Jen’s Posterous

Health Management Rx 

PHR Business Model Cheat Sheet, and Why I'm So Hung Up on Infoviz

If you're in the market of trying to help consumers improve overall health and wellness, one microchoice at a time, then you are armpit-deep in the data market my friend.

Personal Health Records (PHRs) providers are, in essence, next-gen health data companies. 

Yes, this is a vast oversimplification, due to the 'sensitive' nature and uniquely weighted values of health data. Not having info about the cheapest used bicycle for your next Holland tulip tour may not be a life or death issue, while knowing about the latest treatment modality for your type of pancreatic cancer may be. 

But for the sake of argument, and injecting a healthy dose of common sense before it's legislated right out of the personal health data market, let's take the 'PHR providers = data companies' at face value (at least for now).

If you're still reading, and agree to consider the data company angle, this means that once you understand the challenges/opportunities facing next-gen data companies, you can easily extrapolate clear, useful information about what's coming down the pipe at a macro level for personal health information (PHI) platforms, and all without gazing into a crystal ball or opening a vein under a full moon. 

Consider it my gift to you, without making you sign a patient-centric info manifesto in blood. 

In all seriousness, this isn't fortune-telling, but we've been treating healthcare futurism like it's an occult art.

Done right, it's not. Let's take a critical look at business models, current provisions, and market opportunities for data companies, from 30,000 feet. 

If you're a next-gen '3.0' data company you've essentially got 4 business model choices. You can:

1. store data - charge $ somehow
2. sell data - charge $ somehow
3. get consumers to pay you to A. store data (number 1) or B. NOT sell data (number 2)
4. analyze data - charge $ somehow

Current PHR companies, including the "Big 2" -Google Health and Microsoft HealthVault - (which are really just data companies, although some of their departments might argue differently), are organized loosely as rather inefficient answers to business model option 1. 

A developer friend working on an interesting problem today was wading through a pedestrian infrastructure solution build and made a remark about 'dirty code.' 

Looking at PHRs as a business model solution to 'storing data,' or option 1 above, is a model, sure, but it's an ugly-duckling one. It's a necessary first step, but stopping at option 1 is like writing dirty code that doesn't illuminate elegant solutions in a simple, Ruby-on-Rails type manner, and, even worse, leaving it a mess for a lower-level programmer to sort out while you go on building the next 'big thing.'

But even dirty code ain't all bad...let's take a look at what will happen next. 

Next, PHR companies will pull a Twitter, and figure out their largest asset is all that PHI, aka YOUR personal health information.

When PHR providers figure out they can sell all that chewy personal data (even if anonymized, a la Patients Like Me), they're going to go after business model option 2 - sell data, charge $.

Now, if you're following, and you took Marketing 101, or have read any Seth Godin book, right about now the 'Aha! Holy sh*^!' lightbulb should pop on just above your frontal lobe and hover...Option 3 represents the holy grail business model choice for PHR companies. 

Everyone (or at least a goodly chunk of govt, insurers, and HC reform types) wants to get consumers engaged in their healthcare so we cost the system less overall (supposedly anyway).

But how to do this? We have to get people interacting with personal health data and 'taking ownership' - which really means we want them to give us their data so we can figure out how to make money in one of the ways above. 

The smart money is on designing for business model option number 3; aka building something so beautiful and intuitive in terms of visualization and data presentation, that consumers will actually pay either to use it or to restrict how we use it.

Add a little functionality, a little meaningful-use interoperability juice and you've got the fountain of youth, or as near as HIT is going to get us. 

But the really, really, really, really smart money (VCs your saliva glands should be in overdrive right about now) is on the sort of rare organization that designs for number 3 but builds for number 4-from Day 1. 

Without building in a backend analytics platform so crisp you could bounce a quarterweight reduction of the national bloated BMI off it, we won't reach critical mass consumer adoption (let's just say 15% to start, shall we?) of PHRs.

It is exceedingly well designed analytics that will accelerate us, cold fusion style, towards critical mass adoption of a consumer health platform, guided by super elegant infoviz design that makes string theory look like kloogey code.

So what constitutes the penultimate, next-gen PHR model? Look for business model option 3, backend stealth style data analysis integration, and KISS infoviz.

Only with all these elements in place will we be able to trick, ahem, talk, consumers into 'participatory medicine,' aka the kind of healthcare decision-making process necessary to change your mind, my mind, and Grandma Nagy's mind from eating that protean-continent sized slice of pie for desert. 

You can't manage what you can't measure, and we're doing a pretty good job of mangling even option 1, or storing health data effectively enough to charge w/out a common spec. Why? Ugliness. Ugliness and no analytics. Ugliness and no analytics and no looking off into the future. 

I don't need to tote a Tarot deck to see the Reaper and the Fool having a field day with our sector. I also, however, don't need runes to read that a bright future is possible with one strange turn of the cards. 

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Only 27% of Us Think Congress Has "Good Understanding" of Health Care Issues

Dr. G. from Leonardtown, Maryland writes:
I think the question should have been: “How confident are you that Congress has your best interest at heart when it comes to this health care issue?” Answer: Not at all. It seems Congress is intoxicated by lobbyists and their deep pockets and we’re just a piece of chewing gum stuck to the bottom of their expensive shoes.

First comment - a doc from my old hometown (Leonardtown, MD). Excellent to see some political-mindedness, even if it is critical of lobbyists, arising from SoMD.

From the Cafferty File: "Tell Jack how you really feel"
Blog Archive - "How confident are you that Congress understands health care issue?" « - Blogs from CNN.com

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Contagion: It's a Beautiful Thing...

Illness is viral, but health can be contagious too.

Many many thanks to Stephen Cohen and Bess Ho for the brand ID good karma...and to Mike McCabe for the necklace charm which became an Ink Wizard tattoo which became part of the Contagion story.

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When Will the iPhone Allow External Biomed Sensor Integration? Don't Hold Your Breath...

“Unfortunately, the actual implementation of integrating a meter and the iPhone is a process filled with tribulations-mostly internal factors like budget reviews, business development, marketing, hiring of iPhone developers, legal counsel approval, and so on,” Tendler writes. “Everything moves very slowly at the large corporate level. Plus, external factors such as FDA regulations provide extreme liability for a company at this level.”

Read the entire column here.

| 7.16.09 | Qualcomm pulls the plug on LifeComm - Inbox - Yahoo! Mail

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@jensmccabe - Exploring the 'Me-ome' 23andMe Research Revolution Results!

More data, including the weighted-decision making matrix I used to decide to share my genomic data open-source style, coming soon!

99$. 23andMe's Research Revolution was *so* worth it...

Personal health action item 1: Ask doctor at appointment Friday about Celiac's Disease variant(I haz it! Shocker!).

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Quantification of Self - Choice and Control Aware Care (Participatory Medicine Part II) Will REQUIRE IT

Since I'm chomping at the bit waiting to look at my 23andMe results (available as of today) while listening to folks explaining personal self-tracking preferences at the Quantified Self meetup, I'll try to explain my fascination with the quantification of self (or numerical translation of personal health and life narratives) in genomics terms.

Hang with me here - this will be a broad and simplistic metaphorical construct that probably won't withstand rigorous study...

In computational genomics, we have two broad areas of data that we examine for interactions (patterns):
1. expression
2. sequence info
and we essentially 'clock' or 'map' this data to 'read' results. 

The idea of establishing a 'Me-ome' or a 'self-ome' that we're exploring here is nothing new - since we've been drawing family/hunting groups on cave walls we've been mapping the orbital relationships of 3 essential constructs:

1. Me
2. You
3. Everything else

The challenge with #quantifiedself data collection isn't the hunting, and it isn't the gathering. I've got data about me, and you're more than likely, as social human animal, to share data about you (sometimes with more or less prompting required based on your personality, etc). 

It usually isn't even the drawing (or visualization) of that data collection - it's the translation. How do we code data so others can participate in the conversation of our lives? In our personal narratives? (My short answer, in less than 140 characters = Twitter). 

Superficially, methodologies and metrics are what we're all exploring here, but it's also an area of study I'll be pursuing, n=1 style, as a Fellow at the Health Srategy Innovation Cell at Massey College (University of Toronto). 

If you're digging into the role (theoretical and applied) of self-expression, microchoice and microrelevance in healthcare, get in touch. 

Building tools that allow self-expression to go from additive to exponential requires a sample size greater than one. Drop your digits or coding in the comment box. 

It's transcription time...

Jen S. McCabe
@jensmccabe

CEO/Founder: Contagion Health 
CoFounder: NextHealth (NL)

Consulting/Chief Patient Advocate (social media): 
OrganizedWisdom Health

LinkedIn: Jen McCabe 
Skype: jenmccabe

iPhone: 301.904.5136 
Dutch Mobile:  +31655585351

jennifermccabegorman@yahoo.com

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Health InfoViz? I Wish...Taking Notes From Emanio EDI Software

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2008: The Year of EMRs? Nope - The Year of Telemedicine

I am the CEO of a large physician network in CT.

There were four new CPT codes for 2008:
99441 PHONE E/M BY PHYS 5-10 MIN
99442 PHONE E/M BY PHYS 11-20 MIN
99443 PHONE E/M BY PHYS 21-30 MIN
99444 ONLINE E/M BY PHYS

Unfortunately, in my state (CT) hardly any of the large healthplans will pay for these codes, even though Medicare pays for 99441-444 in 2009 ($15-$41). It is hard to get physicians to adopt new modes of patient care if they are forced to make large investments in technology with scant prospects for reimbursement for services utilizing this new technology. I guess we all must hope that the big EHR vendors will all provide free upgrades (dream on) to make sure their products can guarantee 'meaningful use" in 2011 so docs can receive some of their investment returned. I'm not holding my breath.

From "The Health Care Blog: The Doctor Is In and Logged On."

Perhaps by 2011 we'll finally get around to the Year of eHealth, and then by 2015 we may be approaching the mHealth era...that is, if our healthcare reform budget doesn't become the next financial system fiasco.

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"We are all made of stars..."

Next time someone tells you you're glowing, thank them. Seriously.

Even more fascinating is that the light human subjects in the Japanese study emitted did NOT correspond to thermal imaging.

Take a look also at the 'third eye' (ajna chakra). It wouldn't be an out-there theory if I didn't tie it into genoanth somehow...brain stem develops as result of maternal or paternal chromosome?

Rockin' research link courtesy of @realmarcin.

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Individual Reforms First - Saving Our Healthcare System Requires Healthier N=1 Decision-Making

Getting millions of people to go to a polling place on one specific day to pull a lever, touch a screen or mark a ballot using social media really isn’t all that complicated.

Using social media to get one obese 68-year-old man who lives alone to test his blood sugar three times a day for the rest of his life? Now that’s a social media challenge.

From Craig Stoltz's "Social Media, Health IT and Gov 2.0 | Web2.0h...Really?"

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