Moral Hazard: Why the Surveillance State is Here to Stay

If you’ve been keeping up with the news over the past weeks and months, the big headlines had been how former NSA agent Edward Snowden leaked sensitive NSA information about how the US is spying on everyone.

I’m not here to take sides on whether or not he’s a traitor or patriot. In fact, most people I know have taken up the proverbial pitchforks to express their anger at the revelation of such a pervasive program targeting Americans and foreigners alike.

My goal today is not to defend or justify the NSA PRISM program but rather, explain why such a program exist from a technology perspective.

Throughout history, human innovations in technology and sciences have largely been developed in an empirical, innocent fashion. In atomic physics, it started as a way to understand matter and the universe. Many people who worked on the Manhattan Project did not know the result of their work would be the eventual disintegration of hundreds of thousands of Japanese civilians and ushered in decades of nuclear proliferation that still exists today.

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The fact is, the technology to produce atomic weapons was there and if the technology is available, there would always be someone out there to exploit or weaponize it. For example, if you’re in a life and death fight against someone and you had a choice to pick a knife vs a gun, which weapon would you choose?

So going back to explain why PRISM exists, we originally developed Big Data to help us understand information and analyze it from a macro perspective. It has since helped numerous industries and allowed companies to gain better insight on their businesses.

PRISM exists because Big Data technology that supports it has matured in a way that allows us to gain insights on terror suspects. Try to put yourself in the shoes of an NSA director and understand the moral hazard behind all this:

“The technology exists today to monitor and spy on everyone, including potential terrorists”

“My job is to protect the American people and I want to do my best to prevent terrorist attacks”

“I don’t want to look bad if a terrorist attack happened and I have to tell the American people I haven’t exhausted all available options.”

“Implementing PRISM would grow my department, increase funding, and make my position more powerful.”

As you can see, the rationale and thought process of why the PRISM exists is founded on good intentions. Politically, it serves as a backstop for anyone who dares to question the effectiveness of anti-terror programs because it is the most effective weapon we have to prevent terrorism. Personally, it provides job security, and power.

If we were to dismantle such a program, we would be disarming ourselves in the intelligence arena. Just imagine if the US decides to dismantle all of its nuclear weapons, its nuclear deterrence would be nonexistent and other countries can threaten us with whatever they want.

We know other countries are doing the same thing. The proliferation of the surveillance state thus, is here to stay. Otherwise, other countries will gain a competitive advantage, targeting political targets,  potentially inflicting harm economically by way of stealing technology and IP.

It’s a rather unfortunate reality in this day in age but I don’t share the same optimism of my peers in trying to completely eliminate the NSA surveillance program. If there’s any country I rather trust in the responsible use of this technology, it would be the United States. Therefore, the best-case scenario for change would to enforce a robust oversight process to prevent any possibility of abuse, corruption, coercion, manipulation of political targets.

The “Glue” for any IT Project

Friend: So what do you do for work?
Me: I’m an IT Business Analyst
Friend: So what do you actually do?
Me: I’m a glorified translator…

So how would I describe what I’ve been doing for the past year? Let me describe it through the context of IT projects such as business intelligence. The concept of Business Intelligence have been around for decades. For some, it is just a fancy word for business reporting. For others, it is a disproportionate investment that serves only managers and executives. Many people go about their day working on these projects with no sight of what their output ends up.

The thing is, Business Intelligence can be such an enormous part of the organization that very few people understand the big picture.  In fact, one of the major reasons why IT projects tend to fail is because of poor business/IT alignment. I like to use restaurant example to illustrate the point. The customer are the people you ultimately serve while the cashier would take the order and relay that back to the cook to prepare.

process2

You can take the same relationship and apply it to IT projects in general.  I look at it from this simplified picture.

process

Going back to Business/IT misalignment and problems it represents, the analogy would be going to McDonalds and ordering a  McDouble with Mac sauce but you end up getting and paying for the more expensive Big Mac.

So whose fault is it when this communication chain breaks apart?  Is it the customer who didn’t give the right instructions? Is it the cashier who took the order incorrectly? or is it the cook who thought a McDouble with Mac sauce would just be the same as a Big Mac he’s used to making hundreds of times?

I truly believe the responsibility almost always lies with the Business Analysts (BA), yes the cashiers. These guys take requirements from the business and translate them into work that programmers and developers can understand.  They are responsible for clarifying what’s been ordered with the customer and setting expectation on what the output should be with the cook (“No, it’s not a Big Mac!”).

It’s easy to point the finger at the programmers and developers. The repercussions are tragic,  there’s many examples of clients who have alienated their IT department and laid off entire IT staff because every output had not produced a satisfactory result. Most of the time, the problem came from the IT just not understanding what the business wanted and they were doing as they were told.

BA’s are the translators of the company and they are an essential part of any organization who is making hefty investments in technology. Therefore, I strongly recommend that companies make sure they recruit and retain the best and brightest business analysts out there to minimize project misalignment.

I apologize if this is an overly simplified view of how IT and Business works but I felt compelled to share and emphasize an important point. Finally, for those who have not seen this,  I leave with this famous cartoon that we live and die by.

Full Disclosure: I own McDonalds stock and I enjoy eating their food.

Opinion: Our Primary Care System Needs to Be Overhauled

change

Having moved back to Columbus, Ohio exactly a year ago, I was ready to start my new job. Wanting to use my new health insurance and get an annual check-up soon, I needed to get myself a new Primary Care Physician (PCP). Let’s examine what how my experience went….

*Calls nearest primary care clinic*

Receptionist: Hello welcome to ABC Primary Care, how may I help you?
Me: Hi, I just moved here. I’m looking for a new doctor and an annual   check-up
Receptionist: Oh I’m sorry, none of our doctors are accepting new patients at this time, try calling the XYZ Clinic
Me: Thanks

*Calls XYZ Clinic, which is happens to be 30 minutes away*

Me: Hi, I just moved here. Is your clinic accepting new patients?
Receptionist: (Paraphrasing) Our best doctors aren’t but one of our foreign sounding named doctors are.
Me: Sure, I would like to have an annual check-up as a first visit.
Receptionist: Alrighty, let’s see here, it looks like the first opening is three months from now. Shall I go ahead and schedule it for you?
Me: *Smacks my head* That’ll be fine I guess…….

The sad thing is, when I showed up for my annual check-up, I waited and waited until a back-up physician told me the PCP I was supposed to see was too busy.

This happens to be just one of the issues I have with the primary care today. My opinion also, is that younger healthier people are not using primary care the way it should be if at all. The fact of the matter is, I have many reasons to believe that the primary care system needs to be overhauled. Here’s why:

Human Nature  doesn’t mesh with the Primary Care System today
Depending on where you live, PCP appointments can be hard to come by. As a relatively healthy person, the human nature in me says I don’t need to see a doctor unless I absolutely have to and even then, I can wait perhaps the next day. If you were to tell me I have to wait weeks for a PCP visit about a health concern that I have, I would’ve probably forgotten about it by the time the visit comes up on my calendar. This is why for someone my age, I don’t bother seeing my PCP anymore  except for maybe routine things like … an annual check-up. PCP’s are suppose to be the consultants in your health and provide expertise in preventative and cost effective treatment.  Instead, the PCP/Patient relationship has become dysfunctional as a result of overcapacity in the system and limited consultations.

Primary Care Physicians are a Dying Breed
The incentives to become a PCP are not enough to shift the current supply/demand equilibrium. As a matter of fact, the number of PCPs are on the decline while the number of new doctors entering the  field has remained steady for the past decade.  Also, according to Wikipedia -

“The number of medical students entering family practice training dropped by 50% between 1997 and 2005. In 1998, half of internal medicine residents chose primary care, but by 2006, over 80% became specialists.”

Primary Care is Unattractive
PCP’s are overworked and underpaid, period. Salary and compensation levels remain much lower compared to their specialist counterparts. Many long-time PCP’s have been forced to sell their practice or get acquired by a health system due to rising overhead and unsustainably low incomes. In order for accountable care to function properly, primary care needs to be sustainable and incentives need to be in place to keep doctors happy.

Some Ideas for Change:

depositphotos_6505135-3D-Health-Care-Reform-Crossword

Reform Medical Education
This piece often gets overlooked in the national debate for healthcare reform. There’s a certain hypocrisy surrounding the medical education system today.

The AMA remains adamant about keeping things within their scope of practice yet they continue to limit the supply of primary care physicians.

The AMA needs to sanction more medical schools and revise the medical education system to accelerate the supply of doctors. Instead, they are keeping the PCP supply low to maintain higher demand which equates to higher salaries.

To put things in perspective, 1,054 college programs received accreditation in 2012 alone. There hasn’t been a medical school accredited since 2010, and that’s only 12 schools since the year 2000.

I give you  "Doctors"

I give you “Doctors”

In addition, there is absolutely NO transparency in the medical education system today. A medical degree will somehow set someone back over $250,000. Early in my career, my dream was to become a doctor and I went as far as taking the MCAT. I eventually gave up that dream as reality sets in… I couldn’t afford it and I couldn’t afford to put my family through it. Where is that money going? and why does tuition raises seem to correlate a lot with an individual’s maximum borrowing limit?

(I’ll give you a hint: it has to do with maximizing profits)

Allow the Scope of Practice to be Encroached Upon by Innovation
Primary care is becoming less and less about the expertise of licensed doctors and more about innovative ways for preventative treatment. I envision it will evolve into a network of technology, mid-level practitioners and an engaged patient who can utilize the system more effectively. Things like telemedicine, crowd-sourced medicine and having nurse practitioners provide care should be embraced and not rejected in order to preserve a way of life. Again, the AMA is lobbying hard to keep innovation from encroaching on traditional practice and patients like you and I have suffered to endure this. The AMA needs to relinquish their scope of practice and allow others to fulfill a demand they simply cannot meet.

Primary Care should be De-coupled on the Insurance Side
What I mean is that primary care should be separated from other outpatient, inpatient care as far as insurance goes. If you’re looking for an explanation, then ask yourself the following. Do you currently buy car insurance? Well, does your car insurance cover oil changes and maintenance checks? Let’s go deeper. Why are dental and vision insurance relatively cheaper?

The thing is, primary care claims equates to twice as many filings, which equates to extra overhead, which contributes to the overall cost to the healthcare system. De-coupling primary care from insurance means that insurance companies can focus their actuarial efforts on managing high-ticket items or they can offer primary care insurance as a stand-alone product. In addition, this allows people who don’t utilize primary services a chance to opt-out.

We’ve already begun to see a few pioneer clinics break away from the insurance model and accept cash payments only. Everyone knows how bundling will lead to upcharges, just read the New York Times article that came out recently about how Anesthesiologists bundled their services with colonoscopies to essentially double the price of the procedure.

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Congratulations, you have endured my first rant post on my blog! Thanks for reading.

What is Epic Consulting? A closer look into the hottest EMR consulting niche

What is Epic Consulting?
Epic Consulting is focused on advising clients how to best manage and implement Epic (Electronic Medical Record software) to meet the objectives of the health care organization. Like many other lines of information technology consulting, this field requires in-depth knowledge and expertise of both industry and technology in order to succeed. Successful consultants are able to navigate between the complexities of the health care industry and system design to implement a system that is for the best interest of the client.

Epic Consulting can be regarded as a fast and growing market. Big box firms such as Deloitte and Accenture already have their own Epic practice. Many major IT consulting firms have Epic practices as well. In addition, there are also over a dozen boutique firms that work specifically in Epic consulting.

Epic and its EMR
Epic is a privately held health care software company headquartered in Madison, Wisconsin. Over the past decade, Epic has seen a dramatic rise in its market share among all other EMR vendors due to its highly successful integrated software.  It currently employs over 6,000 people and its revenues are estimated to be around $1.2 billion as of 2011. To put things in perspective, the company employed only 400 people in 2000. Epic is focused on targeting large health care organizations with clients such as Cleveland Clinic and Kaiser Permanente.

Competitive Advantage
Epic prides itself in delivering the best software that is focused on the patient at heart. With that strategic vision, the company was able to develop a product that is highly integrated. Enterprise clients can manage patients when they first walk through the door, see the doctor and out the door all in one system. Because all of the software was developed in-house, the big selling point is the seamless transition between different modules whereas Epic’s competitors that have grown through acquisitions struggle to transmit information between modules.

Epic also claims that another competitive advantage is in its consistently high KLAS scores, a research organization dedicated to evaluating health care IT products/vendors. KLAS reports are highly regarded in the health care industry and many CIO’s and IT managers use these to help make purchasing decisions.

Applications
Epic’s software comprises of over 35 different applications or modules. Each application requires specific technical knowledge to know how to successfully configure the system. Depending on the size of the application, training can range from 8 to 50 hours per application.

In sum, a large portion (but not all) of these applications can be classified by its role in the patient cycle:

Access – Applications involved in registering the patient when they first arrive to the logistics of scheduling and patient movement around the organization.

Clinical – Applications involved in the caring of the patient and assisting health care providers document their findings and results and administering treatments.

Revenue – Applications involved in patient billing and transmitting of billing information to collect and monitor claims to the insurance companies.

Certification in Epic is on an application-by-application basis. One is not simply certified in Epic. Many consultants specialize in one or multiple applications and may spend their entire career working with a select few apps.

Epic Implementation
In the eyes of the IT industry, Epic implementations can be seen as unique. Depending on the buyer power and influence, Epic strives to have its hand in as much of the implementation process as possible so implementation of the software leans to being vendor lead. Only in the hands of highly influential clients do they stray from their project management methodology. Epic has been known to devote a copious amount of resources to ensure budgets and deadlines are kept.

Flight Plan vs Project Management
Epic’s standard project management methodology is branded as “The Flight Plan”, a 5-phased Waterfall implementation model that some may consider too rigid for an IT project.

  • Kickoff/Discovery – requirements gathering phase
  • Validation – prototype phase
  • Build/Reengineering – software config and development phase
  • Testing – testing the new software configurations
  • Go-live – turning on the system in production mode.

One would argue for a more Agile approach, nevertheless, Epic has had success in managing projects and within deadline. The Flight Plan incorporates many traditional project management tools such as risk registries, a work breakout structure and project plan. However, one criticism of Epic project management is that most of the implementation specialists are not trained on how to properly use those tools. Since many health care organizations don’t have a project management office or proper PM expertise on staff, the CIO is more often than not to oblige by Epic’s implementation strategy despite its shortcomings.

The Players
Within the context of Epic Consulting, there are three groups of players in this market, Epic, Epic client, and the Epic consultants. Each of these players will be described in detail to highlight their roles and how they interact with each other.

Epic Systems
Epic Systems is a bit unique in terms of the vendor/client/consultant relationship. The company maintains a list of consulting companies that are allowed to send consultants to become certified in their software with or without a client request. However, there are no Epic consulting “partners” and they do not refer clients to specific consulting firms and do not favor one over another.

Overall, the Epic implementation staff is apprehensive about the use of consultants mainly because of potential power clash and the potential to usurp a vendor lead project by introducing conflicting methodologies. To understand this mentality is to understand their corporate culture. Epic believes strongly in growing people from the ground up. This is mainly the reasoning why almost all their employees are hired entry-level, regardless of background. Therefore, Epic consultants need to be mindful of how Epic does their implementations because it might affect the firm’s reputation if there is conflict.

Certification Control
In Epic consulting, Epic certifications are KEY and Epic has an iron grip on its certification process. Clients will only bring in consultants who are certified and you must be sponsored by a client. All training takes place in their headquarters in Madison, Wisconsin and it involves 2-3 weeks of classroom training plus 2-3 exams and a project. Because of the demands of training, certified individuals require a significant time and monetary investment.

As previously mentioned, consulting firms cannot simply send their employees to get trained. They must either be sponsored by a client or the firm is in “The List” of what Epic considers are reputable firms. Because of this, many consulting firms struggle to break into the Epic market because of the dilemma of winning client work without previous success in Epic because they don’t have certified individuals.

Epic Clients
Recruiting resources for Epic projects can be a significant challenge for Epic clients, highlighted by the artificially controlled supply of certifications. Large implementations are usually staffed with the following best practice. Current IT staff maintaining a legacy system rolls off and gets trained in Epic headquarters. Maintenance of the existing system gets backfilled by legacy consultants until the system shuts down. This allows current employees to develop and retain Epic knowledge. The client usually signs a huge blanket service contract with an IT staffing firm such as Encore, TEKSystems and  maxIT because these firms have a national presence and can assemble a staff quickly.

In addition, since an Epic project is very demanding on resources. An Epic implementation usually requires additional system analysts in the area of business expertise, project management and area leadership. Depending on the client, they can pull existing resources and hire new analysts to get trained in Epic or hire consultants specializing in Epic.

Epic Consultants
Epic Consultants are in demand because of the surge required to properly staff an implementation. Epic requires that anyone working with their software be certified. This is a blessing and a curse because clients can quickly vet these people based on what Epic Certifications they have but suffer from the limited pool of resources available.

Background and Roles
Epic consultants typically originate from being part of a client that implemented Epic in the past. They received their certification from being sponsored by the client and they are allowed to go into consulting after a period of time after their client’s go-live. Big box IT staffing firms such as Accenture and Deloitte are also a source of consultants. In addition, former Epic employees who are certified during their employment with the company go back to consult for clients after a period of time.

Roles and skills needed depend on the status of the implementation.

For new implementations, consultants need to possess the following skills: Change management, training/mentoring, workflow analysis and system build

For optimization projects, consultants need: software analysis, performance metrics, reporting and analytical skills.

In addition, consultant roles typically follow the paradigm of Analyst, Team Lead, Project Manager. These are the most needed roles and most consultants fall into one of these categories.

Market Demand
Having alluded to this already, the Epic Consulting is currently the hottest EMR consulting niche in terms of demand. However, salary remains comparable to consultants of other EMR systems.

demand

Nevertheless, Epic Consultants are enjoying a steady supply of work due to accelerated EMR adoption and Epic’s lead in the market. I have reason to believe the EMR market is behaving in a winner-take all fashion.

Decelerating market
There are signs the Epic market is slowing down. Average salary is a good indication of increase supply versus demand from the end of last year to now.

Trend2
However, consistent with my previous hypothesis is a sign that hospitals are needing more and more reporting expertise after the EMR wave. Epic Reporting experts are seen commanding some of the highest salary in the category.

Capture3
As a result, Epic Consulting firms need to come up with a strategy to scale back on Epic staffing and potentially enter into the Reporting/Business Intelligence/Database Warehousing field, which is a highly contested market and an obvious next move for many healthcare organizations. I hope you enjoyed this brief look into the Epic Consulting market!

My Top 7 Trends in Healthcare Technology (Finale)

And now for my #1 Top Trend in Healthcare Technology and it’s no surprise because it’s been the talk of the town for the last few years. However, I do want to share some ideas I have around its application in healthcare.

1. Big Data Analytics

This is THE buzz around the industry and what quirks me is that you often hear technology firms throw around the term “Big Data” in front of healthcare organizations. Sales executives from those firms will taut their Big Data experience to healthcare clients as a hot sell in hopes of securing contracts.

I will go far enough to say that there are currently NO application of Big Data on the healthcare provider side today.

The reality is, Big Data has a very specific definition and doesn’t involve just big things and data.   Next time you hear someone talk about Big Data, remember the 3 V’s:

Big Data requires a combination of
Volume: we’re talking about hundreds of million records of data,
Velocity: the data has to have liquidity and originate from rapid data collection
Variety: the data has to be rich and diverse, coming from a variety of sources,

So how does all of this relate to healthcare? Here are the challenges in healthcare that conflict with the 3 V’s:

  • Consider a medium-sized hospital organization have only around 200,000 admissions per year with associated records exploding to less than 100 million
  • IT is wasting storage space on storing streaming data in relational databases thinking they’ll use it someday and many current data collection methods in hospitals are batched.
  • Most IT departments are only concerned with storing and capturing patient-related data and financials.

In addition, this whole time, the healthcare IT industry have been enclosed in its very own ecosystem. Big EMR Vendors remain  closed to the idea of mixing patient information with non-clinical data, which is understandable for liability reasons.

It’s nice that I’m starting to see big institutions like the Cleveland Clinic, and Kaiser Permanente leading efforts to embrace Big Data in innovative ways.  They are paving the way for others and see the true value in applying Big Data to healthcare.

Here are some of my ideas and very powerful ways that we can use Big Data in healthcare:

Hospital “Smart Grid” System: Smart Grid Technology is an application of Big Data in the Energy and Utilities Industry. My idea would be to use the same concept to have hospital beds and rooms function like “meters” where streaming data can be collected. This is more sophisticated than aggregating room monitor information. I’m talking about collecting all sorts of real-time data such as temperature readings, foot traffic, air quality. Here’s the kicker:  The system can run algorithms to potentially contain never events and MRSA outbreaks in real-time!

MRSA outbreaks are a major problem in hospitals today

The major obstacle to a solution like this would be device integration. Again, interoperability, privacy, and security are major barriers to this type of innovation in the healthcare industry….

Will we have a Hospital Control Room?

Population Research: Hospitals can incorporate social media data, geographic area,  clinical population data, even genomic data to perform advance studies such as Human Behavioral Genetics (how genetics affect social behavior) in ways we could not have done in the past. This could lead to better ways of diagnosing and treating patients with Behavioral Health problems.

Identical Twins Share Similar Financial Behavior

Decision Support for Providers: Big Data can help clinicians perform their jobs more efficiently and deliver consistent care. Certain EMR Vendors are scratching the surface of this concept but face tough barriers because  healthcare organizations are not willing to share information with each other. However, if there is any chance that they are willing to cooperate, then I see a lot of potential. For instance, doctors would be better informed if they get information on what their peers are doing when faced with the same conditions. Healthcare policymakers can keep tabs on trends in care administration. Medical societies can also find, disseminate important information such as best practice protocols for a  particular specialty based on provider success outcomes.

These ideas are just some examples of what I see would be the most transformative trends in the industry. We are a more sophisticated society than we were 10 years ago and I foresee many great applications of Big Data not just in healthcare, but in all other industries as well.

Any feedback is greatly appreciated, Thanks for reading!

My Top 7 Trends in Healthcare Technology (Part 2)

4. Data Governance
A recurring theme floating around many CIO’s minds in the healthcare industry is the concept of Data Governance. For years they have been frustrated with having to deal with different definitions of data depending on the audience.

Here is a classic example of one particular client I worked with:

- The Case Manager define an Admit Date as the date when the patient is transferred from the ED to Inpatient.

- Patient Census define the Admit Date as the date when the patient is roomed.

- The Operations Manager define Admit Date as the date when the patient first entered the facility

- The Billing Manager define the Admit Date as the date when the patient’s first charge is dropped.

- The Scheduling Manager define the Admit Date as the date when the patient is first scheduled in the system.

and so on….

Obviously Data Governance involves A LOT more components than just Metadata Standards (previous example) such as Data Quality, Data Integration, Master Data Management, etc. All of these components combine to form a Data Governance Program.

Data Confusion is every hospital CIO’s worst nightmare. In addition, like many buzz-word or jardon I’m about to throw at you today, the concept of Data Governance itself gets misused and confused in the industry. So clients often confuse DG with Data Quality, Master Data Management, or Data Stewardship when they are in fact just pieces of the same pie. The trend now, is for healthcare organizations to establish a solid Data Governance strategy that includes all the components.

Recommended Reading:
Data Governance: How to Design, Deploy and Sustain an Effective Data  Governance Program

3. Predictive Analytics
Next on my list of top trends for healthcare technology is Predictive Analytics. In my previous segment, I talked about BI and Database Warehousing. Predictive analytics takes that to the next level. For the pioneers in the industry, the next big jump for them is to not only make sense of historical data, but to anticipate and predict future outcomes based on that data and make actionable decisions. This powerful tool is currently used most prevalent in Retail. There’s a famous story to illustrate the point:

One day, a father discovered that Target (Retailer) mailed coupons for baby diapers addressed to his teenage daughter. The father was furious and called customer service to complain why they assumed his daughter has a child when she isn’t even pregnant. As it turns out, the retailer was right and the teenage daughter was indeed pregnant because it was able to predict buying habits of chocolate, nausea medicine and Advil.

For healthcare, we’re not quite there yet but there are great non-malicious ways the industry can benefit from predictive analytics. For example,

If a patient has been seen for chest pains for 3+ times in the past year, we can predict that the patient will most likely suffer from acute cardiac arrest (very expensive to treat) soon. Doctors can then intervene early and prescribe preventative measures (less expensive) as a cost effective alternative.

Another example where analytics are currently used would be in case rate billing. Healthcare analytics are already being utilized to predict how much a patient’s CHF admission would cost the hospital based on a set of metrics. They are able to utilize a Six Sigma to identify outliers to constantly re-adjust their predictive models.

2. The Rise of Mobile Medical Devices (MMD)
Imagine, if you will, having a blood pressure cuff, heartbeat sensor, and insulin monitor in an attachable device hooked into your Smartphone. You’ll have an app on the phone that will display all that information next time you see the doctor.

smartphone-ultrasound
At the HIMSS conference earlier this year, the big talk was all about having medicine in the palm of your hands. I foresee two great benefits from this technology. One, it will reduce the time for office visits

More importantly, It will facilitate my concept of self-medical treatment. To elaborate, gone are the days of the Dotcom Era 2000′s of using WebMD for self-diagnosis only to be debunked by real medical doctors. In the near future, we can see great synergy with Smartphones, commercial availability of Mobile Medical Devices, and the mobile apps that serve as the “glue” to more effective self-treatment and self-reliance in an age where medical staff shortage is at an all time high.

I’m not downplaying the medical profession, but I am a firm believer of the concept of Necessity being the Father of all Innovation. Government regulators are already moving quickly to regulate these devices. Be prepared for this trend!

I’m sorry to have to do this but you guys will have to wait for Part 3 to see my #1 Top Trend for Healthcare Technology in my next post! Stay tuned!

My Top 7 Trends in Healthcare Technology (Part 1)

I present to you my list of the Top 7 Trends in Healthcare Technology based on my personal experience on the field.  I predict that these trends will be a driving force behind the innovation in healthcare technology for the foreseeable future. The higher rankings implies the level of innovation needed to drive this technology.

7. Strategic Optimization
There’s no doubt that the EMR industry is starting to plateau. A 2011 HIMSS Survey noted that 90% of hospitals have adopted an EMR while a CDC survey that same year reported 55% of physicians are using an EMR, up from 42% in 2009. By now, I would imagine that rate of adoption for hospitals is closer to 100%.

The reason for the rapid adoption of EMR comes as no surprise as the government enacted the HITECH Act in 2009 to pump over $25 Billion into the EMR market. The unintended consequence resulted in a gold rush where many healthcare providers haphazardly implemented their EMR systems in order to qualify for funding. For people familiar with product development, they would equate this to a Minimum Viable Product (MVP). Here is a nice definition from Wikipedia:

An MVP is not a minimal product, it is a strategy and process directed toward making and selling a product to customers. It is an iterative process of idea generation, prototyping, presentation, data collection, analysis and learning. One seeks to minimize the total time spent on an iteration. The process is iterated until a desirable product-market fit is obtained, or until the product is deemed to be non-viable.

As it relates to EMRs, most hospitals have deployed or in the process of deploying their MVP. The trend is that it’s only a matter of time before they need to iterate and optimize the product for it to work at full efficiency.

6. Business Intelligence/Database Warehousing = Accountable Care
The previous trend described how hospitals were narrowly focused on getting their EMR “Up and Running” versus using it effectively. Another unintended consequence to this madness is a frequent phenomenon I’ve encountered with my clients. Clients are now inputting massive amounts of information in a relatively new EMR system with no strategy on how to retrieve it. Now they’ve come to a quick realization that EMR vendors are not Business Intelligence vendors! Most of the reports coming from EMR systems focus on OPERATIONAL Reporting, and not what I called Strategic Reporting. As a result, operations are moving along fine but high level managers and executives don’t know how to steer the ship.

The trend now is that CIO’s are wising up and investing heavily on BI/datawarehousing technology. With an Enterprise Database Warehouse model, they can incorporate information from Cost Accounting Systems, HR systems, and even other EMR’s. The resulting product allows the Executive team not only on how to steer the ship, but also plot where they’ll be going next. In addition, new government initiatives such as Value-based Purchasing and Accountable Care Organization model relies heavily on BI/datawarehousing and would be impossible without it.

5. Telemedicine Integration
Yesterday, I witnessed first-hand the potential power of telemedicine as I met with the Vice-President of Engineering from HealthSpot. Their basic model centers around these “Pods” you can deploy inside hospitals, Walgreens, even your workplace. The Pods would have devices inside just like a normal nurse station, blood pressure cuffs, weighing scale, ear thermometer. The patient will then have a video conference with a doctor who controls the Pod remotely to administer care. This all looks great because ER departments can save money by using a Pod as an Urgent care site, doctors can augment their revenue by working from home, and patients can access these Pods more conveniently if it’s located in a local pharmacy like Walgreens.

Image

A HealthSpot Station

However, my meeting with the VP quickly evolved into a dire realization that the information needs to be relayed back and forth from EMR systems. This integration challenge needs to be addressed as the benefits from telemedicine is no doubt a reality. Physicians using these HealthSpot stations would like to access only one system as opposed to accessing that and the EMR to retrieve information.

This concludes the first part of my Top 7 Trends in Healthcare Technology, Stay tuned for the my next 4 Trends!