Very interesting article by Brian Klepper.

http://www.thehealthcareblog.com/the_health_care_blog/2008/10/an-impending-ha.html

“The other big idea is that the Web can facilitate the efficient aggregation and reformulation of knowledge and data to create new information that is not only descriptive, but prescriptive, evaluating complex situational configurations and recommending next steps based on current best knowledge and experiential data. Health care is fundamentally an information-based discipline, and the Web catapults us way beyond individual expertise to the organically evolving wisdom of mass collaboration.”

This is precisely what Gazoont does at its core.

Last week I spent some time shadowing an employee of a potential client, to understand what her work day is like, how she uses the technology she has, how it could be better, and what are some of the limits and constraints of her environment, tools, and patience dealing with it all.

When I called her to set up the appointment, she said, “you know, I’m not sure how much you’re going to get out of watching me. I don’t use the laptop and software on the job. I write everything down and then go back home to use it.” What she didn’t realize is that her description of her situation is actually a gold mine for people like me. The real puzzle is why it’s better to do things twice than do them once with the available tool.

In the day I spent with her, I learned a lot of detail about “real life” in a job like hers. Because realistically, when I set out to design a system for someone whose occupation is very different from mine, involving people very different from me, I can’t do a very good job unless I immerse myself in that world. Design isn’t in the details, it is the details. Those details are the difference between something people like to use, and something they leave at home.

For example, the software program she uses expects information in a linear format. You fill in a section, click next, fill in another, change tabs, and so on. But the delivery of that information, from the customer, isn’t linear at all. Part of this has to do with the fact that the customers are elderly and generally in poor health. They forget things and then “ah-hah!” they come back to them (don’t we all). The software has to be forgiving in instances like this, and right now it’s not. The domain is a fuzzy one. Things don’t always go according to plan. Anticipating these kinds of situations and handling them gracefully is essential in an effective software application.

There’s just no substitute for ethnographic research in an unfamiliar domain. Even in a familiar one, you can always learn something when you view the situation from a different perspective. Before you set out to define requirements, take a stab at understanding context. You’ll be suprised at how much that shapes the entire endeavor.

From this very compelling story: “When we asked them if they see universal healthcare as an unfair burden to certain taxpayers (and would they like a lollipop), almost all children said yes.”

Study: Most Children Strongly Opposed To Children’s Healthcare

Because of our work with CapMed, Microsoft has chosen PointClear as a HealthVault Consultant (at the time of this writing, there are only four in the world, including us).

You can see the directory on Microsoft’s site here:

http://msdn2.microsoft.com/en-us/healthvault/cc136753.aspx

How can we help you use Microsoft HealthVault to expand your business and build your brand with consumers?

This is a very interesting PR effort that Microsoft has launched around its HealthCare initiatives. Obviously, you have to take this with a grain of salt; but, personally, I got chills when I first watched this video. The main reason it had this effect on me is that a lot of what we are working on at PointClear and Gazoont made me say ‘hey, we do that!’ as I watched the video. This is also true of some other companies with whom we have worked (Halo and CapMed, for example): ‘hey, they do that!’ Consider the following:

0:17 - ‘Secure Data Sharing’ - that is a plug for HealthVault (PointClear is currently one of three vendors approved by Microsoft as HealthVault integrators)
0:26-0:30 - when the Care Manager notifies a particular set of patients of some information - this is precisely on of the things Gazoont does!
~0:50 - interaction between the jogger’s personal tracking device (personal monitoring devices are a specialty of Halo) and the application on the ‘big screen’ - looks like a next generation PHR (CapMed) + secure message delivery - uploading data from a personal fitness device to a PHR is also a classic HealthVault use case
~1:45 - I just have to say the medication reminder ‘table’ is extremely cool. The whole doctor/hospital workflow reminds me of a next-generation Awarix product
~1:55 - side note: what’s up with the Doctor’s X-ray vision device finder thingamagig? That’s a super-power; not a technology, right?
3:29 - Digital Wallet card - the great-great-grandchild of a PHR running on a personal USB key

And of course, Lee Farabaugh and our superior Usability team should love the very cool ‘Minority Report’-esque User Interfaces.

Here is the video called ‘Office Labs: Future of personal health concept’:

From ‘Google to Offer Health Records On the Web’ in today’s Wall Street Journal (page D1):

HealthVault, launched in October, offers a number of personal health record options. One called icePHR from CapMed, a unit of Bio-Imaging Technologies Inc. that was an early developer of personal health records, allows users to designate specific information to be available to responders in case of an emergency. Users then print out instructions on how to access the record on a wallet-size emergency card. The service costs $10 a year per family.

You may find the article here (subscription may be required).

We at PointClear helped CapMed develop their online PHR products, icePHR and onlinePHR, and we are extremely proud of CapMed and excited about the press they are getting. Congratulations, CapMed! Woohoo!

Now, how can we help you achieve the same level of success? Contact us and find out.

Most people don’t particularly enjoy staying in the hospital. If you’ve ever had the misfortune of spending some time in the hospital, you’re experience of departing likely left much to be desired. For folks with complicated conditions like heart disease, diabetes, etc., the instructions they receive on diet, new drug regimens, things to do and not do, things to watch out for, whom to call when there is a problem, etc. can be downright overwhelming. Perhaps this is the reason that “nearly 18% of Medicare patients admitted to a hospital are readmitted with 30 days of discharge, accounting for $15 billion in spending”, according to a fascinating article in the Wall Street Journal (Landro, Laura. “Keeping Patients From Landing Back in Hospital.” Wall Street Journal 12 12 2007: D1). Not only does inadequate follow-up care cost the healthcare system a great deal of money, but it degrades the quality of life when patients return home:

“We have to start paying attention to people’s needs beyond the hospital door,” says Mary Naylor, a professor at the University of Pennsylvania’s School of Nursing. She has conducted a number of clinical trials on a model to help older adults with complex care needs after they are discharged. “The experience of multiple hospitalizations can take a devastating toll on the human psyche and the quality of life for patients and their caregivers,” she says.

Fortunately, many folks have some great ideas about how follow-up care can be improved:

There are about five million readmissions a year in U.S. hospitals, with approximately a third occurring within 90 days of discharge, according to the Institute for Healthcare Improvement, a Boston-based nonprofit. But with so-called transitional-care programs, which follow patients for varying periods of time at home, as many as 46% of readmissions could be prevented, says Pat Rutherford, an IHI vice president.

The institute is working with hospitals to reduce readmissions. Its programs include: identifying patients at risk for return, scheduling follow-up doctor’s appointments before patients are discharged, sending nurses to patients’ homes within a few days of discharge, monitoring patients at home, and educating patients and families on how to adhere to medication schedules and self-care regimens

(emphasis added).

For our sister company Gazoont is building a platform that can be used to accomplish much of what IHI’s programs seek to do. In particular, the Gazoont platform can be used to increase patient awareness by providing them packages of information tuned to a particular patient’s needs, as well as allowing hospitals, managed-care groups, etc. to mount patient wellness campaigns that target patients that match a particular set of criteria.

Some hospitals, like St. Luke’s in Cedar Rapids, Iowa, are participating with IHI in a pilot to implement some of its programs. The results for their patients are compelling:

David Dunn, a 69-year-old retired golf-course manager suffering from congestive heart failure, diabetes and kidney disease, was admitted to St. Luke’s earlier this year to have three stents placed in blocked arteries; with a history of repeated hospitalizations, he was signed up for the home transition program, which included follow-up visits by home-care nurses and special instructions to help his family monitor his condition.

“The care was so much better than anything we’d experienced,” says his daughter, Deb Kacena, who recalls other hospital stays marked by poor communication with doctors and little follow-up care. “It was really crucial, because there were so many things going on with him”

(emphasis mine).

As these pilot programs give way to larger rollouts, it is easy to imagine how the Gazoont platform (as well as other tools such as the devices for wellness monitoring like those offered by Halo) can accelerate the effort to save money for the healthcare system by introducing new efficiencies, and, most importantly, improve the quality of care for patients.

One of the things we espouse here at PointClear is achieving a balance between work and life. We have an office but we can work from home whenever we want to or need to. We don’t have strict hours. The company supports our outside endeavors such as my cycling team, other employees’ kids softball and volleyball teams, and the famous Walker Street Opry bluegrass band.

A recent study by the Wake Forest University School of Medicine reports that setups like this result in healthier workers:

A flexible work life, including telecommuting and job shares, is good for your health, researchers said on Tuesday.

They found that if people have the ability to work from home and to compress work weeks, they are more likely to make healthier lifestyle choices, to exercise more and to sleep better.

“Perhaps it gives people the time to fit in healthier lifestyle into their everyday regimen or maybe it just enables people to better manage their time,” Professor Joseph G. Grzywacz, of Wake Forest University School of Medicine, said in an interview.

Another thing the article cited is that, while work/life balance initiatives are often started to help women balance work and family, they tend to benefit both men and women. We see this kind of phenomenon all the time. A classic example is curb cuts for the disabled who are in wheelchairs. These curb cuts benefit wheelchair users, true. But they also benefit people pushing strollers, pulling luggage, those who have bad knees, etc.

Perhaps the far-reaching benefits of this kind of work environment will urge more companies to implement policies that help their employees strike a balance and lead healthier lives.

Read the whole article about flexible work life at Yahoo!

As the only child of a parent who is ‘older than 50 but less than 100′ (Mom, I hope this is vague enough), I have a particular interest in my role as caregiver in the use of technology to help me help my Mom more efficiently, while maintaining her privacy and independence. There is a burgeoning market of hardware and software (the latter of which is of particular interest to us at PointClear) that helps caregivers monitor various tasks and events–from whether or not certain medications are taken at the appropriate intervals to whether someone needs assistance because of a fall in the home. More importantly, it gives folks who are living independently a sense of security that help is always available–even if they aren’t able call for it. The obvious issue to overcome is concern about loss of privacy. Apparently, the trade-off is worth it for many seniors, according to this recent article in the Wall Street Journal:

When John Fowlkes’s adult daughter suggested installing an electronic monitoring system in his apartment to oversee his well-being from afar, “I was very skeptical,” he says. To Mr. Fowlkes, 86, who has an active social life including an 80-year-old girlfriend, the idea evoked thoughts of Big Brother.

Work and Family columnist Sue Shellenbarger learns about new home-monitoring technologies that may allow doctors and families to track the medical condition of seniors from afar.
Mindful that a younger friend had fallen at home and lain on the floor for hours before anyone came to help, Mr. Fowlkes, of Raleigh, N.C., gave in. To his surprise, he found the setup “makes you feel more secure.”

source: Wall Street Journal, November 29, 2007; Page D1
Link to article (may require log-in)

Here is a video that compliments the article:

On this topic, we are all very excited about Halo Monitoring, Inc., a company in Huntsville, AL, and a finalist in the Alabama Launchpad competition. Halo has some very exciting products that they will bring to market in the near future in this space. You can listen to a very interesting conversation between Halo’s CEO, Chris Otto, and ClearCast’s host David Karabinos in our Podcast series here.

After I had left my last job and before I had really decided to start PointClear, I made up a list of “Lessons Learned in the Last 5 Years”.  Basically a brain dump of stuff I had learned about the IT consulting business and business in general.  I have that list posted at my desk where I can see it every day.  The goal being not to repeat the same dumb mistakes of the past, but to make only NEW mistakes…  (If you want to see the list just email me…)  One of the items is as follows:

• There is always a temptation to think that the grass is greener somewhere else.  This is why services companies want to move into products, government contractors want to “go commercial”, project-based consulting companies want to create a staffing arm, etc.  It rarely works and you lose focus…

Well, this year has been a good one at PointClear.  We have had some great successes and have built a really impressive team of folks – the best I have ever worked with.  But we have sort of bent the rule above.  I’ll explain how and why we are only “bending” the rule, not breaking it outright J