Sep 15

Will Big Data be big in healthcare?

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It will make a difference but you will need to start small if you are going to achieve its full potential. Big data is not just about size, it aims to finds answers from complex, noisy, and large volumes of data.  We want it to answer questions that were previously unanswered, to be a true partner in the delivery of healthcare. This has never been so appropriate with the volumes and types of data growing in a chaotic manner, not only from advances in technology and Electronic Health Records (EHR) but also with the inclusion of data from genomics, social media and the internet of things.


3 ways Big Data can make a difference now to your business

  • Provide basic descriptive analytics reporting at the individual patient level as well as at the business and population health level.
  • Improve the use of technology to monitor and record patient care with optimized pick lists, visual representations of patient condition and care plans, and patient specific reminders and alerts.
  • Be part of research collaborative to learn and expand your delivery of healthcare services especially for chronic and rare conditions.

3 things you will need to address to make the most of this opportunity

  • You need to have a big data plan which includes what you are planning on analysing, how you are going to get the data; how you are going to ensure it is complete and of the best quality.
  • Purchase an Electronic Health Record that can either provide you with the technology and terminologies that you need to achieve your plan or has the capabilities to integrate with third party products that will.
  • The technology has to be easy to use; this includes inputting the data, reviewing the quality and extracting the results.

But there is an “Elephant in the room” ie a truth that no one wants to talk about.  Big Data is not Data Warehousing. While good analytic products exist which are based on data warehousing these are providing the prequel to Big Data. Big Data will not replace data warehousing analytics solutions but hopefully will learn to work side by side to achieve different but complementary objectives.    The major challenge for Big Data to achieve it’s potential in healthcare, will be affordability and the ability to provide real-time information. This may be a number of years away for larger businesses and completely out of the reach for small to medium businesses.

However, by starting small on project with limited and targeted business scope to provide answers to very specific questions will help you gain immediate results.   A great example of this is the  program called UnitedHealthcare Motion which provides insured employees with a fitness wearable device that tracks their steps. The wearable device sends the health tracking data to the UnitedHealthcare Motion app. If they meet certain goals, employees can earn health reimbursements credits, up to $1,460 per year, based on the number of steps they take.

Similarly on the technology side, start small, think of using cloud storage to keep costs down and make sure you have access to the expertise you need in the form of training, hiring or outsourcing. Without the right skills you make take way too long to achieve the results you require.




Sep 01

Who wants an Electronic Medical Record?

Who wants an EMR (1 of 1)Every patient and carer wants their healthcare provider to have access to the best technology, tools and information possible to manage their care. Even if patients do not always know what the “best” represents, healthcare services delivery benefits from the assistance of technology.  So why is the uptake in electronic medical records (EMR) within an institution and business slow? I was recently asked who wants an electronic medical record? I responded enthusiastically, the administrators, healthcare providers and the patients. I was shocked when they disagreed. They felt the decision makers on the purchase of the EMR have greater concerns about cost, privacy and time to achieve ROI which outweigh the benefits of technology.

3 ways EMR can make a difference now to your business

  • Improve the quality of the services provided. Patients, health care and treatment and complex technologies help to minimize this complexity with access to the right information and tools.
  • Maximize patient safety; medication decision support is a MUST for all healthcare professionals, patients and carers.
  • Set you apart in the marketplace as an innovator

3 things you will need to address to make the most of this opportunity

  • Ensure you have privacy and security policies and procedures in place.
  • The technology you purchase must meet your needs and have the ability to grow with you as your needs and your client needs grow and expand.
  • Market what you are doing to your clients, they will love it.

Practice and financial management systems implementations have far outweighed electronic medical records as they provide tangible benefits such as cost savings.  The intangible benefits of technology in the improvement of quality of care and patient safety have to have a higher impact on the decision to purchase as we move forward.  Forbes reported in October 2015, that “medical errors are the third leading cause of death in America, behind heart disease (1st) and cancer (2nd). Additionally, a 2011 Institute of Medicine (IOM) study, “The Healthcare Imperative: Lowering Costs and Improving Outcomes”, indicated that of the $2.5 trillion spent on domestic healthcare costs in 2009, $765 billion (or 30%) was attributable to preventable costs”.

An Electronic Medical Record (especially with medication decision support) is a MUST HAVE not a nice to have as we move forward in healthcare as we need to do everything we can to reduce preventable errors and improve the quality of care.


Aug 15

Social Media Journey

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Social media is like every eHealth project, it’s about clinical transformation over a period of time not just an app you can turn on. A healthcare business, when starting on the social media journey, must not expect instant success. Even if your first social media campaign is excellent and well received, a good social media program will only be effective when you have established that connection between your business and the population you are looking after.


3 major things that Social Media will achieve for your organization.

  • Business – Many Healthcare organizations are using social media to promote their business by connecting with the community and patients; marketing products, services and promotions; news about activities and fund-raising; and providing customer service and support.
  • Professional Networking and Education. The most popular social media sites are those where they can participate in online communities to discuss business and clinical issues and gain access to experts.
  • Patient Care, Patient Education and Public Health Programs. Evidence indicates that electronic communication with patients can improve their care and health outcomes however there is still major resistance to use this platform for direct patient care.

3 major lessons we have learned about Social Media in Healthcare

  • Check the legislation in your country on patient privacy and health information especially in relation to social media.
  • Establish an acceptable employee use policy for social media and clearly communicate the policy to all staff. This will help to ensure you avoid breaches of patient privacy, violation of professional boundaries, licensing or legal issues and help to minimize the risk of you publishing poor quality content and protect against damage to your professional image.
  • Put technology in place that controls and monitors social media communications in real-time and flags any posts that contain certain key words or phrases for review before they can be posted.

There are success stories. The uptake in third-world countries seems to have the most impact allowing connections between local clinicians with specialists in more medically advanced locations.  For example, surgical procedures can be streamed via the Internet and questions can be asked via Twitter in real time allowing the exchange of medical information faster than was ever possible. The heart valve team at Jewish Hospital in the US streamed and tweeted a Transcatheter Aortic Valve Replacement on April 2, 2015. An experienced heart specialist provided updates on Twitter and answered questions; they were not part of the surgical team.

The CDC maintains an active presence on Twitter and Facebook to track “tweets” that might indicate a flu outbreak and to share updates about such incidents.

There are also resources to help you, the Mayo Clinic established the Social Media Health Network in 2010. In addition to its presence on Facebook, YouTube, and Twitter, it provides access to resources, blog posts, podcasts, conferences, and webinars to help others healthcare organizations on their social media journey.

Many social media tools are available for healthcare, although the main ones used would be Facebook, LinkedIn, Twitter, Instagram and blogs.  However the uptake of social media in healthcare has been definitely slower than other industries. This is changing with some healthcare businesses seeing opportunities to serve their patients and staffs better, both for the greater good of the population, as well as all building trust within the community and enhancing their brand.


Aug 01

Governance not governing

Governance (1 of 1)


If your project does not have good governance it has a 99% chance of failure.  Organizations often expect employees to adopt and adapt to the new processes or tools before securing the necessary organizational buy-in. Similar to Nobody likes change, while everyone will say they want control, very few people will want to be controlled.  Your governance model needs to reflect what you want for your business, a functional democracy or a dictatorship; benevolent or otherwise.


3 major things that Governance will achieve for your eHealth project

  • Increases the value of an eHealth implementation by ensuring the project is on time, on budget and being used to meet the business objectives.
  • Keeps everyone on the same page with roles and responsibilities clearly defined, while making sure that everyone and every project is moving in the same direction and it is pointed clearly at the strategy.
  • Most importantly makes sure the project is business-driven rather than just a technology project.

3 major lessons we have learned about Governance in eHealth projects

  • Your governance framework needs to be properly sized and balanced. The level of governance you implement must be appropriate for your specific needs and initiatives.
  • Must be led from the top and represent all parties Obtaining executive leadership and support is a pre-requisite to the success of any major initiative. If this does not happen in addition to the establishing a governance function it becomes a marketing role with you spending a lot of time and effort competing for resources and selling the value of your project / governance to management. This is both difficult and ineffective.
  • Measurement and reporting. This doesn’t just tell them where you have been, it also has to help you guide where you want to go.  Measure to improve, not simply prove.

People want to be successful. They also want to understand what success looks like, both in terms of what will be achieved and what needs to happen to get them there. COBIT 5 defines governance as:

Governance ensures that stakeholder needs, conditions and options are evaluated to determine balanced, agreed-on enterprise objectives to be achieved; setting direction through prioritization and decision making; and monitoring performance and compliance against agreed-on direction and objectives.

Organizational perspectives must be coordinated in the context of eHealth to deliver best decision and ensure required actions are indeed undertaken for the success of any eHealth vision. “If management is about running the business, governance is about seeing that it is run properly.” [1]

[1] (“Corporate Governance”: Robert Ian Tricker)


Jul 15

Internet of Things (IoT) are you ready?

IOT 4 (1 of 1)


The Internet of Things (IoT) will be here sooner or later and will have a disruptive impact in Healthcare. In April 2015 Forbes reported that there will be a $117 billion market for Internet of Things in healthcare by 2020 as estimated by Wikipedia define the IoT as the network of physical objects—devices, vehicles, buildings and other items which are embedded with electronics, software, sensors, and network connectivity, which enables these objects to collect and exchange data.


3 Sensor Applications making a difference now

  • Fall Detection – Assistance for elderly or disabled people living independent.
  • Medical Fridges – Control of conditions inside freezers storing vaccines, medicines and organic elements.
  • Patients Surveillance – Monitoring of conditions of patients inside hospitals and in old people’s home.

3 things you will need to address to make the most of this opportunity

  • Big Data plan – Watson Internet of Things on Bluemix is probably the best example which creates a platform for collecting, storing and analysing device and sensor data.
  • Device management – this has moved from adding one device at a time to an electronic medical record, to being able to handle different platforms, different devices in an ever increasing number.
  • Fail fast mentality – collecting data for the sake of collecting data can become a drain on resources very quickly. You have to work out quickly if the data is usable and useful and if not fix it or move on to something different.

The most exciting part of the IoT for me is its application in developing countries. It has the potential to maximise the use of scarce resources over a greater geographical region. This of course means that sensors developed have to be easy to use; rugged for harsh environments; re-chargeable battery with a small hand crank; affordable; data storage in device; and can transmit data via bluetooth/cellular networks.

This can be seen in action, INSPIRE is a portable pediatric device using patented technology to automate the counting of respiratory rate, to assist in the early diagnosis of pneumonia in children in developing countries.

The big question for IoT is, is western society ready to move beyond the Orwellian definition of “big brother is watching”. Let´s hope we have smart politicians and responsible users to make it the disruptive solution that is needed in healthcare. That is my hope for the future.


Jul 01

eHealth Strategy and Roadmap in a nutshell

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It doesn’t matter how small your organisation or where you are along the eHealth journey you should develop or refresh your eHealth Strategy and Roadmap regularly.  You will need to keep it simple and focused with business goals at the forefront so everyone moves together and not at cross purposes. It needs to include: Why you need eHealth and what you want it to achieve for you; How are you going to use eHealth to help you; What and when are you going to do it.


3 major things that eHealth Strategy and Roadmaps will achieve for you

  • Ensure that eHealth/ICT is linked to the business goals and directions.
  • Provides a platform for people to be on the same page and make the hard decisions.
  • Makes people accountable.

3 major lessons we have learned about developing eHealth Strategies and Roadmaps

  • It must start with the WHY? It has to be driven by WHY you are doing this and WHAT you are trying to achieve!!!
  • The process of developing a strategy and roadmap is just as important, if not more, than the final document. Senior management support is critical, as is listening to your stakeholders, users and clients and gaining consensus with all key stakeholders.
  • Timing – Keep the strategy simple and don’t change it for 3 to 5 years unless your business goals change. However measure your progress against the roadmap regularly (at a minimum annually) and update as the business or your resources change.

The process also has 3 phases.  The initial phase needs to be sharp and focused where you meet with all stakeholders and establish what the business wants to achieve, where you are now and where you want to be in the future. At the end of this phase you will have the “WHY”.

The second phase focuses on the “HOW” ie eHealth strategies / objectives you need to achieve the business strategies / objectives. This also needs to include how you will measure your success.

The final stage develops the Roadmap ( the ‘’WHAT” and ‘’WHEN”) this is a critical step so that you ensure that your strategy is executed and not just a pretty picture on the wall.

Remember the Roadmap is not your operational plan but will be used to develop it.

Good luck and let me know if you have success stores or lessons you learned when developing your eHealth strategy and roadmap.


Jun 15

Improve your eHealth success rate

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Often eHealth Projects feel like walking on a tightrope. How can you improve the success rate of your eHealth project? I wish I could say that the success rate for eHealth projects was high but we all know that is not the case.  There are always too many risks, too many variables, conflicting priorities, restraints to change and funding obstacles.  However, there are steps you can take to give you the best chance of success



3 things critical to the success of an eHealth project

  • Start with the end in mind– each project is only one part of the full jigsaw. Develop an eHealth Strategy and Roadmaps (the subject of my next post). It doesn’t matter how small your organisation ( this can be on one page) you will benefit from knowing:
    • Why you need eHealth and what you want it to achieve for you
    • How are you going to use eHealth to help you specifically
    • What are you going to do and what will it cost
  • It is about People not Technology- you will need to plan and invest time and money into how you are going to get the change you need?
  • Governance- every organization—large and small, public and private—needs a way to ensure that the eHealth and all information technology sustain the organization’s strategies and objectives.

3 questions you will need to answer at the start

  • Where does analytics fit in? You have to make sure you build this in from the start; there is no point collecting data if you cannot use it.
  • How do I handle innovation? Health and wellness applications is growing at an ever increasing rate, your business will need to keep up.
  • How to handle devices and the internet of everything? Since the launch of the iPad in  2010 the expectation is that devices of all types are now a huge part of life both at home and work and this will need to be incorporate.


The list of success ingredients does vary from project to project. What about you? What other items would you add to the list that works best for you?

Tune in on Thursday for the follow-on post which highlights the critical success factors of Strategies and Roadmaps.



Jun 03

eHealth dilemma – does it achieve its promise

The promise of eHealth has long been promoted as the development of technologies that aim to significantly mitigate or eliminate nearly all of the challenges that exist in healthcare now and in the future, but will the eHealth journey lead you to the promise land.

World Health Organization defines eHealth as ‘the cost-effective and secure use of information and communication technologies (ICTs) for health and health-related purposes’.


3 major things that eHealth has achieved

  • Digital administrative systems are available to a significant number of healthcare providers. Clinical eHealth solutions availability is also on the increase in many countries.
  • Clinical Decision Support systems can save lives.
  • Devices and Healthcare applications are developing at an exponential rate.

3 major lessons we have learned about eHealth

  • A single system will no longer meet the future needs of most healthcare communities.
  • eHealth implementations are about people not technology, you cannot digitalize an existing process and expect change.
  • Devices and Healthcare applications are developing at an exponential rate ( yes this is both good and bad)

The dilemma arises for us all on how we define success and is this holding us back on achieving the “promise”.

The success of an eHealth implementation is often judged by the fact that a single system is available, being used and on budget ( tick) rather than did it bring about the change to achieve the “promise” needed. Infact this is often a conflicting priority as major change is harder to implement (and more costly with the additional change management) and less likely to be used initially making it harder for implementers to claim success and the magic tick.

The other part of the problem is a single system is often only the start of the journey with plans needing to be in place as part of the implementation process for when the system needs to be upgraded/ maintained and what other systems can now and in the future be integrated to increase the network of eHealth solutions required to progress your business. One of the most valuable assets of any implementation is refining the procurement and implementation process. eHealth is rarely a one time purchase and understanding the lessons learned is invaluable when you have to do it again.


We need to define success differently. Success factors should include:

  • Was the procurement and implementation effective
  • Was the system implemented ( time and budget) and can be integrated with to support your roadmap of activities
  • Does it improve the business/system goals.

At some point in the future I do hope we come to a place where we can also judge success as how quickly businesses have progressed leading to eHealth systems needing to be upgraded, replaced or additional systems added to support the next phase of growth and business goals.




May 15

The CIO Dilemma

CIO (1 of 1)

Will we see the CIO role sail off into the sunset or will 2016 be the year when the CIO resolves their dilemma. The role of the CIO, Chief Information Officer, is under crisis in all industries and health is no exception. The CIO is far too often just seen as the person in charge of the people who get or fix the computers, phones and pagers (Yes, people still have pagers).  Yet organizations see the need for more and so we have seen the addition of new roles, the Chief Digital Officer, Chief Innovation Officer, the Chief Medical Information Officer etc, rather than a change in the CIO role.



3 major things that a CIO can achieve for eHealth at an organization

  • Intelligence – provide the right data to the right people on the right devices.
  • Innovation – identify disruptive technologies and implement them into your business in an innovative manner rather than just replacing old systems and keeping pace with the organizations around you.
  • Inventory – anticipate business needs and provide a seamless environment where users can select the services and the level of support they require (similar to the Microsoft app store).

3 major lessons we have learned about CIO’s and eHealth

  • CIO’s sit on the biggest resource in Healthcare …. data, they need to find a way to change this data into knowledge. This isn’t easy and includes setting standards, generating quality data, data mining, big data, social media and analysis.  They need to make this knowledge with appropriate skills available across the business.
  • The smartphone and social media era need to be embraced. They say that today’s cell phones have more computing power than NASA used to go to the moon in the 1960s. As we now have convenient, agile and affordable technology which can connect us with the world, friends and family at our finger tips. This has created an often unrealistic user expectation that current eHealth platforms can provide similar. eHealth platforms have to be able to be able to keep pace with this new era.
  • Strategic as well as tactical. To be effective the CIO needs to be part of the business Strategy team to be able to optimize technology to meet current and future needs while delivering operational excellence.

The tension between the business and IT has been around forever, but instead of getting better, it has gotten worse in the last couple of years. The reason is that technology is a normal part of everyday life and almost everyone now feels at ease with technology, which has seen the perceived value of the IT department drop.  Additionally, the visible benefit of eHealth solutions are not keeping pace with the benefits of the user’s personal computing power (smart phones, tablets and PC).

This can be resolved by businesses and CIOs who are ready for the challenge.

We need to ask for more from our eHealth vendors. For too long they have held the power of what is included and what is not available. The days of a healthcare organization having only one software system and vendor are long gone.  You have to be able to support multiple applications either by the traditional integration or by having an application platform. The SMART Health IT Project has been working on providing one for a number of years now, it is run out of the Boston Children’s Hospital Computational Health Informatics Program and the Harvard Medical School Department for Biomedical Informatics. Similarly you need to be able to deliver workspace mobility, a way of doing this is using a virtual desktops such as  VMWARE would be a great start.

The final challenge will be inside the organization. The CIO will need the right skills inside his department and these are likely to be different to what they have on board today such as: social networking skills, Big Data analytics experience, digital communications knowledge, application development, virtualization management and conversation management etc. The CIO needs a strong business credibility to be able to shake off their departments past history of extremely painful   ‘’IT projects”, rebrand and market themselves as the business expert they already are and embrace the future.  The future may look more like the Microsoft application shop with the CIO leading through influence and persuasion rather than authority.


May 01

Nobody likes change

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It is always the right time for change, and while everyone will say they want change, very few people will want to change. An eHealth project is not a success at go–live, although this is a very positive milestone, it has to also meet all business objectives and human objectives, which need to be defined early on in the project.




3 major things that change management will achieve for your eHealth project

  • Transform your project from a technology installation to an eHealth implementation which has the greater likelihood of achieving ROI.
  • Can transform your software application into an organizational change agent.
  • Change will inevitably happen; it can be good or bad, effective or ineffective. When change is managed it can exceed your expectations.

3 major lessons we have learned about change management in eHealth projects

  • Strong leadership and senior management commitment is critical. They need to be genuinely and visibly committed to the initiative – something they really believe in and this needs to continue through the life of the project and beyond.
  • eHealth projects are dependent on many users entering a lot of information into systems to achieve the business benefit which may not be visible to them. This can mean a lot of extra work, you need to communicate to the users “what’s in it for them” and it will need to be compelling.
  • Deliver tangible and visible benefits early to build trust and confidence of the users, business and stakeholders. The first project must be selected according to its ability to act as a stepping stone for further organisational and cultural changes.

Change Management has a negative image. It is often quoted that change management projects have a 70% failure rate. This can be misleading as it does not address the real issues that without a change management program your eHealth project has an even greater chance of failure.

You will need to be honest with yourself about you and your team’s capabilities. A recent Harvard Business review article stated that Only 8% of Leaders are Good at Both Strategy and Execution, and only 16% were good at either one. Caring about a project is not the only prerequisite to making it happen. Invest in change and get all of the help that you may need.


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