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



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, 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 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


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

Health inSite: Consumer Directed Healthcare Part I



I was recently invited to participate in an interview for Stride (on twitter), a developing local Health Information Technology ecosystem that is the first of its kind in scope and vision. I’ll let you check out their site for details and spare them here, but I was excited to participate in helping to promote this project as a local member of the Health IT community in Colorado. 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.”

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

A shifting landscape

The Affordable Care Act has caused a seismic shift in our healthcare landscape and some are preparing for the fault lines’ impact on what were once the prairielands of the healthcare system. The new mountain ahead of us consists of layers of changes that I will attempt to outline as I see them. These are the result of following some very bright people that I will try to mention as I go. Follow these people! They are making huge steps toward preparing for these changes.

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. Those changes could result in significant, down-stream implications for how the future healthcare consumer engages with their health. 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.

Institutional vs. startups

If there is one person that I’ve heard that captures this coming change the most succinctly from the institutional perspective, it’s Aetna CEO, Mark Bertolini. A keynote at HIMSS 2014, Mr. Bertolini explained how Aetna is preparing for a more engaged, consumer-like patient in the Aetna model. If you don’t believe it, simply look at their acquisition of iTriage (among other advances, led by Michael Palmer, Chief Innovation and Digital Officer) that put the power of access and empowerment in the hands of their future patient.

Aetna made the right move by acquiring iTriage. By purchasing tech, rather than trying to build it out themselves, Aetna’s model is to scout and engage experts trying to help quell the shift in the landscape by harnessing technology. This means that rather than developing that internally, at a potential loss to the organization if it’s unable to deliver, Aetna can focus on its core offering. It also highlights a bigger shift in the healthcare ecosystem – one that Stride is very interested in nurturing – coopetition. Because these lean startup organizations have the ability to make changes quickly and bring in top talent to tackle tough, smaller issues – issues that can then be used in many different arenas. In my opinion, that nature of coopetition is a critical element to the new model of healthcare delivery, as I hope to illustrate in this blog series.

This is what disruption looks like


There’s no question that telemedicine is becoming a more regular part of the healthcare industry with companies like CirrusMD, Call-a-Doc Plus, and AccessCare Technologies’ Aveo platform and many others (disclosure: MINES currently has business relationships with CADR+ and AccessCare Technology) making strides to disrupt the traditional delivery model for healthcare by enabling secure text messaging, prescriptions by phone, and HIPAA-compliant video telemedicine, respectively – this isn’t an exhaustive list of what these platforms do, but just a couple of examples. This enables asynchronous, non-geographically-specific, and convenient communication between a provider and patient. While our current model of on-site care is relatively new compared to the entire history of medicine where patients go to the provider, the bigger disruption here is in the fact that the premises is moving away entirely.

Retail health

The weekly #HITsm chat had a great discussion on January 24th (transcript) regarding retail healthcare – the movement of retail organizations into the healthcare space. Companies like CVS, Walgreens, and Target are making movements to put clinics in their retail locations to decrease barriers to accessing care for routine events like physicals and non-urgent medical needs. If you want to check out a really cool aspect of this, Theranos is partnering with Walgreens to make onsite blood testing a realistic part of this system.


If you’ve not heard of wearable tech or the Internet of Things (of which wearables are only a part), you soon will. While Nike took early steps in tracking the efforts by athletes with the Nike+ system, this sub-industry has exploded with newcomers like Jawbone UP, Misfit Shine, FitBit, and even a tracker that will shock you into behavior change. While these various tracking devices are great at providing data to the person using them, efforts to make them usable in healthcare have been lacking. That said, there are efforts between Apple, the Mayo Clinic, and Epic EHR to solve this problem through Apple’s HealthKit. However, this change is only helpful to those that are on the iOS ecosystem. As you probably know, Google’s Android continues to gain ground in market share and as these devices continue to become more customizable and cheaper, iOS will either need to adapt or face staying in an ever-growing, niche market.

These are only the first step in a long development cycle of devices (and even things that don’t look like devices) that will someday be a part of our daily lives. In fact, watch the sequence a few minutes after Ewan McGregor’s character wakes up in the movie The Island, and you’ll get a sense for how this might play out in our daily lives. Actually, while trying to find that toilet scene where the character’s urine is tested while he is excreting, I found this article on a real-life example! Which now has my mind wandering on sample integrity…

Other major tech innovations

In fact, there are A LOT of people – very smart people – working on a number of innovations related to healthcare. Look no further than the IBM 5-in-5 if you’re ever wondering what some of those things might be. But we are quickly moving into a world where the things that are imagined in movies and TV are becoming reality – or are being worked on now to become reality. If you want a great example, check out the Tricorder X-prize. If you’re not familiar with what a tricorder is, here ya go!

A word on purchasers

The purchasers of the past are slowly slipping into the fog of a system going the way of dinosaurs. While our current healthcare system relies on someone purchasing insurance on behalf of a group of people, the new model of consumer-directed healthcare would include patients insuring themselves in a similar way to most other insurances – life insurance, car insurance, etc. In this model, the purchaser is correctly aligned with the responsibilities for maintenance. During deliberation of the Affordable Care Act, the Supreme Court actually highlighted how insurance could be mandated because cars can be mandated to be insured by the state. To ensure protection for all others in the pool of “drivers,” in much the same way that maintenance of one’s health and insurance for that health is a responsible act for the pool of citizens.


Consumers make this sort of decision regularly. When purchasing electronics, for example, there are often options for insuring the item from damage and even loss. When confronted with this decision there is, in the mind of the consumer, a cost:benefit decision to be made. When making a decision regarding level of coverage to insure one’s vehicle, a similar cost:benefit decision must be made for the consumer regarding their risk tolerance related to the value and potential loss in value of the vehicle. But in these situations, consumers are aware of their role as a consumer; that same level of awareness needs to be at the core of a consumer-directed healthcare system if we expect those decisions to be more straight-forward and realistic.


Millenials are fast becoming the largest part of the consumer segment of the economy; and they do things a little differently than their predecessors. As the CTO of Connect for Health Colorado (the health insurance exchange in Colorado), Proteus Duxbury, mentioned in a Prime Health Collaborative event that Millenials are soon to make up as much as 50% of the purchasers through the exchange in Colorado and they are preparing for this group which prefers peer-reviews to authoritarian ones. When I asked him about this posting, he shared this report from the White House on Millenials that you might find interesting for more details. Keeping an eye on the factors that make up this group is going to be important for their continued planning and development and healthcare organizations from insurance to consumer-facing wearables should take heed to the particulars of this shifting landscape. Community-focused, socially-aware, technology-forward, and averse to traditional signals of “growing” up like marriage and purchasing a home are all key differentiating factors. As those factors become more pronounced, healthcare will need to be aware of, and respond to, the way that these individuals view themselves and the world. Further, the section on a personal profile below will become even more pronounced and necessary to keep these individuals engaged and aware.

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, or in the case of labor organizations, a trust into which employers contribute along with the dues from the members. But now that is shifting as smaller 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 (see more in shared-economy model, below), we could very well see a one-to-one relationship between the provider and the consumer (patient-purchaser-payer). Hold on to your seats, kiddos. It could happen.

Part II

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


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?


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: Decisions and Privacy


There is a shift in healthcare related to our concept of privacy that is sorely needed – and it’s probably a little different than what you’ve heard from a lot of groups/people around the web.

We need to stop thinking about healthcare as a private thing.

As far as information about us, it’s simply no longer acceptable to consider our lives as private.  Not in a time where we actually understand our social network to such a degree that we can accurately and effectively map our connections in the social network (not like Facebook but friends, family, co-workers, neighbors, and the ‘guy at the gym’) and understand how we consciously and unconsciously make decisions about how we behave.  These behavioral changes manifest in health outcomes and as we move to a healthcare system (rather than a sickcare system) what you do is what you are – or more precisely what you are going to become.  Now, I’m not saying you shouldn’t be protected from abuse or discrimination or anything like that, but functionally, your decisions every single day are going to have an impact on more than just you; you owe some accountability to your social network (and they to you) as to what your decisions are doing every day, because Community is the Key to Health.

You may not know it yet, but what you decided to eat for lunch today (if you ate lunch today – and for some of you that might not even be the case) was decided long before you actually ate your lunch.  Here’s a non-exhaustive list of the ways in which this decision was made before you actually ate it:

Schedule: The structure of your day had an impact on what you ate for lunch.  Did you have a co-occurring meeting and therefore ate a “bagged lunch?” Did you have a meal prepared ahead of time – and if not did you have to throw a lunch together this morning before leaving, or did it force you to “forage” for a lunch?

Environment: Consider how the environment surrounding your lunch impacts your lunch decision. Did you run out for lunch because you needed some fresh air or a break from the office?  Do you have a place where you regularly eat lunch and therefore have a system for preparing for that meal each day – conversely, did that get interrupted for this particular lunch by environmental impacts like bad weather or the space itself was occupied in a way that prevented you from following that regular schedule?

Social Impact: For some, eating lunch is a social activity.  Do you have a regularly scheduled lunch partner? Was that true today?

Resources: Money and time as resources have an impact on the structure of lunch.  How do you use these resources in an intentional way related to your lunch habit? Do you spend money at a restaurant / court / vending machine each day or bring your lunch?  Do you have the resources of time and money to prepare ahead or use those resources to forgo preparing ahead?

And let me tell ya’, this isn’t even the beginning of the ways that this could be further expanded.  Think about all of the ways that a single meal is planned and replicate that process for each decision you make today.  Exercise, nutrition, social activities, occupational activities, mindfulness activities, financial decisions, personal intellectual development, etc. etc. etc.

Now think about this: why did you make those decisions?  Consciously or not, you may have made those decisions because of someone else.  Did your partner pack your lunch and therefore help to make the decision of what you’re eating – or was shopping not prepared in a way to pack that lunch in the preferred way?  How much of your diet is based on someone else’s decision?  Maybe your doctor suggested a change in your diet?  Maybe you or a family member has a dietary restriction that changes your diet on a daily basis.  In the case of a family member’s restriction, maybe your lunch is the time when that restriction doesn’t apply to your personal diet?

Lastly consider this: Can you push yourself to make a given decision either by limiting or adding options?  Can you change the options you have available at the point of decision-making with a little bit of foresight?  Try to find one example of a way that you can “pre-decide” by removing the alternative option.  Maybe one of the questions above can be flipped to help you make a “pre-decision” that will help you make a single, healthier decision this week – even if it’s only once.  You might find it’s pretty easy to do and may be a powerful way to change your behavior in a positive way.  And then consider the flip-side of this.  How can you help someone else through a “pre-decision” that helps someone in your social network make a decision that is healthier for them?

Here’s what I’m saying, and to slightly alter a quote from Cloud Atlas:

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.

It’s time for us to stop thinking that we are fully separate members of society that don’t have an impact on others and start being accountable to one another for how the decisions we make impact others – and vice versa.  Yes, even in health.

To our health,

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