Gallery: Designing for Health - Ongoing

As a project for Nexthealth, I've been gathering things I'd like to see in my dream hospital.

Some are products (chairs, laptop stands, infusion pumps), some are services (hairwashing - don't ask), some are 'atmosphere' or environmental scenes.

This project began when I attended JCAHO's first Hospital of the Future conference in Florida last year. Almost no one (with the exception of Bumrungrad CEO Curt Schroeder) I saw speak seemed to really be interested in incorporating a service/user-design centric perspective.

It was that conference that inspired me to take the Walt approach to designing a dream hospital in this early HMRx post.

Having these kinds of design innovations in hospitals isn't just far-fetched, in many cases it's downright impractical (and potentially unsafe).

But I WAS seeing all kinds of nifty things in Dwell, Discover, Fast Company, and a bunch of other magazines that wouldn't be so out of place in a well-designed hospital of the future - so I started ripping them out (or visiting the manufacturer websites for digital copies) and saving them.

And then I learned about Dell Texas Childrens' Hospital, which actually seemed to be incorporating some dreamy features and practical green designs.

The good news? Most of the product photos I'm squirreling away are goods currently available on the market.

So I'm going to start posting nifty design photos up on Flickr under the "Design:Health" set.

Every time I see something neat it'll go onto Flickr instead of into my black binder of design.

Why does this matter?

It's dark days for healthcare. Anything that makes people who are also patients feel good about healthcare choices, wellness experiences, deserves some time in the spotlight, however fleeting.

Here's the gallery where I'll be posting Design:Health shots: http://www.flickr.com/photos/24983074@N06/sets/72157607578827484/.

If you work in healthcare/wellness, I encourage you to start your own Design:Health gallery.

You're the navigator of your personal health narrative - what would you like to see next along the way?

Blogger's Note - the image above is the Zoo de Vincennes in France. Bien, no?

Part IV: Go Edupunk - When Incubators Don't Work in Healthcare

So when will incubators in startup health NOT work?

When the group (and leaders or PMs or 'community advocates' or coalition) does NOT take the time to sort out IP ownership (or the lack thereof, by going completely open platform/open source) and establish guidelines for gainful exits.

Anytime you're shackled by IP issues in incubators, future output is leg-shackled to an open-ended debate that can get ugly, fast.


When else will healthcare incubation NOT work?

1. An incubator will NOT work in healthcare if it's a thinly veiled disguise for larger incubator members (big firms) to 'acquire' tech and keep the innovation and development process on a tight leash.

• UNLESS the incubator sponsors/sponsees AGREE to this goal up front (and in writing, por favor).
  
• With that type of patronage agreement, this form of incubation can be very successful (Exhibit A: Microsoft).

2. An incubator will NOT work in healthcare IF its members can't agree on a central and unifying goal/vision so integral that we're all willing to wring out ways to make it happen, with blood and sweat and tears.

• Startup life is hard. You work your a%$ off, sometimes with little personal/professional financial incentives.
  
• If your chunk of change is an equity stake and a low salary, and the incubating company/group/product tanks, you're left with some bills and a good lesson in getting back on your feet.
  
• This goal can be quantitative (ROI goals for each firm in the incubator within 2 years, etc) or qualitative, but should ideally be both.
  
• You have to pay the rent, yes, but you also have to feed the soul.

3. Incubators in healthcare will only work IF you don't stop when you get the warm-and-fuzzy "we're gonna save the world" feeling.

• IF you don't move quickly from idealistic dreaming (vision: consumers will be able to access healthcare goods and services, online and offline at will) to functional organizational mapping and strategic flow planning (with end products, pricing discussions, budgets, deadlines and innovation lifecycles of how to get there) - you're all fluff with no future, and that doesn't incubate anything other than depression.

4. Incubators and healthcare won't work IF you don't agree on compensation, or the lack thereof.

• IS this whole thing voluntary?
  
• Does someone get a salary for coordinating?
  
• Is other staff involved?
  
• Are MEMBER companies' staff expected to contribute time, output?
• If so, what is the staff's role with respect to incubator member firm interaction?
  
• What support are they expected to provide?

5. Incubators in healthcare won't work IF you don't agree on how new members/applicants will be added, and how/why old members will drop away.

• What is the structure?
• What do you call yourselves? An angel network with office space? A healthtech incubator? A mentor network? A startup plantation? An accelerator? Whatever the name, get the sticky issue of cohesive identity establishment out of the way first.
  
• Who's picking the applicants?
  
• What are the selection/enrollment criteria?
  
• How bare bones does it need to be? How open access?
  
• Is there an approval process for incubatees? Budget changes? If so who signs off? And what motivations do they have?

Final thoughts:

IP is the hairy wart on healthcare incubation's nose, but that doesn't mean we should ignore it. That thing may just be cancerous.

Incubators in healthcare won't work IF you don't agree on an intellectual property platform, OR clearly state that you're leaving this up to the parties negotiating incubation agreements.

But if that's what you're really about, you're just a matchmaker for partnerships, not an incubator, right?

Tomorrow we'll take a global, quantitative look at services incubators in a variety of sectors provide, and how they're structured - just in case, oh, you're in the process of launching one.

Part III: Go Edupunk - Healthcare Incubators: Time to Burn or Become Steel

Blogger's Note: Today I'm skipping around a bit during our week-long look at healthcare incubators.

Before we look at when incubators in healthcare/startup health WON'T work, let's take a look at what's working from the business end of startup tech incubation.

Part of the problem with incubation in startup health is that startup tech has been playing this game for at least 2 decades.

As a result, they've got a cast of characters - expected players who will scoop in and pick off any smaller firms whose products and services they want to integrate.

Want the ultimate exit? Look for acquisition by Google, Microsoft, Yahoo, etc.

But it wasn't until earlier this year that Microsoft and Google's health interests pushed them into releasing PHRs. In health, we couldn't look to the big boys for adoption. But that's changing as we move towards consumer-centric care.

So who might we expect to see adopting healthtech incubators' grads? Of course the same cast of characters is now attending to our space, so you might go after Google, MS, Yahoo.

But what about other firms?

Of course you could look to big pharma if you've got biotech grit, or one of the DTC genomics firms like 23andme if you're working in genetics/medtech equipment or processing.

But what about hospitals? Are big brick and mortar healthcare factories looking at investment in startup health?

Sure, but probably not at the level of a total acquisition - they're much more likely to cough up cash for partnerships or to pay for leasing/subscription/installation/service/support fees.

Wait a hot second...That's AT LEAST 4 big potential markets for health startups (big tech, pharma, biotech/genomics, hospitals).

So why aren't we seeing more incubators birthed to take advantage of a group of buyers with big wallets in a space that's, as Unity Stoakes puts it in this Organized Wisdom interview with Esther Dyson, "under-focused on and under-funded?"

It's crucible time for consumer-centric healthcare tech; as a recent issue of SmartBrief Leadership e-newsletter put it, time to "burn or become steel."

The Health 2.0 movement is at a precarious turning point ("the terrible 2s") - we've got companies with some very interesting traction, large community strength numbers, and even a few with some revenues in the black (a very few).

But the cyclical boom/bust nature of tech movements, including startup tech in health, opens wide the doors of opportunity for investors and larger big money sector leaders to fund incubation.

For goodness sake - we're dealing with people's most precious asset (even above financial security) - if you don't have life and limb intact it'll be hard to enjoy the fruits of the post-bailout economy.

You'd think more companies and individuals would be flocking to the space to look at incubation and VC/mentoring networks. But it's still a pretty insular world.

If startup tech can be THIS creative - with an online artisan food marketplace I love, Foodzie, birthed in the 2008 TechStars incubator, blogging about a "Magic of Mole" cooking class (warning: 'gastroporn' alert - do not look at the Foodzie page while hungry!) at La Cocina, an incubator for food entrepreneurs - SO CAN STARTUP HEALTH.

Want to see more examples of startup tech incubatees? Here's a look at some of the firms in the Y Combinator stable.

If you want more startup tech ed, check out this short video interview with VC investor Brad Feld, who reminds us that incubators are NOT the same as angel investing. But angels are a series for another time...

ADDITION: Just to really get your bloomers in a bunch, here's an irreverent panel at CommunityNext moderated by Guy Kawasaki that blows business model and 'standard' VC value benchmarks right out of the water.

The point? We need more innovation in HIT, eHealth and mHealth, not less.

I'd like to see increasing design-consciousness among medical equipment manufacturers in particular - haven't they learned anything from Amy Tenderich's open letter to Steve Jobs and the Diabetes Mine Design Challenge?

Need examples of the kind of innovation I'm talking about, and how it might be specifically translated to healthcare incubator selection?

• Reserve a spot in an incubator for a medical equipment maker looking to integrate biomimicry.

• Recruit a company, or university team, looking at bringing a product to market related to accessibility and gaming.
  

• A no brainer? A startup team designing a fitness game for the Nintendo Wii or for wiihabilitation.

Startup health incubator. Steel health. Steal Health? Crucible? Hmmm. I like it.

I like it alot.

Any investors want to do a startup health incubator?

Tune in tomorrow for when incubators in health WON'T work, and a discussion of the elephants in the room, including IP.

Part II: Go Edupunk - When Incubators MIGHT Work in Healthcare

Today let's take a look at when incubators MIGHT work in healthcare.

Remember, an incubator is not the same thing as a collaborative, but a collaborative can act as an incubator, and vice versa.

But an idea or networking collaborative does not automatically qualify as an incubator, especially if you're not talking business model, output, and exit strategy.

As a result, throughout the series coverage on incubators, I'll also include some examples of healthcare collaboratives that are (or are close to) incubator status, or, for the goal of healthcare startups and new initiatives, achieving 'success.'

First, a common frame of reference...

Although it's dangerous to assume there's a 'typical' startup tech incubator, let's look at one fairly 'standard' successful group with features similar to many in the space.

Meet Curious Office. I discovered them reading TechCrunch (skim their enewsletter daily for tech ideas that may translate well in healthcare). They're a tech business incubator in Seattle with several productive exits for investors (acquisitions).

This is a tricky issue to cover - there's not a whole lot of data out there (that I've been able to find) comparing successful incubators in healthcare.

Perhaps some of the difficulty arises from the different way incubators tend to qualify success:

1. Startup tech? Acquisition baby.
2. Startup health? A product/service line innovation is born.


There's even less coverage connecting incubators in various health subsectors, including academic, government, foundation, association, and corporate/startup.

For instance, TechStars has a health/wellness company, Gyminee, in their most recent 'class,' but I don't think it would do them justice to label them a 'healthcare' incubator - they support all types of startup tech.

Also, focusing on the healthcare side for the last few years, I might have missed something (or several somethings) in the startup tech world that's cultivating health/ehealth/mhealth startups - if you know of additional resources, dear readers, please leave a comment.

As a result, we're going to need to employ some mental elasticity when we look for examples of what's working and what's not working.

A bit later this week we'll take a look at some specific examples, but for now, let's think about some overall guidelines for what works.

So, incubators in health might work IF:

1. Incubation in healthcare works IF you have a party like RWJF, in concert with the California Healthcare Foundation, who are willing to fork over substantial amounts of time and capital to develop goods that may or may not work.

• Obviously, everyone's hoping they work, because we do want to improve healthcare delivery.
  
• But incubators are about risk. They take a chance and make an investment - returns aren't guaranteed.
  
• This is why the partnership between CHF and RWJF for PHR development can be considered an incubator, but I wouldn't consider the CHF an incubator per se (again, it'd be selling their overall mission short).
  
• But incubators are also about reward. Selectivity in picking applicants to support, whether in startup tech or startup health, is a big part of hedging your bets for success.

2. Incubation in healthcare works IF and ONLY IF you're completely upfront (internally and externally) about IP and how monetary gains from possible sale of incubator-developed applications (goods, products, user data, etc) will be split.

• Do mentors sign an NDA?
  
• What's the process for protecting companies in 'stealth' mode (or does the incubator wait til firms are out of stealth?)
  
• Who wins when there's a successful exit?
• How many people and or companies get a cut? What's the stake? 5% ownership? etc.
  
• What does the revenue breakdown look like?
  
• Who's involved in the final business model decision (license tech? Sell it? Sell whole company/product?)
  
• And what is the goal? Is the goal to birth babies that will be adopted by larger papa PHR companies?
  
• If so, who banks the adoption fee?

3. Incubation in healthcare works IF and ONLY IF you're completely upfront about who's footing the bills (and how sponsorship or 'ownership' of incubator firms is reflected) and EXACTLY what's expected in return.

• Are there any fees involved for participating companies, or does the incubator give them seed money? If so how much? For what period? Is it a lump sum or an 'allowance'?
  
• What *exactly* is provided to incubator member organizations? Capital? Mentorship? Office space? Internet connection? Skype? A cell?
  
• Do they have to wear sponsor tees in media/press/speaking appearances?
  
• Does the incubator program have rights to *share* the experience of incubator members?
  
• Is this carte blanche access to finances, strategic plans, etc? Be specific. Be quantitative.

4. However, incubation in healthcare works IF and ONLY IF you are big-picture, thinking beyond just the specific expected output. You have to think about the overall market space, and where the firm/product will survive, thrive, or die in that ecosystem.

• So what if a collaborative develops a new PHA?
  
• It only matters if you can DO something big with it, which means integration into the current world. Which means coherence - are you thinking partnerships, collaborations from the get go? Is the incubator candidate thinking big picture?
  
• Got revenue? You better look at a way to monetize before you ever enter the incubator space, unless you're providing a completely open-source PUBLIC good from which you DO NOT expect to generate revenue (a charity case).
  
• What's the way incubator candidates plan to wrangle revenues? If a company is 'self-funded' and plans to be 'ad revenue based' but hasn't researched SEO or signed up for Adwords, run the other way in most cases - or at least exercise extreme caution.
  
• Be aware - there are more revenue drivers and business models present in the Health 2.0 space than many people are aware of, including licensing, ad revenues, DTC consumer fees a la IPhone apps, or 'freemium' models for online health tools...we hope to illuminate some of the variety at the upcoming Health 2.0 conference (I've been working with speakers on how to address the 'business model' question).
  
• New businesses are businesses in flux. Does the revenue sharing or ownership model (options, etc) for the incubator change if the incubatee's business model changes?
  
• At some point you're going to hit the wall, literally - when you intersect with the brick and mortar healthcare delivery world - are thoughts on expansion (incubator, incubatee) mutually compatible?
  

5. Incubation in healthcare works IF and ONLY IF you're working from a user-centric design platform that integrates consumer principles and is 'customer' directed.

• REMEMBER: There is no single monolithic 'customer' or user in health; sometimes the 'customer' is a person who is also a patient, sometimes they are a doc, sometimes they are a joint academic/research partnership looking for a way to cure breast cancer.
• This intersection, especially when it involves virtual/web-based healthtech and the real-world brick and mortar system, can get messy. We're not at the point where healthcare goods and services accessed online won't at some point have real-world relevance to daily life, and usually we're using online knowledge to augment, not completely replace, offline care. So you need users on your side.
• Which means surveying your potential users and integrating service-design principles from germination onwards.
• Whoever your user is? Yeah. You need one of them on your design team. On your Board of Black Swans. If you're designing a PHA for people living with diabetes, guess what - you'd better have a person living with diabetes advising you on UI, functionality, flow, etc.
• If you're a healthcare incubator supporting the development of patient-directed tech, or want to be - why not consider a patient testing panel? Like the judging panels on shows like American Idol - let them hash out how they feel about a service, and why they'd find it valuable, or not. Even the harshest criticism from a potential user can be more worthwhile than an entire room full of yes-men (and women).
  

Tune in tomorrow for a look at when incubators won't work in healthcare.

Part I: Go Edupunk - All Healthcare Incubators NOT Created Equal

Blogger's Note: This week Health Management Rx will feature a series of posts taking a closer look at incubators in the healthcare, eHealth, HIT, and Health 2.0 spaces.

"The love of things ancient doth argue stayedness, but levity and want of experience maketh apt unto innovations."

--Hooker.

It's been awhile since I did a glass-half-full post.

Reading the latest debate on 'Health 2.0' (Vijay Goel gives an analytical overview here, while Ted Eytan sums it up concisely here) and biting my lips over PHR offerings on the market (I'm not using ANY of them, and I'm prime e-patient territory) provides more than enough incentive to look at the glass and see half empty.

It seems like we keep circling around the central issue - which is not, in fact, the definition of Health 2.0, or whether or not it's cooked.

The central issue if we really want to change healthcare? How to encourage HIT and mHealth innovation from research to implementation. And where to find the bucks to build/run the wonderful world of next-gen applications.

Enter incubators - stage right.

Monetizing knowledge, capitalizing on the energy of design teams in a manner that permits open-source, open-platform development, and the nightmare business model and IP debates involved might influence one to take a night on the town, spending time/money on best pick of a bad B-grade movie rather than dreaming up ways to change healthcare.

But last week I attended RWJF Project HealthDesign incubator demo day. I watched watched as nine amazing teams, representing a cross-section of academia, entrepreneurship, and tech, presented PHAs (personal health applications) based on a common platform developed by the very talented Samuel Faus and his team of 4 at Sujansky & Associates.

Reread the graph above. Slowly. Operative words:

1. PHAs (not PHRs). Trend: Someone builds the common platform (ex. Twitter) and a myriad of companies and individuals build apps (or widgets, ex. Twhirl, Summize, not Twitter Search).

2. Common platform. Trend: Someone has to bite the bullet and develop a 'public good' or open source platform that encourages the growth of semantic interoperability for multiple apps. This means you don't OWN the apps that will populate your platform - if you've done it right they spring up like clusters of mushrooms, breaking through dirt in unexpected new places. However, even if you don't 'own' the apps, you might 'lease' them space on your platform. Check out the plethora of Health apps springing up for purchase by happy IPhone owners.

3. Team of 4. Trend: Microteams. It doesn't necessarily take massive multinational teams like the Wikipedians to develop real-world healthcare innovations. As we've found in the Nexthealth crew, a small, tight team buzzing around a central mission and bringing in innovators from all over the world can be extremely effective in designing and implementing solutions, especially if they move from thought to action lickety-split.

So why talk about incubators?

1. There's not much in the blogosphere (yet) connecting separate incubation shops, even though, as we'll see this week, there are several very interesting HIT/eHealth/Health 2.0 examples.

2. I have a particular soft spot for incubators.

This story might help explain why I'm so interested in geeky tech and VC news. And why I'm so keen, often without monetization (read: not being paid) to connect the two worlds (startup tech+startup health).

By the time I hit 20, my uncle Craig, role model, sometime boss, and successful entrepreneur a few times over, was an active angel investor in the DC area.

Several times he'd field me a firm's prospectus - this was nothing new. He'd been throwing these things at me since high school because he knew:

• I was a geek;
  
• I'd need the experience later (even though I was set on being a poet at the time), and;
  
• (God bless him) I might as well mess up big when he was the only one answering questions so I'd get used to falling flat on my face and bouncing right back up.

One of the prospectuses I told him I liked? Yeah. A little company called "Honest Tea." I don't think he bought in. Live and learn.

That gig later helped me get a summer internship (2000) with Cal Simmons and John May, the authors of "Every Business Needs an Angel."

At the time, Cal was operating a tech incubator called ASAP Ventures in northern VA, and I spent meeting time hanging out at the offices securing launch party sponsors and suggesting dumb themes like "the color blue" because it "smells like first place" (what can I say, I was 20, and yes, unfortunately I still have a fondness for cheesy themes).

Why does this matter?

I remember the smell of the place, the logoed tins of mints that were party swag announcing to visitors the current residents of the incubator. I remember hearing about successes (and failures) while touring the open office space where a few businesses camped.

And I remember thinking - so. Incubators. This is how it starts.

And often, incubators are instrumental in how it continues...

Business and nonprofit incubators can be remarkably successful - "87% of incubator graduates stay in business." (If you've got other stats, please consider editing this Wikipedia entry).

Look at some of my favorite examples OUTSIDE of healthcare tech: TechStars, the Knight News Challenge, etc.

Incubators can get things started in healthcare too. Project HealthDesign is doing a damn good job of showing us the way.

Tomorrow, using the RWJF Project HealthDesign demos, and our Nexthealth experience, as an example, we'll take a look at when incubation in healthcare works.

The rest of this week, look for more general info on incubators, when they DON'T work in healthcare, and why it should be a sector goal to see a Health startup or 3 at TechStars next year.

Pitching a Healthcare Blogger Part II: Don't Burn Your Bridges

Even if you give the best pitch in the world, sometimes you're gonna get singed. Guy Kawasaki recently received this email reply from a reporter.

Last week I blogged a response to a PR pitch by Houston Neal, Director, Business Development for Software Advice. Houston wanted me to cover a corporate blog entry exploring the EMR/EHR nomenclature debate.

The email was blech, blog entry was ok, but the site itself was more interesting.

Any HIT firm connecting providers to eHealth resources with a revenue-generating business model not based on ads should be of interest to Health Management Rx readers.

Rather than just deleting the email, I posted this entry, which earned me a phone call from Houston, who had indeed actually read the coverage.

That led to the interview with his CEO, Don Fornes, which is published below. It's a behind-the-scenes look at how one firm is helping docs research EHR purchasing decisions. Medical Software Advice's goal? To move providers from the 'learning' to 'buying' stage - pronto.

Although this is a bit of a departure for HMRx readers, docs who need some help moving quickly from the research to the buy phase of EHR purchasing may find Software Advice useful.

I don't know for sure, as I'm not a doc, and so wouldn't generate a qualified lead (grin).

I'm hoping one of you, dear readers, will give it a try and report back. And healthcare bloggers - sometimes reading those pitch emails yields unexpected fruit.

"And most of the time, all the marketing sounds the same." -– Medical Software
Advice website


Q: Jen: This story begins in an unusual way for a business interview...I was contacted, as were several other bloggers I know, by Houston Neal, your Director of Business Development, who sent an email with a link to a corp. blog entry discussing the difference in the EMR/EHR terminology. I followed the link, and was unimpressed by the initial pitch, but interested in the company.

I used Twitter to ask colleagues what they would do - delete the email? Take time to 'educate' the PR contact? Many suggested the former, but I chose the latter.

Instead of emailing Houston back, I posted a reply on my blog, which included ways to improve his pitch to healthcare bloggers. I invited him to respond to the blog entry, and if he did, I'd spend more time learning about Software Advice.

Houston was good enough to read a very tough bloggers' review and respond in a professional manner, which allowed us both to carve out time for this interview today. So, how do you feel about Houston's results (not method), and has your strategy for contacting bloggers changed at all as a result?

A: Don: Yes, I think our strategy will be refined, but I don't think it will change. I'm very metric driven. We have to contact a certain number of relevant blogs to get a certain amount of relevant coverage. So we'll probably continue to contact the same number of blogs.

Houston learned that those contacts (email or phone) have to be more personalized and to the point. We had our weekly one- on- one meeting the Friday before you posted your blog post and some of the comments you had were the same comments I had.

It's hard. Houston's a pretty good writer, and business communication is very difficult for a number of people; getting to the point, making the ask, and getting to the point where you tell them the ask. So we'll continue to work on making those communications better, but we're not shy. We are very assertive in going out and trying to get our name out there. And we'll continue to do that.

We'll just try to do it better and make sure that people like you know we are talking just to them - not that we're not spamming every blogger out there. And that impression is rooted in us digging deep into the blog and understanding the angle the blogger takes.


Q: Jen: Now let's get down to business. Tell me more about Software Advice, and your service for physicians. What are you doing? And why do it for free?

Your site says you're a "Matchmaker between software buyers and vendors."
Do you want to be the Consumer Reports of EHR systems for docs?


A: Don: So my whole career before starting this company was in software and market analysis and research. I was an M&A (mergers/acquisitions) banker working with software companies. (Jen: Don also has a degree in Economics from Princeton). I realized big companies can go to a Gartner group and pay them tens of thousands to build a short list of products.

Small organizations don't have anywhere to turn. We started looking at how to use the web to do their initial research - not make their final selection. So I built that website and then I had to figure out a business model. And it became clear that it had to be referral based such that we would be paid for making referrals.

We've learned a lot about making referrals. We were originally doing that without human involvement; however that automated process leads to bad referrals though because people don't make the right decisions on the web - as you know they skim, they don't read.

So we got on the phone and started talking to people to see what was going on. We found that phone call started to really help us understand buyers’ requirements and help develop quality referrals - talking through features, deployment options, which specialty are you in? What's the size of your practice? Etc.

Q: Jen: So what's the business model? Are you paid by the EHR/EMR companies? You list 11 companies here including Abraxas, eClinicalWorks, iMedica, Practice Partner, etc.


A: Don: Yes, we're paid per referral, but it has to be a quality referral. We give the software vendors the flexibility to decide if it is a quality referral.


Q: Jen: Is there a limit to that free consultation call with the physician? Do you have people abusing the free call and calling back several times?


A: Don: There's no limit to the call, but there is a limit to how much we can help them...so if it gets to the third call, they're so deep in the analysis that we can't help them. We can't make the final decision for them, but we can help them get down to the final 3-5 options.

We don't make the final decision FOR a provider because that gets down to subjective assessments of 'what's easier' to use. That last decision is very tough, but as matchmakers, considering the level of knowledge that we have, it wouldn't be prudent or useful for us to make that final decision.

I would say less than 5% of the time we are asked for that opinion. We decline to offer it.


Q: Jen: So what's the goal of that first call?


A: Don: We have a specific quantitative goal - to help the provider narrow options to 3-5 providers on that first call.


Q: Jen: How many vendors are you working with?


A: Don: We're currently working with about 50 software vendors in medical, and about 150 across our other two industries. We are aggressively every day trying to profile more products and partner with those software companies.


Q: Jen: Software advice works in other sectors (construction, retail) correct?


A: Don: Yes, we work in construction and retail as well.


Q: Jen: Does Software Advice gather and share reviews/feedback from physicians using the service?


A: Don: We get feedback usually on how the sales process went (from vendors) - we don't often talk to people, you know, 6 months in. We'd love to know more about how vendors are performing for people, but we don't want to get into the position where we're liable for one negative physician review.

There are lots of stories out there about software failures - but I really think the buyer of the software, regardless of the industry, has to take a fair bit of responsibility for their own success.

Sometimes they buy software expecting it to solve all of their problems - make my bed, make my dinner - simply by paying for and installing the system.

But they totally overlook change management - making sure they are using the software to its full potential.

Q: Jen: Right now it's obvious your marketing strategy includes some social media outlets, including those in the health/medical blogosphere - how else does Software Advice communicate with potential customers?


A: Don: Our biggest focus is the search engines. So if you google OB/GYN EMR software or cardiology EMR software you'll see us ranking very highly. EMR software we bounce back and forth...so we're not in the top spots that we're aiming for, but we’ll get there. We're always working hard to achieve strong “organic” rankings (Google, Yahoo, and MSN Live).


Q: Jen: Which blog reviews would definitely help you with?


A: Don: Of course.


Q: Jen: Tell me what differentiates Software Advice from other resources docs might use to evaluate EHRs. What do you see as the firm's place in the Health 2.0 ecosystem?


A: Don: It's really the phone conversation. So what you see on the website is fairly simple - there's no complex functionality on there, but if you were to see the back end system that we look at, we have a lot more filters, including specialty, size of practice, do you want web- based, web- enabled, number of users, bidirectional lab integration, eprescribing, integration to ECHOs, etc.

The amount of sophistication in the filters that our Customer Advocates have access to is very powerful, and so we're able to perform a consultation that is very helpful in narrowing down that short list, whereas if the physician were left to their own devices on the web, it's a lot of sorting through marketing content and other data.

Our system almost brings us to the point of being a consultant, but we're not. We don't work through the process of installation and implementing the software for them. It's valuable if you can afford to hire a local IT consultant for that, but we don't serve that need. We just narrow down the options.

I don't want to stretch things so far and say we're Health 2.0 - it’s a hot phrase, but we are what we are.

Having said that, it's exciting to talk to some of the younger physicians who are starting new practices and want to extend information to patients via a patient portal, scheduling online, integration with a PHR, etc.

That's a fun part of our job - to start talking about some of those cutting edge technologies.


Q: Jen: So how many of the providers who call are asking for patient-directed or consumer-centric features like emailing a patient, PHR integration with Microsoft or Google, etc.?


A: Don: Less than 5 percent are asking this - more are asking for integration to lab, pharmacy, and hospital health systems.


Q: Jen: Walk me through the process for a customer call? Do you facilitate the end purchase via link, etc?

A: Don: It's a dynamic conversation. We do train our Customer Advocates on a script to make sure they're asking the right questions - who are you and what do you do?

This helps us know how to walk them through the process. So we might learn: The buyer is a physician in a 6 cardiologist practice with a staff of 12 in medical records and billing.

Then we ask what do you need? And we might hear: “I need a complete system that includes an EMR, medical billing, and scheduling, and I want them it all in one system. Currently my charts are all on paper and I have DOS-based 15 year old practice management system (Jen: Yikes!), our hardware's failing."

And we'll say ok we know which apps/modules you need. Let's drill down into some features. Are you interested in cardiac templates? eprescribing? Do you need this to be certified by CCHIT? And we get those answers and we can check them off in our system and the list of products is narrowing as we do that.

Our Customer Advocates, while very intelligent, don't need to know everything - they just need to ask the right questions. Then we look at the overall functional map for the provider as we move onto deployment questions. Do you want it on premise? Do you want web-based access? Access at home? At the hospital?

There are other things we can get into in terms of functionality and integration...for the most part that helps us narrow it down.

Then we'll talk budget; have you thought about how much you want to spend? Have you gotten any pricing information? Obviously that can be a big deal.

Our goal is to have buyer start with functional/tech needs and then compare prices. We don't do anything with pricing – just ask questions. We know enough to eliminate some of the choices and or point them in another direction.

Finally, we make our recommendations: "Based on what you told me, I'm going to recommend the following products - I can recommend two to five, so what's your appetite to digging into the a short list? OK, here are the ones I suggest and here's why."

We can pass on the notes from our call and your contact info and a rep will contact you to walk you through a live demo like a WebEx.

We're very careful to get confirmation; this that is what qualifies makes a good referral. So they say sure, we confirm we have permission - then we ask what is a good time for the vendor rep to call? Is there a better phone number? Do they have preferences with regard to phone or email?

At this point it's critical that we have them bought into the process, that they're ready to roll up their sleeves, get serious with the software vendors, otherwise it's not a high quality referral. We don’t make connections that don’t benefit both the buyer and the seller.


Q: Jen: Ok, so you're much more geared towards moving physicians from the EHR research stage to the EHR system buy stage than I anticipated reading the website.

It appears to be just this free helpful research service, but you really want me to be ready to buy. It seems a bit like Consumer Reports or the Blue Book - I don't pick up those resources and spend time on the short list until I'm really ready to buy a car.

So what's the attrition, or rate at which physicians drop off? How many go through the call and aren't ready to buy?

A: Don: Attrition rate is probably 5% - 10%.

We call it “taking our advice and running” with it. We know it's gonna happen, it's not ideal, we get really bummed out and sad, but that buyer was probably not ready to engage the software vendors.

So we're far less sensitive to it than we used to be. But at that point we've already put in the cost and effort and everything that goes into making that recommendation but we didn't make any money. Frankly, that is fine. That was not a qualified referral.

From the outset keep in mind it's a 20 minute phone call, 30 minutes if it's a talkative physician - so we start by understanding needs and acting as a reference for them. The best thing we can do is demonstrate that we really know what we're talking about during that call. People are amazed they're able to accomplish so much during that phone call in so little time.

We've compressed 2-3 weeks of research down into that brief call.

Q: Jen: Are your Customer Advocates physicians? How do you pick them? What are their qualifications?


A: Don: We're picking them for their charisma and their ability to relate to people on the phone, similar to the type of person that a software vendor might hire for their inside sales, but we don't look for closing skills because we don't need to sell anything. So maybe they're a little less aggressive but a little more thoughtful or consultative in that they need to understand a wide range of products and a wider range of buyers.

But these are not physicians, nor do they need to be.

Do they know as much about EMRs as a consultant that has years and years of EMR software experience? Maybe not, but they're a lot better organized and empowered by the tech we've built.


It was myself and Austin doing this until recently for most of our existence, so we had two people who really care about the business. We just hired two new Customer Advocates. The biggest challenge as a company is how we'll scale.


Q: Jen: Give me an idea of call volume.


A: Don: Well, there are two ways to contact us (800 number or form) - so we've got inbound and outbound inquiries. In a few weeks we'll do a new release of site, where users will be able to ask specific questions and request a free consultation in multiple different ways.

If you add up all the inbound calls and forms on website it's between 50-80 a day.


Q: Jen: Of those 50-80 inquiries/day, how many turn into software referral for a vendor?

A: Don: I'd say 35-40 percent.

Another 20 we're unable to help for one of many reasons - they're overseas, looking for tech support, students doing a term paper, etc. Another group of people we can't help or they need custom system, or they want home health care and we're not there yet, long term care, we're not there yet.


Q: Jen: I like to open with a tricky question and close with a trickier one. Everybody hates this one, but final thoughts about where you think healthcare in the US is going?

A: Don: I'm going to have to think about that one a little bit, but as a small business that just got healthcare coverage for all of its employees, the challenges are clearer than ever for me personally.

One thing I believe is that tech can really help create efficiencies. If you look at the manufacturing industry and the way worker productivity has increased over last 20 years,those macro stats demonstrate the value of IT in that industry.

We haven't seen that in physician practices - they have been too slow to adopt. I think that providers/physicians have so many other demands in terms of what they do and focusing on their own very arduous educational development that they haven't been able to focus enough on work flow and process to wring out all the gain all the efficiencies technology can bring.

I can't answer the question about whether or when that kind of process innovation will happen but I hope it will.


Q: Jen: Don, it's been a pleasure. Thanks very much to Houston, for coordinating this talk. I know it was tough for him, and he should be applauded for his response.

Subliminal Educating for Health: Kaiser & Grey's Anatomy

You've heard of subliminal advertising, but what about subliminal EDUCATING for health?

We can't handle healthcare info. Health literacy will prevent massive PHR adoption among patients. Perhaps. But who's tried selling health to us where we live, work, and play?

What about using 'mainstream' TV shows as a public health education tool?

Kaiser's seeding of the Grey's Anatomy sitcom produced some surprising results.

Kaiser worked with the show's Director of Medical Research (who?) to pick health topics based on 3 criteria:

1. 'appropriate' for the show
2. not well understood by the American public
3. topic where learning could be 'measured in a straightforward way' in a survey

The winner? Mother-to-child transmission of HIV (relatively low risk - less than 2% - if mom receives treatment during pregnancy). Without treatment, the risk of transmission is closer to 25%.

The 3-year old TV show has an average viewing field of 20 million. The variety of health/medical scenarios faced by the fictional staff of Seattle Grace provide "a multitude of opportunities for communicating health information to the public."

The storyline aired on May 1, 2008, after a briefing with the Kaiser Family Foundation, the Grey's Anatomy writers, and even a young woman who is HIV positive and delivered a healthy baby (husband HIV negative).

3 rounds of surveys, with separate survey respondents, were conducted: pre-show, post-show (week episode aired) and follow-up (6 weeks after show).

For more information on the scripting, survey process, and results, see the KFF report here.

Bravo to the Kaiser Family Foundation for this unique "edu-tainment" experiment.

Key Findings:

• proportion of viewers aware that, with proper treatment, there is more than
  a 90% chance of an HIV-positive woman having a healthy baby increased by 46 percentage points after the episode aired (from 15% to 61%).
  

• 17% of respondents in the post-show survey volunteered the specific response that the woman has a 98% chance of having a healthy baby (WOW).

• Six weeks after the episode, respondents who gave the correct response had dropped to 45%, but was still substantially higher (by 30 percentage points) than it had been prior.

• proportion of viewers who agreed that “It is irresponsible for a woman who knows she is
  HIV positive to to have a baby” went down by 27 percentage points after the show aired, from 61% to 34%.

• "Six weeks after the episode aired, the proportion who agreed with the statement had gone
  back up to 47%, which was still a statistically significant decrease of 14 percentage points
  from the pre-show level."

More interesting still are self-reported effects watching Grey's Anatomy has for viewers:

• (45%) of regular viewers learned something new about a health care issue from watching the show (although only 29% of all viewers can actually name an issue).

• Younger and lower-income viewers are more likely than others to say they have learned something new about health from the show (50% of 18–39-year-olds, compared to 38% of those age 60 or older; and 51% of those with incomes under $50,000 a year, compared to 41% of those above that level).

• Seventeen percent of all Grey’s viewers say they have either tried to find more information about a health care issue (13%) and/or actually spoken to a doctor or other
  healthcare provider about a health issue (9%) because of something they saw on the show.

• lower-income viewers are more likely to say they sought information or visited a
  doctor in response to the show than higher-income viewers are (24% compared to 14%).
  

So, if we want a 'viral' approach to educate American consumers about a killer health app (PHA, PHR, etc) and drive rapid adoption towards 30-40 percent, should (or shouldn't we) be considering product placement, just like the big consumer good companies?

Yes? No? Are public health initiatives up to competing with global multinationals for viewers attention? Should they be?

Help Wanted: Doc Social Networks & Evidence Based Practice

A new contact, Nan Solomons, needs help with a research design project for school.

Nan saw Maarten den Braber and I share the Nexthealth research at Medicine 2.0 in Toronto, and contacted me to ask about physician social networks (for doc, by doc sites).

Since connecting people, online and offline, interested in health innovation is a primary goal of Nexthealth, we're helping out.

Nan's working on some pretty interesting and relevant stuff, so I hope you'll take the time to help out if you can.

She asked me to post her area of interest here, dear readers, in the hopes that someone can flush out additional sources/lines of inquiry.

Although this is an unsual post for Health Management Rx, encouraging multi-modal collaboration and working to renovate the current medical education system is a goal near and dear to Nexthealth and Medical Education Evolution hearts - and we hope yours as well.

Nan's Project: Examining Provider Participation in Social Networks as an Indicator of Using Evidence Based Practice (paraphrased).

Her questions:

1. Is anyone else researching this? (if so, connect!)
2. Companies she should examine (Sermo, Within3, Ozmosis)
3. Where else can providers get online advice from other providers (Twitter!!)

Please leave suggestions/resource links in the comments section and I'll make sure they get back to Nan.

Open Source Learning: Live Today from RWJF Project HealthDesign - New Frontiers in PHRs

Today I'm at the Westin, Washington DC City Center, for the Robert Wood Johnson Foundation's Project HealthDesign unveiling of "New Frontiers in Personal Health Records - a 'Report Out' from Project HealthDesign and Forum on Next-Generation PHRs."

I think we'll be seeing some exciting stuff, and I'll be covering it for THCB (look for live, thoughtful, in-depth coverage later) and livetweeting (if we can get consistent WiFi in the basement where sessions are held).

When I first used Twitter last April to liveblog from the World Healthcare Congress in DC, I did it to keep the Nexthealth crew back home in Holland up to date.

I was missing my network of mindstorm pals, and thought Tweeting would be an ideal way to keep in touch.

It would be quick, I thought - a few updates here and there, some jokes, some quotes, snarky comments, and tossing out links to newly discovered companies with the potential to carve out a niche and scratch the hell out of it.

It would be easy, I thought - 140 characters? I can spit that out in my sleep.

Ha.

More about the challenges of livetweeting here.

Since April, along with many friends and colleagues, I've livetweeted from healthcare and tech events in Canada, the US, and NL.

Some people hate it (believe it or not I do have friends on Twitter who are not health-o-philes); for these I give advanced warnings that I'll be livetweeting, and recommend they 'unfollow' me for the duration.

But a larger subset of Twitter friends and colleagues who can't attend all the conferences I'm privileged to see live follow the tweets as a substitute for being there.

It's for all of you that I take the time, energy, and parse out some of my limited computational brain power to tweet. Why?

Let me make this clear - I don't get paid to livetweet. The vast majority of conferences I attend I pay for myself, or get a reduced/free media/journalist pass (or the event itself is free, in the case of the RWJF event today).

It would be a dream though to find a company or foundation to sponsor a team of livetweeters who would travel around to healthcare events the world over and freely disseminate knowledge with the online health community.

Wait, do I smell another Nexthealth Knight News Challenge entry?!

So if I don't get paid, why do it? When in doubt, go back to the heart of the matter.

When I find myself asking "why do it," I go back and measure everything I do professionally against the Nexthealth mission: connecting people, online and offline, interested in improving healthcare.

Sparking healthcare innovation via livetweeting from conferences? Sharing thought-provoking quotes, links, and comments? Learning more myself in the process? Check. Ok. It's a worthwhile use of time and energy.

Furthermore, this open-source sharing of health event info via livestreaming lives up to the Nexthealth vision of consumer-centric, patient-directed, hotealthcare - people will be able to access healthcare goods and services, online and offline, at will.

This goal includes healthcare bloggers, providers, educators, students, executives, patients, critics, and 'enthusiasts,' who should be able to access 'open source learning' quickly and easily online, at will.

So the pitch: I view livetweeting as a platform for collaborative continuing education in healthcare.

The great news is, many of us are doing it. The even better news is, this is a completely new field. We're looking for ways to radically increase the value of backchannel content.

Now when I'm going to attend an event, I'll post it first to my Google Calendar. Next, I tweet it, usually with a link, in case any of my network is interested.

Sometimes people will ask me to help them find more information, which I usually do.

Other times, people respond that they can't attend but will look forward to the livetweeting.

I'm increasingly choosing livetweeting over live/microblogging for a couple of reasons:

1. It's real time, like watching stockbrokers on the floor, energy and urgency - or boredom at the lack of action - conveys itself via the characters I choose.

2. It's impossible to capture the look, feel, and substance of an event live, while it's engulfing your senses. Some of the best journalists I know have difficulty with this, and I'm nowhere near that level. So while I do liveblog at times, usually I go right back to my tweetstream after an event and 'start' there - composing a more elaborate narrative from the bursts of opinion and thought generated throughout.

3. Blogging is static, passive, and top-down. I generate content, if you like it, you read it. Livetweeting is active, reactionary, involving, and two-way. Often questions from fellow Tweets inform what I ask presenters, and their opinions modify, in REAL time, how I begin to filter the event.

4. Twitter is fluid. It's Health 2.0. It makes blogging look like the AMA - clunky, slower, and behind the times. Followers can search via keywords (like Health 2.0, Nexthealth), friends can search for my name, people looking for something to do near them can search via location, etc. Followers drop on and off based on the utility of the conversation you provide, not just the static coverage you can generate as a blogger.

But again, I'm biased - obviously I find livetweeting a valuable way to enrich the healthcare innovation conversation online and offline.

So here's a quick review from around the blogosphere of who finds livetweeting and Health 2.0-style coverage valuable...it's for all of us that I hope more healthcare bloggers will livetweet:

• The Health Care Blog (picked up from e-patients entry by Susannah Fox)
• John Sharp at eHealth
• Bob Coffield at The Health Care Law Blog

One of the most interesting evaluations of going totally web 2.0 in healthcare coverage is by a new blogging buddy, Kirsten Broadfoot, of Spineconnect, Syndicom, and the Scoliosis Research Society.

You don't even know who you're touching when livetweeting for health, but keep reaching out. Thanks Kirsten.

Lesson of the week: Shouldn't you consider livetweeting? Or at the very least, 'lurking' on Twitter and following those of us who do?

Even if all you do is field questions for us to ask in person, you're contributing to the conversation. N0w - Let's tweet!

Pitching Healthcare Bloggers 101: Houston, We Have a Problem - What Not to Do, and How to Get Better

For some reason, I decided to respond to this pitch.

I don't get hundreds a day, rather a few a week, but sometimes I *really* wish PR agencies and startups with decent products and services would just refine their 'ask' a teensy bit. It takes so little time, and as many of my new Business Development friends know, I'm happy to give thoughts/suggestions and feedback usually for free.

So, Houston, I decided to use this as a lesson on how to pitch health/medical bloggers.

Here's my response, and your original email (and contact info). Readers: If you know Houston, let him know I gave him some coverage.


Houston -

Thanks for contacting me.

Since I love hearing about new companies and sharing healthcare advances with Health Management Rx readers, as well as my wider tweetstream and colleagues from Nexthealth and Health 2.0, I'm going to take a few minutes to give you some suggestions on how to pitch healthcare bloggers.

This isn't altruism. Really. I'm going to use this as a blog entry. Unfortunately, you're the example. However, if you're the adept PR/Business Development person I hope you are (you had a pretty nice email, just not quite 100% there), you'll capitalize on it, take these suggestions to heart, and get back in touch.

If, that is, you read my blog. If not, you'll never see this as I'm responding via blog rather than email (tricky tricky).

1. Mention the blog. By name. I can't tell from your entry if you've ever read it (probably not, I'm not fooling myself with false modesty here, but I'll give you the benefit of the doubt). It's a simple matter to pull up the blog you're pitching, pick an entry at random, and quote the title (or a sentence for extra brownie points). Devious? Perhaps. But you'll have my attention. Extra extra brownie points for a 1 sentence overview on how that entry ties into something your company is working on.

2. Please bury, for all time, the phrase: "we thought it might interest you." You and I both have an audience. A purpose in our communiques. I write articles I think my readers might find of interest. I usually tell them why, or at least try to make that obvious (the old call to action is a personal favorite). If you think your article about the semantic differences and linguistic intricacies that convolute patients' abilities to discern differences between an EMR and an EHR (what should they request from their doc? which term should they plug into Google?) tell me so. Capitalize on the fact that I make no bones about hiding my consumer-centric, patient-directed orientation towards healthcare reform. You missed your chance with this generic opener.

3. Always tell me what my call to action is...why do you want physicians to read about this on Health Management Rx? If you did some homework on me as a blogger, you'd note not many docs read my blog. A few mavericks (hello Ted, Vijay, Theresa, Jay) yes, but mostly I chat with docs on Twitter. You'd have more success if you just asked me to tweet a link to your report.

4. Also, don't pitch me bro. Or at least do it a bit more gracefully. Acknowledge your goals flat out. I'm not your salesperson. If you want me to use blogspace to evangelize your product, you have to convince me why my readers might find it of interest, and you haven't done that yet. In fact, you don't demonstrate any understanding of who my readers are (good start - check out 'blogs that link here'). If you want docs to buy your software/consulting because you use the 'preferred' term for electronic health records (i.e. "helping physicians understand what role the acronym should have in their purchase"), I'd suggest you'll get better ROI by buying ad space on a blog that takes ad revenue. Mine doesn't. Again, this is very clearly stated in the lefthand frame of my blog, and accessible by spending 5 minutes perusing the site.

4. Give me your title. Yes, I hate titles. I have personal and professional difficulty limiting myself to one role. But if you're pitching me, and thus my network, and thus my readers, and THEIR readers, please be clear. Are you a PR person? A marketing rep? The CEO? These are all things that can help you sell the fact that Health Management Rx should cover your report (or not).

5. You asked: "Would you be willing to post a brief write-up about it? Please let me know what you think..." Houston, your wish is my command. Let's see if you follow up on that request. If so, you've got your coverage.

PS - You caught me on a Monday. This is a high blog traffic day, so instead of saving this, I'm putting it out there quickly. Capitalize on that placement, and may the force be with you my friend. I think you have great potential to improve your pitch, if you ever read this post.

Jen McCabe Gorman

neXthealth NL
Health Management Rx

Twitter: jenmccabegorman
http://www.linkedin.com/in/jenmccabegorman
Skype: jenmccabegorman

Blackberry: 301.904.5136
Dutch Mobile: +31655585351
jennifermccabegorman@yahoo.com

--- On Thu, 9/11/08, Houston Neal wrote:

From: Houston Neal
Subject: Question about your Health Management blog
To: jennifermccabegorman@yahoo.com
Date: Thursday, September 11, 2008, 4:03 PM

Hi Jen,

I was reading your blog this afternoon and noticed you cover stories on medical technology. We recently wrote an article about the difference between an EHR and EMR, and we thought it might interest you.

As you may already know, earlier this year the NAHIT established definitions for EHR, EMR and PHR. Given their authority, and the Bush administration's plan to build an interoperable health IT infrastructure, EHR has become the standard phrase to describe an electronic patient chart. However, the majority of physicians are still searching for an EMR, and software vendors haven't renamed their products.

We wrote this article (http://www.softwareadvice.com/medical/ehr-vs-emr-whats-the-difference/) to explain the difference between the two systems and help physicians understand what role the acronym should have in their purchase. Would you be willing to post a brief write-up about it? Please let me know what you think.

Thanks,
Houston
_____________________________
Houston Neal
Software Advice
www.softwareadvice.com

Office: (415) 449-0577
Fax: (360) 838-7866
Skype: hjneal
Email: houston@softwareadvice.com

Take the Survey. Think Hard About How You'll Answer.

Today I received an invitation to participate in The Association of Clinicians for the Underserved's survey on healthcare reform.

I opened the link, thinking, like most healthcare surveys in which I'm invited to participate, my views wouldn't be useful, and/or the questions would suck.

They didn't.

Even if you don't end up participating in the survey, these are hard questions we should all be asking ourselves.

Here's the invite:

September 15, 2008

Dear Colleague:

The Association of Clinicians for the Underserved is concluding its survey of your views on the health care system and the upcoming Presidential election. This is the last invitation you will receive to complete the survey, and we hope you will strongly consider doing so. Your participation matters to us, and has the power to make the study more meaningful. Also, if you began the survey, but have not finished it, please take a moment to return and complete all of the questions. The response deadline is Friday, September 26.

Your voice will be heard on a national stage by your colleagues and those who shape the healthcare system in which you work. Findings from this study will be presented at the National Summit of Clinicians for Healthcare Justice in Washington, DC, to an audience of policymakers, industry leaders, and healthcare advocates. We encourage you to register for and attend this important conference. By completing this survey, you have the chance to make a very real difference for yourself and the patients you care about.

Most people have completed the survey in under 10 minutes, but you also have the option of starting the survey and completing it as time permits (i.e, you don't have to finish it all in one sitting). Plus, you can win one of more than 40 prices worth up to $250 just for making your views known!

Follow this link to the Survey: http://uncodum.qualtrics.com//WRQualtricsSurveyEngine?SSID=SS_7PQutEvldg2TrsE&SVID=Prod

If you have any questions or concerns please do not hesitate to contact the ACU staff using the information listed below.

Sincerely,

D. Brad Wright , Ph.D.(Cand.)
Asst Director for Health Policy
Association of Clinicians for the Underserved
University of North Carolina-Chapel Hill
(202) 465-4815
bradwright@unc.edu

Kathie Westpheling, MPH
Executive Director
Association of Clinicians for the Underserved
(703) 442-5318
kathiew@clinicians.org

For Doc Rob: 10 Reasons Why Doctors Are Like Truckers

Blogger's Note: I know I'll get into some trouble with this one (humorous post folks! funny! not serious!), so a little background is in order...

Earlier this week, Doc Rob wrote one of the best posts by a physician I've ever read.

If you haven't read it, get thee over there pronto.

Driving back from Blacksburg Tuesday, I overheard a bunch of truckers talking around the coffee pots at a convenience store.

As they talked 'shop' like logistics, traffic problems, selfish motorists, etc., I realized maybe docs and truckers have more things in common than we might expect.

Here are a few:

1. They mostly work alone.

2. We expect perfect performance and safe, ontime delivery, rain or shine.

3. They work through exhaustion, pain, and important personal/family events.

4. Some work for small outfits, while others work for larger concerns. The rarest breed are secure, independent owner-operators.

5. We pay them pennies on the dollar for what they do.

6. Both need a special license.

7. They handle our most precious cargo.

8. They're in it for the long haul, unless they burn out.

9. They're always subject to a labyrinth of new rules and regulations.

10. They wish people would just get out of the way and let them do their jobs.

And the bonus round:

They don't get as much respect as they deserve. Thank you docs, one and all.

Whether you're in research, academia, practicing, law, etc. we owe you a debt of gratitude that will never be fully repaid.

Health 2.0 Around the Blogosphere

There's a lot of buzz surrounding Health 2.0 'the movement,' and quite a bit of froth and churn in the young consumer-centric HIT sector. (Blogger's Note: I work with Matthew Holt and Indu Subaiya of the Health 2.0 conference as speaker liaison, volunteer manager, and ranger).

To keep up with news as we ramp up for Health 2.0 in San Francisco next month, I've created Google Alerts for the following terms:

• consumer-centric care
• Health 2.0
• patient-directed care
• Health 3.0
  

Although you have to spend a bit of time reading the Google summaries for each link to separate the wheat from the chaff, it's well worth it to set up an alert for your company name, competitors, and areas of the sector that interest you, like Health 2.0.

Here are some links my Health 2.0 Google Alert recently turned up (as in, this morning):

The latest in Health 2.0 - health coaching from Hummingbird Coaching.

Ian Furst at Wait Times tackles security issues in Health 2.0 using quotes from an excellent piece in Scientific American.

HeartHawk blogs live from Medicine 2.0 on the changing doctor-patient relationship.

Patricia Donovan of the Healthcare Intelligence Network talks about 'injecting' Web 2.0 into healthcare.

And of course, the neatest interview series on Health 2.0, brought to us by Easy Rider David Kibbe...can't wait to see his documentary aired next month. Safe journeys!

David's asking everyone he interviews the same queston: "Are you Health 2.0?" How would you answer, dear reader?

The Nexthealth Business Model(s) - Leave Your Preconceptions at the Door

At Medicine 2.0, Maarten and I decided to be true to our, ahem, unique communication styles.

We knew we'd need to shake people out of their comfort zones to spark hard-hitting dialogue on combustible issues like consumer-centric care evolution. We took a big risk with our particular brand of casual informality, but we think it paid off.

We did a lot of things differently. There is nothing in this list your organization cannot and should not be doing before presentations/demos.

A few examples:

1. We posted our presentation on Slideshare.net BEFORE our timeslot so potential attendees could decide if we'd interest them. Not interested? Don't attend. Luckily, plenty of people did.

2. We posted our ENTIRE research paper on Scribd for public review. Critique away. No copyright. Again, before our presentation.

3. We twittered the hell out of our upcoming session, as well as the rest of the conference, which let us make new friends and meet bloggers we'd only interacted with online. Of course we invited them all to attend.

4. We also posted qualitative aspects of the Nexthealth model/application up on our blogs, including our 'warm and fuzzy' elevator pitch.

When you do things differently, it generates comments you might never have expected.

Scott Shreeve left an interesting one on the Nexthealth Elevator Pitch post asking about our business model.

Scott says: "The only problem I see is that you are offering the service for free, you are giving away your technology, are not accepting ads, and you do not plan on using anonymized user information in any revenue generating way."

He's right on all counts.

"This leads to the big BM question (no, not that kind of BM) - how on earth do you plan to be around without any source of revenue. You either have a sugar daddy funding your every business whim or you will be out of business in short order. Would love to hear you describe the sustainable business model that will allow you to provide this valuable service."

It's such a good question I'll answer it here.

First Scott, if you find a sugar daddy (or sugar momma) please do send them our way. We'd love to talk.

It'd be a dream come true to develop a collaborative relationship like the one enjoyed (with great results) by Jay Parkinson and Myca. Probably no one else would be visionary enough (read: crazy enough) to take us on. But who knows. There are some amazing folks in healthcare, as we discovered this week.

Second - How do we expect to make money off the Nexthealth application?

By winning the lottery of course. Or gathering a few million via a VC round. Or being acquired.

Just kidding (at least about the first one), but I think far too many Health 2.0 firms have a similar bubble approach (relying on ad revenues in a rapidly morphing marketing world or charging only for premium services which are utilized by a small subset of users).

The short answer is that we don't. We're not trying to make money off the application, that's why we're throwing it out there as a public good.

Make no mistake, this isn't totally a selfless act of altruism. Many of the Nexthealth crew are more sinners than saints! Although we're social entrepreneurs working to spark change and global healthcare innovation, we realize the value of forging a new path with this sort of big splash.

After articulating our mission (connecting people online and offline to improve healthcare) and vision (people will be able to access healthcare goods and services, online and offline, at will), we decided very early on there would be things we wanted to build that should be set free "open source" style rather than siloed and privatized to death.

If you allow a company to put this kind of application to bed in a corporate stable you'll make a lot of money, yes, but you're not going to get the same relative neutrality and objectivity of which a completely NFP app is capable of doing.

Read: You will not be able to generate trust among digital health natives if you're selling off data on the back end with no opt-out a la Patients Like Me, especially once your users find out about it (and who wants a Health 2.0 version of Facebook's Beacon crisis?).

They may not know PLM is doing this yet, but when users (and potentially the media) uncover this I wonder if we'll see some of the first 'negative' HIT/Health 2.0 coverage - the nascent industry may still be too young for people to understand the implications and react in a critical manner.

This is why we won't gather your data and sell it at Nexthealth. However, you WILL have the option to make it available, open-source, to public health researchers (anonymized of course). We'll provide links and you can send it to them at will, or not.

That said, we have explored a few various ways to monetize use of the decision-support search app without sacrificing the relative neutrality and objectivity of the tool.

Some ideas include click-through plans, entering the Knight News Challenge and other similar unique open-source/NFP funding grant programs, etc., but more on those later.

And besides - we've got plenty of talents, skills, and plans that can be monetized. Call us foolish. Call us idealistic. Call us naive. Call us many other things. I'm sure that will happen. We are a new kind of 'business.' We will make many mistakes.

But we're trying not to make the mistake of disguising selflessness for selfishness - an integrated "do not cull out" approach to altruism and a healthy attitude towards capitalistic profit guide our decisions in kind. If a good would cause more momentum in the public domain, we'll drop it there. If a good can be privatized, yet still work in concert with our goals, we'll do it for a paycheck.

This isn't the last application Nexthealth will produce - it's the first of many.

We're thinking ahead to sustainability for the collaborative and other projects already in the design life cycle (including others that will generate revenue). We've got multiple other plans in the works. In fact, Martijn Hulst and Jacqueline Fackeldey present some additional ideas and concepts this week in Holland. Break a leg both!

At Nexthealth, we generate a different business model, with different principals 'shepherding' the project, for each product.

You'll be seeing both more 'public' and 'private' goods developed by the Nexthealth team, sometimes in relative 'isolation' and sometimes in cooperation with other organizations.

This application is the getting-to-know you handshake from our group. It's the best business card in the world - showing we're capable of producing with limited resources and extreme creative prejudice. Consider it our proof of concept, the ultimate whitepaper.

In order to understand why we'd be crazy enough to do research, detail a new model, nearly kill ourselves trying to design/build an app, and then be totally committed to giving it away for free without 'commercial bias' or interference, you have to know a bit more about the group nuts enough to try this.

The short version: Maarten and I are social entrepreneurs who are part of a health innovation COLLABORATIVE (Nexthealth) with a page here. The model/application we described at Medicine 2.0 is just ONE of the projects we have in the works. The collaborative produces both 'public' NFP goods, and 'private' FP goods, and we don't separate the two in our daily business activities.

So, about Nexthealth (the group):

NOTE: I'm taking a stab here at putting 'how we work' into terms many readers can follow...some of my Nexthealth Dutch buddies may have other descriptions (Jacqueline, I know you'd die before using the "PM" acronym for instance:).

1. We are a hive collaborative nonprofit founded in April in the Netherlands (following the first Health 2.0 Unconference NL) with two 'arms': NL and the US. I'm mostly US, the others are mostly Holland, although there's some definite flux.

2. Nexthealth has a core group of 6, but our initiatives almost always involve others recruited from the hives of our personal and professional networks.

A basic snapshot of how our current workflow looks:

• Someone's radar picks up a project they're interested in doing. Sometimes we find it, sometimes it finds us. They bring the idea back to the group (6) - usually first via email, Twitter, Skype, and other social web tools.
  

• Much discussion ensues. Normally the person (or persons - Maarten and I often work as a team) who introduce the idea becomes a 'Project initiator' or internal PM (except many of us call ourselves 'firestarters' - that's just the way we roll).
  

• Sometimes the discussion is kicked offline in one of our famous meetups, but often we get rolling without having seen each other in person (ROPE and ROWE), and have multiple projects and initiatives on the whiteboard (literally) during our next face-to-face.
  

• Sometimes the person who introduces a project just throws it out for discussion and another core member becomes the initiator.
  

• IMPORTANT NOTE: The initiator isn't static. If a project reaches a stage where the initiator loses interest and/or doesn't have the skills/time to continue (most common), someone else picks up the ball and runs with it. We find this change happens, oh, less than 25% of the time (estimate) as we each tend to introduce things about which we're invidividually passionate.

• We decide, kind of individually and collectively, if the project has anything in common with our goal and 'ideal' healthcare system: first, does it connect people, online and offline, interested in improving healthcare? Second, does it work towards semantic interoperability of health - "consumers will be able to access healthcare goods and services, online and offline, at will?" If the answer to one or both of those is yes, chances are we'll take it somewhere.

• Kickoff! The project initiators (and other core members) recruit/recommend resources (human and otherwise) to complete the project. The initiator largely directs the initiative and keeps the group updated on progress via the social web.

• The Payola: Sometime we get paid (for profit, "private" goods) and sometimes we don't (NFP, "public" goods). If we get paid as a group, the revenue will be split according to prearranged terms based on who works on the project. Obviously we aren't making much money yet - the group is bootstrapped for now, and each of us have other gigs outside of Nexthealth (all in healthcare).
  

Also Scott, let me apologize for leading you and other readers on a bit over the last few days.

Maarten and I have been working on the research/model just since the latter half of April. Things have been moving so fast we haven't provided substantive information (operations, people, etc.) about the Nexthealth group itself as quickly as we should have.

At Medicine 2.0 there was so much conversation about the model (and where healthcare is going in general) that we didn't get around to specifics of business models for the group and the application.

That's no excuse, however.

I've tried to remedy that oversight here.

In addition to doing completely new research in Health 2.0 (and trying to act as a bridge between 'commercial' and 'entrepreneurial' Health 2.0 types and 'research' and 'academic' Medicine 2.0 types), we're operating under a new type of business model, a hive collaborative, with our current 'alpha' workflow process detailed above.

Also keep in mind that this is an organization just learning to hold its head up....we're in the infancy of Nexthealth. Our birthmonth is April 2008.

We recognize the org. structure is liable to morph and go through various refinements as the 6 original principal founders (myself, Maarten den Braber, Martijn Hulst, Jacqueline Fackeldey, Niels Schuddeboom, and Jeroen Kuipers) determine what's next for each of us individually as well as for the collective.

Some will stay, some will go. We'll add new members, new strategies, and new revenue streams as we learn to crawl.

But with this sort of commitment to sparking global healthcare innovation, skinned knees and elbows are inevitable. It's how we react to the stumbles that'll show whether or not we're one of the groups to be running at the front looking for what's next.