roll-out) we’ve experienced no disruption in our regular processes.

Today marks the beginning of a new, more data-driven patient management era for the team at MINES and a new opportunity to “save lives and influence the course of human events.”

Health inSite: #PokemonGO and Health

Intro

I know there are a TON of articles and posts that have surfaced in these 6 days since PokemonGO was released in the United States. The sheer volume of discussion around this just-short-of-a-phenomenon app is certainly surprising in many ways, though another very popular app that just recently was eclipsed in downloads, Tinder, also got a ton of press at the beginning – mostly for the questionable intentions of its users. In this case, you might be able to make a case for the questionable intent of the creators, but I’ll stay away from either of those as the crux of this post and use it as a jumping off point for what I see as valuable technology for the future of health intervention.

What is PokemonGO

From NianticLabs.com

Loosely based on “Ingress,” PokemonGO is a marriage between Google spin-off Niantic and Nintendo’s Pokemon company. Both companies have, on their own, somewhat of a cult following at this point. While the platform that enabled Pokemon to flourish, Nintendo, has wider reception, both at this point, are not particularly popular on their own. I was actually never a big fan of either. There may have been Pokemon Pogs when I was growing up, but aside from that, I’m not intimately familiar with either. But this combination of geolocation technology and fantasy are not new at all. In fact, if you check out ARGNet, you will find a number of times when games have moved beyond their stated fantasy world and brought them into the real world. Even Cards Against Humanity’s 12 Days of Holiday Bullshit involved very real things IRL (In Real Life) that helped to solve a massive puzzle by contributing members.

But why is it so dang popular!?!

Simply put: it’s fun to play. In Jane McGonigal’s book Reality is Broken and in her TED talk Gaming can make a better world, she covers why gaming can be so much fun and how it can be used for more than just checking out from reality. For those that don’t know what makes a game, there are 4 rules for game-making:

1. It has to be fun
2. There are rules
3. There has to be feedback
4. It has to be voluntary

And PokemonGO handles these splendidly. If you are able to suspend seriousness and simply play the game, you get the cute characters of Pokemon as if they are in your own world. And then you have to interact with them. There are rules and while you don’t necessarily know them as a newbie, you pick them up rather quickly because there is a lot of feedback as you fail. And voluntary? At over 50Mb to download, significant battery management, dedication of time to the task, and a VERY serious draw on device memory, you’re making a conscious decision to volunteer your time to the goal “gotta catch ’em all.”

How does it work?

Relying on Niantic’s successful incorporation of layering fantasy graphics on Google’s mapping technology, your movement within the real world is translated to the world of PokemonGO. With real world locations acting as stops, real world walking moving you toward Pokemon, and real world feedback as you navigate around obstacles to find these critters, the technology is immersive while being a bit of a “screen suck.” You swipe and click the screen throughout the game to engage different activities (preferably once you’ve stopped moving!) and try to level up through the game.

A word on design

Despite the fact that there are no real instructions on how to use the game, it is incredibly easy to use and intuit as to the next thing you need to do in the game. In the case that you get jammed up, you can always talk to a friend about what they have experienced. And that conversation results in extended conversations about what you’ve seen, done, and enjoyed; even sharing what your highs and lows have been.

Laying the fantasy world on top of the real world allows for the interaction between real and false worlds to transcend the experience of the individual. While it is not necessarily a new technology, it certainly hasn’t been used to this level across a population of people. Look no further than the people walking around parks to see how pervasive this game has become.

Security

Besides the clear security issues that one might expect with an app that logs one’s location, we’ve seen articles that highlight a number of, sometimes false, security concerns that may or not may reveal private details about someone. For example, Instagram’s geotagging feature might reveal that the user is nowhere near home; meanwhile, there have been users that have been vandalized by their Uber driver because they were recently driven to the airport.

While there is only one clear security issue derived by the PokemonGO app, other than the iOS opening that created access to Niantic for the complete control of the users’ Google account (which was quickly remedied within the first five days of operation) PokemonGO does not have the hallmarks of issues, inherent to the app, that many others have had. The one condition to this that I would offer is the use of Lures at Pokestops, which allow for control over the fantasy world for other players as well. This is intended to allow you to attract Pokemon and potentially meet other people, but as you can imagine, that might cause a problem if someone wanted to maliciously use that tech to lure users more than Pokemon. You can’t see other users. You can’t lure those users (unless it’s discovered that incense works beyond the user – which, as of yet, it hasn’t). And until you can hack the database, which, as far as I, know never happened with Niantic, the users are relatively safe.

Health hazard or opportunity

So what are the real opportunities or hazards for this app. Truth is that we’ll likely see more and more stories about the extreme situations like a robbing in O’Fallon, IL that used the technology to target individuals (disproved in this case but could have been a Lure) and a young woman finding a dead body near a stream near her home. But truth is that this has created an engaged population, regardless of age, that is regularly walking through areas that they don’t regularly. And is that bad? We live in a country that is SO LARGE that we don’t inhabit more than 90% of the mass, and yet we have SO many opportunities for exploration for a nation of explorers.

Maybe it is. There are maybe some places that we don’t go and that’s okay. But for the large majority of people playing this game, it seems that it runs through the normal course of daily activity, or just slightly more.

What can it potentially do?

Gamification

Without going too deep into what the values of using gamification are here (feel free to read more here), it is certainly becoming more commonplace to bring this theory into regular technology for deeper interaction with users. The reason that gamification can be such a powerful tool in the capture of behavior change is that it seemingly separates the activity’s goal from the activity’s work by creating an intervening level of excitement with the user. This is done by initiating what is known in psychology as Flow.

From Gamasutra.com, link below

Flow is the state where the skill meets the difficulty that the user is presented with in a maximally optimal position to engage.

Augmented Reality

One of the best arguments for, and against, augmented reality that I’ve seen is nicely packaged in the form of this short film:

While there are many opportunities that augmented reality potentially brings to the table with regard to the mundane (paying your tab at a restaurant, preparing food, even exercising like PokemonGO has been credited with) there are also potential dangers to these augmentations. With regard to PokemonGO in its current version there’s certainly no actual human interface except through the handheld device. While it can influence behavior by incenting the user to do one thing or another, it cannot override human decisionmaking. Yet.

But let’s set aside the potential for danger for a moment to consider how immersive PokemonGO has become for its users and how another user interface might have a significantly decreased reliance on the “phone” to play the game might actually allow for it to become more of a background activity, rather than what one is actively doing. In PokemonGO, the user is staring at a screen trying to find where the leaves are moving and that’s partly because of the limited amount of time most devices can actively “play” the game. But if, say with a device like Google Glass, you could be hunting Pokemon all day long? What if, rather than having to seek out Pokemon in a thirty minute “hunt,” you were hunting all day? Tracking steps all day to incubate eggs? Regularly checking into PokeStops and learning about those locations?

There are certainly risks, and those need to be mitigated. But there’s definitely a lot more opportunity too.

Teams

When you are strong enough to actually do battle at a gym, you pick one of three teams to join. These have their own internal meanings to the game and once you’ve joined a team, you can rely on those other team members for support in controlling gyms and help with training your Pokemon.

One thing that is currently lacking in this first version of the game is the ability to bring in one’s pre-existing social network. Because you must log into the game with your Gmail account or a Pokemon.com account, the audience is potentially limited when it comes to mining the available social network data that might be available with, say, a Facebook login. Then you could invite your friends to join your team in the search for Pokemon. You could actually provide each other with tactical and strategic support in quests as well as provide emotional and physical support in reaching goals. Our social networks are significant in our health decisions, and forcing users into only having the option of the three team options in the game – which are highly contrived and not very useful on their own, so far as I can tell – there are additional opportunities for increasing the effectiveness of the platform for health behavior generation.

Socio-environmental disturbance

One thing that is for sure: there are a lot of people I’ve watched over the past few days playing this game. Will it last? I’m not sure. But watching two people who are running around a park together while staring at their phone certainly acts as a pattern interrupt for me. I’ve watched as someone stared at their phone and walked around corners, and down streets, trying to engage the PokemonGO world largely oblivious to their surroundings except for what is represented on the screen. And when you see someone doing that, it definitely has a similar impact to the way that we all responded when Bluetooth headsets and wireless earphones became popular for holding mobile phone calls in the public.

Yes, it’s a pattern interrupt. And yes, it was extremely annoying when phone calls made it out into the general public, seemingly creating dialogue that only existed in the speaker’s head. But that has become so normalized now, I can’t imagine there won’t be a possibility of a similar normalization of that activity. And once normal, adoption will likely go up, not down.

Why is this important?

These are not the Pokemon you seek

While the PokemonGO craze has blown away the expectations of the game-makers, and frankly any Ingress user is probably also doing the, “I was geocaching before it was cool” thing right now, this does start a discussion about how we can better leverage the technology that is already available to us to change our behaviors in small, although ultimately significant, ways.

Just the beginning…

…but an important one. Critical events like this are rare in helping to shape how we want our world to look. Each of us has the capacity to impact the way that we want to engage with our communities and our technology. What do you want your world to look like? Or, more precisely, what do you want which of your worlds to look like?

To our health,

Ryan Lucas
To stay ahead on topics related to this, follow me on Twitter @dz45tr

Health inSite: The Sharing Economy in HealthIT

This is a draft of Part III in a three-part series on the current, and potential future, of healthcare delivery economic models. The full series will be available on xchangehealth.wordpress.com in the next week. A quick synopsis of parts I and II are extracted as an introduction.

Intro

I was recently invited to participate in a Storyvine for Stride (on twitter). While reading through the questions that had been prepared, I was thinking about the way in which Stride is poised (intentionally) to disrupt our current healthcare delivery model by bringing together stakeholders from startups and the institutional healthcare system.

As a company that’s been around for 35 years, MINES & Associates is certainly in that latter category in many respects; however, one of the reasons that I have decided to make MINES my home is that, as a company, we have embraced technology as a tool to reach our organization mantra: to “save lives, and influence the course of human events.”

There may be a shift to consumer-directed healthcare in the very near future. One of the opportunities (or threats, depending on your viewpoint) of consumer-directed healthcare may be the collapsing of the system within which the decisions in healthcare are made at an administrative level. As a fellow Health 2.0 Denver/Boulder chapter member of mine, Sumanth, mentioned while on a panel regarding open-innovation models in healthcare, ‘We have a sickcare system, we’re working toward a healthcare system, but I’m interested in a health system.’ When we begin empowering people by giving them purchasing power, we also saddle them with the responsibility of that decision and we need systems in place to make those decisions reasonable.

Is 4PHealth going away?

If you’re not familiar with my concept of 4PHealth, check out my earlier blog post for details (secretly hoping I can stop linking to this post at some point!) but the long and short of it is that there are four P’s in the healthcare system: payer, patient, provider, and the patient’s peers. Truthfully, there’s actually a fifth P that was not originally contemplated in that post but comes to light when you consider a consumer-directed healthcare model: purchaser.

For most people in the US, the purchaser is an employer. But now that is shifting as organizations are actually sending their employees to the health insurance exchange. Increasingly, I expect this to grow; and that’s a good thing. When the purchaser and the patient are the same, there is a shift in the financial onus for having a particular benefit plan; which means we need more informed consumers (patient-purchasers). But it also creates an opportunity for further collapsing of our very-tiered silo. If the consumer could then also become the payer, we could very well see a one-to-one relationship between the provider and the consumer (patient-purchaser-payer).

Part III: The sharing economy

What does the sharing economy have to do with the consumer-directed healthcare system? First, let’s look at what is at the core of purchasing: economic offering.

Levels of economic offering

In their book The Experience Economy (I did a post on this too, forever ago!), Joe Pine and James Gilmore explain the value pyramid.

From Pine and Gilmore’s “The Experience Economy”

As products increase in differentiation (customization), a higher asking price for that product can generally be realized. In this way, value to the consumer comes in the ability to match the need with the offering and in healthcare, this means enabling smart, simple decisions.

In a consumer-directed healthcare system, shifting healthcare transactions to goods, rather than experience, and focusing the overall healthcare purchasing and maintenance up to that of an experience will be critical to success. Again, an awareness of this intentional effort to differentiate based on total experience. This can be done when the exchange, for example, becomes broker, maintenance organization (think HMO), and coordinator of one’s health record (not an Electronic Health Record as we know them, but a coordinator of the health profile mentioned earlier).

For such a situation to work, the exchange then will need to either build out, or partner with organizations with experience in guiding human behavior, to successfully engage those patient-consumers in maintaining their profile as well as actively pursuing greater levels of health.

Examples that work

The sharing economy is also making significant changes to the way that we engage as consumers. This economic shift allows for individuals to make transactions with little to no broker (for example, a bank) in order to make purchases. Most of the sharing economy relies heavily on technology to enable people to come together. A chart of examples is below:

Organization	Primary offering	Industry disrupted	Innovation Description
Uber/Lyft	Car service	Taxis	By allowing individuals to directly contact a driver, users interact with an app that can manage their payment and reservation.
AirBnB	Housing	Hotels	Users submit their social network credentials as “proof of trust” for user-to-user reservations of rooms
Car-2-Go and many others	Cars	Every car company	Cars placed around the city, can be “rented” for one-direction travel.
Bitcoin and other cryptocurrencies	Currency	Banks	Distributed, “proof-of-work” based cryptocurrency which allows for peer-to-peer exchange of value.
Kiva	Microfinance	Lending companies	Individuals can register their needs for financing and other members of the Kiva network can make those loans direct to the borrower without a traditional lender.
GoFundMe and other crowd-sourced finance platforms	Project Funding	Investors	Individuals can create a project page with donation-level rewards for contributing to the financing of a project or product.

Considering these examples, I believe that there may be some interesting opportunities for alternative funding and insurance when it comes to healthcare. Consider this: what would it look like if traditional insurers were no longer the primary location to insure oneself. In the current healthcare system, some groups (usually smaller companies with less leverage than bigger companies) might choose to pool their collective employees into what’s called a captive insurance group.

What if a similar model were to be contemplated where individuals were to select a captive group of similar patients, almost self-selecting to become a part of a patient-centered medical home model. Exchanges could do the same with their patient population by segmenting those patients into population groups.

Now, what if those groups could be funded by individuals wanting to bet on the success or failure of those groups. This allows for more direct funding for investors and patients that could result in dividends for the patients and investors when benchmarks are achieved or maintained. What other possibilities for alternate funding models might still be out there to be explored?

The core of the sharing economy

Trust

At the very core of the sharing economy is a redistribution of trust networks. By decentralizing trust models from institutional to peer-to-peer, the sharing economy refocuses and reinforces a community around the exchange of goods and services by moving brokerage to a fluid, and seemingly direct brokerage for those exchanges.

Supply/Demand

The other side of this change to the sharing economy is supply and demand monitoring and connection. Uber has the ability to simplify the exchange of need for transportation with the supply of excess time (and access to a vehicle) on the part of the driver all while it is in the process of cutting out the institutional (and very infrastructure heavy) taxicab industry.

What that means for institutional healthcare

So WHAT DOES this mean for institutional healthcare? Great question! It could mean realignment around roles within the healthcare system. It could mean small market-share loss if the idea doesn’t take off easily. It could mean more competitive models. I’m interested to hear your thoughts.

Questions for Health IT

#HITsm T1: Is a sharing economy model realistic for the healthcare industry, in whole or in part? Where? How?

#HITsm T2: What should a sharing economy model prepare for with the current status of #HealthIT and #Healthcare?

#HITsm T3: If a sharing economy model were to come about, who wins and who loses in #HealthIT and #healthcare generally?

#HITsm T4: What other technology models are out there that #HealthIT can borrow from to enable those changes?

#HITsm T5: Any other thoughts on #healthcare economic models and how #healthIT can help?

Healthcare is not just about the people who work in HealthIT, it’s about everyone…

Special thanks to the many influences that have contributed, directly or indirectly, to my questions leading into this #HITsm chat: @leonardkish @ochotex @avantgame @gzicherm @connected_book @paullikeme @robertamines @kellymcgonigal @joepine @hankgreen

Intro

I’ll be moderating the #HITsm chat on August 28th at 10am MDT and wanted to put together a couple of thoughts related to the topic before going into the chat. Maybe you’ll find these useful. Also, feel free to join us if you are interested in the topic. The more the merrier! Toward that end, let’s have a discussion about what we, in #HealthIT can do to make sure that we’re meeting the needs of those who are our end-users.

Considerations should include #EHR & #App design from #Payer, #Provider, #Patient, and #Peer per this posting on #4PHealth.

It’s the convergence of all four P’s (Provider, Payer, Patient, and that Patient’s Peers) that will allow for greater healthcare reach. When the Payer and the Provider are able to engage the Patient’s Peers, then true health generation is possible and the benefits of one’s social network can then be fully leveraged.

People:Person Design

We have historically looked at healthcare (and by extension, #HealthIT) as though it exists outside the “natural” world, or as though health is outside the realm of our social experience. Yet, we know that health is not divergent from our health reality or our everyday lives.

Healthy behavior is not dependent on what payment models, medical technology, or other innovations come about in the healthcare debate.  We know that your friend’s friend has a great impact on what you do – and vice versa.

How do we reconverge these two realities knowing that what we do in our daily lives result in healthcare outcomes? Framed differently, how do we leverage the way we make decisions every day in considering how #HealthIT is designed?

Our health is not our own. We are bound to others, near and far, and by each decision and every sharing of those decisions, we birth our health.

#HITsm T1: Knowing that #health is dependent on daily life, how do we design #HealthIT in consideration of the larger, social world?

Cognitive Bias, Iterative Decision-making, Behavioral Economics, Game-Theory

Considering the depth of our knowledge related to cognitive bias, are we considerate of this branch of psychology in design? Knowing what we know about iterative decision-making (that decisions have to be made in sequence, often after new or different information) how do we prepare adaptive #HealthIT that responds to new information as it becomes available, like it does for Human Beings? For details on Cognitive Bias and Decision-making, see here and here. For Game Theory (including iterative decision-making), see here.  

So what does a salutogenic framework look like?  Mindfulness, resilience, focus on daily health-promoting activities that increase our ability to get healthier, rather than fend off illness.  Of course, a fee-for-service model doesn’t bode well with this concept, so unless you’re enrolled in a highly visionary health promotion healthcare system, you’re probably on your own – for now.  

Antonovsky’s explanation of Salutogenesis was well depicted by a river.  His concern with the current model of health (Pathogenesis) is that it’s generally believed that we are healthy from the beginning but that because of environmental / circumstantial events, we become sick.  Antonovsky expressed this as a river, where all healthy people stand on the bank, safe from the raging river’s flow.  Once one stepped into the river – got sick – then something needed to be done.  Salutogenesis, however, sees all people already in the river; but at different distances from the mouth.

There are some obvious benefits to these advances in Health IT, but one of the things that may not be fully clear yet is the application of Watson to understanding more about human behavior. While Watson can absolutely tell a clinician the likelihood of a set of symptoms’ association with a given disease, I’ll bet Watson can’t tell you how the patients’ family impacts their overall wellbeing through behavior reinforcement. If Watson knew who the patients’ workout buddy was, Watson might be able to help identify with a high confidence whether that workout buddy was a statistically-sound partner in the overall health management of the patient. Further, Watson would be able to weigh in on the evaluation of treatment adherence based on real-time data pouring into the health record for the given individual.  This is the game state evaluation of the health of the individual in a real and meaningful way.  With this, a total and complete understanding of the long-term treatment of chronic conditions (and even more important to the salutogenic framework that I’ve discussed previously in this blog series, total health production) through the understanding of actual human behavior devoid of the clinical separation from reality is the “social human” version of epigenetics that will become more useful in the coming years.  This is where the data comes to life.

#HITsm T2: How do we achieve #patientengagement over time considering that a one-off solution can’t fix #health?

Gamification

A recent post mentioned that Gamification is failing due to a lack of accurately applying the concepts of gamification; in short, supplanting “badges” for increasing levels of difficulty appropriately. If Gamification is going to solve the #engagement problem, why can’t we quite figure this out? Gamification in health, generally, see here.

Whether we admit it or not, it is the promise of the potential emotional pay-off that lures us into working ridiculous hours already. But unlike gaming environments where we are totally immersed, our modern work environments seem contorted — almost criminally — to keep us from feeling blissfully productive. And once we give up hope that epic wins are possible, our careers turn into drudgery.

It takes more than a website to do this – including focus on using the resources available to a company’s natural habitat, the worksite, to engage employees during the 40 hour work week, and more, by creating a story.  As described in the burgeoning world of Alternate Reality Games and Transmedia Storytelling, the ability to tell a cooperative narrative – on and offline – among those with which you work is an opportunity to actively create health, the benchmark of Salutogenesis.  When you have many platforms for engaging in this storytelling, you increase the modes of access to actively engage all employees where they are, rather than forcing them into a platform that they may not be comfortable with, or is not ideal for their way of engaging in their health generating behaviors.

 #HITsm T3: What game mechanics in #HealthIT are currently being used appropriately? Which are not?

Integration with the larger #healthIT world

Specifically looking at the #payer and #provider perspective, how can we ensure that the same #psych principles are being used to ensure adoption of #HealthIT throughout the Healthcare continuum? When we consider #wearables and #IoT, what do we focus on in terms of integration versus simple cataloging?

#HITsm T4: What should be made usable by #enterprise #healthIT to ensure the #Human element does not get lost?

Free-for-all on Design

#HITsm T5: What design considerations have you seen that work well in #HealthIT / #mHealth?

In review:

#HITsm T1: Knowing that #health is dependent on daily life, how do we design #HealthIT in consideration of the larger, social world?

#HITsm T2: How do we achieve #patientengagement over time considering that a one-off solution can’t fix #health?

#HITsm T3: What game mechanics in #HealthIT are currently being used appropriately? Which are not?

#HITsm T4: What should be made usable by #enterprise #healthIT to ensure the #Human element does not get lost?

#HITsm T5: What design considerations have you seen that work well in #HealthIT / #mHealth?

To our health,

Ryan Lucas
Manager, Engagement & Development

Health inSite: Privacy, Security, and “What’s with my damn data!”

I will be moderating a tweet chat on May 16th with the crew that participates in #HITsm (Health Information Technology / Social Media) and thought I’d go ahead and post those here for anyone else that might be interested or wanted a teaser for that chat.

These topics will be cross-posted on the HL7 Blog for TweetChats closer to the event.

We live in a data-damp world.  While we’ve always generated tons of data, never has it ever been so catalogued and retrievable.  We have begun a shift in our willingness to allow outside groups to do this for us in some cases, for example, in cloud-based applications, social networks, and the like.  It’s not true for everyone, but there’s no question there’s a shift in our culture toward allowing more of this.

#HITsm T1: Is releasing more a/b ourselves an increase in trust, or risk-taking? Is that a positive thing? How is it impacting healthcare?

Some might make the case (myself included) that this is a positive thing as we continue to share ourselves in a way that allows our impact on each others’ decision-making to become more transparent (blog posting) and potentially affect-able.

#HITsm T2: What is the balance between transparency and privacy/security that makes sense when it comes to healthcare? How?

Twitter Head of Safety, Del Harvey (@delbius), recently gave a TEDtalk about how the scale of Twitter requires significant considerations in how Twitter protects its users, in many cases, from themselves.  For example, Twitter made the decision to remove geo-tagging meta-data from photos that are posted to Twitter to ensure that users could not be tracked live as they posted information.

#HITsm T3: What patient data in healthcare may be innately helpful or harmful to safety/security, known or unknown? Examples?

If we accept the premise that some information should be shared for the benefit of the social network (friends, family, neighbors, etc.) in terms of how behaviors affect the health and wellbeing of all who access the healthcare system (effectively all citizens under the Affordable Care Act), who should set what/where/how that information should be shared?

#HITsm T4: Who should control access to data re: healthcare info? Should there be suggested min. shared data? What parallel models exist?

In a somewhat humorous interview with former NSA chief Keith Alexander on his HBO show “Last Week Tonight,” John Oliver asked if recent outcry regarding privacy among the US population was simply a branding issue for the NSA to which there was some assent from the former head.  Sarcasm aside: there may be value in rebranding the healthcare system to focus on increasing sharing to leverage shared health decision-making.

#HITsm T5: If we want to increase sharing data to leverage shared #HC decision-making, how can #HealthIT and #SoMe help?

Have thoughts you want to share? Feel free to comment below!

To our health,

Ryan Lucas
Manager, Engagement & Development
Follow me on twitter: @dz45tr

Health inSite: Small worlds need a u-turn

Where we’re going with electronics…

As we look at the new innovations coming out of the Consumer Electronics Show in Las Vegas, NV this year (#CES2014 on twitter and elsewhere!), I find myself questioning what we are trying to accomplish in HealthIT trends when it comes to interacting with our technology.  Largely, this was prompted by a recent article about the formation of the recent Google-led Open Auto Alliance, a collaborative effort between nVidia, Google, Hyundai, Honda, GM, and Audi.

Humorously enough, or not, the article referenced above for the OAA includes a banner for Door-to-Door Organics (a local-to-online-to-local organic produce company from which I get a weekly delivery for my lunch each day) as the sponsored banner advertisement.

As a Google fan-boy of sorts (I’ve been a Gmail user since 2004, helped start a company in 2005 based on Google search technology, and chose Android for my first [and every subsequent] smart phone), I have long-lauded the value of Android integration into the many facets of life.  I rely on this technology in many ways day-in and day-out to help curate my experience in the real world.  But, I have to express some dismay at Google’s focus on making cars that are our “ultimate mobile device” as it goes against another important soapbox of mine – the future of our online lives actually exists in augmenting our offline ones.  See here: Google Glass, augmented reality, and even Google Goggles which just earlier this year helped me identify additional information for my mom about an artist while I was in a museum!

IBM makes a startling announcement!

Early in December, IBM released its predictions for the next 5 years of which, one in particular, was jarring and interesting to consider – that mobile will enable the local buyer.  While it may seem to be bold to suggest that companies like Zappos and Amazon are going to lose the buyer war, I think one would be foolish to overlook the trend toward buying local in many ways.  I don’t think IBM is trying to suggest that buying local is going to be true for bulk/large purchasing – as it’s going to remain significantly cheaper to buy many electronics direct from the warehouse for many people who don’t need the concierge services of an electronics store – but smaller, everyday purchases will remain daily purchases.  For that reason, I would concur that mobile has the potential to enable local purchasing in a way we’ve never experienced before.

Enter Small Worlds (both literal and figurative)

If my study in Network Science and Sociology has taught me nothing, it’s that when looking at trends in social design, if one ignores the general trend of the people that have to operate in a system, for glitziness, that company is losing out on finding the niche in which it is most likely to thrive.  Minidisc lost out to MP3s, Blue Ray is just now catching on against DVDs and that was a multi-billion dollar campaign, and more importantly, there is a certain level of social responsibility that should come with technological advancement.  For that reason, I ask a simple question: when we know that we are facing so many epidemics within the health of our populace, why would we focus on generating tech for the machine that most clearly has helped to create our epidemic.  Let me explain…

The greatest impact that we could have on the overall health and wellbeing (the optimally-performing self) is by leveraging the interpersonal experience that we have with one another.  There is no greater way, in my view, to leverage the way that we as humans interact with one another.  Network Science explains how we are the product of the many interactions that we have day-in and day-out.  This creates the product known as ‘small worlds’ in which we exist.  If you were to look at a graphing of your daily social interactions, you would find that there are a number of individuals (nodes) that have a significant impact on your daily life.  Some of those people (hubs) have a greater impact on other clusters of people, but ultimately, our interactions occur with about 150 people regularly.  Despite that, our impact on the health and wellbeing of a great number of other people through our interactions allow the network to act in a much more comprehensive way.  In effect, it’s not just our actions, but the actions of those we interact with, that ultimately impact the way in which the network perceives and reacts to those behaviors.

It’s time to focus on our communities, not ourselves

In many ways, the single most destructive piece of technology that we’ve created is the automobile. As of 2011, the average US citizen travels over 36 miles each day in their vehicle – which no doubt is why Google is looking at trying to maximize their time with their users in this environment.  However, from a society-design perspective, this also encourages obesity and ultimately social-distancing.  It enables us to live in communities that are often disparate and incompatible with building social structure.  While it has become a mainstay in our social psyche, it has also enabled a technology-subordinate population.  Our cars have created the perfect self-encapsulated environment that removes us from the need to interact positively with one another in meaningful ways.  My city of Denver, CO receives a walk score of 56; check yours here!

If only Google was spending more time on creating the “public square” instead of the “private car” of the future, we might see some pretty significant impact on mobile health technology and more importantly, helping to engineer with the social network in mind to create a healthier population.

Know of something Google or anyone else is doing toward this goal?  Other insights you want to share?  Tweet at me or comment below!

To our health,

Ryan Lucas
Manager, Engagement & Development
Follow me on twitter: @dz45tr

Health inSite: Believe your own data!

I was recently reviewing a video by the very impressive Kelly McGonigal (author of the Willpower Instinct – interview video here) as a part of, what appears to be, a new series called “Open Office Hours” and posted to the Stanford University Facebook account.  At 1:26 in the video, she explains that when you are confronted with a piece of research (specifically in this instance related to health) that it’s important to test it for yourself and then makes the statement “believe your own data.”

That is a very powerful statement to make!

Awareness of the opportunities to impact one’s own health and then the wherewithal to actually make a change also necessitates awareness as to the impact that that change is having on you.  And to do that, conveniently, we have  useful tools available to us to help begin tracking and reporting on that data ourselves…but how?

Enter #mHealth

One of the trends that has certainly begun to make its mark on the issue of monitoring and tracking this data is the mobile health (mHealth) industry.  From apps to the actual hardware itself – in the case of the iPhone 5s and its motion sensing capability, but even as early as the simple GPS function being used in running and biking apps – many people are starting to log and catalog this data for themselves.  The difficulty is that sharing this information is usually specific to a particular platform, creating a barrier to actually leveraging the social side of health behavior modification, which we know to be so important at creating success (read pretty much anything I’ve previously written in the Health inSite series).

An early leader

WebMD is leading the way with an in-app storefront for purchasing interoperable medical devices that already work with the 2net platform (Qualcomm’s health cloud services) and will make it easier to stay on top of health and health behavior.  Further, with the avado partnership and connection between Medscape and WebMD, the app should be able to handle end-to-end management of those health behaviors beginning with: identification of information related to a certain health metric or behavior; access to the acquisition of a relevant piece of equipment to “sense” the data related to the health factor; wirelessly transmitting and logging relevant data; and then through co-ownership between the patient and the provider, the ability to monitor that data and make adjustments.  Throw in a little bit of personal social network for those wanting to connect this with their existing support (or in the “friends’ friends make you fat” way, lack of support) to help create the conversation necessary to actually affect our health behavior and our health self-concept.

Dr. McGonigal is right

While it is exciting that we are starting to be able to monitor and track all this cool stuff about ourselves (some have been doing it for decades in larger and smaller ways even before the tech was available to integrate the monitoring with the data management), the important thing is that you have to test it for yourself.  We don’t all respond the same way to every intervention method, and some things work better for others that won’t even begin to help us.  But we cannot know how or what will work until we make the decision that we want to try and then start tracking that data and, most importantly, recognize that we need to believe in (trust) our own data to help us make the decisions that will have the greatest impact in whatever we want to improve while creating our optimally-performing self. This is the art of health based on the science of health.

To our health,

Ryan Lucas
Manager, Engagement & Development

Health inSite: #4PHealth

Each week I take an hour to join with a few colleagues and thought-leaders around the world on twitter to discuss all kinds of interesting topics related to where healthcare is going, what to expect in the intersection between Health and Technology, and how we might play a role in that changing landscape. These TweetChats are an opportunity to learn, share, and ultimately understand how social media, technology, and the role of various players in the healthcare world might better work together. Often, we turn to the topic of patient engagement. This is focused on what tools, technology, and other needs might help to get patients more involved in their own health. This can come in the form of tracking various metrics (see the Quantified Self movement) to making sure that individuals on medication are staying on top of that treatment to ensure their continued health improvement. While in our last TweetChat, which emphasized Patient Engagement and Experience specifically, we discussed that it was important for us to focus on what the patient could do, yes, but also what the provider and the payer could do. This is a common picture of the players in the healthcare world. Someone needs the service (patient), someone provides the service (provider), and someone pays for the service (payer). It looks sort of like this:

But that’s not really the whole picture, now is it? The truth is that this is the model of a sick-care system. As I’ve mentioned in blog postings beforehand, in order to keep people as healthy as possible before they need to access the healthcare system, the system must account for one more “P” in this proverbial puzzle (or pie, if you’d like!); one’s Peers:

It’s the convergence of all four P’s (Provider, Payer, Patient, and that Patient’s Peers) that will allow for greater healthcare reach. When the Payer and the Provider are able to engage the Patient’s Peers, then true health generation is possible and the benefits of one’s social network can then be fully leveraged.

With that, I submit a new hashtag for the consideration of a community that continually strives to make the very complicated healthcare system a little simpler as we move towards greater total health and wellbeing of the individuals that have to access this system. #4PHealth represents the four core stakeholders in healthcare that ultimately are responsible for the health of the patient and responsible for keeping that patient out of the hospital, involved and engaged in their total health and wellbeing, and always striving to improve one’s total health picture. When the Patient, Provider, Payer, and Peers come together, total wellbeing is possible.

This doesn’t have to be limited to the TwitterSphere, though. Take a moment and think about the real-world applications of this for you in your life. What can you be doing to help those in your peer group become healthier? What opportunities are there for you to help generate greater health for yourself and for your friends, family, and coworkers? What can you ask of your peers to help you with to create better health for yourself? The 4P model may not be the easiest thing for us to accomplish in our current healthcare system given the disjointed nature of care models, but you still have the ability to start working on the fourth “P” today. What will your first step be?

To our health,

Ryan Lucas
Supervisor, Marketing
(illustrations assembled myself!)

Health inSite: Decision Support, Games, and making people healthier

I’m a bit of a trivia nerd. In fact, I play trivia with a group of friends every week. We do alright, and obviously there are good weeks (I mean, we keep going back) and then there are bad weeks. I play team captain for our group. The responsibilities of team captain are to record our progress (each question gets a wager based on our confidence in our answer) and recording the success or failure of each question in a running total, and helping to marshal the resources of the team (points, knowledge bases of the players, ranking answer likelihood, etc.). The final trivia question of the night is a challenge. Each team is given the question that requires four answers in rank order, usually. When turning in one’s response, a point value between 1 and 15 is assigned to the answer. If any part of the question is wrong, the wager is subtracted from the team’s total score. If the answer is 100% correct, the team gains the wagered points. So it’s no surprise that I would be really intrigued by Watson, a supercomputer that was able to best two of Jeopardy’s greatest champions in a tournament back in 2011. Research into Watson is really interesting.

Confidence

Watson was trained to respond only when a certain threshold had been met in the likelihood that Watson was correct in its assumptions. This confidence was determined based on cross-referencing the available answers and identifying the highest scored answer based on a number of algorithms. While Watson is not right 100% of the time, its significant domination of the final score ($77,147 vs. 2nd place’s $24,000) is no small feat for a computer responding to natural language, searching natural language information, and culling a response to an “open-domain” question.

Game State Evaluation

Part of the programming behind Watson required not just an understanding of the likelihood that Watson was right, but also what the potential for gain or loss in relation to the other players might be. Because Jeopardy includes wagering for daily doubles and Final Jeopardy, Watson had to strategically wager in relation to the likelihood not only that it was right, but also what it would mean if the other players were right or wrong. This is well-illustrated by the final wager that Watson placed in response to the final jeopardy question, which was $17,973. This is a statistically-determined wager based on total game state evaluation at the time of this final question using the above variables.

Thinking

While there is plenty of room for argument as to whether or not Watson is thinking, there is absolutely no question as to whether Watson is logical. As I’ve mentioned before in a couple of articles related to the work of Daniel Kahneman, (if you haven’t, make sure to check out Thinking Fast and Slow) human rationality is very rarely very rational. This is due to a number of intervening variables that interrupt our ability to make rational decisions all of the time. These “biases” can be intentionally or unintentionally applied during the decision-making process. While Watson has a number of heuristics, no-doubt, built into its logical processing, it is probably not as likely to respond to cognitive biases such as anchoring, duration neglect, and certainly curse-of-knowledge as seen in its commanding performance in the Jeopardy games.

Decision Support Systems

Watson is now being used in a number of healthcare applications assisting in the support of clinicians as diagnostic support. Watson is not making decisions, but it is able to cull the plethora of information available in the medical field to provide confidence-rated responses to data that is provided regarding a patient. This marks a big step for the advancement of Health IT as we can standardize clinical response to symptoms, and stabilize health information as it is consolidated into big data stores. And because Watson is able to learn as it answers and receives feedback as to success and failure based on those responses, Watson can only get better at diagnostic prediction and likelihood of treatment success or adherence based on the results of those treatments.

What does this mean for making people healthier?

There are some obvious benefits to these advances in Health IT, but one of the things that may not be fully clear yet is the application of Watson to understanding more about human behavior. While Watson can absolutely tell a clinician the likelihood of a set of symptoms’ association with a given disease, I’ll bet Watson can’t tell you how the patients’ family impacts their overall wellbeing through behavior reinforcement. If Watson knew who the patients’ workout buddy was, Watson might be able to help identify with a high confidence whether that workout buddy was a statistically-sound partner in the overall health management of the patient. Further, Watson would be able to weigh in on the evaluation of treatment adherence based on real-time data pouring into the health record for the given individual.  This is the game state evaluation of the health of the individual in a real and meaningful way.  With this, a total and complete understanding of the long-term treatment of chronic conditions (and even more important to the salutogenic framework that I’ve discussed previously in this blog series, total health production) through the understanding of actual human behavior devoid of the clinical separation from reality is the “social human” version of epigenetics that will become more useful in the coming years.  This is where the data comes to life.

To our health,
Ryan Lucas
Supervisor, Marketing
To stay ahead on topics related to this, follow me on Twitter @dz45tr

Health inSite: Placebo, by any other name, is just as effective?

The Placebo App

A review of a year and a half of Health inSite research and how I think one group is probably more on target than some might think.

I’m going to start out by laying out a couple of concepts for review.

Placebos and psychology

A placebo is defined as “a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient.”  This causes what is called the placebo effect.  A patient is said to have experienced a placebo effect when the intended deception manifests experienced results.  While the research indicates that there is a small range of people that are susceptible to the effect, that range hovers at around 30% of the population.

Rationality

One might ask, “How is it possible that the effects of a non-drug could be experienced as having the results of an actual drug that has the intended, or actual, impact on a patient?”  This is explained as the product of self-fulfilling prophesy, or a form of expectation bias.  If you recall the previous posting on Thinking Fast and Slow, one of the difficulties we face as human beings is both our difficulty in matching up experience and memory, as well as overcoming biases that tint our understanding of rational data.  In a word, we are not always rational beings and sometimes our understanding of an experience or idea is subject to our memory and cognitive constructs that allow us to think fast.  We respond the way that our mind has told our body it expected to experience the event.  The concept, “Where your mind goes, the energy goes,” has been mentioned extensively by my colleague Dr. Mines in his series on Psychology of Performance, beginning with his first posting.

Hysteria (or mass psychogenic illness)

If you happened to miss the events in Le Roy, NY, where 18 people experienced Tourette’s-like symptoms for an extended period of time, there were many that identified the cause of the experience of these individuals as mass psychogenic illness.  Mass psychogenic illness has been largely attributed to situations in which individuals are experiencing similar physical effects (tics, for example) without any clear physical reasons (e.g., environmental toxins, viral or biological triggers, etc.).  Historically, this has been referred to as mass hysteria.  The complexity of the condition has led many to write it off, but the core assumptions of mass psychogenic illness are sound given what we know about social influence.  Oftentimes in mass psychogenic illness, an index case is discovered in which someone’s conversion disorder acts as a catalyst to the development and spread of the illness through the network.

Assuming that this is the way in which mass psychogenic illness works, index cases could be used to induce behavior change in a network towards a positive outcome. In this way, it is not mass psychogenic illness, but mass psychogenic salutogenesis (widespread generation of health through the influence of the mind over the body within the social structure of a network).

CBT and treatment adherence

Critical to adherence to any health maintenance or treatment protocol plan is the ritualizing of new behavior.  In the chemical dependency field, we’ve known this for a long time.  By creating new routines that positively impact our behavior; we are able to more easily overcome the many triggers that previously caused our substance use.

Triggers are defined in the substance abuse field as events, emotions, or thoughts that trigger the addiction response.  They are a major focus in many treatment protocols and are especially important for recognition in the cognitive behavioral therapy (CBT) model.  The goal in CBT is to identify why it is that we respond to thoughts, emotions, and events and then to develop, for ourselves with the help of a therapist, ways to counter the effect of those triggers.  In this way, it’s not the abolition or avoidance of triggers so much as a rational understanding of the trigger and building tools to overcome that trigger’s effect on the coached patient/client.

Network theory, social comparison, and braggadocian behavior

If you’ve read all of the links to other blog postings in the Health inSite category, but missed the posting on braggadocian behavior, the concept is very simply that social media has enabled us to engage in bragging around the things that we are doing and that this activity can influence the way that others perceive us – and we do this to intentionally accomplish that change in perception.  This gives us the ability to influence the way that others behave as they engage in responses which may include trying to match our behavior (wittingly or unwittingly)  or rejection of our behavior as a method of coping with one’s own deficiency in the category of behavior being expressed.  This has a powerful impact on the social network in which agents operate as they can directly and indirectly influence the behaviors of individuals that are proximally or distally connected to them.

In their book Connected, Christakis and Fowler explore the significant effects that our social network has on our health and health behaviors.  Social networks, of course, are not just websites like Facebook or Twitter, but all forms of interaction that we have with various people in our lives, including our family, friends, co-workers, neighbors, and even the people at the grocery store.  The power of individuals to have an effect across a network based on their location within the network is a clear and well-documented reality.

Suspension of disbelief

As I mentioned in an earlier blog posting on the fourth and fifth wall, suspension of disbelief is critical to the effectiveness of theater.  Without the audience allowing suspension of disbelief, a presentation falls flat in its ability to engage the audience emotionally.  Think back to a PowerPoint presentation that was particularly awful because the speaker failed to actively paint a picture that the audience could connect with.  Similarly, engagement strategies are starting to use these concepts to create thick tapestries of story that immerse the audience in the story-line, and even sometimes ask them to co-create the story, as in the case of the Lizzie Bennet Diaries’ spin-off series, Welcome to Sanditon.

New technology

Recently, an IndieGoGo campaign was started for a new project that would create a placebo app.  You might think to yourself, “How the heck could a placebo app affect someone’s health?”  The app, which leverages the power of mirror neuron activity and the placebo effect by creating positive thought-feelings in the brain, could actually override the systems in the brain that cause us to act irrationally in terms of triggers and cognitive biases by leveraging suspension of disbelief.  Further, the app allows individuals to interact with their social network around their use of the placebo app, creating a unique opportunity for mass psychogenic salutogenesis.  Now all we need are some index cases to start the process toward a tipping point.

It will be interesting to see the resulting data from this project as we would expect that there is a real opportunity for this to be leveraged to significant effect, not only for those directly accessing the placebo app, but also those that end up interacting with those users.  But the rest of the story is still to come.

Whew, that was quite a round-up of research, huh?  Comment or send questions!

For more…

…check out a G+ Hangout from HuffPost on placebos and their effect.

Ryan Lucas
Supervisor, Marketing
To stay ahead on topics related to this, follow me on Twitter @dz45tr