2,061 Days in the Making




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



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.


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?


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.


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?

BmsB9w6 - ImgurThese 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

Disruption in #healthIT


Chat topics for #HITsm

Over the last few years, I’ve had some amazing opportunities to meet and work with seasoned disruptors, health IT and healthcare veterans, and even outsiders that are trying to move into this space as it continues to get press as a growing industry. Of course, as complex and regulated as healthcare, any level of health IT disruption requires being able to overcome the proverb about describing an elephant.


In health IT, the problems can be exacerbated by each part of the anatomy fundamentally changing the physiology of other parts as workflow and UI interact. Simple changes in one arena can have extremely important consequences in other parts of the system and when you are in an industry where human factors (such as behavioral economics, lack of sophistication, error, genomics, consumer experience, and MANY others) critically impact the use, misuse, and even nonuse of the constituent parts, the simple interest in getting involved can quickly spiral out into frustration.

I don’t think that this means that we need to shut out outsiders, though. Certainly there are going to be business factors such as proprietary systems and intellectual property to always consider. However, one place where I have seen great inspiration is here in Colorado, where the Catalyst HTI project is currently lifting off. A community of companies including large and small, young and old, established and disruptor, are coming together with a focus toward collaborative solution-finding.

I should say at this point that I don’t think being a disruptor or establishment health IT person are mutually exclusive. I personally work for a 35 year old company and my entire job is disruption. I see them as two axes on a graph, much like below:

disruption square

With this as our teaser, what are the considerations for healthcare and IT when they bump up against one another? In a recent post, the @theEHRguy posits that jamming tech into health can complicate the picture and increase the opportunity for fraud: http://bit.ly/1lblI2f. Is that because our systems are being built on false pretenses or for another reason?

Intro question: Do you consider yourself a #healthIT veteran or outsider? Have you ever been on the other side?

#HITsm T1: Is there value in designing new #healthIT from outside #healthcare organizations, or shd we bring them inside the “garden?”

#HITSM T2: What is the most disruptive #HealthIT, in your opinion, and did it come from w/in a major healthcare co. or outside?

#HITsm T3: Would smaller companies do any better than larger organizations in creating disruptive #healthIT?

#HITsm T4: w/all the disruptive #HealthIT being created, is there value in a national, coordinated effort for tracking dev?

#HITsm T5: Specifically when it comes to #makers, what advice do you have for those looking to break into #HealthIT?

The Ashley Madison hack and healthcare


I was really hesitant to write anything about this topic at all, but a recent article in Gizmodo convinced me that there is something really critical here to be discussed. Yes, I am talking about the Ashley Madison data hack and its implications for the healthcare industry.

What do we know so far? Well, we know that there were approximately 35 million records dumped onto the “dark web” and that within that data was quite a bit of information. In fact, I’ve recently seen a sampling of that data including addresses and names and it’s frankly startling to see someone you know show up on the list. I don’t recommend it.

What I don’t know is anything other than the limited data that I’ve seen and what is presented by what I hope are reputable sources. What I present here is not presently vetted as it would be quite an undertaking to do so on my own. I’m hoping by publishing through this medium (heh — get it!) that we might be able to get some clarification on this topic and to help me with my own thoughts about how this impacts the healthcare industry.

First, let’s talk about privacy versus security

There is a certain amount of privacy that one should expect when engaging with a site that purports to maintain a secret for you, or to help you evade telling the truth. Privacy is “the state or condition of being free from being observed or disturbed by other people.” In contrast, security is “ the state of being free from danger or threat.” There is a nuance to the interplay between these two, but they are absolutely distinct.

In the healthcare industry, we’re well aware of the difference between these two things — or at least we should be. But all too often we confuse the strictures of HIPAA as being about privacy. That’s not inherently true. HIPAA is the Health Insurance Portability and Accountability Act. It’s about security, not necessarily privacy. In fact, HIPAA even covers how healthcare entities should handle informing their patients on how things are handled with regards to privacy because HIPAA doesn’t specifically provide for them. The “P” throws everyone off.

In fact, your Private Health Information (PHI) likely moves around the system in all kinds of ways that you may not realize. When you are seen for a service, your information probably goes to a payer on a claim form. That claim form may be accompanied by clinical documentation that may go to a Managed Care company. Your data ends up going through all kinds of people that you don’t explicitly give your permission to. All KINDS of people.

But just because your information is being moved from company to company, person to person, doesn’t mean your information isn’t secure. Most of the time, the system works just fine. Other times, you run into a problem like Anthem had where a breach in their IT structures resulted in a massive data leak. In such cases, there are actual federal guidelines as to how that breach is handled that are clearly defined. And those breaches are very expensive to the healthcare company.

The reason for that is that PHI can sometimes be more difficult to protect oneself in a breach than, say, your financial information. Because there is no national ID for the healthcare system, often a Social Security Number is used for transactions between systems. While an insurer might also provide you with an individual ID for their internal systems, for those data to move between entities, you have to use an SSN.

But even SSN can be protected against a breach with credit monitoring when it comes to your financial information. What is a little different about PHI is that it can contain deeply personal information about the individual such as diagnoses, current or past treatment, and even likelihood for future diagnoses when it comes to genetic information. Your genome can’t be changed like your SSN or bank account information. That’s all yours.

Let’s bring it back to Ashley Madison

What did Ashley Madison actually promise, then?

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We can discuss the morality behind the purpose of the site all day long, but the site exists and people signed up for it. So let’s just move on past that topic and dig into how this is relevant to our purpose here.

After looking at the data from Annalee Newitz’s article, there’s clearly something else going on here. There are not a ton of married people who are successful in cheating on their spouses. There are a ton of married men who are flirting with the idea of cheating on their spouses.

The societal impact of the hack

Well, we know that Josh Duggar admitted to cheating on his wife andentering rehab after the hack was announced and that he was on the list. I haven’t seen that he successfully met anyone on the site, but looking at the numbers in the Gizmodo article, I’m going to guess not. And there arereports that there may be suicides that have been linked to the hack. And there has even been reporting on the pervasiveness of the use of the site by federal employees.

So, we’re seeing some significant potential impact of the site across many walks of life and affecting many groups throughout the world, in fact. But again, going back to the numbers, this probably isn’t nearly the situation that we think it is.

Let’s focus on the men that were probably brought to this site, since the Gizmodo article all but dismisses the women that were on the site — especially after highlighting that a number of those women could have been checking for cheating spouses, rather than looking to cheat.

There is the issue of Ashley Madison’s promise to its users. That it would allow for discretion in cheating. That’s a privacy promise in my opinion, and not necessarily a security one. Would one assume that their information was being secured as well? Maybe, but I don’t think that’s inherent to their brand promise. Again, I haven’t dug into the language of their policy yet — this is a working document — but there was going to be no protection when you moved from the online world to the offline world anyhow, so how one could have reasonably expected security is beyond me.

You’ll have to draw your own line as to what is considered cheating and what is not, but most of these individuals that were active on the site were more than likely talking to robots. Those that weren’t may have been casually flirting. And of those left, well, I’ll just say the proportions would show that likely if anyone was successful in cheating, they were probably 4th or 5th in line in their area.

For the first two categories, you were made a promise by Ashley Madison and you were either duped or you got exactly what you needed. If you expected you would actually find an affair, the first category; if you were looking for an outlet that let you flirt, you probably got a robot and received exactly what you needed from the site.

What this means for healthcare

Does or would the Ashley Madison hack have an effect on healthcare more broadly? I don’t know. There’s certainly a couple of considerations here.

Does this inherently decrease the public’s trust of the internet and data security generally? I hope not. You should absolutely be concerned about security, but let’s be honest — Ashley Madison is not the healthcare industry, it’s a site for people wanting to cheat. There’s an inherent, goal-oriented difference between the two, we’ll call them, “industries.”

Does the new data lessen the impact that the hack actually has on the greater societal opinion surrounding the fear of data integrity? Probably, but it really shouldn’t. This still highlights a critical misunderstanding that we have about our data and how it gets used. That’s no less true in the healthcare industry as I’ve pointed out above.

Will it change the way that healthcare handles data? I cannot imagine it would. Your data is being protected pretty well already, but this type of hack is the result of something far different than why someone would go after healthcare — that’s largely financial.

Is the Ashley Madison hack still relevant? You bet your sweet you know what it is! We’re entering a new phase in the healthcare industry’s development where you as a consumer are going to be able to make more decisions about the way in which you interface with that system. That means you have more control over who is getting your data initially, and within the new Health Information Exchange models set up in each state, maybe even after your initial input of data. Some systems are prepared to share data down to very granular levels. That means you will have to make some decisions about how you want your information to be shared.

Does this mean you shouldn’t share your data? I wouldn’t go that far. Your data, if properly secured, doesn’t need to be private from legitimate sources in the healthcare industry. That data can be very important for medical advancement for one. But there is also a possibility that your information can help providers make better decisions to help you in making decisions about your own healthcare.

Health inSite: Consumer-directed Healthcare Part IV


This is part IV in a four part series. Links for Part I, Part II, and Part III

There are numerous components that the sharing economy and new applications have developed that will likely make an impact on healthcare moving forward.

Two-step verification

One major integration point that social networks have started to implement is that of two-step verification. This allows for identifying an entry-point for any given social network so that if someone attempts to access your profile from a device that is not recognized there is a second layer of security. In the age of mobile, this has been helpful in beginning to lock down the username/password issue of the past. But there is more needed from this methodology. One day, either through bio-markers or technology insertion, such two-step verification might further button down security related to social networks.

Social sign-on

There are a number of sites that are now beginning to rely on social sign-on where an OAuth call brings over the credentials of a particular user’s information from a major social network to bypass a number of the traditional sign-up information needed to create a new user, creating a “virtual passport.” This usually passes a limited amount of information between the two sites. Some sites, such as Tinder, might bring over your friend list and interests, where other sites may bring over only your identifying account from Facebook. This level of information sharing enables the user to activate the social network to act like a passport for accessing different sites across the web.


Once credentialing information has been brought into the secondary system such as through the ‘social sign-on’ system, it is combined with information related directly to the application into which you ported your ‘passport’ information. However, having a “passport” doesn’t guarantee two way communication, which is the goal. A passport gets you into a country but doesn’t necessarily allow for your travel itinerary to be shared with your country of origin. It affords access to local resources without necessarily communicating back to the issuing authority. As a result, your local identity can be managed locally, only. Which means that while those external credentials can be managed by the external authority, local, additional data (credentials) can be managed within the new authority.

Identity management

But, as a user accesses, and enables that passport to be used across the web, a composite identity can be realized through the passport. Similarly to the stamps that end up in your passport, a comprehensive view of the “travels” you acquire while moving through the social web can be realized. With secure technologies and stronger information security protocols through these passport services, a comprehensive yet protective identity can be managed across the social web.

Essentially, this allows for a deeper sense of security in identity. If you’ve ever tried to apply for a birth certificate, you know that an insane amount of information is collected by a host of agencies and coordinated to test for the authenticity of the person requesting the information. Similarly, a social footprint through the social web’s passport allows for a full, historical picture that can act in much the same way as a credit score or an issuing agency for birth certificates. So long as users can help to manage the information related to that social passport.

Social network analysis

Another opportunity that using these social platforms for credentialing affords is bringing over the social structure information from the network into another platform. Dating sites like Tinder and Hinge have already made strides in trying to develop ways of identifying social connections and even likelihood of compatibility of matches through their apps by analyzing this information. Deeper forms of social network analysis could make possible analysis into what that social network might do once it enters into a third-party application.

Friends of Friends

A study into Social Network Analysis (SNA) quite quickly reveals the possibility of using the information related to hubs, links, nodes, and clusters for the dissemination (or potential, thereof) information with a certain amount of predictability. We in healthcare should look at this as the Holy Grail for culture change and treatment adherence. By enabling that social network, inherent to an already existing system of networks like Facebook, means that information doesn’t have to be populated from the healthcare side. Attempts to do so in the past have been seriously lacking in critical mass. And looking at studies like the Framingham study point to how important our social networks really are in our health behaviors, so healthcare needs to identify a way of making this a reality.

Influencers, mavens, and hubs

But even without the nebulous interaction points and influences in any given social network, by processing the data from networks like Facebook as to link influence and the flow of information and influence, it would be possible with a fairly limited amount of that information coming into a third-party application to reasonably predict these patterns of influence and identify influencers, mavens, and hubs within geographic, familial, and even professional networks.

Social integration for experience-sharing

All of this social integration has value for both the system attempting to impact health behavior and outcomes, but also to increase the overall shared experience of the users as they are able to interact with one another around those behaviors, as well as their personal experience in a given system – such as the healthcare system. Further, those experiences would continue to impact the reevaluation of that experience by members as they share those experiences. Social integration is also becoming a necessary reality to create a consumer experience in competition with the rest of the world that patient is experiencing.

Mutual rating networks

Even further, by bringing the data from a social network into a third-party application for healthcare and allowing for that data to be combined with new data derived by the system’s application, a seemingly private interaction currency could allow for consumers to rate the outcome and behavior experiences they have, their connections have, and they have with their attending providers as well as other members of the healthcare system (the current other 2 Ps in the healthcare system – payer and purchaser). In the healthcare system, this means monitoring of transactions to identify opportunities for improved patient care.

Big data

This all leads to the combination of social, physical, occupational, emotional, intellectual, financial, and possibly environmental and spiritual data for a composite view of the current, past, and future version of ourselves as we actively engage and interact with the healthcare system. This, folks, is what Big Data is all about. It’s not silos or collecting all the information into a repository, but the opportunities inherent in bringing together, ad hoc, the disparate pieces of data so that recombining that data results in insights into helping people. It’s why we get up in the morning at my company: “to save lives and influence the course of human events.”


What I’m suggesting is that there is a coming Uber-ification of healthcare that is the next step in the sharing economy’s development. It’s not certain to me how that shift is going to occur and certainly the healthcare system is significantly more regulated by government, more powerful than taxi companies, more necessary in the daily lives of individuals than most of the ways that the companies we identify as disrupting traditional markets. But I believe it’s coming regardless. We will see consumer-directed healthcare in the coming years become more commonplace with patients that are empowered to take control of their health and wellbeing. The question is only how, and how is the healthcare system preparing for the peak that we’re all approaching that is a consumer-directed healthcare system.

Health inSite: Consumer-directed Healthcare Part III


This is part III in a four part series. Links for Part I, Part II, and Part IV

And now, we get to the purpose of this series. 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.

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. 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 of how they 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


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.


The other side of this change to the sharing economy is supply and demand monitoring and coordination. 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.

The Conclusion: Part IV

Health inSite: Consumer-directed Healthcare Part II


This is part II in a four part series. Links for Part I, Part III, and Part IV

Behavioral economics

The complexity of the healthcare system as it currently is already embroils patients in the very difficult position of having to make decisions with imperfect, nonexistent, and unintelligible data. When individuals are forced to make a decision in a situation where these factors are present, depending on the cognitive capacity of the individual (complexity of thought, for one – see Thinking, Fast and Slow), sometimes results in fast thinking that may include cognitive bias (errors). When this occurs, decisions are poorly conceived and may result in catastrophic results. For that reason, we need a single, comprehensive, coordinated, and collaborative profile.

A personal profile/avatar

Which brings us to the core of a consumer-directed healthcare system’s BIG need. A longitudinal profile. The fantastic Jenn Dennard replied to a question posted on twitter recently

to which I say, Yay! There is a need, in a consumer-directed healthcare system, for the individual to be empowered in their decision-making by having the data on their past, present, and future outlook in the same way that we have the ability to understand our financial wellbeing over time. Organizing this information in a comprehensive, yet easily summarized way can help the consumer make determinations about what works for their short- and long-term investment in their healthcare options. While I’m tempted to refer here to the SAMHSA model of wellbeing to outline the information that should be collected in this profile, I’ll speak briefly on a few that I think are critical to the goal and then finally how they might work in tandem to help with decision-making.


Obviously, if we’re going to talk about a profile related to healthcare decisions, a comprehensive health record, complete with genetic profile, risk-factors, behaviors, and the like should be consolidated and coordinated. Something that looks along the lines of the EHR that is contemplated in this TED talk by Thomas Goetz comes to mind.


I’ve long said that healthcare is as much a financial decision as about providing care, but in more than just from the payer perspective. The provider’s ability to understand the financial impact in concert with the patient’s needs should be coordinated through this profile. But in a consumer-directed healthcare system, this also means empowering the patient with projections based on their health record that helps to estimate the financial burden that they may experience based on their health reality.


If you’ve not read any of my previous posts, I recommend checking the various postings on the importance of ‘social’ in shaping our health reality (I’ll point you to the latest here). The way we interact with our friends, family, neighbors, co-workers, etc. all shape our health reality. Incorporating and ‘animating’ those connections – really analyzing and understanding them – is a key element to making significant changes in our behavior as well as helping to alter the health reality of each consumer.


The psychological aspects of healthcare range from simple awareness (or lack thereof) to the complex co-occurring conditions to their interactions as the patient tackles their health reality. Further, the interpersonal experiences available to the consumer through their social network is sometimes limited by the psychological reality of the consumer – the functions or dysfunctions of cognition, personality, etc.

Game-state evaluation

In all of these components, it’s important to keep in mind that we are not static over the entire course of our lives and rarely so even when looking at only one factor. While research points to potential for adjustments in things like resiliency, literature also shows that we have hard-coded tendencies such as temperament. For more on game-state evaluation and other related topics, see my post on Decision Support, Games, and Making People Healthier.

Why tracking is important

A method for tracking those changes and dynamically responding to those changes along all axes can provide context for how the consumer should, and can, act on their purchasing, but also their locus of control and potential efficacy in using the system through the plan they intend to use/purchase.

Part III