Open Source, Open Licensing, P2P Production in Healthcare

Building the Nexthealth application, I'm having to continuously fight the urge to pull back brutally on the reins of altruism.

Users will sign up, login, and be prompted through a 4-step healthcare decision making process using visuals Maarten den Braber and I developed when trying to describe the evolution of Health 2.0.

The site will have zero ads. We won't charge users a subscription fee. We've committed to making this a free-range, public good, and that type of business model is still VERY unique, particularly in healthcare tech.

Because we're committed to making Nexthealth an open-source, easily customizable tool for individuals and communities struggling with healthcare decision-making, we're giving away the code.

Why are we doing this for free?

This isn't the first app the Nexthealth crew will build. In fact, it's just the introductory handshake. We're already working on a business plan for the next thing. So in essence, building the Nexthealth app and releasing it is building the ultimate business card. It says who we are and what we're capable of producing, with very limited time and resources.

Some more info from our FAQs about releasing the code:

Code - Fried or Broiled: We're actually giving you the code for the Nexthealth tool 2 ways. First, you can use the code open-source, delinked from the database our web guru has designed. Or, you can choose to use the code that's 'connected' to the values linked to our mySQL database on the back end - choose option number 1 to use the graph arbitrarily, or paste it over your own database - choose option number 2 to use the graph with functionality just like that on the Nexthealth site (data from the database populates the graph, so what we're really saying is you can copy and paste our values and options or lift the graph and insert your own).

Open API Means Have it Your Way
: Build a bar graph, a line chart, a pie chart. The database we've developed can be modified to display your data values in multiple visualizations (especially useful for team logins and public health research applications).

But Nexthealth isn't the only group to milk the power of creative collaboration to create a 'public good.'

Although still a rare bird, peer-2-peer production for NFP output is not entirely new to healthcare.

Exhibit A: The Open Source Prosthetics Project.

The project is "an open source collaboration between users, designers and funders with the goal of making our creations available for anyone to use and build upon. Our hope is to use this and our complementary sites to create a core group of lead users and to speed up and amplify the impact of their innovations in the industry."

Here's the wiki for the project; sign up to volunteer here.

The Open Source Prosthetics Project is an initiative of the Shared Design Alliance. There's a good overview of how shared design contributes to industry advancements (especially in tech) here.

For a more general overview of peer governance in collaborative software communities, as well as other great P2P resources, check out the P2P Foundation here..

If you're interested in open-source healthcare, I'll be posting additional examples and Nexthealth info in the next few weeks. Stick around. Collaborative health innovation is the only way to reach warp speed before we self-destruct.


Do U Nable Pts 2 Snd Txts?

We love our texting.

If your hospital or HIT firm doesn't already have a fully 'txt' friendly communication stream, have your team perform a comprehensive audit - what scheduling, appointment, followup and other reminders could be sent to patients via text message?

I won't even get into the picture messaging debate here, but I will tell you the last time I had ankle surgery I snapped a photo of my stitches with my Blackberry camera and yep, emailed it to some family members.

Oh, and the next developer you hire should have experience developing mobile apps...don't have a developer on staff? Mistake numero uno.

If you think people my age are the only ones using the web and mobile tech for health, you're wrong. I've spoken with two Health 2.0 CEOs this week who cite their average user is in their mid-50's.

Health tech, health texting - it's not just for the Guitar Hero health generation.

ADDITION: Link to great resources from Stanford's Texting for Health events here. Hat tip to @zorgbeheer on Twitter.


What I Do (Living in the "Slashes")

In the process of recent work interactions, I've been told by several people that I should clarify who I am and what I do - that I'm more than just a grunt intern for Health 2.0 (still one of the best jobs I've ever held, by the way Matthew and Indu).

When people ask me for my job title, I have a tough time responding. Here's why...I don't have just one job title. Going back to a typical desk job would be the equivalent of solitary confinement.

I live in the middle of multiple 'slashes.'

As Rosetta Thurman explained at the last Women Rule DC meetup, the 'slashes' are hash marks that divide the terms we use to describe who we are and what we do (dentist/dog groomer/painter/dad, etc).

The more slashes you have, the busier you are...more slashes also equals more potential for a frenetic rather than fulfilling life.

If I put all of who I am into just the professional 'slashes,' that would be one hell of a run-on sentence.

But it's vital, now more than ever, for me to consider the 'slashes' I've chosen very carefully.

Designing and building the Nexthealth app is quite a journey, and my work-life balance, ever perilous, is slipping ever more towards 80% work, 20% life (or thereabouts).

I decided to do a little exercise and see - when I introduce myself, what comes up first? Work or life? Does my work eclipse my other passions?

Today, over coffee, I gave myself 10 minutes of quiet time and an even split - 10 and 10 to describe what I do and who I am. Here's what evolved from the evaluation.

Bloggers' Note: If you're struggling through building a startup, I highly recommend this exercise. It helps you refocus, and sometimes, just maybe, helps you make peace with yourself about the fact that, ahem, you might as well admit it....

Work may be life. But it's not all there is.

So, here are some of the things that I do (in no particular order):

1. Vice Chair, MEDBANK of Maryland, Inc. (nonprofit Board, unpaid, 2 years)

2. Newsletter Committee Member, Dress for Success of Washington DC (nonprofit, volunteer, 1 year)

3. Health 2.0 Grunt Intern/Analyst (yes, still, unpaid, although we've changed this title to "Ranger" - ask Matthew Holt about that one)

4. Health 2.0 Volunteer Coordinator - User Generated Healthcare (unpaid, this upcoming Health 2.0 conference)

5. Health 2.0 Speaker Liaison - User Generated Healthcare (paid, this upcoming Health 2.0 conference)

6. Health Policy Blogger - HealthCentral.com (paid)

7. Blogger, Health Management Rx (unpaid)

8. Blogger, Nexthealth.NL (unpaid)

9. Co-Founder, Nexthealth (bootstrapped, international hybrid collaborative nonprofit)

10. Co-Creator, Nexthealth App (bootstrapped, with Maarten den Braber, Brad Sugar, support from Nexthealth NL team)

And here are some of the things that say more about who I am (in no particular order):

1. Cigars. Definitely not just for men.

2. Ancient Egyptian history.

3. Old-fashioned drinks, including dirty martinis, bloody marys, and single malt lowland Scotch.

4. Enthusiastic player of badminton (when I don't get too excited and smash it way out of bounds).

5. Can't cook a fried egg to save my life, but I make a mean Egg Beaters' zucchini frittata.

6. Family. Mostly bugging me not to work so much. And loving me despite the fact that I don't listen. Sometimes. Well, most of the time.

7. Reading. Anything, and everything. I share a bunch of the professional reading I do on Twitter via links, etc. Current passion = genetics.

8. Being an e-patient. Fell asleep at the wheel and hit an 8 foot iron ships' anchor dead on. Multiple surgeries ensue. Don't worry - I can probably still kick your butt at Spinning.

9. Art. Which I buy on Ebay, or from street artists. Favorite sculpture = paper clip free form dachshund.

10. Travel. Homebase in Rotterdam. Family in MD, VA. Lots of time spent in DC for work. I love airports, travel size shampoo. The things that say this discomfiture is only temporary - think about the next exciting leg of the journey yet to come.

Nice to meet you.


Health 2.0 Moving Forward, Going ROPE, Doing Good: Ted Eytan, Matthew Holt , Organized Wisdom Push the Envelope

The combined talent, willpower, business acumen, and capital in the room at Health 2.0 will be a force with which to be reckoned...and getting ready for the event usually kickstarts some interesting discussions as everyone prepares to bring the A-game.

Two of my favorite bloggers this morning offer up innovative views on work environments and 'do good, be well' initiatives.

Here are the goods and why they're relevant to Health 2.0 and consumer-centric care:

1. Ted Eytan details a new "Results Only Patient Experience" (ROPE), built on the platform of Best Buy's Results Only Work Experience (ROWE).

Why Does it Matter?
  • It's already happening in the Health 2.0 sphere - Organized Wisdom is the first Health 2.0 company to go completely ROWE. Better yet, OW takes a collaborative approach, sharing their "Getting Results Toolkit" - read all about it here.
  • I've been a ROWE worker 2x, first as an analyst and business development director, now as an all around healthcare ranger, blogger, and social startup junkie. It's not all peaches and cream and working in your pajamas (although yes, I have worked in PJs). The typical day Ted posts comes perilously close to describing some of my weekdays, especially when I lived in downtown Baltimore or when I'm at home in Rotterdam. Self-management is a must. And yeah. It can be a hell of a lot of fun. I don't think anyone who knows me would call me a slacker (at least I hope not...).
  • ROWE works 'best' for certain types of organizations and personalities, but certainly does privilege the knowledge-worker class who can afford to do work from anywhere (literally - I'm typing this blog entry sitting in a tent at Chincoteague Island, Va). LOTS more healthcare organizations could go ROWE, or, more appropriately, could "ROPE & ROWE" (nice nautical imagery there Ted).
  • The bottom line about why I love being a ROWE (and shortly, advocating for a ROPE environment using the Nexthealth app) worker: it's all about results. What I get done. Not when I get it done, or even necessarily how long it takes me. And the real beauty is that I get a hell of a lot more done working from anywhere I'm comfortable than when I'm stuck in a cubicle drinking lame coffee or listening to my coworkers rave about the Sex and the City movie.
  • Also, consider this: in a daily 'normal' work or classroom environment, the time you spend with rear parts in the seat is the most important thing - it's more about attendance than it is about output. In class, I'd finish work early and whip out a book. In a 'traditional' 9-5 I'd finish work early and be bugging supervisors for something else to do, a new project, etc. I was a pest. A productive pest, but a pest nonetheless. Now, if I finish something early, it's on to the next thing.

2. Over at The Health Care Blog, Matthew Holt and his wife Amanda share their own 'do good' goals. Matthew's asking companies who want to mine his brilliance to help buy a kid a bike. Amanda, who just had some pretty serious back surgery, will also sport supporting companies' colors on during her upcoming training rides (and yep, we'll probably see some photos on THCB).

Why Does it Matter?

  • Social entrepreneurship is arriving early to the Health 2.0 stage, considering the conferences themselves have been around for just under 2 years. Matthew and Amanda are doing something really neat here, and bravo to both of them for helping spread the wealth to benefit Saigon Childrens' Charity. To my knowledge, it's the first time they've 'asked' us, the readership, to help out a crusade. This is an awesome step and the first time I've seen something like this done outside of Doc Rob's sending Zippy all over the world and outfitting us all in Zippy wear to help fight kids' brain cancer.
  • A fascinating conversation from #gnomedex on Twitter.com last week began when Beth Kanter (@kanter) raised almost 4k in under an hour SIMPLY by having those in attendance begin to tweet about the event. Her social philanthropy demonstrated a few things brilliantly: peer pressure in giving works (for good or ill), almost anyone will give $10, and you have to coordinate a few things brilliantly to cut through the noise with an 'ask' - right time, right place, right people spreading your message, and right amount.
  • Doing good is contagious. Doing good is viral. But we don't always (or even usually) give because we're saints.
  • If your competitors start do-good initiatives, and you don't, you'll look like a boob. Is this the 'right' reason to give? Probably not. Nor is the fact that giving in this case will get you a photo and nice writeup on The Health Care Blog.
  • I had a great Twitter discussion with @michah, who was at #gnomedex (type this into the search field at www.summize.com for all the #gnomedex Twitter feeds) about whether or not people were giving to Beth's initiative because of competitive pressures or a desire to 'help.' To a certain extent, the values conversation in giving is often overly simplified, and this type of value judgment is only relevant if we're speaking from the pulpit, or Valhalla, which none of us are.
  • BOTTOM LINE: Give for whatever reason you give. The important thing is that you give. Try not to judge others for what they get in return. This is the hybrid model of social philanthropy at work - do some good, get something good in return. Call it the bartering of philanthropy if you will, but it's how this system has always worked (sponsorships for events, launches, etc). Even those little balloons you buy in the checkout line at the grovery store are the barter system of philanthropy at work: You get to write your name and paste it on the window proving what a generous person you are. Final bottom line: Try not to fool yourself about reasons and motivations for giving. Be clear about what you want people to give, and what they'll get in return, just as Matthew's done at THCB. And if you don't want anyone to know what a good person you are, give and keep quiet about it.

And for goodness' sake people - buying a bike for a kid in Saigon is only 25 pounds....


Reporter Looking for e-Patients - Using HARO (Another Twitter Find)

This reporter's inquiry was posted on HARO (Help a Reporter Out), a website/email list started by Peter Shankman. I learned about HARO from Peter's posts on Twitter (Peter's Twitter name = @skydiver).

If you're an e-patient, physician, or Health 2.0 exec, you should be subscribing to his listserve here: http://www.aweber.com/z/r/?rOwcbIwctCzMbIwcjMxstEa0zOxMnIyc7A==, especially if you don't have a PR agency on retainer (or even if you do).

Finally, help spread the word about accessing healthcare content, communities, and services online...got a good story? See the journalist inquiry below:

Summary: Real People Use Web for Health Problems

Category: Healthcare

Name: PJ Noonan

Email: PJNoonan@aol.com

Title: Freelancer

Media Outlet/Publication: National weekly magazine

Anonymous? No

Specific Geographic Region? No


Deadline: 5:00 PM MOUNTAIN - August 28


"Digital Medicine or Using the Internet to Help Your Health

For a series of five articles on digital medicine, I need several
real people (i.e., not experts) from across the USA who have one of
these conditions: diabetes; high cholesterol; a sleep disorder such
as sleep apnea or insomnia: depression; or a heart or
cardiovascular health problem, and who have used the Internet to
help cope with their condition in one of these five ways:
a) to fight disease, such as by using the Internet for lobbying,
building awareness, fundraising, etc.;
b) to find health insurance;
c) to communicate long distance with their doctors, such as
emailing questions to the doctor, getting lab test results by
email, requesting prescription refills online, etc.;
d) to find a medical community online such as a site that offers
information and support for people who have the same condition; or
e) to research their condition and learn more what it is, what can
be done to treat it and what the latest research has found.

If you or someone you know fits this description and would be
willing to tell your or their story for publication, please email
me ASAP. If possible, please include a photo (headshot or casual
snapshot)with or in your email.

Please note: A different section of the publication will look at
these digital medicine from the health professionals side. For my
section of the piece, I can only use stories from real people who
fit the description above - no doctors or other health
professionals (unless they're telling their own story of having one
of these conditions and using the Internet in one of the ways
listed above).

People who are selected to be in the final articles will be
identified in the article by name, age, city and occupation. This
is for a national news and opinion magazine.

If you have any leads to suggest , please email me at
PJNoonan@aol.com. Please put Digital Med in the subject line of
your email. Thank you!


What's Next After Health 2.0: Content+Community Online?

Bloggers' Note:

This is just a primer to get the cerebral juices flowing on this subject.

Hands down the best discussions about where things are moving will happen at Health 2.0 (in case any Health Management Rx readers don't use Twitter, full disclosure: I'm helping Matthew and Indu manage speakers and volunteers for this event). Matthew Holt will give far more interesting and complex thoughts on the subject, along with an all-star lineup of firms figuring this out during DBAs.

This post is the result of some incendiary conversations that occurred yesterday as I was hanging out with the HealthCentral crowd in Arlington, Va, learning how they manage 35 online communities covering areas of consumer interest ranging from sexual health to ADHD (full disclosure: I write about health, policy, and politics for HealthCentral).

Managing the flow of health-related information, both subjective (user posts) and objective (news links, etc). is an amazingly complex job. The backend content management system that runs this thing is a behemoth.

I don't know why I found discovering the sheer computational muscle that runs the HC works surprising - lets chalk it up to lack of sleep after some crazy Nexthealth design days and nights.

I'm not usually so slow in making these connections, but I also don't usually do this type of synthesis-storming alone - the Nexthealth hive is an excellent supportive group where many of us work together to connect the dots...I don't like going solo.

If the Nexthealth crew was hashing this out over wine, cookies, and whiteboard scribblings, we might describe it this way: If Health 1.0 was content online, and Health 2.0 is content+community online, then what we're looking at with long-tail firms like HealthCentral is an organization similar to libraries with a bunch of book groups...some information, or value, is composed by expert authors and the rest is user or community generated.

But online, the proportions of who generates the majority of content, and thus who defines the 'value' of information, is flip-flopping. And therein arises the credibility of sources issue that has Health 2.0 execs beating their heads against the wall trying to solve.

It's a simpler issue than most of us think - more of the tools, companies, and content we design must allow users to bring subjective values to bear. The tools themselves MUST be objective. Neutral. Search terms shouldn't be the only way to judge 'value' or 'credibility' of information.

Because the subjectivity of healthcare decisions is infinite, variable, and thus indefinable.

Or, I should say, it has been. It's like we're trying to make the evolutionary leap from single-celled to mammalian life without interim stages.

We need to be gathering more data about NOT what healthcare consumers are searching for, or who they're talking to, but what they're trying to USE our tools to DO...what decisions are being driven by online health content? online health communities?

Content is great. Community is fantastic. Commerce, which happens online in Health 2.0 and offline via care in the 'real world', is even better. But we need coherence between all of these for consumers' actual choices and decisions to be impacted. Why?

Because the health content and communities we're pasting up all over the cloud don't actually exist in a vacuum.

How do consumers USE this content? What do/buy decisions do we make as a result of participating in online health communities? A prime example - I might be a DiabetesMine user and buy a new pump after reading about it on Amy's site.

Ok, so, if Amy's site has the coherence factor down, then I don't have to leave that online interaction to buy the thing, unless I CHOOSE to do so...I should have access to that healthcare good online or offline, and the choice to buy at either point according to my preferences and values.

And as a healthcare consumer, it's impossible for anyone else to define how my preferences and values impact my do/buy decisions.

But it is NOT impossible for them to provide tools that help me clarify how I make do/buy decisions in health using Health 2.0 content+community companies. Nexthealth is working on one that we'll release as a public good very soon (we'll even give you the code so you can modify it to be more relevant to your healthcare planning at the 'point of service'). And it's this type of data gathering that should have Health 2.0 companies lifting up the couch cushions digging for coins.

Without knowing how consumers value our services based on THEIR end game, what they want out of wellness, what's next for THEIR individual health, we can't build companies that provide anything of value.

It's no coincidence that the majority of Health 2.0 firms are living on VC vapor, or ad revenues. Freemium models come the closest to helping health consumers reach the end game; they're providing an application, a decision support tool like those SugarStats offers to people living with diabetes.

Again, the system isn't providing people with these tools; it's users, recognizing what's next for them and building an offering that lets them articulate and discuss value to make decisions for health, who are changing the system.

An i for an i model is changing healthcare ("i" need/want this, so "i" will build it and then "you" and "we" can use it) now, but we'll start to see more "i" to "you" built for "us" models. We are most definitely still building out the long tail, which has to happen before we can get to semantic interoperability (dipping in and out of healthcare buying online and offline).

Again, complete semantic interoperability for health means consumers should be able to access healthcare goods and services, online and offline, at will.

We need companies built around data-gathering and ear to door functions that let us hear what consumers want, and what decisions they're trying to make with all our wonderful "Expedias of Health 2.0."

It's no coincidence that you can still build a B2B and B2C software applications company that solves a niche need for people and make millions of dollars. Applications help people DO stuff with what they learn and what they're talking about, based on what they want to accomplish.

What does your Health 2.0 site/service help users accomplish? Where is the "do/buy" intersection? How many clicks does it take me to get there? You damn well better be able to answer a question this simple, in less than 15 seconds. Otherwise, what value IS it you're providing?

But let's go back to where Health 2.0 is right now for a hot second....how can we possibly define a singular health content and community site or service has value for every user at any given point in time?

The answer is simple: We can't.

We have to let THEM tell US what they find valuable in making healthcare decisions - what kind of information? What kinds of people? How do they want to pay? WHAT moves them to the make/do/buy decision point for health?

This means massive amounts of data, and also increased data transparency and transference.

But here's another problem with Health 2.0 companies; we're still feeling verrry proprietary about our users' data and our customer bases, as well we should.

But it is possible to anonymize data, and then explain to consumers in a passionate, engaged manner, why they should consider allowing your firm to release some randomized information for public health research purposes. 23andme is doing this sort of thing already; in essence consumer-direct genetics companies are the first giving us the option to make our genome 'open source.'

But they're still giving us bits and pieces, right?

They're not literally copying and pasting our entire individual genome into a Google doc and letting us share it, compose Wordles from our chromosomes, or lock it up in a vault and throw away the key. It's like getting a hard film copy of our X-rays and having to tote that around - it's literally a disconnected snapshot of one part of our body where something is wrong. We don't have any way to connect that back to our larger wellness picture.

The trick here is for companies to build machines, tools, interfaces, services, and goods that let us just use the hell out of them, however we want, when we want. This means we should be able to access them on our phones. In our homes. In our cars. At stores. At banks. On our laptops. Go mobile. Go web-based. Then build an interesting brick and mortar access point.

Think of the banking industry, which is a tired metaphor for where healthcare is going but will be even more applicable in the next 2-3 years.

Via online banking, physical banking locations, and ATMs, we can access our bank accounts any which way we choose. It's completely up to us, the consumers.

And here's the beauty - I don't have to look at my bank balance the same way every time. If I'm on the road, I make a phone call. If I'm online, I chat and check via the bank's web interface. If I'm traveling and need cash, which I hate to carry, I sniff out an ATM.

Again, the CHOICE is up to me, the consumer, and the really interesting part is that I make that DECISION based not on my 'knowledge' of the financial industry, or my level of education or banking literacy.

I just know I need money, and I need to know how much money I have. Why do we assume it will be any different for consumers of health goods/services once we make data and tools to access it available to them in brain dead simple interfaces, both online and offline?

Look. We trust people to elect a President. To pay taxes. To go to school. To buy a car. To buy or rent a house. To take care of kids. To enlist in the military. To pick a college, or a job, which impacts your earning power, lifestyle, and all manner of complex interconnected factors.

In Africa, despite disease, poverty, and war, cell phones are a booming industry. I may not have indoor plumbing, but I can text someone. We're making all the wrong assumptions about consumers and healthcare, health information, just like we used to do regarding technology.

Can you imagine what would have happened in the consumer electronics industry if Steve Jobs had seen a prototype of the iPod and said, "um, nope, that's not how users listen to music now. We'll pass." The end goal there: consumers will be able to access music and movies, online and offline, at will. We'll build the online piece.

So why don't we trust consumers to make choices in healthcare? They don't all have to be super-consumers; most will not be...go back to the 10-80-10 rule. Most, the Middle 80, will use these services on a limited basis. Some people check their bank balance every day; some check it when they pay bills, some never check it and get into trouble.

If we can't check our healthcare data out when and where we want, and get as little or as much complex info about it as we want, we're all going to be bouncing checks with our health.

To Health 2.0 companies - build the tools. Make em sweet. Make em simple. At Nexthealth we're all about figuring out ways to do that; connecting people online and offline. The decision-support model we'll release is just a handshake- our way of introducing ourselves and getting involved in an ongoing conversation.

Health 3.0 and 4.0 companies will let us do this with our healthcare information. Check out the backend EHR built by Myca for Jay Parkinson's Hello Health...that baby is absolute beauty in pure software form.

So the tools we design from here on out have to be objective, neutral, and allow each user to access them, harness them to make decisions for health and wellness that have PERSONAL relevance, in real time. So, when and where they need to make a decision.

How do we drive population-based healthcare change? Start at the grassroots level, with each individual. Teach each consumer that they have healthcare choices to make. It's that simple, and that blindingly complex. For instance, people my age, and those with open minds (thanks Jacqueline!) are more likely to search for health information online, and much more likely to use online social networking sites. So who's building health decision-support apps that call to the Guitar Hero Healthcare generation? So far, only sites like I'm Too Young for This, etc.

Here's the problem, still, with online health content: In libraries, newspapers, etc. the vast majority of the content was 'expert' generated - authors who go through an academic or 'traditional' publishing process, etc. - they've passed the barriers to entry. Sure, a bit of library and academic content was generated by rank amateurs, but it was much more difficult to gain entry into that rarified atmosphere.

Online health content sites remove many of those barriers to entry. Health 2.0 sites (content+community) break down the walls even more - community members act as peer experts. The rise of the amateur, or here comes everybody according to Clay Shirky.

Libraries needed their Dewey Decimal system for years, and online repositories of content are still struggling over 'logical' organization and creating ever-evolving ways for users to get our hands on the information we need.

Bill Allman and I talked about my helping out with some content management or filling more of a community manager role...after touring the software, and then spending some time in the community pages, guess which one I picked?

In essence, I find it very difficult to remain interested in/invested in business models in the Health 2.0 world that continue to populate the evolving landscape with older barriers to entry.

Everything I'm investing in now breaks those barriers down. I don't want to be an 'expert' writer, or journalist. I don't want to spend time uploading expert content. I want to be exactly what I am; an e-patient. A blogger. A speaker liaison for Health 2.0. A policy op-ed writer for HealthCentral. A Nexthealth initiator, co-founder, and firestarter.

This is the reason we're building the Nexthealth model open-source. Why we'll release the API as a public good. Blow barriers to entry right to bits.

I'm not going to say anything foolish or arrogant like this thing will raise the bar for Health 2.0 firms. It's not even about raising the bar. Instead it's about creating tools that lower the bar, get closer to the ground, where the people are...we don't need more pie in the sky killer apps no one actually uses...we need to build things that get closer to what people want and need, when they want and need to make a decision.

The problem is the gulf that exists between where we are now: Health 2.0, content+community, and where people and companies like Virgin Health are trying to go - incentivizing behaviors so consumers make healthier choices, which saves us money and the system time and resources.

But here's the kicker: You can't incentivize how consumers make healthier decisions if you don't have a consumer-centric system that gathers a hell of a lot of data about how consumers are using your content and community to make decisions. To buy things. To do things. What great hubris to believe we can convince people to do things differently and take responsibility for their own health when we repeatedly lock them out of making choices in the system.

To get from here to there, people have to be able to take that wonderful health content and those wonderful friends they met in health 2.0 social networks and USE THEM TO MAKE DECISIONS.

How will consumers ACT based on the health information they're finding online? WHO will they go see in the real world based on recommendations they gained online?

And once you can figure this out, how to motivate consumers to move to the do/buy stage, THEN we'll start seeing viable, revenue-producing business models for Health 2.0 firms.

Note to the larger Health 2.0 community - banner ads suck. I don't want to look at them. If you alienate me with your ads, I leave your wonderful site. Those things don't tell me what I want. They don't offer things I want to buy. I'm more likely to click on a link for a product from someone I follow on Twitter. If you slam me with ads, I think you lack credibility. Take a harder look at where you're putting your ads and how often you're putting them in my face. Ok. Rant over.

In addition to "how do I make money" we need to be asking ourselves the following about our user bases....

How do they figure out how to navigate in a system that does its best to dictate care?

How do we build and support a consumer-centric system, where the patient realizes "hey, I'm smack dab in the middle of this tangled web, and I've got a hell of a lot of choices to make that 1. I don't understand yet and 2. didn't even know I had the ability to choose."

But oh. Once we can choose to buy health goods and services, online and offline, lookout.

I'll wrap up this break from Nexthealth work with a final question every Health 2.0 firm should be able to answer: How are you helping healthcare consumers (and who are your consumers? patients? docs?) figure out what's next?

And by the way, if you're a poor broke student, analyst, or startup entrepreneur, leave a comment or get in touch - we're looking for 20 more Health 2.0 volunteers (free admission to panels, demos, and events).


Nexthealth Model on The Way...

After hours of feverish coding, emails, phone calls, and international Skype chats, we saw the first Flash animation elements and very rough mockup of our Nexthealth model.

I will tell you that after 3 hours of sleep, with a team of 3 calling in from an office in Baltimore, MD, a family vacation on the Potomac in southern Maryland, and a library in Amsterdam, what we're doing seems even more incredible.

Try using Skype video chat, holding up a graph mockup of the website you've just drawn, showing it to a partner in Holland, while also talking on the land line to your web design partner in Baltimore, who's also walking you through an online mockup of the application.

This is the way thought moves to action in tomorrow's healthcare innovation teams.

Even more amazing than the multi-channel method of communication we've adopted is the way this thing is being built.

Nexthealth co-founder Maarten and I met online at Tony Chen's Hospital Impact Ning site last year before I moved to Holland, and we met a sum and total of once in person before kicking off the Health 2.0 Unconference NL in Amsterdam last April.

We drew the graph we're turning into an interactive roadmap to consumer-centric care on a small whiteboard in his apartment the first time we met for dinner to discuss the Unconference. He drew an x-axis, I drew a y, and we were off.

We've been drawing and refining this &^% graph on cocktail napkins, flipcharts, and available forearms ever since.

Talk about collaboration - it gets even crazier.

I recruited Brad Sugar, our web guru extraordinaire, after being left high and dry via a recommendation from a friend who flaked. Oh yeah. And I found Brad (or he found us) on Craigslist. LAST THURSDAY.

The very rough teaser: We're building an interactive, 'free range' decision support model that lets healthcare users create a roadmap to consumer-centric care.

Health 2.0 sites give us content. They give us community. But consumers still have to find ways to integrate that information and social networking in a way that supports the choices they have to make about what's next for their own health.

It goes beyond needing to verify credible sources or incentivize behavior - first we have to give consumers tools to help them make choices that are relevant to their needs, wants, and lifestyle.

Who or what currently helps a patient answer the question: Which hospital do I choose for my knee replacement surgery - hospital A or hospital B?

Who or what currently helps a physician answer the question: How competitive am I with other docs in my practice area and local environment?

The Nexthealth model walks users through the process of making these decisions in a non-intimidating way.

This baby is the first of its kind. Free to use. You won't see any ads on the site. You won't have to pay to play.

You'll be able to test it anonymously, sign up by yourself or with a strategic planning team. Send someone plotted points. Maybe even connect to other Health 2.0 firms using a search function, but that'd be phase II.

We're building the site, graph, database, and animations in (deep breath) just under 2 weeks. We hope. To say this is one of the most intense work periods of my professional life would be the understatement of the century.

This is an incredible commitment of time, energy, and brainpower by three people who believe in the 'holy grail' of semantic interoperability for health: Consumers will be able to access healthcare goods and services, online and offline, at will.

We also believe this needs to go free-range rather than be kept in a consulting firm's closet somewhere, to be parceled out hospital by hospital, physician group by physician group.

We're talking about providing something real, concrete, to help accelerate our system's evolution to consumer-centric care.

Maarten den Braber and I will present research on the evolution of consumer-centric care at Medicine 2.0.

If you'll be in the Toronto area September 4-5th, please join us.

To the friend who told me at the last Health 2.0 show that I was ready to get something started - You were right. More than ready. I was afraid of failure, and it was holding me back.

And maybe the worst will happen - we fail. Maybe the graph doesn't work, or maybe only our friends and family use the tool to make us feel warm and fuzzy.

But it's time to stop talking about how to bring consumer-centric care to the fore and try something new. If we fail, we'll keep trying. Building other decision-support applications.

Nexthealth is on the way. And it's just the first step.


Weekend Roundup: Whereby Jen, Nexthealth Really Get Going and American Well, Hello Health Make Waves

I'm doing a lot of blog/news scrubbing lately as we ramp up for Health 2.0, just over 2 months away in San Francisco.

Fasten your seatbelts ladies and gentlemen; the lineup this show is bigger and better than ever. Companies are showing amazing features. Line up for tickets here.

Meanwhile, perennial Health 2.0 favorites continue to make headlines:

Analyzing the business models of many Health 2.0 firms, you begin to notice something in common.

Despite the astonishing size and spending power of the hospital segment, MOST have taken one look at the siloed, low-margin marketplace and run frantically in the other direction, towards market-oriented, consumer solutions that 'sell' direct to the individual (whether they charge the consumer as part of a freemium model, are VC-funded, or operate using ad-based revenue models).

Many Health 2.0 firms are helping us nibble away around the edges, building a consumer-centric system user by user, providing solutions at an individual level. There are strong exceptions, luckily, American Well is one, with a business-model oriented around the current payor market.

But there are very few, if any, adaptive, fast-moving, Health 2.0 companies providing decision-support resources for existing brick and mortar players, including hospitals.

Someone needs to connect individual and systemic solutions, and provide non-intimidating, accessible ways for hospital teams to plot a roadmap to consumer-centric care using existing needs and future wants.

And they need to do it in a way that drives viral, rapid transfusions.

Some of you are sensing some dramatic irony here. So yeah. I'll admit it. The Nexthealth folks are working on this.

As a result, I'll beg your indulgence - blog posting will be a bit light for the next 2 weeks as we work on building a killer app. and getting speakers ready...see you in Frisco.


Back of the Napkin Healthcare Policy: The HMRx 25/75 Solution to Reforming the American System

This is a blog post I've been meaning to write for a few months. You know what they say about the best laid plans...

Impetus to finally write it arrived while watching a replay of healthcare-related testimony before the Democratic National Committee on CSPAN2.

Unfortunately it's another sad rehash of problems with very few suggested solutions (although the next President's camp needs to hire farmer Ray McCormick from Vincennes, Indiana, as a policy advisor - his suggestions for improving access to care delivery and info include nifty, 'rogue' ideas like universal broadband availability).

When I think about where our healthcare system IS and IS GOING my stomach gets all swirly and twitchy. I'm certainly not alone.

82 percent of the American public believes US healthcare needs an overhaul.

From the Washington Post article above:

"There is a broad view by the public that our health care system needs a full overhaul, either to be totally rebuilt or reformed," said Cathy Schoen, senior vice president for research and evaluation at The Commonwealth Fund, which commissioned the survey.

Inevitably, when you get a bunch of healthcare types talking about 'saving' the system, the exchange is infused with passionate opinions about what healthcare in the US "should" be like.

We're still having trouble agreeing on the essential philo-social issue here: whether ALL healthcare in the US should be a right or a privilege.

The first thing to acknowledge is that if you're Medicare/Medicaid eligible, healthcare is absolutely a right. If you visit ANY ER in the US, regardless of citizenship (or lack thereof) your stabilizing care (and often much more due to the fear of legal action) is a right. In most other cases, healthcare is a privilege.

Problem is, once we get talking in these terms, the conversation devolves into universal platitudes that need a strong injection of reality.

"Everyone should have access to healthcare." Undoubtedly.

But access to WHAT healthcare?

What kinds of necessary, lifesaving services do we deserve by virtue of being US citizens (and/or residents or "visitors" - see EMTALA)? What discretionary services are a privilege we should pay for with supplemental insurance coverage?

Asking if US healthcare is a 'right or a privilege' is a tragic oversimplification of the issue.

It may be possible to structure a system that acknowledges certain kinds of lifesaving 'needs' are a right, while certain kinds of discretionary 'wants' are a privilege.

Another big problem in the policy renovation debate is based on the thickness of wallets.

Current players (insurance, pharma, hospitals, AMCs, etc.) have significant skin in the game.

The cooption of our current system by a 'universal' federally funded system will create a few big winners and many mammoth losers. Do you think the healthcare PACs will allow that to happen?!

A policy that has any chance of being successful (read: passing House, Senate, and Presidential approval) takes into account the significant infrastructure already in place, and considers the interests of those who will, ahem, support politicians who provide fertile ground for potential continued operations in a new system.

You'll see why I believe that's possible - preserving a place for many of our current players - in the photos above.

Those of you who have suffered through dinner (and after dinner, and breakfast) policy conversations with me have probably seen a simple version of the graph above.

Does the 25/75 Solution have any chance of saving American healthcare? Probably not.

But it provides a way to visualize the issue and get more people involved in the mindstorm. (Also notice I put EHRs under the 'necessary' 25% category...in the future, when costs come down, I'd place personal genetic sequencing here too).

More brains = greater potential for sparking debate that drives change and creates other, more effective potential reforms.

Perhaps we need a 60/40 Solution. May it's 50/50. Perhaps the plan is hopelessly naive. Probably the plan is hopelessly naive. Maybe we need a stronger structure that weeds out more current industry players.

Maybe this format won't work at all, but looking at the graph someone will suddenly be struck with divine inspiration and come up with something that will. Start talking about all the reasons why this wouldn't work - they'll lead you to thinking about what may be successful.

Click on the photos to enlarge the chart. Ask questions via comments. Someone send me a link for a simple design interface one step up from MSPaint so I can stop drawing this thing on Post-Its, napkins, and other paper products. Discuss.

And please, come up with something better. American healthcare deserves many more back of the napkin brainstorms.


Hospital CEOs - Do We Need a Licensure Program?

Are there too many rogue hospital CEOs?

According to Kevin MD, yes.

And the magic solution? Creating a licensing requirement.

Or, of course, we could also solve the problem by requiring all hospital administrators to be physicians.

Like cosmetologists, lifeguards, and plumbers - should we require those who manage our hospitals to pass a licensure exam?

When you position the debate within the rarified realms of electricians and pedicurists (service professionals whose lines of work arguably blend art and science - and yes, I'm poking fun at that particular inter-doc debate), it seems eminently reasonable to get cracking on implementing a board requirement for hospital CEOs.

But do we need licensing (systemic solution), or a more careful selection process for hospital and healthcare CEOs (individual, site specific solution)?

Drew at Our Own System has a great point here, that can be summed up in two highly relevant terms: "due diligence."

Boards need to be taking a microscopic look at executive candidates (and a macroscopic look at community impact, etc), pushing beyond the resume and phone calls to references. Could any level of aggressive HR due diligence have uncovered this? Perhaps.

I've never hired someone without at least a meal conversation. I always check references and preferably in person, at the very least via email with phone followups. My list of questions is often 2 pages. And this is for entry/mid-level positions or personal service providers.

Everyone's style is different, but I've found arranging to have coffee or lunch with a reference or associate of the candidate is a great way to read between the lines (same goes if you've received a committee or board invite - get to know the chair over a meal).

Gut instinct about whether or not a potential manager is a 'good person' or 'likeable' or even 'high achieving' doesn't cut it at any level of recruiting and hiring, particularly in the upper echelons of the executive suite.

You can, however, gain valuable insights by following gut instincts when talking to a reference (and a candidate)- are there unusual pauses? Do they exhibit hesitancy in answering questions? In person, it's even easier to see when a reference is uncomfortable - body language, vocal cues, and facial expressions are windows into the soul, or at least the calculating mind.

But back to hospital administration.

While it's not a horrible idea to implement licensing requirements for hospital CEOs, we should look more closely at the costs and benefits:

1. What would such a requirement achieve?
2. How would a hospital CEO licensing body be run?
3. How would it improve healthcare administration at the 'field' level and the individual hospital site level?
4. Would other hospital executives also need to be certified for us to know they're 'capable' of managing a healthcare organization?
5. Would hospital CEOs need to sit for reaccredidation (I can see JCAHO slavering over the possibility of a hospital management certification spinoff)...

Here's my basic response to the debate - posted over at Kevin MD's entry as a comment:

Hospital CEOs should be licensed.


Because of course licensure will prevent people from being crooks or 'rogues.'

A degree or certification instantly ensures we place individual interest above organizational integrity in all industries (law, medicine, nonprofit administration, etc.), including hospital administration.


A degree, certification, or license doesn't prevent someone from abusing the law. It raises the bar on barriers to entry, a point Drew makes at Our Own System here:

But I'd argue many hospital executive teams (CEOs included) need courses on financial management, governance, community/staff relations, logistics/supply chain optimization, consumer-centric care planning/delivery, trends and innovation, and organizational behavior before they need to pass a pithy licensing exam that gives them a frameable certificate.

That's the cynical view. Healthcare management licensure isn't unheard of...There are models that work within subsectors of the healthcare administration industry, including long-term care. Many job ads for these facilities include a requirement for current state licensure.

It all essentially boils down to what we're really talking about here - better management of hospitals in general (fiscal responsibility, ethical operations, etc.) or raising the quality of hospital executives via raising barriers to entry? Or are we talking about both?

We need to diagram the issue out and look at each component separately to take a stab at accurately assessing potential for improvement.

Also, of course, there's the pesky implementation factor to be considered...exactly what US healthcare needs is another layer of administrative complexity (read: cost) thrown in the middle of the whole tangled web.

Licensure = certification bodies. Certification bodies = staff, paperwork, etc.

Going after the creation of state licensure requirements means lobbying, which means devoting a heck of a lot of money and time to speaking with our elected representatives to get bills on the ground.

I'm not a hospital executive, but it is a career path I'm considering. If licensure becomes a requirement, of course I'll participate. However, it's also one more incentive to get an MBA rather than a Master of Hospital Administration, or similar degree.

That being said, such an initiative could also be nurtured in these programs. Nursing students study for the NCLEX prior to graduation, and then sit for the boards. Master of Hospital Admin students could do the same for relevant licensure.

Even if we consider the long-term ROI rather than short-term, again I'd argue one of the central issues here is education rather than licensure.

Do you agree? Disagree? Should we require licensing for hospital CEOs? As one of the smartest guys I know says often: "Discuss amongst yourselves."


This Summer's Blockbuster = Mission Impossible: Reaching for Perfect 10s in Healthcare

NYTimes Quotation of the Day (8.6.08):

"How could they take away this beautiful, this most perfect thing from us, the one thing that separated our sport from the others?"
- Bela Karolyi, a longtime coach, on the dropping of 10.0 as the top score in Olympic gymnastics

First, a disclaimer. I've been watching entirely too many superhero movies this summer, and all the Olympic coverage has me sickly preconditioned to break out into spontaneous cheering at any time (ahh, but do I cheer for the Netherlands, the US, or both?!)

Luckily, the healthcare industry is in such desperate need of a global makeover that you can cross-pollinate creative metaphors for change from just about anywhere. So away we go.

Maxims and metrics that hold true for one industry often hold true for others.

You can't get a perfect score in gymnastics anymore. That's probably a good thing, especially if one of the most famous coaches of all time believes the opportunity to be 'perfect' is the only distinctive thing about the discipline.

But hospitals, doctors are regularly expected to hand-deliver 'perfect 10s,' at least during inpatient hospital treatment, resulting in never-events that will no longer be covered by CMS (Medicare/Medicaid).

Now, I'm all for the pursuit of perfection.

I've occasionally turned down a project because I didn't think I could complete it at anywhere near my normal level of energy and drive. I'm young, still malleable, still testing my horsepower, and largely (although not hopelessly) optimistic.

I've reached the point with work where if I'm not passionate about an initiative, overdrive-engaged in a cause, devoted to achieving a certain effect, I try not to take on the assignment. It's exhausting, yes, mostly in a good way.

When I lose my excitement for the job, it'll be time to switch gears. Old I'll accept gracefully, tired no way. That hasn't happened yet. But I still say yes too often. I'm still looking for the perfect 10.

I should say no more often, for this very reason. Or at least accept the fact that I'll reach peak energy for about 3 months and then go through trough periods of near burnout (3-7 days). I'm no Olympian, and I do myself and others a disservice by copping to that perspective.

I'm trying to deflect a strong dose of that perfectionism towards being a better team player. If I can't serve the cause, however, I'm happy to connect other star athletes and help A-teams go for the gold.

Healthcare is definitely an ego-centric, OCD friendly-three ring circus (hello compulsive handwashers). We always seem to be reaching for the perfect 10.

With several conspicuously glaring omissions (infamous 'doctor' handwriting, lack of interconnectivity between admissions, care planning/delivery and follow up data, minimizing importance of patient-centric approach and involvement, etc.) healthcare is an industry obsessed with the pursuit of perfection.

Although we use terms like 'sick' and 'healthy' - what do these really mean? There's a reason our measures for recording and discussing a person's total health are highly subjective, while individual, isolated clinical results are related in quantitative terms.

Without numbers and lab values, we might actually come to feel we have little control over our health, and then where would the industry be?

We include both subjective and objective measures (SOAP notes) and observations on a record because both are absolutely vital in our conversations surrounding the pursuit of 'perfect' health - pursuit being the operative word.

But in sickness and in health, for richer and poorer, perfection is a pipe dream.

Unlike winning the lottery, it's statistically impossible, not just improbable, for any of us to be in 'perfect health.'

Patients never operate at a 'perfect 10' on the health scale. Even the best of us.

Doctors never operate (literally and figuratively) at a 'perfect 10' on the care delivery spectrum. Even the best of us.

Nurses never operate at a 'perfect 10 ' on following docs orders, administering meds, etc. Even the best of us.

You get the point. Perfection is healthcare's mission impossible.

And just like the blockbuster action flick series, we have our heroes, who pull impossible stunts in the name of improving the industry.

Granted, I follow these heroes with as much slightly occluded slavish devotion as friends who read Marvel comics, or rabid Apple or Converse All-Star devotees.

Don't get me wrong. We all need heroes. Many of us want to take a turn wearing the cape.

Do you want the good news or the bad news first? They're one in the same: American healthcare is Gotham City, so plenty of us will have a turn to play with superhero stuff.

We need people who reach for the impossible to show us lesser mortals how we can be involved in the dirty, underwhelming everyday work, the wire tapping, the surveillance, the analysis, the commentary and programming addressing what's going right, what's going wrong in American healthcare and how we might tweak programs, start companies. Heroes that shoot for 10s encourage us to shoot for 7.5s.

We're a paternalistic, patriotic, parochial bunch. And despite the pragmatism above, I remain glass half full on most healthcare reform efforts reaching for what's next.

So why the harping on perfection?

First, it's nearing election time, and we're seeing the monolith approach to policy evaluation for both candidates.

Monoliths work in dictatorships (until the populace revolts in attempted coups), monopolies, corporate sponsored white papers, and other flat, tired storylines.

Creative commons are slightly messy around the edges. Peer to peer networks defy the isolated superhero theorem. Service design means observing people interacting in the wild - and you can't tie up singular solutions with a neat uni-product bow. The Cloud is morphing all the time. Collaboration breeds singular productivity with a side order of randomness.

Reaching for a 10 results in a 7.5 and a bunch of flak. Some collateral damage, mistakes, tragedies are unavoidable, but that doesn't mean you completely stop trying.

I'm reading a lot about 'saving' healthcare. Doing some late summer introspection, I'll be the first to admit buying into and using such platitudes on occasion. Ok. On many, many occasions.

There are several reasons I'm increasingly concerned about American healthcare's pursuit of perfection.

1. It's impossible to achieve a perfect 10 in American healthcare. One big blowout routine won't save our system. We need a web of individualized, interconnected, tangled, messy micro-solutions which maximize targeted impacts.

2. The expectation that a mass-population policy approach like federally-funded universal healthcare will make everyone healthy (and many wealthy) doesn't pan out. There is no Neo waiting in the wings to free us from the tangled matrix of missed opportunity and mangled administration we've created. Or rather, we need to cultivate a multiplicity of internal Neos.

3. When we're after the pursuit of perfection, often we make terrible mistakes. Chew on this maxim personally. Now chew on it professionally. Tough to swallow both ways, no? Hubris and smirking self-satisfaction that arises from creating polarizing 'one size fits all' perfect 10 routines cultivates tragedy at least as often as it perpetuates creativity. Today is the anniversary of a 'perfect 10' solution the US used to put a halt to WWII - in 1945 we dropped an A-bomb on Hiroshima, killing at least 66k instantly and dramatically escalating the costs of future conflict ('soft' human capital and 'hard' capital).

So why am I still here? Why haven't many of us opted out? Why are second and third generation healthcare bloggers continuing to form groups with early pioneers and reach for the perfect 10?

There's hope. We keep trying to perfect the routines:

1. Why do we keep searching for what's next in healthcare, no matter where we live, no matter where we work, no matter how our system is organized?

2. Why are people fascinated with defining and redefining Health 2.0? We're having the largest ever Health 2.0 US event in October.

3. Why are global hives of people coalescing without pay, spending personal time and money to revise outdated systems approaches?

Many of us realize perfection is unobtainable, but improvement is absolutely unavoidable. What role do you want to play (insert your own comic book/action hero alter ego here)?

Despite snark, hold fast to belief in healthcare heroes. They often disappoint us. That's called being human. They occasionally amaze us. Ditto on being human.

Shoot for the impossible. Only then do we start to believe in the improbable goals. Perfect 10? Doesn't sound half bad. That's called having faith.

Now act on it. If you need somewhere to direct that drive, I know plenty of all star teams looking for semi-heroes. Sometimes a 7.5 may as well be gold.


This is Hello Health

Welcome to Williamsburg Jay, Sean, Devlyn & Co! May you live long and prosper.

The Hello Health launch party on Thursday was perfect timing - it's easy to feel cynical about where 'primary' healthcare in the US is headed.

Then you perch on the edge of the Hello Health exam table in an office streamlined to provide the best in patient-directed, consumer-centric care, backed by Myca's custom software apps, and a little bubble of hope expands at the base of your throat. Five days later, the bubble's still there.

If you live in Williamsburg - do yourself and your health a favor (especially if you're a freelancer/creative type who's currently un/underinsured) - check out Hello Health.

A few quick questions for the Hello Health crew (which I didn't ask in person - too busy running around snapping photos and drooling all over your new digs):

1. Plans for service design/design collaborative in health?

2. When/where will the next branch open? (Please say DC...please say DC)

3. How do you compare Hello Health to the much bandied about misused and abused 'medical home' renaming of traditional primary care?

4. Serious estimates for scalability? How long to establish baseline goals for Brooklyn practice - how many patients - how long to establish next branch - will this run as a sort of franchise agreement - when/where can I buy one? (grin)

More photos from the launch on Flickr here...net denizens take note - Jay's got some interesting endorsements from the webtech/HIT community.

Many thanks to the Myca folks (excellent hosts) for taking this leap - your software app is a thing of beauty - can't wait to see my docs using it (in the US AND in the Netherlands - why stop with a cross-country bus trip when there's an international need for this kind of solution?).

Thanks also to the Organized Wisdom gang for the whirlwind Big Apple tour, and Sarah Greene for the sparkling company, invaluable conversation, bathroom bites of wisdom, and hospitality.

Anyone interested in visiting Hello Health - it's worth the trip. Trust me.