Apr 19

Gamification of Health is not just for the high rollers

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Gamification is the application of game-design elements and game principles in non-game contexts as defined by Wikipedia. Gamification techniques strive to leverage people’s natural desires for socializing, learning, mastery, competition, achievement, status, self-expression, altruism, or closure. Early gamification strategies use rewards for players who accomplish desired tasks or competition to engage players. This is often seen as a negative concept but in healthcare it can be a game changer. Especially when the behaviours you are trying to make addictive will improve the health of the patient or better still prevent an illness or adverse event. Gamification concept is more than just scoring points and earning badges it also involves understanding the elements that keep people engaged.

3 things that gamification can help in healthcare

  • Help patients monitor their disease especially chronic disease like diabetes and send feedback to their clinician
  • Help patients and carers with treatments especially medication alerts and remainders
  • Motivate the healthy to stay that way by becoming more knowledgeable about disease prevention, screenings, and maintaining healthy and active lifestyles.

3 major lessons we have learned about gamification in eHealth

  • Focus on a motivation that’s the user cares about and not others thing they care about.
  • Needs to include a good mixture of self-monitoring and entertainment.
  • Include the seven key elements behind gamification: status, milestones, competition, rankings, social connectedness, immersion reality and personalization as reported by Accenture.

Gamification principles and examples are all around us, whether we recognize them or not. Many people are naturally competitive and like to compare themselves to others and watch their own improvement.  Activity trackers like Fitbits have become increasingly popular just as our fascination for reality television shows like Biggest Loser continues to grow. These applications can make a huge difference to people’s lives. One of my favourite applications is the Pain Squad™ App developed by the iOUCH research team at The Hospital for Sick Children to help kids with cancer track their pain. The App rewards the user  for using it, climbing the ranks by tracking your pain every day. The more you use it, the more rewards you get!

Jane McGonigal, a game designer and author who developed SuperBetter wants games to be a force for good.  In her Ted talk in 2012 she focused on the top five regrets of the dying and how games can help you avoid them.  She developed a game called SuperBetter, which helps users set goals as they recover from injury or illness or focus on living a healthier life.


Apr 01

Terminology “as a Service”

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In this era of the ‘’as a service’’ models we need to be looking for easier ways of implementing  standards needed to support eHealth tools like decision support and analytics. No longer should standards be something we see in passing. We need ways to implement and update them quickly and efficiently into mainstream eHealth technology products. Products like Intelligent Medical Objects (IMO) may be a way of providing assistance.



3 benefits a terminology service like IMO can provide for you

  • Provide a lexicon for problem management lists.
  • Provide maps to other classifications and codes invisibly to the user.
  • Provide regular updates.

3 issues with IMO you should be aware of:

  • If you are trying to implement SNOMED CT you may need a license for usage in your country. However many countries often have national memberships for all of their citizens to use SNOMED CT from IHTSDO. The same may apply to ICD maps from the World Health Organization.
  • It does not include drug codes which limits its value in decision support.
  • The mapping to SNOMED CT may not be an equivalence map for all codes ie the associated codes may be a more general code which groups a number of the terms in your problems list. This may not be a bad thing but it is definitely something you need to be aware of.

Once terminology and lexicon management tools are readily available, the challenge becomes how they will make a difference in eHealth products. One such advantage being intelligent problem lists where the eHealth products can provide weighted problem lists for better selection of the most common terms to improve the adoption and accuracy of terms selected by clinician.

For great things to happen in this area, multiple parties will need to come together and bring their expertise and tools. In April 2015 it was announced that IMO was collaborating with Nuance’s Dragon 360 and their Clinical Language Understanding (CLU) engine to analyzes the physician free text narrative and extract key patient information, such as patient problems and allergies in real time as discrete, structured data and view this in MEDITECH’s electronic health record. I look forward to seeing the results of this collaboration.


Mar 26

What data can I move to the cloud?

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Cloud computing definitely has a role in eHealth. In other industries, mid-size and large organizations now have some level of investment in the cloud, and what data is being stored in the cloud is growing steadily.   But like the other industry sectors, not everything should go to the cloud, and your Cloud strategy needs to be considered carefully. While the majority of the cloud market is still public, the emerging trend for the hybrid and private clouds may be a better option in a security conscious health sector.



3 things that cloud can help in eHealth

  • The cloud can be a more cost-effective model than running an on-premises data center.
  • Mobility with improvements in remote access; and scalability of cloud storage solution to manage ever-growing data storage.
  • Ensuring that data is kept secure and compliant, especially with the latest encryption technologies and continuous monitoring of security compliance in hybrid and private clouds.

3 major lessons we have learned about the cloud and eHealth

  • Check your cloud service provider’s service level agreement (SLA) especially in relation to performance and uptime guarantees, data security, and compliance.
  • Make sure you have a well thought out migration plan which takes into account your specific applications, has checkpoints and validation and most importantly well-defined acceptance criteria in place. The other direction is also important, that you can easily move your cloud services or data to either another vendor or back into your business for local management.
  • Make sure your cloud provider continuously monitors compliance and security and report on them to you.  Having a plan in place for reporting breaches which covers notification to affected individuals, appropriate regulatory authorities, and the media.

The main challenge will always be what data can I move to the cloud rather than which cloud provider. Regulations and legislations are imposed by the Cloud providers based on their location and where the data resides. Similar Healthcare information privacy and security legislation differ by type of data and location. In healthcare you need to make sure that your local policy, the national regulations and cloud providers regulation are not in conflict. With improvements in security technologies, hybrid and private clouds this is becoming less of an issue.

However, the challenge for what data can I move to the cloud, still remains, more in relation to access and performance.  Cloud outages that could lead to data loss or critical data for critical patients not being available, would have a greater influence on where you store patient’s healthcare Information or at least part of it locally.  The bottom line, your data or functionality that will move to the cloud cannot be business critical at this stage.


Mar 03

Clinical Data Standards where do I start?

standards (1 of 1)Implementing Clinical data standards or more importantly ensuring that any  software you buy is standards compliant is a difficult but necessary process if you are hoping to be able to share data with a national repository, your local health ecosystem or your patients. For this to happen at a minimum the address details, especially the organization, provider and patient identification elements, need to be standards based so that you can send and receive the information.  There are some great resources available. The one I suggest, as it is the most influential with your EMR vendor will of course be the one developed by the Office of the National Co-ordinator in the USA, which is the biggest EMR market and hence why most major vendors focus on that market and their regulations, incentives and standards.  The 2016 Interoperability Standards Advisory focus  explicitly  on  clinical  health  IT  systems’  interoperability including  electronic  health  information  created  in  the  context of treatment.  It does not include administrative/payment data and transactions which are governed by other areas of the government.

3 key objectives of this document

  • To provide a single, public list of the standards and implementation specifications that can best be used to fulfill specific clinical health information interoperability needs.
  • To reflect  the  results  of  ongoing  dialogue,  debate,  and  consensus  among  industry  stakeholders  when  more  than one standard or implementation specification could be listed as the best available.
  • To document known limitations, preconditions, and dependencies as well as known security patterns among referenced standards  and  implementation  specifications  when  they  are  used  to  fulfill  a  specific  clinical  health IT interoperability need.

3 issues you will need to address if you are implementing any of these standards outside of the United States

  • Not all standards that are listed as free, are free outside the US. The US, like other countries, often buys national memberships for all of their citizens to use the standards (for example SNOMED CT).
  • Suitability of the value sets for your region especially Medications ( RxNorm and NDC) which are US focused and may need to be replaced with a local Drug Dictionary
  • The standards listed will not guarantee interoperability unless your interoperability partner agrees and uses them.

The public comment period for the 2016 Interoperability Standards Advisory (2016 Advisory) has closed effective March 21, 2016 and the work on 2017 will be informed by these comments. My favourite part of the documents is the six informative characteristics to provide for each standard to add context including: Standards Process Maturity; Implementation Maturity; Adoption Level; Federally Required; Cost and Test Tool Availability. I also like the inclusion of “emerging alternative” to a standard or implementation specification when known to show what the future direction may be.  While this is a fantastic first step on your Clinical standards journey, I look forward to when Clinical data models are also included to promote analytics and  help the sharing of knowledge not only the transfer of information.


Feb 17

“Internet of Me”, anything but average

IOT 1 (1 of 1)My health is unique to me and so should the treatment I receive and any the technology I use to manage my health.  The Internet, social media and smart devices are connecting information and technology in new ways to ensure that I have the right information at the right time for my circumstances from my weather app telling me the temperature in my location to businesses deploying cookies, tracking and targeting algorithms which can be extremely annoying at times. When it comes to our health outcomes we need preventative medicine, health information, disease treatment and wellness activities to be part of a coherent network of activities supported by an equally coherent network of technology, devices, applications and information. Welcome to the Internet of Me.

3 reasons why the time is right for the Internet of Me

  • We as individuals or carers of our family (children and the elderly) are more interested in participating in our care, from understanding treatment options and cost, to improving our wellness and preventing illness.
  • Genetic information about an individual will allow treatment to be tailored specifically for them.
  • The technology is available with digital information stored by my health care providers, pharmacist; wearable devices for monitoring and fitness; and compliance applications.

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

  • Combining the information into a coherent network. While a signifant amount of digital data exists about my health, it is still very much siloed in each health care provider’s system with occasionally summary data shared between them and with me. This data is rarely connected to my preventive health and wellness needs or treatment applications.
  • When tailoring the data to be relevant to me, I want to make sure that it matches my appetite for data security and privacy. Data security and privacy policies need to move from one size fits all to configurable based on personal preferences.
  • As a consumer I need to make sure I have a way of ensuring that the information I am using is trusted medical advice not just sponsored content. This can be via association with accredited institutions or having a review system similar to Tripadvisor.

It is important that the “internet of me” is not confused with a national electronic health record which aims to provide a lifetime record of my interaction with health care providers. The “Internet of me’’ will collect data about me from a range of settings and devices, ANALYZE IT , and recommend courses of action, options or simply provide encouragement when it tracks my great progress.

For this to work a new model is needed which shifts the ownership and control of data, privacy and security back to me. When I have all my data together in one place the benefits are obvious and immediate. This is also unlikely to be ever achieved by a single third party, and I am not convinced I would want them to be able to do this either.  I want to be able to control what data I collect and who is allowed to access and use this complete data based on what is in it for me. Health care businesses need to see that this alternative model is better for them too. They can then use it to personalise their treatment and services to obtain better outcomes.

Australian-based digital health firm Health& has gone live with an application to help consumers to take control of their health and their health information. The personal health record and preventative algorithm component of its consumer health portal, partners with IBM Watson to power its natural language processing capabilities and with the Royal Australian College of General Practitioners (RACGP) to provide that element of trust. While it is not a complete version of the “the Internet of Me” the addition of analytic power and trust elements is certainly a significant step in the right direction.


Feb 01

Visualize your data

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Data visualization describes any effort to help people understand the significance of data by placing it in a visual context. Patterns, trends and correlations that might go undetected in text-based data can be exposed and recognized easier with data visualization software. I decided to put this to the test and visualize our international eHealth experience at eHealthMasterminds. In Healthcare data visualization can also take on a whole new meaning.



3 ways that data visualization can help in healthcare

  • Patient treatment with alerts to healthcare providers about patients that need urgent attention that may otherwise go undetected or improving medication tracking and decision support.
  • Advancing Research by providing a way to summarize, filters, and present large amounts of information with visualization tools. Also helping to perform scenario analysis, such as, how intervention delivers different outcomes for patients in different age groups.
  • Public Health with visualization approaches for early detection of disease and other global health concerns such as flu pandemics and bioterrorism.

3 major lessons we have learned about data visualization in eHealth

  • While there is a lot of good resources available there has been limited uptake
  • Poor quality data will display poor quality results. However, on the flip side visualization may allow you to quickly sometimes see potentially dangerous errors and omissions. Data visualization can be worthwhile for the data cleaning capabilities alone.
  • Multi-disciplinary teams need to work together to understand and display data that is meaningful to the user.

Data visualization not only provides a new way of viewing data but also raises question on what data you can use. According to Roni Zeiger, former Chief Health Strategist at Google,  “Google Flu Trends re-imagined how we gather medical information and track diseases. Flu Trends monitors the spread of the flu around the United States by processing how often people search for “flu” on Google. Its results are almost identical with those of the U.S. Centers for Disease Control and are available weeks before the official numbers.”

However, the true promise of data visualisation to advance medicine will come when we can statistically analyze anonymized electronic health records of large populations. The secrets of treatment success and failures are locked within the accumulating data of electronic medical records but those benefits will only be realized when the interoperability of medical records improves.


Jan 21

eHealth innovation inequalities

innovationHealthcare is an area where you see major inequalities in the implementation of innovation.  Therapeutics has seen unparalleled advances in technologies in the last two decades with great success stories such as cochlear implants and diabetes pumps changing people’s quality of life. Yet the implementation of technology to support the system that delivers the care that could provide more efficient access, improve quality of care and reduce costs has primarily been the domain of monolithic systems in hospitals and a reducing number of vendors in all levels of care. The focus of these applications has been Making Health Services Work where even though the capacity or will to change is modest, the systems allow incremental changes in response to projected future needs.  Currently, few people working within the  system wants disruptive solutions but can the current problems in healthcare and the threat of turbulent times ahead from pandemics, aging populations and diminishing resources etc., allow this to continue?

3 success factors for innovative technology advances in health care

  • Understand what the problem is they are trying to solve and have a clear vision of the future
  • Tend to be patient focused rather than system focused
  • Have a business model that supports the development, testing, implementation and building trust

3 technical challenges for innovation to work at the system level

  • Interoperability and unlocking the data that exists in the current systems used to allow systems to be extended by other 3rd party applications and vendors
  • Enterprise strategies for handling data from obsolete systems and/or processes without valuable data loss
  • Understanding that this is a transformation initiative not just a technology innovation and adjust all process to include the users

eHealth innovation at a system level needs to have a systems thinking approach to innovation  which must address all six of the critical questions: Why, What, How, Who, Where, and When.  The need for innovation needs to be driven by the business need / strategy and address agreed problems. It cannot be technology driven or the end result may be technology for the sake of technology rather than a step towards the future change needed. I am not saying that this is easy but as we move away from the traditional models of care and towards patient centre care, opportunities exist for new business models that can drive this innovation.  And we are seeing the change at a number of levels with investors  now challenging entrepreneurs to pitch the next big idea in health and the increase of design challenges forums like the Hacking Health events. The biggest challenge for widespread implementation of innovation will be developing models which minimize risk and build trust quickly.


Jan 04

Integrated care – can they work together?

integrated care (1 of 1)Can integrated care really work when it requires more than one enterprise delivering that health care to work together or are these species just too different.  Does this mean a radical, wholesale shift in the way that services are organised, delivered, costed and measured.  How will new care pathways be developed, duplication eradicated, model treatment plans be continuously analysed patient outcomes and value measured?  There’s no doubt that with an ageing population and an increasing number of people developing chronic illnesses with a growing healthcare bill that overcoming these obstacles to make it work will become more and more important and eHealth tools will be essential to its success.

3 essential integrated care tools

  • Cross Enterprise – shared patient centric medical record. This may require an additional application to sit across all of the individual electronic medical records to combine an in-depth patient centric record. This differs to national electronic records many which have only summary information at the end of an episode.
  • Cross Enterprise – shared care plans. Integrated care plans help to manage the care being provided by all of the health care providers across the multi enterprises.
  • Secure communication/ messaging. For integrated care to work it is essential that providers don’t work in isolation which will mean a secure communication channels.

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.
  • Who pays for the technology?
  • Developing shared process with regular communications.

There are some create tools that can help with this like dbmotion which provides convenient access to data collected by and stored in disparate clinical information systems, and enabling that data to be securely shared and consumed by users throughout the broader healthcare community. Similarly a range of excellent secure messaging products exist.

The biggest issues will be who pays for the technology especially as the major problem is often the very different size of the integrating enterprises with different levels of IT access, capabilities, support and access to funding options.

Finally, if the aim of integrated care is to be truly patient centric it will require set of patient focused tools to maximize the benefit to the patient such as: allowing the patient to have a single view of their treatment plan; and a single place to book appointments.


Dec 28

Why do we need person centred care?


All stakeholders in health are in agreement that improving individual’s health and well-being, preventing the need for healthcare services and optimizing healthcare delivery when needed requires a holistic approach and a move away from the traditional sickness episodic models of care to person centred care. Medical institutions are building patient satisfaction and a successful patient experience as seen by the rise of Chief Experience Officers employed in healthcare. On the other side there is also the trialling of new models of care especially for end of life care. Both which require technology to be effective.


3 core elements of person centred care

  • Enables the person to be involved in their care and optimize their wellness
  • Care is personalized for individual people
  • Optimizes a person’s journey through the healthcare system. The biggest complaint with the current healthcare system is not about the treatment that is provided/ received but more how the care was coordinated and the hassle and inconvenience of it all

3 challenges for person centred care

  • Privacy and security – have a mechanism that ensures the security of the person’s health record while allowing the flexibility of who can read or write to that record
  • Requires a different model of care, funding and technology to support it, needs to start and end with the person’s needs, involvement and cross different providers and enterprises.
  • Needs to support and address the issues of genomic data to truly support personalized medicine

Pulling the above together means thinking about and validating, with individuals, what they want to know and how best to support them. Simple, effective, and non-promotional communication.

Additionally learning from others and recognising people for their person centric efforts is essential. Cleveland Clinic has long been recognized for driving some of the best clinical outcomes in the USA, but it was not always a leader in patient experience. There was a time when this revered organization ranked among the lowest in the country in this area. Within ten years, however, it had climbed to among the highest and has emerged as the thought leader in the space. Much of this change is underpinned with technology.

Another successful model is Sutter Health’s Advanced Illness Management (AIM) program for patients with late-stage chronic illnesses, funded by a CMS Health Care Innovation Award. Located in northern California, Sutter Health has implemented a complex medical home model that provides patients with RN home visits, telehealth support, and coordination of care providers through the individual’s primary care doctor. The preliminary analysis shows a 59% reduction in hospitalizations and a 67% reduction in ICU days among patients within 90 days of enrolling in AIM, putting the program on track to exceed its goal of $29 million in Medicare savings. However they did have issues with eHealth. The lack of electronic interoperability among Sutter hospitals and affiliated physician practices has been both a challenge and an opportunity. They reported that “ensuring that the AIM team notes are electronically available to hospitals and physicians is easier said than done. “We are dual documenting in multiple EHR systems and, when we can’t do that, we’re faxing.” Sutter Health is now committed to improving data analytic capabilities to uncover targeted information that would help in better managing the AIM population.

People want the Healthcare market to become person centred.  They want to be able to select the options that work for them: different models of care; the mix of conventional and non-conventional therapies like eastern medicines and mediation; and the technology they need to bridge that gap including Dr Google. The eHealth industry must prepare and support person centred care even without funding models currently available to support the transition or they will be left behind with other obsolete technologies like the “the fax machine”.


Dec 05

Person controlled health

person controlledHealthcare is at a crisis point with costs spiralling out of control and outcomes only marginally improving, if at all in many countries. We have been waiting a long time for “the next big thing”, a disruption that will change this trajectory. Disruptions in other industries like Uber and Airbnb were only possible when people were open to different possibilities. We have been talking about person centred care (subject of my last post) and while we are making some great inroads it has not provided the “disruption” that is needed. We need to look outside the box, we need something that changes Healthcare from sickness focused to wellness focused, from clinician controlled to person controlled.  For a person to be able to control their own health they need information and engagement and eHealth technology will be critical in supporting this process.

3 areas were person control technology is needed:

  • Administrative tasks – booking treatment, organising treatment, reviewing treatment providers, understanding costs and payment, securing financial assistance, filling prescriptions, receiving supplies etc.
  • Emotional support -motivational support, connection with other as well as dealing with a diagnosis/ prognosis.
  • Health management – education, reminders for preventative measures, promoting fitness, health and fitness monitoring as well as understanding treatment options, accessing a second opinion, managing your treatment, telehealth, medication reminders and adherence programs, etc.

3 challenges that will need to be overcome to promote client control:

  • Access to clinician data – this incorporates both physical access and that the information is in a form that is understandable by the layperson.
  • Quality – the technology and the information being provided by the technology needs to be good quality, easy to use and integrated. And most importantly there needs to a way for the person to be able to gain assurance of this quality.
  • Cost – this includes both affordability of the technology to the person and also the development cost which to be truly successful will distributed across the continuum of care and not the burden of a single institution or provider.

Disruption will require that the technology is holistic, incorporating: the continuum of care, fitness and preventative measures and address all three needs, administrative, emotional and health. The biggest barrier to overcome will not be the availability of the technology, rather it will be the attitude of the healthcare industry to relinquish control. The role needs to evolve to provide support and services to people to enable them to control their health and wellness future.

While this may take some time to achieve, the first step is understanding the person experience, then continuously measuring and adjusting care delivery in response to that understanding is a step in the right direction.


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