My Twitter Integration/Use Methodology: DPSR

Steven Krein
of Organized Wisdom and I sat down in a Starbucks in Philadelphia last month to talk about healthcare, HIT, online health search, etc. I left the meeting with a really fascinating offer to collaborate and a really tough question to answer...

Steve asked me at that meeting how I use Twitter, and whether or not my process was replicable.

Stumped, at the time I answered that I had no idea - use/posting to Twitter was just a semi -automatic stream of consciousness flow of links and concise commentary.

On the train back to DC, I started thinking, hard, about how I use Twitter. Would it actually be possible to identify components of the process in order to explain, and yes, teach the process?

After a lot of thought, I figured sure, why not? But test the process. See if it works for you.

So here goes, what I do on Twitter...

Here's a short summary of my four step process, DPSR, involving these components:

1. Data Gathering

2. Processing

3. Synthesis

4. Redistribution

If you break a specific action, say posting a link on Twitter, down into these 4 parts, you can begin to measure, analyze, and visualize how you're spending your time (or wasting it).

Try this: Pick a link from your email inbox (say MedPage). Here's DPSR in action:

  • D = reading the email news digest ~ 5 mins
  • P = finding relevant link on breast cancer ~ 2 mins
  • S = reading the article, thinking about who's interested in this type of research, where to post it, do I need it for anything on which I'm working, etc. ~12 mins
  • R = tweet the link ~ 30 secs
This is DPSR done *right. Picture what a pie chart of this activity might look like...

However, most people are spending the majority of their time on D or R - reading through a ton of information in depth. It's complete data overload, and it fries the fuses faster than Christmas with the in-laws.

You should be spending the majority of your time on processing and synthesis. Pare down your incoming data streams until you know they're at least 75% likely to give you something useful during data gathering.

If an e-newsletter, magazine, or newspaper isn't giving you good actionable data, parse it out.

NOTE: It's important here *not to cut yourself off from a small % of 'pure' research sources - sometimes an idea springs from a completely unexpected source like looking at the Red Envelope catalog. I am not a machine.

I waste some time reading historical romance narratives and watching C-grade movies on iTunes. Cut yourself some slack.

Useful information is that which helps you synthesize new synaptic connections between content and coherent usage - sometimes the benefit of a source is generative rather than redistributive. And sometimes useful information just helps you recharge, a la the approximately 10% of time I spend "personal" tweeting on Twitter.

NOTE: Can't state this strongly enough - always, always, keep your end audience and end action goal in mind.

  • What specific goals (quantitative and qualitiative) should your time spent help you and others achieve?
  • Do you want to start 2 debates per week on revolutionizing primary care?
  • Find a good researcher with whom to collaborate on a paper by February 1st?
  • Get 10 health colleagues interested in an event?
  • Engage someone, *anyone* in a conversation about what's going on with your health?

If you don't have goals for how you use Twitter, you're wasting a significant amount of time and energy twittering about.

Cathartic, yes, but then you're missing out on the significant collective power of the health/medical Twittersphere.

And healthcare needs full asset utilization, full speed ahead, not more empty talking-head commentary.

And now, practicing what I preach. With that, back to processing...


Twin Post Day: Why n=1 Really Matters - A Conversation with Docs on Twitter

"...the patient's perception is the core of the interaction..." - @DrCris

"The patient will always tell you what's wrong, you just have to listen..."
- @KittKlaiss

This week's successful post was going to be the long-winded, semi-elegant (or so I told myself as I spent nearly 2 hours typing it) diatribe on underutilized, subjective, individual patient narratives published below.

But something funny happened on the way to the forum.

En route to hitting the "publish post" button, I paused and thought - hmmm...it'd be great to get a doctor's perspective on why, when, and where in the care process a subjective patient narrative matters, like during the history & physical.


If I'd like to learn about how to become a better patient, and connect my subjective personal health narrative to my provider in a way that helps them treat me more efficiently and empathetically, shouldn't I just ASK why we conduct history and physical interviews the way we do? And learn more about how THEY learn to communicate with patients? And how THEY value (or don't value) patient narratives?

But where was I going to get this kind of access to doctors? What type of rarified environment and community would actually encourage this kind of exchange? I could think of only one.

So I posted the question on Twitter. And @symtym, @DrCris, @ruraldoctoring, and @KittKlaiss answered. Someone even brought snacks...

Two more hours later (amidst lively discussions of chinoiserie, color matching, and orifice differentials - don't ask) - what I learned about being an effective, empathetic patient:

  1. Your doctors don't want to miss a thing. They also don't want to waste your time, or theirs.
  2. Carry a current medication list in your wallet. That's right. Very Health 0.0025, but it works...
  3. Why are you there? What happened? What do you feel happened? What makes you tremble in the night?
  4. Take a lesson from chronic patients who do it right - keep information in your narrative clustered and congruent like a Nerds Rope - tight and sweet.
  5. Surprise: Your doctor is listening. He or she spends significant time gaining n=1 professional knowledge to conduct this H&P interview for greatest ROI.
  6. What is your hypothetical wish list? Why does it matter?
  7. Don't front load. It's like butting in line at an all you can eat buffet. Or screaming shamelessly for votes in the latest Twitter popularity contest. It works once, but catches up to you later.
  8. If you're going to bring up ancient history, make sure it is relevant to the issue at hand, at least until we get a kick-a#$ PHR underway....
  9. Give relevant details. She isn't asking about your holiday party exploits for her amusement (well, perhaps that story about table-dancing and spiked punch does serve a dual purpose...), but since you hit your head on the corner going down, you *may want to share that event when talking about your blurred vision.
  10. Alternate for 9 above - cut the crap. If you had 10 slides of 140 characters to tell your doc your concerns, what would you say (pure hypothetical)?
  11. Don't always count on the web to save you (or your fellow patients).
  12. Consider bringing cash money. Or dolls. Kidding! Maybe...
  13. Everybody lies. But try not to lie on this one - What do you want?
  14. See 13. Your doctor cannot read minds. Bonus: Neither can your significant other. Thank you for your attention to this matter. Your health definitely depends upon it.

Long and short of the subjective, patient narrative: It's vital for you to share. It's vital for your doc to hear, filter, analyze (and record). An antagonistic or diametrically oppositional orientation between patient and doctor can only be prevented with n=1 adoption from both sides.

Why are you there, after all? To seek care. Why is she there, after all? To deliver care.

These are complementary, not competing, goals.

Your narrative is a vital piece of the puzzle and your doc needs to not waste precious appointment time sifting through your data with the blunt instrument equivalent of salad tongs.

Being a proactive e-patient means adopting the n=1 orientation whole hog. Right and responsibility. What I heard from doctors tonight gave me hope that we haven't (quite yet) reached the mushroom cloud of mutually-assured healthcare system destruction.

As long as there are docs willing to take time out on Twitter, a social media channel for God's sake, to answer idealistic n00b questions about 'being a better patient,' there's hope for the system.

One even found it "fun!"

Doctors on Twitter - thank you.

The post below is self-serving, somewhat fancily written vaporware with some good soundbites and metaphors for chewing later. I won't delete it so readers can see the contrast. This post, relating our conversation, is the opposite.

That Twitter conversation will be the centerpiece of my "something promising in the system," a positive experience we've been asked to share at Dr. Val's on Healthcare Community Meeting December 30th, at President Elect Obama's behest.

It's a lesson I hope all those working for healthcare reform take to heart next year: Ask, don't assume you know what's important. Ask patients. Ask doctors. Whenever you're writing a whitepaper, or a blog post or a policy recommendation, ask first. Write later (or simultaneously).

Thanks to all of you on Twitter, here's what I learned this morning, sitting at the computer (but not sitting alone) re-learning how to be a good patient, and why I have more hope than cynicism moving forward...

The healthcare profession is n>1. Being a patient is n=1. But doctoring is also very much n=1.

It isn't the n=1 orientation that matters, although that is the first (and a vital) step.

It is the ability of each individual n=1 to be cumulative, to add to a larger aggregate that increases value, clarifies understanding, and promotes communication across professional healthcare constituencies. You've done that with me, for me, this morning.

Now, who's going to design tools *you'll actually value, based on challenges you see in real-world practice* that help you make better use of our time together?

And who's going to design tools that will help other doctors pick up the narrative when I see them?

That's a post for another morning of revelation...


Why the Focus on Personal, Experiential Care? The n=1 Manifesto

"...to classify as a puzzle, a problem must be characterized by more than an assured solution."

- Thomas Kuhn, "The Structure of Scientific Revolutions"

If there's one thing I could shout from a patient perspective next year - it would be this:

I want to be a "
live node in the network" (slide 5/51 by mingyeow, on Slideshare).

And I want that node to carry more weight via its connections than via a rogue satellite orbit.

Disclaimer 1: This is a necessarily selfish orientation - because while I can posit what other e-patients will think of that statement, I can in no way guarantee the majority (or even many) feel the same way.

Disclaimer 2: In addition, I can't speak for other patient orientations - as a 'live node' in the medical network, my data transmission may be either voluntary (willingly given during a conversation with a doc or via consent to testing/treatment) or involuntary (incapacitated or unwilling, via testing while unconscious for example).

Patients may convey information verbally or physically or both, via spoken or typed responses to an H&P interview or via lab and test results, etc.

In this post I specifically address the portion of data that is shared verbally, at will, by the patient, during conversations with a provider.

Disclaimer 3: The background, generative interactions that inspired this post happened in a combination of real-world settings (Medicine 2.0, Health 2.0, Geek Tech Brunch, Clinovations, Ignite Boulder) and online conversations (mostly on Twitter - god love that 140-character channel and tinyurl.com).

With the political climate focused, at least superficially as Dr. Stanley Feld notes, on generating input for PE Obama's incoming administration and subsequent healthcare reform efforts, we have a chance to pulse that live node for all it's worth.

It's a kind of 'nowtopia' for healthcare.
It's called engagement (micro and macro). And some e-patients are ready for it. So are some physicians.

Why does any of this matter? How can a study the size of an individual hold any populational or systemic relevance?

One limited perspective is that there is NO populational impact for healthcare that does not germinate in the personal.

For the purposes of this post, I'll argue from this perspective.

Even when we vaccinate to protect against this season's latest strain(s) of flu, we begin one shot, one person at a time. The most important and also most difficult decisions in the healthcare delivery system are also n=1. Death is individual. Deciding how you want to prepare for death (or if you do at all) is a highly personal choice - but one that should be discussed more often.

This is, to some extent, also very much about control/choice-aware care, or the lack of it in our current system.

Let's gallop ahead to an example where individual control of healthcare decisions are swept out of our hands. Say a government decides to perform secret medical testing on a population, and administers a 'treatment.' At some point, it IS a decision left to an individual to authorize. n=1. For better or worse.

I'm not arguing for 'snake oil' sales pitches or anecdotes in leiu of science. Smooth talkers (and adept marketers) abound in any industry, and healthcare is no exception. But we need a sentient approach to conversations in addition to more rigorous scientific exploration of concepts.

n=1 care isn't about 'in leiu of' - it's additive rather than reductive. It's about a coalescence of all available resources in the healthcare system pushing towards a ripeness, nearer to 99.995 percent utilization.

Docs are time limited and resource strapped. Patients need to bear some of the burden for effective resource utilization. This means acknowledging and recognizing a nuclear, patient-centric orientation, with incorporation of subjective, experiential data, is absolutely necessary from the offset.

Patients: It means not messing around when that doc enters the room. It means putting down your magazine, holstering your Blackberry/iPhone, and being ready to share questions and concerns.

What are your fears? What are you feeling? Why are you there? What background knowledge and perceptions about what's happened bring you to seek care? That's vital patient knowledge.

And patient knowledge is being wasted.

Experiential, subjective, n=1 knowledge is the most vastly underutilized human capital in the healthcare system. And what do we call an asset we're not using? A frakkin' waste.

Or is treating patients one at a time a "wasting asset?" (thanks to @sjdmd for the link and quote).

The patient's narrative counts for something during a history and physical. But what about after that?

Don't listen to this blogger, who is undoubtedly tarnished by an association with all things -wide eyed and wonderful related to Health 2.0 (despite the fact that I've also been an active interrogator of companies, and the movement, from the outset).

This is a call to action. Form your own hypothesis. Use informatics. Do a study on it (or 20). Prove your point. Or disprove it. Use methodologies valued objectively for their statistical and quantitative outputs.

And lest you think my focus on n=1 here indicates a blind eye turned to larger, more statistically/population relevant studies, please understand one thing: the fact that I don't regularly (and personally) run the numbers doesn't mean I don't highly value this kind of n>100 analysis, it just means I don't have a natural talent for it, nor a learned skill.

I'll leave it to those with more informatics experience, appropriately so - to produce good, juicy data sets.

Back to n=1.

We are always looking for services that help us create meaningful connections, whether it's an oil change or a knee replacement.

It's a question of fixing systemic functionality in an individual context, whether that helps me drive safely over the hill and through the woods to Grandma's house for Christmas or kick ass on my next golf game while skipping along the path to all 18 holes.

Healthcare is no exception.

In fact, in healthcare 'meaningful' connections take on a whole new contextual meaning. And here lies the serious opportunity for serious (#sarcasm) scientists - too connect this new contextual meaning with relevant online/offline analytic data and personal, n=1 subjective me-trics.

We are in the midst of a scientific revolution in healthcare, or we would be if scientists (both amateur and professional) would get off their a*& and work at connecting these disparate theories.

If that's not enough, oh scientists shouting into the void for funding - this is a hot area. Read: $$$. Grants! Population studies!

To focus on the aggregate, however, we must first focus on the personal. Communities behave differently than individuals, and of which are we more afeared in health? My compliments and complaints about healthcare? Or my social network, n=35k strong, complaining about 2 mins with our primary care physicians?

I'm going to take some flak for this one for sure, but check out the relationship between characters played by Morgan Freeman and Jack Nicholson in the boomer hit "The Bucket List." The two men bond, kudzu-tight, over a patient experience.

While few patients I know of have the good fortune to meet up with a wealthy co-sufferer who funds their every impossible dream before death, the vital import of connectivity and companionship, and the revision of personal identity in the face of patienthood, is a subject, surprisingly valued in the movie, that we've shunned for too long.

These are n=1 questions: Who am I? Who am I with an illness or injury? What identity do I want to keep?

Becoming a patient forces a personal reformation that has the chance to become either your Great Enlightenment or your Dark Ages. The resources and connections you utilize may influence choice in either direction.

HIT, eHealth, mHealth, Health 2.0, HoIP - all these 'movements,' conferences, and subsectors are, at the most basic substrate level, helping consumers (whether patients or providers or purchasers in the form of pharma or insurance) devoted to scanning the system to create additional enmeshed connections where opportunity doesn't fall through the cracks.

Another perspective: Only an n=1 system allows us to close distances between people and resources in the system needed to enact change.

Separation, or a feeling of isolation, is the enemy of healing and also the enemy of healthcare reform. Jacqueline Fackeldey, typically, has it right ahead of the rest of us - this is about human to human. Hotealthcare, she calls it.

Anything bigger and we hit the reform-wall equivalent of 'one day at a time' - we won't be able to push our own boundaries past systemic obstacles to envision, must less enact, improvements. Doc Searls theory of The Big Zero is a must-read here. Doc posits that nothing in a zero needs improvement.

But we already have a superorganism in the healthcare system - a self-contained unit of knowledge and experience that has multiple datastreams related to individual illness and injury. It's the patient.

Patient-knowledge is literally transcribed on the body, in multiple dimensions. Three small theoretical examples:

1. Mind
2. Heart
3. Body

Why are we afraid of a one-at-a-time orientation in healthcare? It forces us to be present with the person, rather than the process. It's about dialogue combined with diagnosis. Neither supersedes the other in an n=1 orientation.

But n=1 is powerful for more important reasons. It means when we ask about fears and dreams, what we want to do if and when we heal (and what specific clinical treatment pathway we choose as a result) - we will hear very difficult things. Things like a fear of death. Things like the fear of failure. Things like having to say: "I'm sorry. I cannot save you."

We start from a fundamental disconnect in the healthcare delivery system.

There are only two absolutes in life. First, you are born. Congratulations, since, if you're reading this blog, that's already happened (Happy belated birthday). Second, you will die.

Everything in between is negotiable-at least until we get way further along with predictive genomics and genoanthropology.

When we start out at the top 3 of Maslow's heirachy of needs - once safety is relatively stable, we're looking ahead to belongingness, esteem, and self-actualization.

But there are some marked benefits to exploring an n=1 orientation.

For one, user-centric design in the healthcare setting with an n=1 focus brings more benefit to designing 'lightweight interactions' or those that make it easy for users to contribute. Ted Eytan and Carlos Rizo have suggested various uses for Twitter in the hospital setting, including a pre-op waiting room 'time capsule' and alarms linked to playlists rather than machine sounds, which then Tweet your current song.

Life is increasingly lived via an in-the-moment orientation. n=1 orientation can help smooth the psych barriers that living in this constant magmal flow of information cause.

Set aside for a minute good/bad - this means archiving will be a top priority, and opportunity, and then data analytics/informatics that let us monitor and reflect upon individual trends in societal/self-appointed group context will be big challenge (me-trics).

I'm not advocating for anarchy here - or complete and total divisive rebellion where n=1's band together to become n>1 and take over existing organizational orientations. Rather those of us who are working to be small splinters of reform are moving forward towards a more holistic integration of n=1 tech into the healthcare provision and delivery system.

Again, I am not arguing for snake oil in leiu of science. A bivalve approach is what's needed in healthcare - valuation and integration of both subjective, personal, patient-contributed n=1 knowledge, and objective, clinical, provider-issued n>1 determinants.

Personal, subjective, anecdotal and population, clinical, scientific, statistical - they both have roles to play in healthcare. To negate either is to perpetuate a myth that the practice of medicine occurs in a clinically effective void where all is efficient and antiseptic. It does not. Medicine is not delivered in a neutral, homeostatically perfect envelope.

Its delivery, BY and TO the human element, means anecdotal data is constantly computing in a never-ending stream. And this data does have value.

But to mine that value we must have n=1M, n=1ook, n=300, n=30, n-1. Large scale AND small scale studies.

This is the reason, anecdotally speaking, that I'm personally and professionally involved in both the Health 2.0 and Medicine 2.0 communities, in addition to various others. I am defined wholly by NEITHER.

I am a composite. As is each person, as is each patient, as is each physician, as is each treatment plan. A compendium of experiential knowledge combined with more statistical rationale.

I am a member of many, many groups, but my identity is not subsumed by my membership in any, or in the aggregate. Group identities allow us to lay claim to bits and patchwork pieces that help us formulate more robust self-images, which we then refract to the wider world via social media.

Social media, for better or worse, allows some control (real? illusory? both?) over the identities we portray. There is something disturbingly powerful, potentially dangerous, and wonderously cathartic in this. And in the sharing of individual patient experiences and personal medical knowledge via these lenses.

And if you believe my anecdote has no value because I haven't done a study of Hawkins IV talar fractures and subsequent operative/therapeutic recovery patterns and efficacy, if you believe my anecdote has no value because I haven't looked larger than n=1 , consider this...

There is a reason I don't do these studies. That is not where my strengths lie. Would I be capable of doing them? Probably not. With guidance? Perhaps. With collaboration? Yes. With additional mentoring? Sure. You see where I'm going with this.

N=1 isn't an end-destination for healthcare innovation. No one person embodies the knowledge needed to move forward. But it is a starting point. A growth medium.

N=1 experience needs to be additive before it can become exponential. Patient (n=1) + Physican (n=1) and all of a sudden you have a larger N. N+N2 and things begin to multiply. Utility becomes multiplicative.

Here's the thing - anecdotally. Medicine is statistical. Health is statistical. Life beyond vital signs, however, the sharing of experiences in health and medicine, is anecdotal.

Medicine, health, as practical applications, as care delivery, as lines of research, are indivisble from the pursuit of LIFE. This debate is indicative of a larger failure we share (scientific, academic, Health 2.0, etc) to value integration and utilization of "n=1." The subjective. The anecdotal.

It is turning a blind eye (or n=1) to the fact that clinical, and thus statistical efficacy of care delivery, is influenced by individual interactions between patient and provider. That patient emotions, and, gasp, decisions, may be based in part on our relationships with our doctors, which are very n=1.

But don't take my word for it. This is purely anecdotal evidence. Which isn't evidence at all. It's opinion. Just an opinion. But one last thought - why is it that during an exam we begin with the anecdotal H&P?

If we're constantly trying to divide patients out of the equation we're wasting precious energy for a needlessly reductionary exercise.

Stop wasting so much energy on trying to keep patients 'out' and we'll begin to reexamine/redesign the spatial orientations and interactions (both 'real world' and in the cloud).

An n=1 orientation allows us to focus on the "psychology of space" created by our interactions with healthcare environs, and think of ways to augment that wave pattern with embedded online access points.

With Twitter, for instance, the message decays (and has a half-life that varies by channel - each social media app or site has its own half-life signature) but the channel of engagement doesn't. Like an aquaduct, the piping/transport system is there long after a certain volume of water has flowed through it to the end destination and been utilized.

Now I'll restate the blatantly obvious, but bear with me for a few more sentences. N=1 brings social media into healthcare's orbit because each patient also has an individual half-life. Like chemical symbols, each one is unique. Social media is, increasingly, the way we leave radioactive marks, our personal signatures, behind.

When I'm past the latter end of the lifecycle, I hope my family and friends read my notebook scribblings. My tweets. My blog entries. Combined with what they know about my physical, interactive self, this presents a more complete picture of who I am and what I value. What information I used to make decisions. What things I found important enough to write for and fight for.

This is my digital genome. N=1 healthcare will, cyborg like, enable it to coexist with my physical proteome. Together, the two equal my meome.

And it is always with the meome in mind, first and foremost, that I make healthcare choices relevant to my personal narrative, and how I want my choose an adventure story to progress.

Our genetic blueprints vary, despite large similarities - there is no one exactly like us (or at least not until cloning goes mainstream) - no intersection with care that works *exactly the same way with 100% certitude. Each person's body of knowledge is an isolated, underutilized scrpt, an individual Rosetta Stone that must be translated for best care efficacy.

Until we allow ourselves to focus on the n=1 in healthcare, we will not succeed in utilizing this largely discounted asset to the fullest.

I don't know about you, but I'm not a huge fan of senseless waste. New Year's Resolution - focus on channels, methodologies, tools, and groups that allow n=1 utilization, and integration into a systemic ecosystem of care planning, delivery, and evaluation.

Now, who's got the eggnog?


Dutch Grand Rounds - Grote Visit: Happy Holidays Edition

Unfortunately for my Dutch friends it's my turn again to host Dutch Grand Rounds.

It's been a frantic few weeks preparing for my presentation at Ignite Boulder (organized by Startup Weekend and VC Wear founder Andrew Hyde and buddy Ted) working on various other behind the scenes meetings and initiatives, helping some Health 2.0 and Medicine 2.0 friends with values clarification and goals, and getting some new fires started with the Clinovations gang in DC.

Many thanks to @laikas for calling my attention to this week's assignment, as otherwise I would have fallen down the on the job!

For this edition, let's take a quick look at living well during the holiday season, and gearing up for a Big Bang new year.

Sinterklaas has arrived in the Netherlands, and here in the US we're still busy preparing for Santa (and if some of your Twitter accounts are any indication, downing entirely too much eggnog and other assorted holiday cheer).

First up, let's talk winter blues.

SAD getting you down? Dr. Shock, a physician at Erasmus MC in Rotterdam, tells us how to prevent the onset of depression here at his neurostimulating blog. We could all use a good jolt now and then...

And speaking of SAD, winter blues, jolts that jerk us out of complacency, and other things mental health...

Those of you who have seen the research Maarten den Braber and I have been working on for most of last year will know I'm addicted to improving care, via an almost rabid focus on advocating for transparent, usable online health content to support patient-provider conversation and subsequent decision-making.

Despite a near-constant wellspring of optimism that things are changing, a recent four-part experiment with my sister (searching for a Lasik provider; videos posted on YouTube here) changed my view of where we are in the evolutionary eHealth, Health 2.0 adoption process.

Patient/consumer-facing health content online is still largely found via an inefficient series of disconnected queries. Google encourages us to search for things like SAD, depression, etc. But we think in context, not in keywords, especially with regards to our health and wellness.

Over the past year, looking extensively at content online, I've come to the conclusion that if I believe we're headed for ubiquitous or semantic interoperability of health ("consumers will be able to access healthcare goods and services, online and offline, at will"), we need to focus first on credible, trustworthy content that helps patients and providers communicate based on a common substrate of personally, situationally relevant data.

This means, health and medical folks, that if you're in the field, you may want to try a test search yourself and see how far we have to go. And then think about doing something to solve the issue, instead of just posting complaining blog posts or tweets.

So next year, I'll be focused on doing just that - working to improve patient interfaces with web tech for health use (a very cyborg-anth orientation as I learned from @caseorganic at Ignite Boulder - check Amber out here).

As such, I'm proud to join the Organized Wisdom team as Chief Patient Advocate.

It's a unique new position (more details to follow) with a stellar company and team (@stevenkrein, @unitystoakes) I've admired for some time.

Responsibilities are still being ironed out, and I'll continue to work on various other initiatives (Nexthealth, Clinovations, semantic interoperability research, etc. etc.) but what better ways to chase away winter blues than gearing up for a big change?

But don't let me take the cake on this one...

To health and medical bloggers (and tweets) - seasonal downtime is the perfect opportunity for us to move forward with new initiatives and reenergize each other for the cold weather left before spring.

Even if you loathe the whole 'Happy New Year' resolution cycle, think seriously about where healthcare is headed, and where you want it to go. In this season, nearly anything seems possible. Focus on how to reenergize yourself for the next long year ahead. Let's figure out how to be each other's Vitamin C.

Now I'll jump off the cheerleader pulpit and back into the meat of this post...

Although Vitamin C may help prevent scurvy, it may NOT have drastic preventive effects when it comes to prostate cancer. Jacqueline at LaikasMedLibLog takes a refreshingly thorough, well-cited look at trials examining Vitamins C and E here.

Big lesson from Laika: Forget the quick fix.

"The trials make it highly unlikely that vitamins prevent the development of prostate cancer (or other cancers) when given as a single nutrient intervention. Instead, as Dr Sasso puts it “At the end of the day this serves as a reminder that we should get back to basics: keeping your body weight in check, being physically active, not smoking and following a good diet.”"

And yes, Jacqueline DOES practice what she preaches - op en fiets!

If you're a pharmacy tech and you want to move forward next year, consider certification.

Matthew Evers, of Evers Marketing LLC (and also apparently a premed student by day), has a guest-written post (I believe? Who's Ruth?) about allergies over at Fast Medical Info. This was a pretty random submission (and is hopefully not spam) but I'm the tolerant type, especially bolstered by holiday cheer.

Matthew - if you're on Twitter, please respond in the comments so we can follow your exploits. Also, you should get in touch with Berci Mesko of ScienceRoll and Webicina -you guys have interesting goals in communion it would seem...

Jan Martens at Medblog.NL gives us a review of a new 50 top Health 2.0 blog listing (which includes Laika's MedLibLog).

Good Christmas reading if you need to escape from the family for a little work time...are there any additional Dutch medical/healthcare/health innovation bloggers who should be included?

Any new entrants in the space to whom we should extend a virtual handshake? If you know anyone who's just begun publishing in our sector(s), please leave a link in the comments.

And finally, a very happy, safe holiday season for all.

May our health, and that of those around us, drive us to productive heights in the new year.

Gelukkige Vakantie!


Do Docs HoIP? Physician Engagement Series - American Well & HMSA

A recurring topic of conversation (online and offline) lately involves discussion about US primary care circling the drain.

KevinMD suggests rebranding the specialty (pre-hospitalists, anyone?).

Jay Parkinson suggests a good ol' fashioned with a twist - Hello Health's ridiculously convenient concierge-type system that provides physicians with the flexibility, financial freedom (cash-only practice) and tech-enabled tools to reconnect with patients in a more efficient and empathic manner.

In several of my professional healthcare 'tribes' (health/medical tweets, at industry shows, via email/Skype), another hot point is how the eHealth/mHealth/telehealth firms will successfully (or not so successfully) engage and/or recruit physicians.

My focus of late has turned to those in small group practices (1-6 docs) who may not have time or money to implement such systems, or protect themselves from legal ramifications of deployment and use.

Many of the most detailed (and heated) exchanges and stringent calls for evidence of Health 2.0, eHealth, and mHealth efficacy are happening on Twitter.com.

But even debates between the most stalwart critics and enthusiastic fans of the Health 2.0 movement, chatter almost always ends with pleas for published case studies or 'best practice' examples.

Blogger's Disclaimer: I will not be providing a peer-reviewed academic study on best-practices in physician recruitment to the HoIP space (yet), since I don't want to sit on this information for half a year to go through the publication process (shocker).

I do, however, absolutely recognize and acknowledge the importance of such studies (I'll be co-chairing the HoIP track at WORLDCOMP 09 - many thanks to Dr. Andy Marsh for the invitation) and hope more qualified readers will engage with this data to perform a rigorous statistical analysis of what's working to engage docs - and what's not.

For my part, I'll provide n=1 interviews with several companies in the space to perk your interest and get you started.

Please contact the companies directly if you'd like to discuss enrollment in an n=100 study. Feel free get in touch if I can be of help facilitating engagement, which I'll be happy to do on a volunteer, 'public good' basis as long as you agree to distribute resultant research in an 'open source' manner with Creative Commons use agreements.

Let's get started with a bang. First up is American Well, scheduled to deploy an internet-enabled online care marketplace, in partnership with HMSA, throughout Hawaii mid-January.

Yael Glassman, VP of Marketing, was kind enough to explain how the partnership engages physicians in great detail last Friday. Thanks again Yael for your time!

Interview with Yael Glassman, VP of Marketing - American Well

1. Jen
: With HMSA/Hawaii being the first state set to go live with the American Well Online Healthcare Marketplace (still set for Jan 09?), has utilizing only doctors already within the state's plan given HMSA and American Well a jump on finding doctors who will use the service?

Yael: HMSA is going live on January 15th. For the most updated view on the launch plan visit HMSA.com and check out the most recent press release here-- http://hmsa.com/mediacenter/press/2008/081203_onlinehealthcare.aspx.

HMSA is offering American Well’s service to all the residents of the state of Hawaii (1.3 million people). The doctors are all part of HMSA’s existing provider network. They are credentialed by HMSA and they are all local Hawaii doctors.

And with regards to AW recruiting physicians – American Well partners with health plans to bring online care to both patients and doctors. The health plans, who operate the service in any given geography, offer it to their existing provider network.

AW also supports the rollout process to physicians with templatized knowledge, starter kits and close collaboration during the implementation.

2. Jen: How many physicians in the HMSA network are you expecting to participate on initial rollout? Quarterly? At the 6 month mark? Within a year? Two years? Give us some quantitative, specific stats on how many docs you expect to be using AW in Hawaii. What percentage of total docs in Hawaii does this represent?

Yael: Stay tuned for a little longer because HMSA is going to be publicly announcing how many doctors are signing up...

Here’s a recent news clip: http://www.khnl.com/Global/story.asp?S=9455548

3. Jen: What are ongoing AW efforts surrounding doc recruitment/awareness in Hawaii?

American Well is a partner to HMSA - HMSA organizes the plan's rollout and performs primary physician awareness activities, but the marketing team for this project is a joint team.

We participated and we've helped with pretty much everything that's going on - for example we helped HMSA launch an online community for doctors, a blog, etc. All of our joint efforts are very much in support of the health plan.

4. Jen: What are ongoing AW efforts surrounding doc recruitment/awareness in other markets? Will AW work with partners who roll out the online care marketplace to share recruitment costs, time spent, etc?

Yael: American Well markets to health plans. Our service is offered through health plans, and they are the ones, that offer the service to the physicians that they have already recruited – their existing provider network.

5. Jen: How do you protect docs against liability, malpractice issues? (short version, I know there's been a lot of coverage here).

Yael: Just pull from website - there's plenty of information available in the FAQ section here: http://www.americanwell.com/physicians_faqs.html.

6. Jen: How much do you pay doctors who choose to practice with American Well?

Yael: For one example in the state of Hawaii check out -- http://hmsa.com/mediacenter/press/2008/081203_onlinehealthcare.aspx . The payments for physicians using the system is determined by the operating health plan, so there is geographical variability and plan variability.

7. Jen: How are you preparing doctors who *don't* participate in the current, brick-and-mortar system for unexpected demands? i.e. - "I chatted with a doc on American Well, who told me to come right to the ER...." What happens if a patient and a provider are using the American Well system and something goes wrong?

Yael: When practicing Online Care, physicians have full discretion to use same medical judgment that they have in the practice. Just like in the practice, it’s up to the doctor to decide what the best course of action may be for any particular patient.

In some cases, the doctor can give advice immediately, in others she will require further evaluation tests, workup. Each case is very specific and it’s up to the doctor to decide how best to proceed based on the information that they have in front of them. It is important to note though that online care complements in-person care.

8. Jen: Saved the biggest for last - what 'pain point' are you trying to solve for physicians with the American Well online care marketplace? Why should physicians consider practicing via American Well?

Yael: It comes down to one simple statement – freedom to practice on your own terms. Physicians can practice anytime, from anywhere and generate revenue. Check out Roy Schoenberg’s short interview to The Doctor’s Channel here: http://www.thedoctorschannel.com/video/1173.html.

Thanks again Yael - stay tuned to HMSA's site for the latest updates on AW's online care marketplace rollout.


Thankful for Life? Talk With Your Family About Dying - Engage with Grace

Blogger's Note: Please. Talk with your family, friends, advocates, and caregivers about end of life choices. Do you have an advanced directive? A living will? This is *not* the kind of thing you want to leave til the last minute (literally). Live well. Engage with grace.

From the Engage with Grace team:

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones "know exactly" or have a "good idea" of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences.But our end of life experiences are about a lot more than statistics. They're about all of us.

So the first thing we need to do is start talking. Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences.

And we're asking people to share this One Slide - wherever and whenever they can. At a presentation, at dinner, at their book club. Just one slide, just five questions.

Lets start a global discussion that, until now, most of us haven't had. Here is what we are asking you: Download The One Slide and share it at any opportunity - with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them. Just one slide, just one goal. Think of the enormous difference we can make together.

To learn more please go to www.engagewithgrace.org.

Dying is never easy. Don't place an added burden on your family by requiring them to sort out these decisions for you.

Don't just read and talk about your choices. Document your wishes for future use.

"As a health care lawyer, my occupational disability is seeking to ensure that conversations started through the one slide actually end up with properly documented health care directives that are entered into medical records and discussed in advance with physicians and caregivers."

Blogger David Harlow provides a link to legal forms for end of life care here:http://healthblawg.typepad.com/healthblawg/2008/11/engage-with-grace.html.

Get started thinking about how you want the finish to go. Can you control death? Prevent dying? No. But you can spell out how you'd like to be treated. Engage with grace.

If you follow me on Twitter, you'll see updates related to the Engage with Grace project throughout the week, including how my friends and family have prepared and documented wishes for end of life care, marked with the #engagewithgrace hashtag.

Plug that term (with the number sign preceeding) into Twitter Search, or just use the terms 'engage with grace' and 'one slide' to look for more.

Special thanks to Bob Coffield (@bobcoffield) who engaged me with an eloquent email, and provided the links below:

Watch Alexandra Drane tell the story that I heard at the Health 2.0 Conference:

Read the Boston Globe's article today:

The Engage With Grace main page:

Special special thanks to Matthew Holt and the team at THCB (John, Sarah), and Paul Levy and the BIDMC community, Running a Hospital, for getting this conversation started. Now, take it offline people.

Special special special thanks to Alexandra Drane. This was gracefully done. Thank you.


Growing the Tree Trunk - An Argument for User-Friendly Personal Health Platforms

"A common theme that emerged was the desire to better integrate their health and healthcare into "real life." As a seasoned nurse reported, one of the most common patient questions is “where am I in this care regimen?”"

-Lygeia Ricciardi, Project HealthDesign Blog, fellow Clinovations member

Two months ago I attended the Robert Wood Johnson Foundation's Project HealthDesign day in DC (9.17.08).

Thoughts about the project, PHRs in general, and issues of control (real and perceived) with regards to personal health information, have been marinating since then.

Blogger's Note: Many of you who follow me on Twitter will recognize some of this material from discussions we've had, but for those of you who still rely on the blogosphere exclusively, I'll import some of the dialogue.

This morning I was preparing for an important meeting where I'll talk about PHRs and consumer-facing personal health platforms. Sipping my normal banana, peach, and mixed berry smoothie, I had one of those sudden lightbulb (or lightning strike) moments...

RWJF Project HealthDesign, acting as an incubator, only succeeded because the 9 design teams involved could build on a custom designed platform constructed by Sujansky & Associates LLC.

They had the 'tree trunk' custom bioengineered by a provider whose interest was in creating a viable platform for further application development with a highly specialized goal.

So what can we learn from this in Health 2.0? Who are liable to be the big platform builders?

I think we'll find ANY organization, not necessarily one that began as an HIT or Health 2.0 firm, that builds a COMMON PLATFORM (skeleton, tree trunk, take your pick of bio-aware metaphors) enabling mushroom-like growth of 'add on' applications will succeed big time.

Who's my pick for driving biggest adoption of healthcare incubation activity next year?

Apple. The God of the iPod will strike fear into healthcare executives' hearts as health and wellness apps flourish.

We're talking about an industry where brick and mortar care delivery processes are designed by teams that are still arguing over whether checklists are valid methodologies for CQI. This isn't even a matter of high tech versus low tech; it's closer to a 'no tech' sector (outside diagnostics, surgical, and imaging advances).

These guys will be snowed in by current consumer-facing tech.

Like Detroit's Big 3, they'll be looking for a bailout, or praying President Elect Obama's healthcare gurus (Starck, Baucus, Pelosi, and Kennedy) push for universal healthcare, which would secure payment without requiring consumer/patient-centric process renovation.

Look, if you won’t sell the experience to us properly, then don’t even bother. We’ll just build it ourselves and sell it to one another, or, even more confounding for old-school commercial stalwharts, we'll give it away.

I wonder what percentage of hospital execs read TechCrunch? Use Twitter? I'm sure the numbers aren't pretty.

So why should hospital execs be looking at Apple?

They're throwing open their store (ITunes) for apps they bless. They've built the scaffolding. They're growing the tree trunk upon which other apps can flourish.

Customers are building applications they want to use. It's a consumer mutiny, constructed in a thoughtful, organized, and controlled manner. And it generates revenue. Big time.

Let's take a moment to triage Apple's business case and developmental strategy, from a healthcare industry perspective.

1. Apple adopts consumer-facing orientation, develops iPhone.

2. Apple's IPhone is the common platform (tree trunk).

3. Health applications built for iPhone, including ADAM Health Navigator. Look here:

4. Money DOES grow on this tree trunk - Apple collects 30% cut from all developers.

I'm certainly not the only one focusing on the promise of the platform -Craig Mundie, Microsoft, says it's going to be all about cloud computing, and building the "composite platform(s)."

But locking up access to the common platform with twisted IP and swallowing the key means you may lose apps consumers find valuable. Pay attention to developments in open source and open ID.

From an email by Ted Eytan 9.23.08: "The great thing about Health IT is that it forces all of us to care about what everyone else on the team is doing to support the patient. So, bring it, please!"

Common platforms are the holy grail of Health 2.0 - a missing link between users and organic revenue models that don't throw banner ads in our faces or stuff our inboxes with market-spam.

But current consumer-facing health platforms fall short of the mark.

There's a reason I'm not using GoogleHealth or MS HealthVault. At this point, they're a waste of my time.

And yet, I'm their ideal user - a patient with a long-standing condition that sometimes requires care, daily wellness/fitness habits that I'd like to monitor, and enough Type-A tighta@# adherence that I'd like to actually see graphs of my exercise activity (and caffeine, dessert, and alcohol intake) per week.

And yet. They've failed to grab me.

Why? I just don't like what I see, and I just don't see value in what they're offering. They haven't successfully jumped the cost/benefit hurdle.

Where's user-centered design in healthcare platform development?

When I see it, I'll be patient zero for a well-designed, efficient, effective, safe, easy to share, easy to access PHR.

We're not there yet - reviewing current PHRs (including Google Health and Microsoft HealthVault) is a bit like looking at a narwhal and seeing a unicorn.

But I still want to believe in the possibility of that mythical creature, which is why I'm doing what I do (business plan work, advocacy, etc).

In addition to Apple and Facebook's moving the internet from an ad-revenue based model to an application building and selling model, there's another bright spot: RWJF Project HealthDesign's commitment to patient-centered design principles.

Read - "patient." Yeah. Patients as consumers. Get over it. As Carlos Rizo says, "All consumers will at some point be patients, but not all patients will choose to be consumers."

A fundamental assumption about healthcare delivery must be aired repeatedly (and rinsed, wrung out, hung out to dry, and used again) before we can really engage in a productive conversation about building a consumer-facing platform.

To wit: Our whole medical system is organized to deliver care to one person: the patient.

Even population-based health starts with individualized approaches. Innoculate the individual to stop the spread of disease among the group.

The only element connecting disparate nodes of care delivery in the system is the patient. The patient is the glue. The patient is the medical home. CMS will pay for systems and services that recognize and accelerate patient-centric care modalities.

Applications that acknowledge this centrality will get ahead. Those that don't will have their hands out for a subsidy check.

Patient-centered care is not new; patient-directed care is (to some), and thus threatening.

It's an imbalance of power. If we can hire docs, we'll be able to fire them (gasp).

Providers: Your efficiency, indeed, your clinical acuity is no longer the only factor in question. I'm not going to get into the debate about whether or not this is 'right' or 'wrong' here, but pay attention to your bedside manner.

Is your empathy up to the emerging mantra of consumer-centric care? It should be. After all, you got into this to 'help people' right? That means talking. And listening. And more importantly, engaging.

To those of you (Health 2.0 entrepreneurs especially) going after the upper 10 percent (10 80 10 rule), and even the middle 80: Get ready...you'll have to compete based on more than just your rung on the med school or HIT companies bought/sold hierarchy.

Example for docs: If you don't listen to my concerns before surgery, I'm going to another doc. If you don't rate high among users with my condition, I'm going to another doc. If you don't have a low complication/re-admission/post-op infection rate I'm going to another doc (yes, I know the hospital in which you operate plays a huge role, so you'd better start choosing your hospital more carefully, no?)

I don't give a rats a@# whether you went to Yale or wherever, unless you're able to sell your technical skills to the extent that your glaring lack of people skills don't matter to me (IF I'm in the top 10 percent of engaged e-patients. If I'm hooked up to a vent on the ICU I may not care, but my daughter/caregiver may. Same story, different day).

Another interesting portion of the healthcare platform debate - engaged consumers are clamoring for it, and so are younger, engaged, tech-savvy patients-to-be.

Let's take a look at yet another industry (would-be platform builders should be paying much more attention to sector/industry cross-pollination): higher education.

From a very interesting article in the NYTimes: "Goldman has always made the case that his youth is in many ways his chief qualification. “When I brought this up from scratch, some people said, ‘Look, you’re just a kid — are you really the right person to do this?’ And we tried to make the case that we’re the perfect people to do it, because we’re the only ones who know what college today is really like and who know how to reach other students in a way that someone 20 years out isn’t going to.”"

What the heck does this article have to do with healthcare?

Clue: Include people who are patients. We're the only ones who know what healthcare delivery/receipt is really like and who know how to reach other patients in away that someone 20 years out isn't going to.

This article got me thinking. "Who’s a better judge of a college than its students?" In healthcare, our equivalent question might well be "Who's a better judge of consumer-facing HIT, eHealth, mHealth, and PHR applications than patients?"

And yet, the voice of patient reviews is often lacking conspicuously amongst luminaries on the health conference circuit (as Lodewijk Bos, Gilles Friedman, and Carlos Rizo all pointed out after Health 2.0).

If you're a Health 2.0, 3.0, or 4.0 company, and a person who is also a patient, for goodness' sake, come out of the closet already. Start owning that identity and trumpeting it for its personal challenges and its professional benefits. Health 2.0 companies need a Chief Patient Advocate.

Why? Many of these consumer-facing applications, for lack of a better term, suck.

I'd pretty much lost hope and started, out of desperation, working on a business plan for a combo tethered/untethered PHR.

At the Robert Wood Johnson Foundation Project HealthDesign unveiling in September, for the first time this year, I was sitting up watching videos of personal health applications I'd actually use, created by teams (mostly academic) from the RWJF Project HealthDesign incubator.

I get that many of you don't agree that consumer advocacy is important in healthcare. It doesn't have financial realism (@symtym), etc. And then there's the digital divide, still a gulf with no bridge and only a few hangliders facilitating crossings.

But make no mistake - consumer-friendly tech has enabled us to build our own hangliders. Just because Health 2.0 is currently a soapbox derby doesn't mean someone won't one day build a rocketship.

What would you do, for instance, if someone used a Flip video camera to record their hospital experience? And then uploaded that to their PHR? If sites like Flickr, etc. lets me upload photos now, it' s not a far stretch to say I could upload 12 seconds of video updates from 12seconds.com and then post that on Twitter and thecarrot.com, a personal health and wellness journaling site, describing my hospital visit.

I hear some of you scoffing in the background. "This isn't happening!" you're thinking. Um. Think again.

From the NYTimes article: "Each Unigo editor has a list of 10 colleges (including, always, his or her own alma mater) to oversee; their most important task may be finding an unpaid intern on each campus willing to act as a liaison and an occasional reality-checker for Unigo’s efforts. The real masterstroke, though, was the purchase of a hundred Flip video cameras, which were delivered to the on-campus interns themselves with a minimum of instructions."

Said Adam Freelander, a Unigo managing editor: “Even the best guidebooks kind of make it seem like every college in the country is an awesome place to be, no matter who you are. And that’s not true.” HOSPITALS ARE THE SAME WAY.

“The colleges are going to have to change what they’re doing,” Martinez said. “The pictures of the kids on the lawn won’t do anymore.”

Sound familiar? Involved e-patients are tired of pictures of kids on the lawn. We're tired of providers who block our engagement in healthcare as a conversation.

Ignorance is bliss. Except when, suddenly, you find yourself smack dab in the hospital and desperately in need of a working, easy to use PHR. Let's hope the industry catches up with the need. Someone better start believing in unicorns. Someone else better start designing a rocketship.

HealthDesign? Yeah. We could use a double dose, stat.

Further Reading on RWJF's Project Health Design, PHRs, etc:


7 Ways Healthcare Will Surprise You Next Year - Part IV

Let's finish up this tweetsourced series on a positive note, with Chris Hogg's 7 hopes for healthcare (verbatim):

great question. i dont know if these are really surprises, but things i think (or hope for some) might happen

- unfortunately, it will get significantly less attention from new administration than we hope/expect, due to other 'more pressing' commitments

- significant increase in applications developed on google health / microsoft healthvault platforms, with some of them actually being useful, although funding will become increasingly difficult for these startups. significant increase in press for these platforms/applications

- first hint at what the killer app will be for google health / microsoft healthvault platforms, although it will not yet be widely adopted (is this the first view of what the 'trunk' might be?)

- restriction barring Medicare from negotiating prices with Part D plans will be lifted, with dramatic impact on pharmaceutical company stock prices, but benefit to overall health industry

- significant consolidation in biotech / pharma landscape, with multiple biotechs going bankrupt / acquired in weak cash positions

-may see a minor (or regional) health plan fail under pressure from increasing HC costs and decreasing reimbursement (with a sprinkle of bad management), but this would create a big scare for insurers

-one major CLINICAL advance in personalized medicine. i hope it will be approval of Nuvelo/ARCA's heart failure drug, or Vanda or PGx Health approval of PGx drug for CNS. if it happens, should get a lot of press.

Best Regards!
Chris Hogg

Thanks Chris! Later this week we'll explore platforms in more detail (aka the 'tree trunk').

7 Ways Healthcare Will Surprise You Next Year - Part III

In part three of our series on ways healthcare will take us by surprise in 2009, we get a view from health publisher and family doc James Hubbard, MD, MPH (@DrHubbard).

Dr. Hubbard's input was gathered by Leigh Ann (@FamilyDoctorMag), Managing Editor for My Family Doctor Magazine.

My Family Doctor aims to be "your trustworthy, evidence-based source for reliable health information."

Dr. Hubbard's big pick for first horse across the finish line:

"Medications imported from other countries will become much more prevalent. By the end of the year, there will be headlines about reports of tainted quality."

Buying drugs from across the border has hit relatively 'old guard' consumer-facing sites like About.com, and with China's recent tainted milk crisis, it's only a matter of time before manufacturing defects are found in a variety of medical goods, from medication to hip implants.

The real surprise next year may be how the FDA responds. In 2006, the agency restructured its Center for Drug Administration and Research, placing improved medication safety at the top of the to-do list.

How has the landscape changed in 2 years?

Well, in addition to shrinking pharma development pipelines and hospitals/AMCs banning drug reps bearing gifts, the election of Obama to the US presidency might bring some significant change, especially since the throne is empty.

Dr. Hubbard, you're absolutely right. Global medication development and flow, as well as medication safety, will be a hot topic next year.

Let's just hope we hear more about FDA innovation before breaking news tells us the foreign - sourced Ibuprofen we took last night may kill us.

7 Ways Healthcare Will Surprise You Next Year - Part II

Part deux in our series of crowdsourced "ways healthcare will surprise you next year" provided by CTO @ Healthways) who views his mission in life as pointing out the obvious.

Scott's not afraid to tackle the issue of carrot/stick incentivization head on...

Via email Scott shared his belief that next year we'll see organizations penalizing staffers for NOT making healthier choices.

Reverse incentivization rears its ugly head in 2009? Do you agree? Disagree?

Predictions from Scott:

"Employers get serious about outcomes.

Stop using incentives as merely "carrot and stick" to get people to enroll and engage in programs, and start using them for what they really should be: value for cost.

It's not enough to offer an incentive for a member to join the wellness program, or even to get that A1c checked

If you tracked outcomes from your programs in a meaningful way, then you can start to adjust payment for said outcomes.

Value for cost. I will pay more for a positive outcome than just performing a test.

What was the RESULT of that A1c test? Did it get better than the last one? HURRAY! Here's $100. Keep on keepin on. If not, then maybe your premium contribution is going up $200 next year.

The point being that it should hurt your
pocket book now if you're not going to be actively engaged in managing and improving your health status.

Not defer that financial pain 20 years from now, when it's more likely to impact many more stakeholders.

Just my $.02."


Scott, thank you - worth a lot more than .02 cents.

7 Ways Healthcare Will Surprise You Next Year - Part I

President-elect Obama's campaign used social media and online networking sites/applications to crowdsource support. But community is good for more than spreading a relatively watered down mantra like "change."

Like this year's presidential election, social media and networking sites are breaking down some siloed barriers in the healthcare strata. On Twitter, I chat with docs, nurses, med students, marketers, health executives, entrepreneurs, analysts, etc. Would I ever have the opportunity to find and initiative conversations in the brick-and-mortar delivery world with such a diverse group? Not bloody likely.

So what kinds of things do we, the health-e-nation, talk about online? What visions and missions grab and hold us?

Here's an example: Crowdsourced on Twitter, this week we'll take a look at 7 ways healthcare may surprise you next year in a series of posts.

After I tweeted a link to this McKinsey article, asking for opines on surprises we'd have in healthcare, 5 health tweets answered the call.

These folks are some of the most informed, proactive crowd of prognosticators the world over, so I'd give at least Superbowl-winner type attention to their predictions.

First up in our series is Zane Safrit, who actually gave us a bonus prediction.

Zane thinks healthcare next year will surprise us in these 8 ways:

* More expensive, even more expensive than we project now.

* More people will be uninsured. That's from the economy, it's more expensive and insurance companies will fight to preserve their kingdom.

* The ugly truth will emerge. That will be around either side-effects from drugs barely reviewed, huge ongoing ethical lapses with researchers/doctors/big pharma and their products and relationships or poorly performing hospitals/clinics.

* More openness and transparency. That leads to the previous point. That leads to the insurance companies fighting harder to preserve their oligopoly.

* More participation. More engagement by the consumer in creating OUR healthcare system. That will be seen in more anger and more demands..and more solutions. See above points.

* Huge turmoil by end of the year in the institutions delivering healthcare: FDA, AMA, Big Pharma, Corporate hospitals, Congress. The boil they've created with our permission is being lanced. It'll be messy for awhile.

* Movement towards an universal healthcare system by year's end. Movement. Resignation by opponents. And embrace of mandated health insurance like we have with car insurance.

* Pandemic. There will be some new pandemic, like AIDS/HIV. MRSA may be it. Bird flu isn't it.

That's 8.

Zane Safrit
twitter: zanesafrit

Thanks again Zane for your top 8. Pegging the 'new pandemic' is also interesting because it's part of the GAO's 'hot list' of urgent issues for President-elect Obama's incoming staff - see number 8, preparing for public health emergenciehttp://uspolitics.about.com/b/2008/11/06/throwing-down-the-gauntlet-gao-lists-13-urgent-issues.htms.

Dear readers: You can follow Zane on Twitter here. Zane blogs about healthcare issues every Monday.


YES. We Can.

President Obama - congratulations.

If you need an international healthcare team focused on innovation, we're already assembling one on Twitter.

I donated to the campaign. I was at your speech at Manassas. I'll be here commenting on your policy. I'll be here - fired up. Ready to go. So will many others on Twitter.