Year: 2016

Is superintelligence the inevitable next step in evolution? by Dr. Roshini Beenukumar, @roshiniBR

https://www.cryptocoinsnews.com/wp-content/uploads/2014/10/ai-handshake-wide.jpg

Experts predict that by 2050, there is a 50% probability that AIs which will match the intelligence of an average adult human. It is not a long wait, isn’t it?


Last week, my husband and I finally sat down to plan our summer vacation. After spending two full hours on 10 different tour websites, we ended up being completely overwhelmed by the options; all-inclusive vs half-board, city vs seaside or sea vs land. 


Decision making is getting more challenging and time-consuming day-by-day. With growing amounts of data and information, there is an increasing need for intelligent systems that could help us make our daily decisions. Several applications use AI to help customers with their decision making, for example, Amazon recommending you the smoothie maker that you always wanted but never bought or Netflix recommending you a new crime series to watch because you are a crime series fan. 

The rise of the “bots”

The AI trend is here and it is going to grow in the coming years. Investors are backing more AI startups than ever. In the first quarter of 2016, there were over 140 equity deals to startups focused on AI, according to CB insights. The spotlight is currently on chatbots and voice assistants. Bot startups like Growbot, Angel.ai, X.ai, Digit, Meekan, Viv and others help their customers with scheduling meetings, tracking employee accomplishments, tracking spending as well as finding the right products and services. This means that, the next time I plan a vacation I could just go to Angel.ai and ask the bot to find me the right vacation package!


As an AI enthusiast, there isn’t a shred of doubt in my mind that AI systems are here to make our lives easier. However, it is hard to ignore issues raised by prominent thought leaders in the field like Stephen Hawking and Elon Musk on the future of AI. Once machine intelligence surpasses human intelligence, will it become an existential threat to the human civilization? 

What happens when AIs start doing AI research?

“Machine intelligence is the last invention that humanity will ever need to make.” Oxford philosopher and leading AI thinker Nick Bostrom, TED, March 2015. 

The answer lies in the concept of intelligence explosion, says Daniel Dewey, an AI researcher from the University of Oxford. The thought experiment goes like this. Imagine that we have created a machine that is more capable than today’s computers. This machine is given the task to improve its current capacity. This leads to a very large and rapid increase in the abilities of these machines. This is called intelligence explosion. To prevent unwanted consequences resulting from such superintelligent AIs, it is absolutely essential that the AI research community collaborate to carefully steer the evolution of artificial intelligence.

Evolution of intelligence on an exponential scale

“It is hard to think of any problem that a superintelligence could not either solve or at least help us solve. Disease, poverty, environmental destruction, unnecessary suffering of all kinds: these are things that a superintelligence equipped with advanced nanotechnology would be capable of eliminating.” – Ray Kurzweil, The Singularity Is Near 

AI is among the top three technologies that is expected to grow on an exponential scale, says Ray Kurzweil, founder of Singularity University. As of now, humans have conquered the lowest calibre of AI called the “weak AI” that specializes in one area, like Google’s AlphaGo beating the world champion in the game GO. The next step in the AI Revolution is a “human-level AI” or “strong AI” with a general mental capacity matching that of a human being. The final step in the evolutionary ladder is postulated to be an ASI or “artificial superintelligence” which is not only smarter than humans but also self-improving. 

A group of AI researchers at companies and leading research institutions around the world are making significant strides in the field of AI. The fruits of their work can significantly change the way we live on this planet. Experts predict that by 2050, there is a 50% probability that AIs which will match the intelligence of an average adult human. It is not a long wait, isn’t it?  

Author
Roshini Beenukumar

Dr. Beenukumar is a molecular biologist turned science writer. During her PhD, she studied how cancer cells behave the way they do by exploring the humble yeast. Currently, she works as a freelance science/technical writer in the Life Sciences industry . She enjoys communicating science to the public and discussing new ideas in the interface of medicine and technology. She spends her spare time getting lost in a book or in nature.

Architecting Innovation Portfolio – Part 3, By Prashant Joglekar @ideabound

Technology needs to be viewed from the function it delivers to a product or service which satisfies a market need. Technology can be leveraged by innovating on various business model elements

This is in continuation with my last two posts. 

The first one was architecting innovation wherein I discussed how organisations can architect innovation portfolio for them to begin their innovation journey & stay on the course, its a plan that they would like to build on. 


The second post talked about ‘sensing the consumer wave’ where I touched upon the customer side of innovation which is gleaned using several population behavioural trends. This effort saves a lot on the traditional market research.

This post takes a brief view of technology side of innovation. I would invite reader’s view to further my own learning on the subject.

Defining Technology
Let’s define technology in simple terms. Technology is nothing but practical application of science to commerce or industry. Therefore one route to innovation is when organisations marry technology with the user need.

Classifying Technologies
The technology world can be simply categorised into 3 parts physical, biological & digital. The last one provides a great interface between the first two.

Physical technologies deliver something tangible to us. Some of the key technologies of the future are autonomous vehicles, 3-D printing, robotics, new materials will redefine our lives and businesses in terms the way we travel, the way we produce & use, the way we process things & the way we design things.

Biological technologies will impact agricultural produce, health care and provide customisation in every sphere of biological world.

Digital technologies are connecting physical objects & humans and humans with humans in seamless way. Organisations use these technologies to give a new voice to their products and services.

Marrying Technology & Market Need with Business model
No technology can transform an industry unless a business model can link it to an emerging market need. Market need is a result of ‘jobs to be done’ by larger number of people, more about this in my next post. Simply put, anyone will hire your product or service because it helps him/her do a jobs that they are trying to get done more efficiently. Many of these jobs didn’t exist yesterday, but today with the advent of technology these hidden needs of ‘jobs to be done’ are driving growth of new businesses with the product & services they offer.

With transformative business models (Reference 1) technologies are linked to the market need to achieve success. Some key features of these business model ideas are

  • Personalisation – I want what I want
  • A closed-loop process – Recycling to reduce cost
  • Asset sharing – Mitigating the risk of high investment in acquiring assets by a distributed asset ownership 
  • Usage-based pricing – I pay as I use
  • A collaborative ecosystem – No single entity can manage & win, collaboration to deliver a product & service is key
  • An agile and adaptive organization – less hierarchical decision making, allowing front line employees to analyze & decide according to market dynamics.


Following figure shows how organizations can match technology & market need by an innovative business model feature (the example here is just an illustration & there’re could be many ways of doing it). The key learning for strategist is to make a dashboard like this and continue mapping technologies and market need as they realize one & ideate to come up with a new business model



Criteria for selecting technologies
There are several factors in selecting technologies, these can broadly divided into 2 categories; industry factors, company factors. Let me touch upon them briefly

Industry Factors
These factors include the pace with which technology changes in a particular industry, so the decision between ‘make & buy’ becomes very obvious. Revenue potential of technology and cost of evaluation are other factors. For market ready products of technology the speed of revenue generating (first mover advantage) is usually high.

Organisational Factors

This depends mainly on 3 factors ;

Purpose to use technology which largely depends on the overall strategy of the firm which is based on mainly whether they want to enter new market, or counter disruption by enhancing existing products with the help of technolgy. The other factors that are considered are product development capability of the firm and the product portfolio that they have. The weaker the product development capability greater is the tendency to adopt to a market ready technology.

Conclusion
Technology needs to be viewed from the function it delivers to a product or service which satisfies a market need. Technology can be leveraged by innovating on various business model elements.

Thanks for your time. Let me have your inputs.

We help our clients with various intervention in their pursuit to innovate


Reference
1) HBR Oct 2016 : The Transformative Business Model by Stelios Kavadias, Kostas Ladas, and Christoph Loch

The article was first published in Mr. Prashant Joglekar’s LinkedIn pulse page. It has been re-published here with the authors’ permission
Author

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Prashant Joglekar

An engineering postgraduate from IIT Mumbai. His career spans over 21 + years and core skills include Systematic Innovation- TRIZ Training / Facilitation, Business Transformation, Total Quality Management, Business Process Design & Management, Lean and Six Sigma training / facilitation. Prashant’s mission is to prepare, nurture innovative minds & broker ideas by cross-pollinating them across an enterprise

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Successfully Implementing #HealthIT: A Health Informatician’s perspective by Dr. Thanga Prabhu, @thangas

A fresh approach to HCIT product development is required where the product can quickly meet the clinician’s need. Actively involved clinicians, HCIT trained manpower and HCIT aware clinicians can transform healthcare today; it is not an option but an idea whose time has come


IT is an enabler of change and not the change itself. When customers look at IT as the one solution to all their problems, it is set up for failure from the beginning. Introducing an IT system necessitates an in­-depth study of existing workflows, roles and responsibilities and change management aspects in every speciality.



Healthcare IT implementation is complex, interlinked, domain­ sensitive and clinician­ focused, thereby being different from other IT implementations. The generally high failure rate for IT implementations tends to be higher in healthcare due to this complexity.
Clinicians need to be involved actively from the requirements gathering phase and given ownership of clearly defined sub areas within the project to be successful. IT should be a tool to transform healthcare delivery model and not expected to be a solution by itself.

HCIT ­ Domain intensive

Healthcare is an environment of trust wherein many actions are performed without being specifically asked for. The single point of focus for all clinicians is the patient and roles are synchronized, each one playing a small but significant part in the care process. A study found that when a patient walks into a healthcare facility, is registered, vitals taken by nurse, seen by doctor, takes medicine from pharmacy and walks out 50+ people have to work in harmony for this to happen successfully.
Intensive training ensures that the personnel on the ground know exactly what is expected of them and they do that role with conscience. In contrast transactions in banking or the travel industry are simple and straightforward. Clinicians ranging from doctors, nurses, pharmacists, technicians in lab, operation theatres, dialysis centres, and emergency services have varying data needs and data recording responsibilities.
When a doctor charts his patient for the first time he goes into details on illness, past history, allergies, drugs being taken by patient, builds a problem list, identifies/ lists differential diagnosis, plans lab/ radiology investigations and prescribes initial treatment. The methodology followed is standardized during his training and practice over the years ensures that it comes naturally while examining a patient.
Nurses also train on similar lines to examine and document key information on the patient initially and then as patient moves through the system. The data that is recorded by each clinician is useful to take decisions for the patient and is used by the entire team. As clinicians become experienced most of this data processing is done without actually recording it on paper and it is known that consultants record only key points in their patient records.
When HCIT requirements have to be gathered in such an environment they should be involved early as only clinicians understand the significance of each piece of information. Many tools are available to assist the clinicians during the course of their work and it is important to note that none of them are mandatory. HCIT is also a tool, which if not user friendly tends to be ignored.
HCI (human computer interaction) has to offer better ways to input data as the traditional mouse/keyboard system does not fit into the busy healthcare environment. Speech recognition is now being used in radiology reporting and touch screen systems are being deployed in operation theatres and ICUs to gather data without the clinician having to actually sit and type.

Change management

Clinicians have been known to be resistant to change for ages. As an example, usage of stethoscope amongst the medical community took almost 100 years. If the systems that they are expected to use in their day­to­day work is unfamiliar to them and takes too much of their time, without tangible benefit, there is a very serious risk of non usage. Every clinician has to see clearly the benefit that will accrue to his / her work to adopt a new system. Resisting change is natural and it is seen in a greater degree within healthcare.
‘Clinician champions’ have to be identified within the customer’s staff who will lead the implementation and support their colleagues later on. The resistance to change is often because of three broad reasons: political, technical and attitude. If the new system upsets an existing hierarchy or even gives an impression of doing so, it can be a serious risk.
Technical reasons such as lack of training, not being comfortable with using technology, HCI (human computer interaction) factors such as clinicians in the operation theatres being expected to remove their sterile gloves to type can also jeopardize a project.
Attitude is a subjective phenomenon and usually can be overcome by peer pressure and strict enforcement of policies. Once clinicians see the benefits they tend to voluntarily train their teams and the rate of knowledge transfer then goes up significantly. This is after all the existing culture within healthcare where peer support and sharing of best practices is common.

Interoperability

HCIT procurement should be done by knowledgeable personnel who see the big picture and can build a system incrementally. In the western countries it has been seen that departments usually acquire systems individually starting from radiology, cardiology then laboratory and finally the HIS / EMR. None of these systems are expected to communicate with each other initially and after significant cost, effort and time has gone into implementing it the results could be diverse systems that cannot communicate.
Rather than follow a big bang approach it has been observed that incremental adoption with the larger picture in focus assures success. It is imperative today that all systems communicate freely amongst themselves and also with external systems. Most facilities have homegrown basic billing HIS systems but clinicians are not exposed directly to these systems. Technology savvy specialties such as Radiology, Cardiology, Anaesthesia and Lab medicine should be starting point for a HCIT solution. Such pioneers are excellent ‘User Champions’ for future more complex specialties.

Benefits

It is futile to incessantly discuss the many reasons of why HCIT solutions are not useful in healthcare. Success stories and proven benefits of HCIT implementation need to be highlighted to build customer’s confidence in adopting a HCIT solution. It has been seen that instead of trying to force fit a solution on existing workflows, a system that can adapt to and respond dynamically to end user needs is liked and used by clinicians. Existing HCIT solutions have limitations on their configurability, nevertheless when products are extensively customized; it becomes difficult to maintain the product over time.
A fresh approach to building HCIT solutions which are easy to customise, can be hosted on a cloud and paid for on a utility model (pay­as­you­go/case by case) and preferably allow clinicians to tailor on their own with minimal IT support is required. With the advent of Web 2.0 (Read and Write) and Web 3.0 (Read, Write and Run) technologies and customers using Facebook, Twitter, YouTube, Apple iStore etc. the same is now expected from HCIT vendors. Author has personal experience of Anaesthetists requesting data mining features with drag­drop tools to create queries/reports on their patient data which is then used for research and academic presentations.

Government initiatives

The government has to play a regulatory role and help identify ‘EMR Interoperability standards’ after studying the globally available standards and identifying those that are relevant, affordable in the long run without any strings attached and mandate their use by HCIT vendors. Patient data has confidentiality and privacy implications which need to be covered by Government with a legal framework.
The newly enacted addenda to IT Act 2000 which mandate vendors to take necessary and reasonably good measures to protect patient data is timely. Ownership of patient data is an unresolved question globally but the consensus has been to retain ownership of data with patient with government being a guardian for that data.

Learning from Aviation / Nuclear / Space industries

We need to learn from our predecessors who have taken the failure bull by its horn and controlled what was given up as impossible earlier. Aviation industry had some depressing statistics before FAA (Federal Aviation Authority) stepped in to rein in the problem. The FAA conducted due diligence and created open reporting mechanisms to identify problem areas which then went on to become starting points for other interventions.
Nuclear industry by nature is risky and allows no scope for slip­ups. Enforcing safeguards, defined protocols, on­going training to keep personnel updated on latest skills has resulted in safety. Space industry is intrinsically dangerous and failure rates were high initially. NASA today has managed to mitigate these risks and regularly sends rockets and shuttles to space. The key is to take a holistic view of systems and blame the system and not the user of that system when failures do occur.

Transforming healthcare with IT

IT is an enabler of change and not the change itself. When customers look at IT as the one solution to all their problems, it is set up for failure from the beginning. Introducing an IT system necessitates an in­-depth study of existing workflows, roles and responsibilities and change management aspects in every speciality. IT is but another tool available to transform healthcare and when its role (and limitations) is understood the chance of success increases.
A clinician who leads HCIT implementation on a full time basis starting with initial seeding of idea amongst clinicians, brainstorming with them implications of introducing the system into workflows, hand holding during the implementation and ongoing support post ‘Go Live’ should be minimum criteria in HCIT implementations. 
Just mapping the paper based workflows to IT and replicating it does not allow clinicians to fully utilise the complete capabilities that IT brings in. New ways of working such as real time chat on social networking sites such as Twitter and SMS can allow clinicians to interact and mutually support each other while delivering care. Document once and reuse infinitely, auto calculating all variables, adding layers of security to ensure role based access are all possible only with HCIT.

HCIT manpower

The realisation that has dawned on health informaticians today and backed up by research is that HCIT implementation should not be treated as another IT implementation. The domain is complex, most work happens like clockwork without much communication (for example when a surgeon operates, the nurse assisting him knows exactly what instrument he needs next). Thus clinician­ lead HCIT implementations are realising higher success rates. Medical Informatics workforce is non­existent today. A separate cadre of foot soldiers who can man the posts is required as bridging clinical and IT worlds, is difficult. ONCHIT is spending billions to encourage academic centres to churn out this workforce in USA.
NHS in UK supports employees to acquire additional informatics skills as it is clearly required to practice in tomorrow’s healthcare world. India has the opportunity to recognise this need and use our excellent educational system in public and private sectors to train HCIT manpower at different skill levels using modern teaching resources such as on demand learning and online delivery systems. The demand for this manpower has always been much higher than what the system has been able to provide.

Conclusion

HCIT is no different from other IT implementations in that it is also force fitted on existing systems without understanding fully all the ramifications of doing so. The interlinked and mutually supportive healthcare environment where trust on peers and a single minded focus to work for one goal – patient care without direct orders is an amorphous beast to an outsider to healthcare: the IT person.
A fresh approach to HCIT product development is required where the product can quickly meet the clinician’s need. Actively involved clinicians, HCIT trained manpower and HCIT aware clinicians can transform healthcare today; it is not an option but an idea whose time has come.
The article has been published here with Dr. Thanga Prabhu’s permission
Author

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Dr. Thanga Prabhu

Dr. Thanga Prabhu has 20+ years of healthcare experience working in India, Abu Dhabi and United Kingdom. Clinical leader evangelizing medical informatics, Communications leader-regular speaker in all major HCIT events. He has authored a paper for the UK Parliament Health Select Committee in 2005 titled ‘The utilizations of telemedicine (telecare) and its future potential for improving services’. Dr. Prabhu is currently the VP of the Indian Association for Medical Informatics (IAMI)

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Architecting Innovation Portfolio – Part 2, By Prashant Joglekar @ideabound

Sense The Wave : Understanding Consumers Better Than They Understand Themselves


This is in continuation with my last post ‘Architecting Innovation Portfolio‘. 

The first inspiration ‘Sensing The Wave’ has two components under it, the first of which is sensing the consumer signals to build innovation around it, the second one of-course is sensing the ‘technology’ wave which I will cover in the following posts. 

In this post, I am focusing on the consumer angle. The method / approach is very unique and fast replacing or have replaced market research by decoding & coding deep customer motives across generations and thinking styles. This becomes a good starting point to a question ‘what does customer really wants’ 

Introduction
Successful Innovation requires right answer/s to the right problem/s. It is said, “Once what is to be done” is known, “How to” part merely follows. The biggest challenge however is recognizing the “What” part. Before going further let us remind ourselves of Einstein’s definition of a problem or an opportunity “Problem is the gap between what we want and what we have”. Many times falling prey to prevalent thinking “If ain’t broke don’t fix it” & “All is Well” 🙂 we fail to recognize what might be needed. (Opportunities = Un-recognized customer desire /need/ want etc,)

The successful innovation therefore requires answering three questions

1.    “What does Customer Want or Need?”

2.    “How do we recognize what he wants”

3.    “How we meet that unmet need? (What product/ services we will design & create or enhance to meet the unmet need).

Absolutes of Innovation (Reference 1)
If we have to have a simple definition of what successful innovation means to most of us, then we can say it is something which has all of good things ( Both for customers and business ) and less or none  of bad things again for both. Thus if we now have to define what a successful innovation must have; it leads us to state two necessary absolutes

1.    Solving a trade-off or compromise

2.    Adding a new function or an attribute that no competitor is offering

Recognizing Unmet Needs = F (Trend)

Innovation requires organizations to go beyond understanding the ‘Voice of The Customers”“Slipping into their shoes” or “knowing their conscious mind” to a newer level -“Seeping into their unconscious mind observing several of their behavioral trends” to comprehend what they will appreciate in future products and services by way of its unique functional features & attributes (tangible and intangible).


TREND (Reference 2) is all about understanding people, the populations they form part of, and most important of all for a business, understanding what motivates them to spend their money. The basic idea behind recognizing trend is that the most powerful forces in our society are the emerging, counterintuitive trends that are shaping tomorrow right before us. For e.g. need to stay fitter, Yeh DIL MANGE MORE attitude, a smaller car but a bigger house first, few years later both get bigger & bigger, getting attached to one “sect” & creating more diversity of sects are all forming part of trends. “Jain food” is one such trend which does not meant food for “Jains” but food that is devoid of onion or garlic which is even preferred by the rest of the population. While people are eating healthier food than ever, number of chat shops shows an increasing trend as they are frequented by a sizeable population.

I-pod, I-phone are not the result of customer surveys but a deeper understanding of behavioral pattern observed in few individuals which soon was embraced by the rest. The power of extreme individual choices has never been greater and the reasons and patterns for those choices never harder to understand and analyze. Identifying small, intense subgroups and communicating with them about their individual needs and wants has never more critical in marketing than now. Small groups, drawn together by shared needs, habits and preferences are on the rise.

Late Sh.C.K.Prahalada & M. S. Krishnan in their book “The New Age of Innovation” (Reference 3) has put forth a concept of N=1, R=G which means product / services that are truly innovative can cater to the individual need (N=1) by leveraging global networks resources (R= G). I-pods are popular not because we can carry music around- we could do that with the walkman, they are popular because it gives us the ability to choose our own songs thus personal technology has become personalized technology. (N=1, R=G)

Thus a trend is a behavioral aspect by an intense identity group that grows a need and influence behavior of a larger population not met by the existing businesses.

TREND and Its Relevance to Business (Reference 4)
Most managers can articulate the major trends of the day. But in the course of conducting field and market research in a number of industries and working directly with the companies, they often fail to recognize the less obvious but profound ways these trends are influencing customer aspirations, attitudes, and behaviors. This is especially true of trends that managers view as peripheral to their core markets. Consequently, they ignore trends in their innovation strategies, include product features that only superficially address a trend’s impact on consumers, or they adopt a wait-and-see approach and let competitors take the lead. At a minimum, such responses result in missed profit opportunities or wasteful investments in R & D. At the extreme, they can jeopardize a company by ceding to rivals the opportunity to transform the industry.

Why Firms Fail To Leverage Trends (Reference 4)

Ignoring trends that originate outside their markets
Most firms naturally think of themselves as offering products within defined categories. (“we make cosmetics” We make Automobiles” “We are apparel company” “We are bank” etc This often directs innovation efforts toward customer needs that have been considered relevant to the category and need of the population as a whole is ignored.

Responding to a trend in a superficial way
Siemens launched Xelibri (Reference 6) 
(http://www.canadiancontent.net/mobile/phone_pictures/siemens-xelibri-6.jpg), a Smartphone for women that contained two mirrors and was designed like a makeup compact but could not actually hold make up. The rise of digital media has prompted consumers to seek products that allow them to multitask, but Siemens didn’t appreciate that people expect such products to deliver this benefit in substance, not just in form.

Ill-conceived offerings that don’t speak to consumers new needs or desires often dilute rather than enhance, the brand’s equity, thus responding to a trend in a superficial way doesn’t help.

Waiting Too Long to Respond
Sometimes waiting to watch the competitor to make the first move can often lock valuable assets. Nike was able to secure a partnership with Apple to co create Nike +, a sports kit and web service that allows runners to track their performance with their i-pods and share information with others. (http://www.apple.com/ipod/nike/) Given the i-pod’s popularity among joggers, a firm that now seeks to enter the new space has lost an opportunity to launch their services with a capable partner

What is trenDNA?
The approach I am going to discuss hereon is summary of my understanding of “trenDNA” a six years of research by Systematic Innovation GURU Darrell Mann and his Turkish counterpart Yekta Ozozer. The main theme of the book is “Understanding Populations Better than They Understand themselves” by understanding trends and their connections with each other.

trenDNA is about observing patterns of behaviors that form a trend & re-focusing the way we look at world. It is a tool for firmer predictions about the future not just by looking at the trends but looking at the conflicts and synergies between trends.

The book contains 160 + trend cards each describing a unique behavioral pattern (trend) which is distinct from the other. Authors claim that during their research they have come across more than 1000 trends & were considered for a detailed assessment, after intense deliberations they rationalized them based on their resemblance finally sizing them up to 160+ unique trends.

Each trend-card describes the trend in brief, the other side of it lists other trends that the trend in review leads to or contradicts with. The greatest opportunity for innovation is realized by solving a conflict between the trends. It also relates trend with the thinking style (based on the work of “Spiral Dynamics” by late Dr. Clare Graves) and the generation archetype (Hero, Nomad, Prophet and Artist) theory put forth by Strauss & Howe through their work on “Generation Cycle”

One chapter is exclusively devoted to trend mapping strategies suggesting use of these trends for getting customer insight & into their probable needs. At the back of the book a list of winning solution strategies have been summarized. The strategies may appear abstract for people who do not have basic orientation to systematic innovation methods,(check my post : ‘Systematic Innovation Toolkit’ https://www.linkedin.com/pulse/systematic-innovation-toolkit-prashant-joglekar?trk=mp-author-card) for others it can help pointing towards possible innovation directions based on the clues provided by trend mapping strategies.

trenDNA Map
This first part being an introductory part, I will touch upon briefly the key concepts of trenDNA and its overall map.



At the core of the map, is ‘as-is’ and ‘to-be’ the two key elements of any innovation project. ‘As-is “part is where the things are as they are as on date and ‘to-be’ part is the future state which might be an ideal state as foreseen by the team or sponsor of the project. It might happen that there is no ‘as-is’ part and the canvas is completely blank, these are typical situations where a CEO asks his team a need to create new growth engines & business verticals.

The next in the map is “absolutes’ where we identify the function delivered by a product & services few may term this as ‘jobs to be done’ or ‘likely benefit’. The reason to think more deeply about the function is to unravel the functions beyond tangibles and finding the likely areas to innovate or finding out an alternate way of delivering the same function as is done by some of the other industries who may not be your direct competitors.

The ‘inevitable’, next in the map is all about data driven predictions may be a simple example of this could be if a shaving products company wants to predict the demand for their products in next few years then they can have the data of the number of students passing out of the college and starting their carrier as a professional. They may or have to shave regularly in their new life,  (They may not be shaving daily in their earlier “student life”) So such a prediction if not accurate can provide a reasonable estimate of the product sales growth.

The next in the map is ‘inherent’ which will make us understand the higher order effects. Taking the shaving example further we might realize that “shaving is not considered as a “cool thing” and it’s best to have some trimmed beard on one’s chin to attract & retain attention of “interested parties”JJ. This may make you think about the investments that you might make in augmenting the production facilities of your existing products. Instead you might think of something else for making your top line grow or at least stay even.

The two key themes have been introduced here may be we can call them vehicles of trenDNA. The first one is based on the different thinking styles (thinking gears) that an individual, group or society at large have. This is based on pioneering work by Dr. Clare Graves on “Spiral Dynamics”( Reference 5) which is about how thinking style changes depending on the change in the external situations and affect the behavior of an individual, group or society at large. These thinking styles are used as a dimension in comprehending the trend thereby understand customer & plan out future things (e.g. transformations in the organization, predicting buying behaviors etc).

The other concept is based on “William Strauss & Neil Howe’s” pioneering work on generation cycles (The Forth Turning6) the basic premise of the work is; generation cycle repeats itself after certain years so one can have a better understanding of the current generations based on the attributes possessed by its equivalent generation of the past. Each generation cycle is known to repeat after every 80 years, so if you want to understand the GEN Y or HERO generation (born during 1980-2001) then it is best to correlate them with people born previously between 1900-1925. This provide good basis for understanding different generations & their key attributes as a consumer/ customer. Each trend is further classified based on the thinking style it represents and generation with which it finds the closest match.  

The next stage is “Probables” where all the market and consumer trends that marketers spend so much of their time talking about are found. The job is describing this forth level is to make sense out of what is going to turn out to be close to two hundred individual trends. The section also help us arrange the trend database in a meaningful manner so that if we know what age group our customers are and what is probably their thinking style is then we can consider only those trends to work with that fits the selection. This can give us some early lead in innovating in products and services that will satisfy this segment.

The last one is “Possible” the authors here are quite open to accepting any such event which may have a distant correlation with the purchases made by the consumers. Now in India we already have such correlation where certain days are considered auspicious for purchases as the planetary position favors to do so. As we know smart Marketers in India are already exploiting and cashing out on such events.

We will see in some detail of each area of the map in the next few posts.

Why we need trenDNA
Why should I consider trenDNA approach for scouting new business opportunities or understanding the missing ones in the existing one? Once motive is clear commitment follows let us see some of these motives.

Motive 1
Any innovation project or for that matter any improvement project starts with documenting “As-Is” & “To-Be” state of improvement parameters e.g. “Increase Revenue By X % or by X folds in next Y years” or “Cut Cost By Z %” “Improve Customer Satisfaction Score by “S” units or “Develop New Business with Product & Services that will add R % to the top line” etc”.  If you are leading the project which has goals like this then you are completely lost at the start. Where & How to start is the next question on top of your mind. You may just start doing it to know later that what was started was not the best of the approach. You might then feel that I should have got enough time for thinking before doing. But most of the time need of the moment is action rather than thinking and unfortunately time spend on thinking is considered as procrastination. This happens because there is no methodical approach available to our thinking According to me trenDNA coupled with Systematic Innovation can best aid our efforts.

Motive 2
If your company is undertaking a market survey trying to talk to customers & understand what they want better from your products & services, then advice by the author is to think again. Sometimes people are asked to find out what customer wants within few days before a product development cycle is undertaken. The result of such quick survey often leads to a product that either overshoots or undershoots existing customer requirements & looks like a sibling or at best a cousin of what is already available in the market. They however recommend with their experience that the resources otherwise spent on surveys can be better utilized in testing the product before launch. In author’s own words more you practice (with concepts) with trend mapping the luckier you will get. J One of the companies they work with, depend significantly on trend mapping & build its understanding of customer’s unrealized needs to come up with a differentiated product / service.

Motive 3
I am not a market analyst or a strategist but when I see everyone spending around me ( except me, my frugal up-bringing does not allow me to spend unnecessarily J ) I believe there is a growth happening. Numbers are helpful and bring seriousness to the discussion. The US GDP is $ 14 trillion and the contribution of personal consumption expenditure accounts for nearly @ 65%. The further break up amongst products & services include 35 % by products and 65 % by services. (Annexure I)

Some of the growth indicators in the Indian context are summarized in Annexure II. Every organization would like to have maximum share of those growth numbers and hence would like to innovate and introduce products and services that creates differentiation. The organization that understands the need of the customer who is at the core of these numbers will stay ahead in the race.

Motive 4
Consumer Expectation Trend follows a following path

Commodity- Product- Service- Transformation- Experience

The trend shows that customers are more and more interested in ultimate NIRVANA :)(The experience) and at that stage they are ready to shell out more from their wallet t that they would at all the previous stages. The forward trend is “customization” & the backward is “commoditization”, to stay well ahead of the competition organizations needs to create more experiences through their product & services else they will have to fiercely fight in the “RED” ocean instead of creating a “BLUE”. (Reference 9) The figure below depicts the point. For moving upward in the graph in order to have more pie of the customer’s wallet the organizations need to observe, recognize and capture trends & create experiences.



Motive 5
The Halo Effect (Reference 8) Observes that those organizations that correctly determine “What” part, stays ahead of competition because from start their resource productivity and efficiency is far better that their competitors. For competitors it becomes difficult to catch up and eventually even if they do, they exhaust themselves by then, losing stamina in the process for their possible next run.

Elements of trendDNA



The Way Forward
The next parts will describe in sequence the trenDNA concept in some more detail, the innovation challenge identification process and finally integration with Systematic Innovation to unfold a structure of an “end to end” innovation process which any organization would like to implement.

Connect & explore how we can work on this to identify most desirable customer needs for your organisation’s products & services.

References
1)Mann Darrell, Yekta Ozozer trenDNA – “Understanding Populations Better than They Understand Themselves”, IFR Press, UK, 2009

2)Penn Mark “Micro trends”, Penguin Allen Lane

3)Prahalada C.K., M.S.Krishnan, “ The New Age of Innovation” Mc-Grawhill 2008

4)Elie Ofek, Wathieu Luc; A” Are You Ignoring Trends That Could Shake Up Your Business? Harvard Business Review July-August 2010

5)Cowan , Beck “Spiral Dynamics”, Blackwell Business 1996

6)Strauss & Howe “The Fourth Turning”, Broadway Books,1997

7)Pine B.J. Gary Gilmore “ The Experience Economy” Harvard Business School Press, 1999

8)Rosenzweig Phil “The Halo Effect” Free Press, 2007

9)Kim & Mauborgne “ The Blue Ocean Strategy”, Harvard Business School Press

The article was first published in Mr. Prashant Joglekar’s LinkedIn pulse page. It has been re-published here with the authors’ permission
Author

[tab]
[content title=”About Prashant Joglekar”]

Prashant Joglekar

An engineering postgraduate from IIT Mumbai. His career spans over 21 + years and core skills include Systematic Innovation- TRIZ Training / Facilitation, Business Transformation, Total Quality Management, Business Process Design & Management, Lean and Six Sigma training / facilitation. Prashant’s mission is to prepare, nurture innovative minds & broker ideas by cross-pollinating them across an enterprise

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Philips Digital Healthcare Conclave 2016 by Sagay Mary, @hisagay

 The future of healthcare is here and it is up to all players in the sector to leverage emerging technologies to improve the quality and reach of care


What if you could consult your doctor from the comfort of your own home? Could a Star Trek like future with sensors assisting doctors to diagnose disease come true? According to the industry leaders gathered at the Philips Digital Healthcare Conclave 2016, the day is not far when both these scenarios and more, will be the reality of healthcare. 


Digital disruption has had reaching effects on the healthcare technology space. The second edition of the Philips Digital Healthcare Conclave focused on the possibilities, the benefits, the risks and the tremendous potential offered by integrating and leveraging emerging technologies to revolutionize healthcare and offer better care for patients. The event brought together an impressive mix of thought leaders from hospitals, OEM manufacturers, doctors and government officials to elaborate on the ways their sector is implementing digital technology and their predictions for the future.

Accessibility, affordability, acceptance and security were the four most prominent themes that dominated the day’s discussion. All the speakers and most of the audience shared common views on the potential of digital technologies in enhancing the accessibility of quality healthcare, democratizing the care process, and the need for developing affordable solutions. 

On the topic of security, however, the gathering remained sharply divided, with the doctors emphasizing the seriousness of the threat to patient information and their right to privacy, and the policy makers and industry leaders choosing to prioritize accessibility over an exaggerated scrutiny of security. The highlight of the day was the session by Shri Rajendra Pratap, advisor to the Union Minister for Health, on the various welfare schemes launched by the Government of India using digital technologies.  

The conclave also looked at the other side of the innovation and digital disruption coin – start-ups. There is no denying that these nimble, creative, entrepreneurial establishments have turned the world of business on its head with their out of the box solutions. As a leading innovator in the healthcare technology space, Philips believes in mentoring and encouraging the start-up economy. 

This year’s conclave instituted the first ever Philips Start Up Cup. Eight promising start ups pitched their ideas and plans to a panel of industry leaders. The array of brilliant solutions ranged from AI powered physician assistant, analytics platforms, to wearable heart beat monitors and devices for analyzing pathology samples and radiology reports quickly and efficiently. 

Predible Health won the Philips Start Up Cup, INR 2 lakhs as prize money, and the enviable opportunity of being mentored by Philips Innovation Campus for their projects.

The future of healthcare is here and it is up to all players in the sector to leverage emerging technologies to improve the quality and reach of care.

The article was first published on the Authors’ LinkedIn Pulse page. It has been reproduced here with the authors’ permission.
Author
Sagay Mary

Manager, Corporate Communications at Philips, Bangalore responsible for branding and communications

@iCHRCloud & iNICU: A Complete Child Healthcare Solution by Ravneet Kaur and Harpreet Singh

Only 65% children in the first year of their life have been able to achieve full immunization and the increase in coverage has stagnated in the past 5 years to an average of 1% every year

Our goal with iCHR is to attain the sustainable development goals and reduce the child mortality rate. 


In present day advance technologies are playing crucial role in most aspects of human life. Now extending its footsteps in one of the most treasured moment of any parent, birth of a child. A thought of building a complete child healthcare solution catering from the birth of a baby till it’s adolescent age powered by technology and big data came into existence when Oxyent Medical — a company run by Harpreet Singh and his wife Ravneet Kaur joined hands with Dr. Raghuram Mallaiah of Fortis La Femme Hospital in Delhi to combine their skills.


The interest of Harpreet Singh, a biomedical engineer with two advanced degrees in engineering from the University of Wisconsin, and Ravneet Kaur, post graduate in computer science stems into this solution from personal tragedy. He along with Mrs. Kaur lost one of their twins as babies were preterm, born in 26 weeks instead of normal 34-38 weeks. One of the children survived, the doctor said that the deceased infant — barely bigger than the palm of an adult — had succumbed to sepsis.

The on ground journey to formulate the solution started by conducting a new research to collect data from preterm infants, tracking their progress over the months of their stay in the neonatal intensive care units (NICUs) in Delhi hospitals. The approach to design the complete child healthcare solution leverages IOT, Cloud and Big Data technology, enhancing the doctor-parent engagement model by enabling continuous and personalized child health monitoring. In this regard, the first product launched by company on 19th February’16 was iCHR – integrated Child Heath Record (iCHRCloud). 

iCHRCloud is India’s 1st Hospital linked solution – a revolutionary concept of automated vaccination record & scheduler, growth monitoring and prescription & lab investigations panel for the precious child. It provides the web portal for doctors and mobile application for parents, which enhances doctor-parent engagement. The adaptability of the solution allows it to be implemented across hospitals and clinics with minimal infrastructure investment.

iCHRCloud offerings are aligned to the Digital India mission. 

An estimated 26 millions of children are born every year. As per WHO in 2015, 5.9 million children under age five and 696,000 neonatal deaths were recorded.  

These deaths are mostly due to issues related to malnutrition and lack of vaacination. Malnutrition, wasting and stunting are major growth burden in child healthcare and growth monitoring is needed to build policy framework to solve this issue. Moreover, full immunization against preventable childhood diseases is the right of every child, and to provide this right to every child, the Government of India launched the Universal Immunization Program (UIP). 

Only 65% children in the first year of their life have been able to achieve full immunization and the increase in coverage has stagnated in the past 5 years to an average of 1% every year. 

It has also been observed that every year in India, 5 lakh children die due to vaccine-preventable diseases. 

Another 89 lakh children remain at risk, because they are either unimmunized or partially immunized against vaccine-preventable diseases

Our goal with iCHR is to attain the sustainable development goals and reduce the child mortality rate. It helps in keeping track of all the vital parameters up to 12 years of age responsible for monitoring the growth of a child such as: vaccination records, prescription notes, head circumference, height, weight and BMI. 

The parameters are plotted on Fenton, IAP and WHO based charts, which help the child’s pediatrician to analyze any risk of malnutrition, and the statistics can also be used by policy makers for future studies.

Oxyent is looking to extend its solution offering by bringing iNICU – integrated Neonatal Intensive Care Unit in the market. iNICU a one stop workflow solution to assimilate and disseminate neonate information by connecting the generated source data from various devices. The application is designed to cater to all the responsibilities of various roles/owners (Nurse, Resident Doctor, Senior Doctor, Pediatrician and Administrator). It’s an effort to virtually eliminate human error in neonate health monitoring.

The combined solution package of iNICU and iCHR is a complete child healthcare solution which was envisioned by company during the inception of idea. What stands out this offering by Oxyent from others is it caters to both preterm & term babies from birth to adolescent age. iCHRCloud and iNICU applications have been succesfully implemented in NCR region in major hospitals and clinics.

Also, the first one to bring live data monitoring from anywhere, auto discharge summary and prediction of onset of infections, kind of advance technologies in the child healthcare segment. These advancements are unprecedented even in the international scenario, which provides the global platform to Indian IT Healthcare industry. 

Recently, Oxyent were declared the winners of the IBM India Smartcamp for HealthTech 2016

“IBM Global Entrepreneur program is the Startup initiative of IBM. We engage with Startups in providing them with Cloud credits worth $24000 / year on Softlayer and Bluemix. IBM, GEP also provides technical mentoring, assist with go to market, work with accelerators in India. We engage with large enterprises in helping them finding their next set of innovations. One of the key initiatives done by us is IBM Smartcamp which is India`s biggest Industry focussed Startup challenge. ibmgepindia.com has the details of that.”  

Mr. Radhesh Kanumury, Country Lead, IBM Global Entrepreneur Program 

The article has been published with the authors permission.
Author

[tab] [content title=”About Ravneet Kaur”]

Ms. Ravneet Kaur

Ravneet as the co-founder of Oxyent Technologies, is an entrepreneur involved in working with domain experts to bring digital transformation in the Healthcare Industry. With her engineering skills she is interested in resolving business challenges through technical innovation, showcased in the products she has brought to market.

Her Favourite Quote “The best way to find yourself is to lose yourself in the service of others.” – Mahatma Gandhi

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Dr. Harpreet Singh

Harpreet is a Technology Strategist, an entrepreneur with international consulting experience. As founding member of Oxyent, he has a Proven track record in rapid IP creation and execution; taking idea from conception to GTM, and is involved in building strategic insights and shaping future direction with a blend of deep analysis and high level synthesis.

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Architecting Innovation Portfolio – Part 1, By Prashant Joglekar @ideabound

Organisations innovate through its people


When organization’s leadership expects people to innovate it makes them tad anxious as most of them start thinking about Thomas Edison, Steve Jobs, Larry Page, Sergey Brin, Elon Musk. They think that as an individual they may never be like them, but we often forget that all these greats were like us before they attained the greatness. The quality of being a contrarian has put them in the north star position.


Other reason probably is the risk associated with innovation/s. Clayton Christensen in his ground breaking work on disruptive innovation has revealed that risk averse nature of successful leaders also stalls company’s effort to innovate. The higher the risk longer is the process of evaluation of the selected idea and thus longer is the duration before it sees the light of the day.

The other questions organizations grapple with is whether innovation efforts should be top down or bottoms up, do everyone need to be involved or it be restricted to select business functions like marketing, product development etc, whether what they are doing at present can be called as innovation or not. The list can really go long.

Here are some thoughts of how we can make it systematic and structured. The first & the foremost thing that an organization & its leaders must do is to build an innovation portfolio. If value derived out of innovation is all about more, different & better of good things (benefits) with less & less of bad things (cost and harm) then everyone needs to be invigorated to contribute towards this organisational effort.

Building Innovation Portfolio 
The benefit of building innovation portfolio and sharing it across organisational hierarchies make people acquire a sense of organisation’s priorities with regards to innovation. This also ensures their commitment to all execution activities that they need to play part in to achieve larger business goals of the organisation.

There are tools and methods we use to build this, but for now let’s take a macro view of how senior leadership of organizations can architect portfolio of innovation opportuities.

Rishikesha Krishnan (1) in his pretty neat book “8 Steps to Innovation” presents 3 key themes to identify innovation opportunities. These themes are Sense the Wave, Feel the Pain & See the Waste. Let’s understand & build around these themes to architect portfolio of innovation opportunities across product, process and business model. 

Sense the wave 
When we talk of a wave its usually the wave of technologies that are emerging, the ones that has already been put in productive use etc. Promising technologies are nothing but the solutions that are in search of the right problem to solve. 

On the other hand, sensing the market trends help us glean insights about the consumer wave, generally dictated by generation type, thinking styles, PESTLE forces and the context in which a particular set of consumer group thinks & consumes an output. 

These set of customers or business organizations (even organization has a personality broadly referred as a culture, generally influenced by its leadership) implicitly informs provider businesses about the expectation of value to be delivered by its products & services. At the cost of repetition & just to drive the above point, I would say Apple and Amazon have perfectly leveraged both these trends.

Feel the pain
Disruptive opportunities are generally discovered by understanding existing pains that consumer faces while using current product or services. A simple rule of thumb one can apply to unearth innovation opportunities is to look at 4 dimensions of consumption viz. access, skill to use, convenience and cost of acquisition, maintenance & usage. Customer journey & job mapping are some of the ways to look at it & spot hidden opportunities across these 4 dimensions. 

‘Jobs to be done’ and ‘Outcome Expectations’ are some of the tools that help us decode the opportunities through the themes that we discussed above. 

See the waste
Although product/service life cycles curves are shortening & will vary according to the nature of the business viz B2C or B2B, there is always a steady state or growth phase of product / service life cycle, it can range from months, years or decade depending upon the nature of the industry. In this phase, businesses need to stay competitive by slashing down the waste in everything across the value chain. So for a product it will be value engineering efforts, for processes it will be application of lean thinking to eliminate wastes and re-engineer the processes with an objective to achieve the maximum output at faster speed with minimum unit input. 

Here is a snapshot of how the innovation portfolio may look like, the risk & reward metrics of innovation will proportionately taper down as we travel down through these individual approaches viz ‘sense the wave’, ’feel the pain’ to ‘see the waste’ respectively.



Are you ready to build innovation portfolio for your organization? Let me know if you have any questions, will be happy to answer & help.  

References

1) 8 Steps To Innovation : Rishikesha T. Krishnan, Vinay Dabholkar, Collins Business 


The article was first published in Mr. Prashant Joglekar’s LinkedIn pulse page. It has been re-published here with the authors’ permission
Author

[tab]
[content title=”About Prashant Joglekar”]

Prashant Joglekar

An engineering postgraduate from IIT Mumbai. His career spans over 21 + years and core skills include Systematic Innovation- TRIZ Training / Facilitation, Business Transformation, Total Quality Management, Business Process Design & Management, Lean and Six Sigma training / facilitation. Prashant’s mission is to prepare, nurture innovative minds & broker ideas by cross-pollinating them across an enterprise

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Patient Satisfaction: IoT Enabled patient pathway by Arnab Paul, @iArnabPaul

They may forget your name, but they may never forget how you made them feel… Maya Angelou


Patient satisfaction is not a clearly defined concept, although it is identified as an important quality outcome indicator to measure success of the services delivery system

Ever since the Institute of Medicine’s 2001 ‘Crossing the Quality Chasm’ report codified patientcenteredness as one of six health care quality aims, patient-centered care has gained footing within the landscape of health care reform. There is no consensus between the literatures on how to define the concept of patient satisfaction in healthcare. In Donabedian’s quality measurement model, patient satisfaction is defined as patient-reported outcome measure while the structures and processes of care can be measured by patient-reported experiences




Many of our Linkedin friends would concur that even if we run a million dollar enterprise and have a fairly good experience on dealing with stressful situations in our everyday business life but when it comes to visiting the hospital we get cold feet – because of the element of unforeseen and unexpectedness of the entire process that we have to undertake and on top of that we as a patient community do not have a collective voice and it makes matters worse.

I believe we have a tremendous potential as a nation provided that we as a provider and receiver of healthcare services are on the same page, though it is easier said than done.Patient who visits a hospital is looking for value on investment (VOI) and the Provider is looking for return on investment (ROI). Healthcare providers have their limitations, financial and otherwise — but at least they are doing their bit and performing reasonably well. Since they have fixed resources at their disposal – the only thing humanly possible for them is resource optimization.

In India, we have already missed the bus when it comes to patient satisfaction surveys unlike our western counterparts. For everything in life we need some kind of metrics, some tools to measure the clinical outcome and the patient satisfaction. So to make up for it may I suggest we incorporate Tech enabled, IoT optimized patient feedback mechanism.

Various Accreditation bodies like NABH, NABL, CAP, JCI and ISO are functioning in the healthcare domain but these are mostly voluntary, these accreditations are a reflection that the entity has undergone high quality of audit in its internal departments, but does it say anything about the patient satisfaction or patient engagement, the answer is a big NO. In India, one could safely bet that 90% of the patients visiting the hospitals do not have the foggiest notion of what do these accreditation means, entities need to think beyond certifications and accreditation, entities need to educate people, create more awareness among the stakeholders specially the patient community, they ought to let the world know that these organizations have the benchmark this will inspire confidence in the patient community.

So in a truly democratic healthcare system the patient ought to have a voice and a mechanism in place just to ensure that his voice his heard and above all accreditation agencies must also factor in the patient voice.

Few days back I got a very interesting email from someone who heads the ‎Clinical Transformation and Analytics, Clinical Technology and Patient Safety Innovations at a Super Speciality, New Delhi, she enquired about the tech solutions that could be put in place to enhance the patients positive experience,it so heartening to note that the providers are seriously interested in improving the patients experience and by and large I presume most of the providers do want to improve the patients experience.

So what is the solution, how do we propose to go about it, well unlike Press Ganey & HCAPHS, I don’t know of any organization in India working towards the goal of providing patient satisfaction survey. Press Ganey has stated that a minimum of 30 survey responses is necessary to draw meaningful conclusions from the data it receives and that it will not stand behind statistical analysis when less than 30 responses are received. The entities mentioned above are highly detailed paper based patient feedback mechanism, in this time and age we need to think digital, think ahead.

If we go digital & truly real time in the patient feedback mechanism it would greatly enhance the whole patient experience and maybe help to manage solve some of the issues in real time. Wouldn’t it be just great if we incorporate IoT’s in the patient feedback loop, we wouldn’t have to wait for 30 odd surveys to be analyzed we could just go ahead and fix the situation right away if it warrants an action. 

The article was first published in Mr. Arnab Paul’s LInkedIn pulse page, it has been re-published here with the author’s permission
Author

[tab]
[content title=”About Arnab Paul”]

Arnab Paul, CEO, Patient Planet

Globally-minded systems thinker, action-oriented and inspired toward optimizing health outcomes through innovation, creativity, cooperation. Passionate about facilitating the alignment among technology, people and processes to ultimately improve patient experience and the functioning of healthcare.

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Shift in US Healthcare by Srinath Venkat, @ConnectSrinath

The adoption of EHR is growing rapidly because of billions of dollars spent by the government to incentivize providers for EHR usage.
Also, there is a greater commitment by government to reduce the drug related adverse events in healthcare by recommending e-prescribing to the providers

Transformation in US Healthcare through EHR and Personalized Healthcare
Healthcare has undergone series of changes in last few decades. From passive, reactive, one size fits all approach, it has moved towards more customized, responsive, real-time care administration. Electronic Health Record (EHR) is systematized longitudinal collection of patient health data which gives the complete record of clinician-patient encounter. 

It also streamlines the clinical workflow, thereby improving the health outcomes through decision support, quality management and reporting of information across the continuum of care. There are various vendors who provide EHR services based on the care setting (Ambulatory, Hospital, Clinic or Physician office), and the major ones include EPIC, Cerner, McKesson, Allscripts and GE.
 

The Health Maintenance Organization (HMO), which provides managed care by giving access to providers in its network for self-financed and insured individuals, were first started in 1931 by Farmer’s Union of Oklahoma, where flat fee is collected irrespective of the services rendered. By 1951, it was estimated that 45% of the Americans were insured, and in 1965, Medicare which covers the older people above 65 years of age and younger people with disability was introduced. 

In 1996, Health Insurance Portability and Accountability Act (HIPAA) was introduced, which helps in protecting the healthcare information and reducing the healthcare administrative costs. In 2010, Patient Protection and Affordability Care Act (PPACA) was introduced which helped the people to purchase health insurance through Health Insurance Exchanges.
 

The Four Ps of Healthcare (Patient, Provider, Payer and Public) benefit from the EHR which helps in integration of healthcare information, reducing the duplication, avoiding redundancy, thereby reducing the administrative and treatment cost in healthcare. 

The Meaningful use of EHR is the usage of certified (Certification Commision for Healthcare Information Technology) health information systems and software for improving the health outcomes and reducing the cost. EHR has both provider and payer component. Doctors, Hospitals, Laboratories, Pharmacy and other ancillary services use provider systems, which includes, practice management, EHR, Revenue Cycle Management (RCM), Document management and E-prescribing. 

There is a shift in healthcare towards retail-like scenario leading the consumer driven healthcare, where the patient is well-informed and shops for different treatment options using web portals like Web MD. Remote medical practice, real-time data collection, information integration and transfer, and collaboration among providers using EHR, creates significant improvement in overall health outcomes and cost. 

The adoption of EHR is growing rapidly because of billions of dollars spent by the government to incentivise providers for EHR usage. Also, there is a greater commitment by government to reduce the drug related adverse events in healthcare by recommending e-prescribing to the providers. The shift from pay for volumes / pay per visit towards pay for performance / outcomes which is encouraged by creating Accountable Care Organizations (ACOs) is a motivational factor for meaningful use of EHR in healthcare.

The article was first published on Srinath Venkat’s LinkedIn Pulse page. The article has been republished here with the authors’ permission

Author

Srinath Venkat

Srinath Venkat is a Healthcare Management Professional with qualifications in Public Health, Healthcare Technology Assessment and Entrepreneurship in Emerging Market Economies. He has been in to research and consulting roles with leading healthcare research firms in activities like Market study, Go To Market strategy, Technology Mapping and Business Model evaluation. He is passionate about innovative business models, startup ecosystem and the evolving landscape.

Putting patients at the heart of IoT in India, By Arnab Paul, @iArnabPaul

Patients are the most important stakeholders in the healthcare ecosystem and that they should be empowered to make informed choices.


In a broader sense, the “patient pathway” is the route that a patient will take from their first contact with a healthcare provider or a member of staff, through referral, to the completion of their treatment. It also covers the period from entry into a hospital or a Treatment Centre, until the patient leaves.


In healthcare, there already exists whole gamut of technologies in various states of maturity – wearable devices that are perhaps not yet ready to be used as clinical-grade, beta-versions of monitoring devices, inventory tracking systems already being utilized in hospital operations, etc. The innovations we will see in the coming years will push these to new heights and give health system operations the opportunity to be leaders in adoption of the connected world empowered by the internet of things. Willingness to explore the opportunities presented by this world will be the differentiator between those who leverage the capabilities for optimization and those who stick to what’s been just good enough so far.

Internet of Things (IoT) refers to any physical object embedded with technology capable of exchanging data and is pegged to create a more efficient healthcare system in terms of time, energy and cost. One area where the technology could prove transformative is in healthcare. The potential of IoT to impact healthcare is wide ranging. We’ve already seen an increasing movement towards fitness tracking wearables over the last few years. Imagine a world where your vital signs were being constantly monitored and fed back to your healthcare professional.

Many of us who advocate LEAN in Healthcare, we know that lean stands for removing all that is not required, Simply, lean means creating more value for customers with fewer resources. A lean organization understands customer value and focuses its key processes to continuously increase it. The ultimate goal is to provide perfect value to the customer through a perfect value creation process that has zero waste. The core idea of lean involves determining the value of any given process by distinguishing value added steps from non-value-added steps, and eliminating waste so that ultimately every step adds value to the process. To maximize value and eliminate waste, leaders in health care, as in other organizations, must evaluate processes by accurately specifying the value desired by the user; identifying every step in the process (or “value stream,” in the language of lean) and eliminating non-value-added steps, and making value flow from beginning to end based on the pull — the expressed needs — of the customer/patient. When applied rigorously and throughout an entire organization, lean principles can have a dramatic affect on productivity, cost, and quality.

With the deployment of IoT in healthcare it would enhance the scope of monitoring patients response, since huge zettabytes of data are going to be generated from the many monitoring sensors, if we are somehow able to remove the noise and work on the intelligence derived from it, and if we could somehow wed the intelligent data derived from IoT with the LEAN/ SIX SIGMA tools it would greatly enhance the quality of the patient care pathway. We would be able to do a better job of mapping his entire journey and improve on the patient e care pathway.

IoT in itself wouldn’t be a big help unless the information that is obtained from the sensors and other embedded systems are not synced with data analytics.

These are exciting times for Healthcare Delivery system, after proper deployment of sensors and by the optimum use of other remote monitoring system, suffice to say monetizing the data generated by the IoT would be the principle driver for enterprises and small businesses alike in years to come.

The article was first published in Mr. Arnab Paul’s LInkedIn pulse page, it has been re-published here with the author’s permission
Author

[tab]
[content title=”About Arnab Paul”]

Arnab Paul, CEO, Patient Planet

Globally-minded systems thinker, action-oriented and inspired toward optimizing health outcomes through innovation, creativity, cooperation. Passionate about facilitating the alignment among technology, people and processes to ultimately improve patient experience and the functioning of healthcare.

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Medical Imaging Informatics Market by Swapna Supekar

Increase in number of diagnostic imaging procedures and high prevalence of chronic diseases spur the growth of medical imaging informatics market





Medical imaging informatics involves usage of digital technology to capture medical images, facilitating data analysis to record and correlate observations, and draws conclusions that play a vital role in the diagnosis of medical problems. The implementation of electronic health records (EHR) in the healthcare industry increases the demand for medical imaging to exchange medical images in the various departments of healthcare settings.

Increase in number of diagnostic imaging procedures and high prevalence of chronic diseases have raised the demand for various advanced diagnostic image processing and analysis software around the world. The healthcare industry focusses on developing procedures for early diagnosis due to rise in the number of chronic diseases, providing maximum growth potential for imaging procedures. 

For More Professional and Technical Industry Insights: 
https://www.alliedmarketresearch.com/medical-imaging-informatics-market

aAccording to the Organization for Economic Co-operation and Development (OECD), North America had an increasing number of imaging procedures for computed tomography (CT) and magnetic resonance imaging (MRI). For instance, in the U.S., 76 million and 81.2 million CT scans were performed in 2013 and 2014, respectively, representing an increase of around 7% from 2013 to 2014. Similarly, MRI scans of a total 1.78 million and 1.87 million were performed in 2012 and 2013, respectively, in Canada. 

Furthermore, Europe reported an increase in number of diagnostics imaging procedures. In Germany, positron emission tomography (PET) scans of a total 0.08 and 0.09 million were performed in the hospitals in 2012 and 2013, respectively. Thus, increase in the number of medical imaging procedures, rise in number of installations of medical imaging informatics, and high prevalence of chronic diseases worldwide are expected to propel the growth of the market.

Developed regions such as North America and Europe together accounted for the highest share in 2015 and is expected to maintain their leading position from 2016 to 2022, due to increase in demand for medical informatics technology, high adoption rate of technological advanced healthcare IT systems, well-established healthcare infrastructure, and presence of leading players such as Dell Inc., General Electric Company, Siemens AG, and others.

However, Asia-Pacific is anticipated to grow fastest during the forecast period, owing to large patient pools who require medical imaging procedures for the diagnosis of diseases. Moreover, increase in healthcare expenditure in the region and improving healthcare infrastructure are expected to support the growth of the market.n

The article has been published with the Author’s permission
Author
Swapna Supekar

Swapna Supekar, is a keynote senior consultant on digital marketing at Allied Market Research. She has been recognized for developing a robust social network strategy for the company. Swapna has written several whitepapers, case studies, and articles. She is a visiting faculty member at various educational institutions and has expertise in life sciences and medical devices.

Challenges and Promise of #IoT in Healthcare by Arnab Paul, @iArnabPaul

A critical path to improving healthcare efficiency is to shift focus from acute care to early intervention. Remote patient monitoring technologies would be just a small cog in the wheel of Connected health


The ‘internet’ of people changed the world well there’s a new internet emerging and it’s poised to change the world again this new internet is not just about connecting people it’s about connecting things and so it’s named the Internet of Things.


Ok so connecting things to the internet big deal right well it kind of is and here’s why because things can start to share their experiences with other things, you take things and then you add the ability to sense and communicate and touch and control and there you get an opportunity for things to interact and collaborate with other things so think of it like this, we as human beings, we interact and contribute and collaborate with other people in our own environment through our five senses we are seeing and smelling and in touch and taste and hearing, right well imagine things with the ability to sense and to touch and then add the than ability to communicate and that’s where the internet of people and the internet of things intersect. I believe like the internet revolution, IoT opportunity is transformative. 

However there are few challenges   Some of the challenges that I can think of is like the interoperability issues of different software programs we do have an issue of  Heterogeneity of sensors and networks also last mile gap in delivering quality of service & Security with regard to  Privacy and Governance.

Broadly Challenges could be categorized under

Integration:  Gadgets & Devices
The diversity of devices in the networks is another obstacle for the successful implementation of IoT in healthcare.  The problem lies in the fact that the device manufacturers do not have an agreed-upon set of communication protocols and standards. The lack of uniformity among the connected medical devices also significantly reduces the opportunities of scaling the use of IoT in healthcare.

Security: Data Transmissions at risk
The main concern for regulatory bodies and users alike is, of course, the security of personal health information that is stored and transmitted by the connected devices. Strict access controls are required to ensure compliance with healthcare regulations.

Analytics : Data insights
Even though the process of collecting and aggregating data comes with complications, healthcare IoT is responsible for accumulating massive amounts of valuable data it can be used to benefit the patients, however deriving the insights from immense amounts of data is problematic without sophisticated analytics programs and data professionals.

A critical path to improving healthcare efficiency is to shift focus from acute care to early intervention. Remote patient monitoring technologies would be just a small cog in the wheel of Connected health. Health and fitness monitoring will precede patient monitoring as the driver for IoT solutions in healthcare. IoT in healthcare holds great promise for the coming generations because it could just transform the quality of life of the aging population. IoT could feel a bit intrusive  at times for the current generations, but looking at the trends it would help the millennials and the aging populations both get really helpful insight about the status of their health and act upon them.

The article was first published in Mr. Arnab Paul’s LinkedIn Pulse post. The article is reproduced here with the authors permission.  

Author

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[content title=”About Arnab Paul”]

Arnab Paul, CEO, Patient Planet

Globally-minded systems thinker, action-oriented and inspired toward optimizing health outcomes through innovation, creativity, cooperation. Passionate about facilitating the alignment among technology, people and processes to ultimately improve patient experience and the functioning of healthcare.

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3 P’s framework – Product Motivation by Prashantha Sawhney

This article is the last in the series related to 3 P’s framework to be successful. We finally focus on Product as it relates to the “why” and “what” work needs to be done.

Traditionally most people talk about products focusing on Feature – Function – Benefit methodology which has worked well for the past 40 years since it was introduced by IBM in 1976. With changes in times as well as proliferation of products, to differentiate their products, people also started to focus on USP (Unique Selling Proposition), RoI (Return on Investment), Efficiency savings, increased Effectiveness,  reduced TC (Total Cost of Ownership) etc. These are logical things which appeal to the mind, however many times we still are not able to decide on a specific product given this multitude of facts and figures.


This is where the Golden Circle from Simon Sinek comes in handy.  Focus is on moving from the Why to the What. It helps us understand the right way to reach our potential customers/partners and drives to deeper meaning on the very existence of the product.



The focus is now no longer just on the functionality that the product offers or how it achieves certain business objectives. With the clarity on why the product is needed, and with people who believe in the product, that brings in a good motivation for all involved parties and leads to eventual success.



PS: If you haven’t watched his TED video (in the top 3 most watched videos on TED) – please do take some time to watch it and get inspired.

Do share your feedback/ views on other approaches you may have followed to be successful.

The article was first published in Mr. Prashantha Sawhney’s LinkedIn Pulse post. The article is reproduced here with the authors permission. The views shared by the author are shared in his personal capacity

Author
Prashantha Sawhney

Results-driven engineering professional with ~17 years of experience in leading high performance product teams

Healthcare IoT Strategy for Entrants & Incumbents by Arnab Paul, @iArnabPaul

The long-predicted IoT revolution in healthcare is already underway, as new use cases continue to emerge to address the urgent need for affordable, accessible care


We are still running around, jumping in the puddle of data mining and other data insights when we are hit by this new wave called ‘Internet of Things” . Typically in the healthcare system the  patients dont really care what sensors will record and transmit and to whom and to where and whether it follows the standard protocol, what they really care about is whether they will be able to get well soon and how this IoT is going to help him have a better quality of life and how soon that would happen.  

Similarly the providers dont care about the tons of data that will be accessible to him, he would be more eager to know the intelligent real time information that would help him diagnose any ailment. However, at the moment, the health monitors, wearables remain largely outside typical care channels. 

One common IoT-enabled wellness monitor, for example, creates, transmits, analyzes, and stores data—but in a database not linked to, and incompatible with, traditional health records.  However useful, the information is unavailable or even unknown to doctors unless patients volunteer it—and, indeed, physically bring it to a visit. There is a gridlock in the flow of information at the aggregate stage. 

Alleviating that gridlock—and integrating prevention and wellness monitors with existing electronic health-records systems—is key to taking full advantage of IoT-enabled devices’ capabilities and keeping people healthier longer. Established health care IT companies, will no doubt find these new business models threatening, considering the new entrants eager to join the fight for customer value.  It is critical that IoT Companies deliberately identify how IoT technology fits into their existing products and strategies, and enables the delivery of transformational innovation. 

Simply using the IoT to enable innovation is unlikely to create sustainable advantage.  Companies should identify areas of high unmet needs and clearly articulate the value they will deliver for their customers. Development should begin with a specific use case in mind and a clear vision of how each stage in the Information cycle will contribute to addressing customer needs. Strategy to access capabilities through in-house development, acquiring companies, or partnering will be necessary. 

In all cases, whether entrant or incumbent, the IoT strategy should be built from an understanding of which care settings and which gridlock the entity seeks to alleviate.  From there, choices as to whether to focus on the setting or the stage of the gridlock will determine the appropriate business model. 

The long-predicted IoT revolution in healthcare is already underway, as new use cases continue to emerge to address the urgent need for affordable, accessible care. 

The article was first published in Mr. Arnab Paul’s LinkedIn Pulse post. The article is reproduced here with the authors permission.  

Author

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[content title=”About Arnab Paul”]

Arnab Paul, CEO, Patient Planet

Globally-minded systems thinker, action-oriented and inspired toward optimizing health outcomes through innovation, creativity, cooperation. Passionate about facilitating the alignment among technology, people and processes to ultimately improve patient experience and the functioning of healthcare.

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Pragmatic #Interoperability by Dr. Charles Webster, @wareflo

“Pragmatic interoperability (PI) is the compatibility between the intended versus the actual effect of message exchange”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

Healthcare is awash in data. We build messages. We send them. We parse them. We look up their meaning using nomenclatures, classifications, and terminologies. But health IT often fails to systematically do useful things with this encoded, sent, parsed, and looked-up data. We lack a sound theoretical foundation to our thinking about how to use healthcare data to communicate and coordinate human and machine action. I argue that this missing theory of interoperability is Pragmatic Interoperability.
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Issues of pragmatic interoperability manifest themselves as issues about coordination among EHR workflows (with and among other health IT systems). Pragmatic Interoperability is the science behind the practical engineering nuts and bolts in my previous 7000-word, five-part series, Achieving Task and Workflow Interoperability in Healthcare.
I will further argue that the most mature technology for implementing pragmatic interoperability today is workflow technology. Workflow technology encompasses a number of related technologies, from workflow engines, task and workflow management systems, business process management (BPM), and other process-aware information systems such as case management, interface engines, and customer relationship management systems. “Process-aware” means there is an explicit representation of work or workflow and engine executing or automatically consulting this representation of work during automated accomplishment or facilitation of work or workflow.
In many ways, the healthcare workflow, workflow technology, and workflow interoperability stars are aligning. There’s a great fit between BPM (Business Process Management) and FHIR (Fast Healthcare Interoperability Resources) when it comes Achieving Task and Workflow Interoperability in Healthcare. FHIR provides access to EHR data. BPM orchestrates tasks and workflows across EHRs and other health IT systems, potentially in different healthcare organizations. FHIR (and non-FHIR) EHR API (Application Programming Interfaces) initiatives will play an important role in ushering into healthcare the kind of process-aware BPM-style interoperable workflow it so desperate needs.
The key to achieving task-workflow pragmatic interoperability is representing clinical and administrative task and workflow states and events, and making them accessible via APIs. This is the necessary layer between data interoperability (syntactic and semantic, to be discussed below) and task- and workflow-oriented pragmatic interoperability. The next interoperability layer up from data interoperability consists of workflow engines orchestrating choreographies of workflow conversation among EHRs, and between EHRs and other health IT systems. Intelligent, transparent, flexible, workflow-managing process orchestration engines in the cloud will supply healthcare interoperability’s missing workflow layer.
Current healthcare interoperability rests on a two-legged stool. One leg is Syntactic Interoperability. One leg is Semantic Interoperability. (More on those below.) Plug-and-play syntactic and semantic interoperability is the holy grail of EHR interoperability. We hear less about the next level up: pragmatic interoperability (the linguistic science behind task and workflow interoperability).
Pragmatic Interoperability is the third leg missing from the healthcare interoperability stool. This five-part series describes pragmatics (a subfield within linguistics), its relevance to healthcare interoperability, and how to leverage process-aware workflow technologies, such as Business Process Management, to achieve task-workflow pragmatic interoperability. We need to add the crucial third leg of the healthcare interoperability stool.
Linguistics is made up of a number of subfields. You may think of them as a pipeline or series of layers from compression and rarefaction of sound waves to purposeful communication and coordinated action. The output from syntax is the input to semantics. The output from semantics is the input to pragmatics. In the pragmatics layer we do things with words to change the world to achieve goals. It’s actually way more complicated that how I make it seem. There are feedback loops. Linguists argue about where to draw the lines between syntax, semantics, and pragmatics. But this simplified model will serve the purpose of this series about pragmatic interoperability in healthcare.
Syntax and semantics are terms borrowed from linguistics, specifically, the study of signs. A sign is something, such as an ICD-10 code, that can be interpreted to have meaning, such as a medical diagnosis. Syntax is about relations among signs, for example relations among fields in an HL7 message or characters in an ICD-10 code. Syntactic interoperability deals with the structure of healthcare data (reminiscent of sentence diagrams in high school English class). It is necessary for transmitting healthcare data in a message from one system to another. Syntactic interoperability is the ability of one EHR (for example) to parse (in the high school English class sentence diagram sense) the structure of a clinical message received from another EHR or health IT system (if you are a programmer think: counting HL7’s “|”s and “^”s, AKA “pipes” and “hats”)
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Semantics is about the relation of signs to what they mean or denote in the world, such as a diagnosis, etiology, anatomic site, and so on. Semantic interoperability deals with the meaning of data. It is necessary for sharing meaning between transmitting and receiving systems. Semantic interoperability is the ability for that message to mean the same thing to the target EHR as it does to the source EHR or health IT system (think controlled vocabularies such as RxNorm, LOINC, and SNOMED).
Syntactic and semantic interoperability are not enough. They are just tactical tools. Pragmatics is about how we use syntax and semantics as a tool to accomplish goals. Semantics is about literal meaning. Pragmatics is about non-literal meaning. I will discuss pragmatics, in depth, in Part 4 of this series, but will introduce the idea of pragmatic interoperability below.
To review: Syntactic interoperability parses sent data structures; semantic interoperability preserves meaning across sending and receiving systems; pragmatic interoperability does something useful with the outputs of the former. It would not be grandiose to say a theory of healthcare pragmatic interoperability is a theory of healthcare interoperability, since syntax interoperability serves semantic interoperability, and semantic interoperability serves pragmatic interoperability.
Let’s start with a straightforward definition of pragmatic interoperability.
Pragmatic interoperability (PI) is the compatibility between the intended versus the actual effect of message exchange.” (Towards Pragmatic Interoperability in the New Enterprise — A Survey of Approaches)
Compatibility between intended effect versus actual effect of message exchange…
When you speak to me, you are trying to do something, to change the world in some way. Even if you do not explicitly tell me to do something, I grasp your intended meaning and likely help you do whatever you are trying to do. I consider the context of your utterance, your likely workflow (your goal, remaining tasks and their order, and which uncompleted tasks I might help you complete), and help if I can.
If you ask me if I know the time for the next scheduled surgery, I ignore your literal question (to which my overly literal answer would have been “Yes”), and respond to your intended meaning (”2:30″). I act in a pragmatic interoperable manner. The intended effect of you question is to find out the scheduled time (so that you can show up on time, so that you can complete your residency, so you can … and so on). The actual effect is you find out the time. Since intended and actual effects match, we achieve pragmatic interoperability.
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Key to modern conceptions of pragmatics is that human communication is not just encoding a message in my brain, sending it to you over a potentially noisy channel, and then you decoding that message. This is a naive model human communication. Among linguists an inferential model of communication replaced the simplistic encode/send/decode model of communication.
What do I mean by inferential? Speakers imply (suggest indirectly) and addressees infer (deduce from evidence and reasoning rather than from explicit statement). Consider an extreme example. Suppose everyday at 6PM an on-call physician sends a text message to a partner that everything is under control. Whenever no text message is sent, they both understand the partner needs to come in to help out. Since no overt message was sent, there is nothing to decode. Nonetheless, the address successfully infers the “speaker’s” intended meaning. This was an extreme example. For the rest of this series I will assume some overt token, a message, is exchanged. But the literal content of the message is insufficient to achieve pragmatic interoperability. Non-literal meaning must be inferred from shared background knowledge. The most important shared background knowledge to achieve healthcare interoperability is knowledge about tasks, workflows, plans, and goals, all of which are explicitly represented and automated by workflow technology.
Healthcare interoperability must incorporate more inference-based communication. The key technology to allow this to happen will be workflow technology. Workflow technology relies on explicit models of work and workflow. When these models (such as shared care plans) are shared, this is the context that make task and workflow interoperability possible. Shared context between sender and receiver make possible inferences necessary to achieve pragmatic interoperability. Current shared care plan-based health IT applications rely on humans to be the workflow engines, to react to changes in state and to trigger workflows. Increasingly this will be accomplished, or facilitated by software-based workflow engines.
A reasonable objection is that, designed right, all communication among health IT systems can be based on literal meaning (semantics) and not have to rely on non-literal meaning (pragmatics). I disagree. There is always some implicit message context that is not captured in the message itself. In some instances, perhaps it can be ignored. But in general, health IT needs to perform a better job taking into account the clinical context of sent and received messages. In this series, I will specifically focus on task, workflow, plan, and goal context, because we have an available tool to manage this context: workflow technology.
The earlier offered definition of pragmatic interoperability is deceptively simple, but nonetheless powerful. First of all, it makes intuitive sense. Clinicians can understand it, as in, do what I mean, not what I say, sort of way. Second, it can apply to relatively simple scenarios and to relatively complicated scenarios. “Effect” can refer to something as simple as sending someone (perhaps in another healthcare organization) a task to complete. Compatibility between intended and actual can be as simple as checking to make sure the task moves through its task life cycle (pending, started, resigned, started, escalated, complete and so on) to “complete” by a certain time or date. On the other hand, “effect” can refer to complex constellations of tasks, workflows, and mental states, as in, “I accept responsibility for completing all tasks in this assigned workflow, promise to complete them within one week, and inform you when they are complete.”
This series is about the science behind task and workflow interoperability, recently outlined in my recent 7000-word, five-part series Achieving Task and Workflow Interoperability In Healthcare. That series was about practical engineering. So if you are looking for a practical guidebook, go there. Here I am talking about theories supporting why I believe process-aware technology is key to achieving task and workflow interoperability.
Science is about understanding the world. Engineering is about solving problems. Scientific theories are abstract, tentative, and eschew practical consequences. Engineering is concrete, decisive, and about practical consequences. However, as Kurt Lewin, the famous organizational psychologist famously said: “There is nothing as practical as a good theory.” Have no fear, though; mine will be a gentle introduction to linguistics and pragmatics.
Stay tuned for (or proceed to… if there’s nothing there, it hasn’t been published yet) Task, Workflow, and Interoperability Definitions: Pragmatic Interoperability Part 2.
Read the Blog Posts on Pragmatic Interoperability by the Author
Here is an outline of this five-part series on workflow, linguistics, and healthcare interoperability.
  1. Task-Workflow Interoperability Benefits and Next Steps: Pragmatic Interoperability Part 5
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Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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Workflow, Usability, Safety & #Interoperability Perspectives by Dr.Charles Webster, @wareflo – Part5 #AMIA2016

Population Health Management and Business Process Management: Part – 5
“Workflow is a series of tasks, consuming resources, achieving goals.”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

Way back in 2009 I penned a research paper with a long and complicated title that could also have been, simply, Population Health Management and Business Process Management. In 2010 I presented it at MedInfo10 in Cape Town, Africa. Check out my travelogue!


Since then, some of what I wrote has become reality, and much of the rest is on the way. Before I dive into the weeds, let me set the stage. The Affordable Care Act added tens of millions of new patients to an already creaky and dysfunctional healthcare and health IT system. Accountable Care Organizations were conceived as virtual enterprises to be paid to manage the clinical outcome and costs of care of specific populations of individuals. Population Health Management has become the dominant conceptual framework for proceeding.
 

I looked at a bunch of definitions of population health management and created the following as a synthesis: “Proactive management of clinical and financial risks of a defined patient group to improve clinical outcomes and reduce cost via targeted, coordinated engagement of providers and patients across all care settings.”
 
You can see obvious places in this definition to apply trendy SMAC tech — social, mobile, analytics, and cloud — social, patient settings; mobile, provider and patient settings; analytics, cost and outcomes; cloud, across settings. But here I want to focus on the “targeted, coordinated.” Increasingly, it is self-developed and vendor-supplied care coordination platforms that target and coordinate, filling a gap between EHRs and day-to-day provider and patient workflows.


The best technology on which, from which, to create care coordination platforms is workflow technology, AKA business process management and adaptive/dynamic case management software. In fact, when I drill down on most sophisticated, scalable population health management and care coordination solutions, I usually find a combination of a couple things. Either the health IT organization or vendor is, in essence, reinventing the workflow tech wheel, or they embed or build on third-party BPM technology.
 

Let me direct you to my section Patient Class Event Hierarchy Intermediates Patient Event Stream and Automated Workflow in that MedInfo10 paper. First of all you have to target the right patients for intervention. Increasingly, ideas from Complex Event Processing are used to quickly and appropriately react to patient events. A Patient Class Event Hierarchy is a decision tree mediating between low-level events (patient state changes) and higher-level concepts clinical concepts such as “on-protocol,” “compliant”, “measured”, and “controlled.”
 

Examples include patients who aren’t on protocol but should be, aren’t being measured but should be, or whose clinical values are not controlled. Execution of appropriate automatic policy-based workflows (in effect, intervention plans) moves patients from off-protocol to on-protocol, non-compliance to compliance, unmeasured to measured, and from uncontrolled to controlled state categories.
 

Population health management and care coordination products and services may use different categories, terminology, etc. But they all tend to focus on sensing and reacting to untoward changes in patient state. But simply detecting these changes is insufficient. These systems need to cause actions. 
And these actions need to be monitored, managed, and improved, all of which are classic sterling qualities of business process management software systems and suites.
 

I’m reminded of several tweets about Accountable Care Organization IT systems I display during presentations. One summarizes an article about ACOs. The other paraphrases an ACO expert speaking at a conference. The former says ACOs must tie together many disparate IT systems. The later says ACOs boil down to lists: actionable lists of items delivered to the right person at the right time. If you put these requirements together with system-wide care pathways delivered safely and conveniently to the point of care, you get my three previous blog posts on interoperability, usability, and safety.
 

I’ll close here with my seven advantages of BPM-based care coordination technology. It…

  • More granularly distinguishes workflow steps
  • Captures more meaningful time-stamped task data
  • More actively influences point-of-care workflow
  • Helps model and understand workflow
  • Better coordinates patient care task handoffs
  • Monitors patient care task execution in real-time
  • Systematically improves workflow effectiveness & efficiency

Distinguishing among workflow steps is important to collecting data about which steps provide value to providers and patients, as well as time-stamps necessary to estimate true costs. Further, since these steps are executed, or at least monitored, at the point-of-care, there’s more opportunity to facilitate and influence at the point-of-care. Modeling workflow contributes to understanding workflow, in my view an intrinsically valuable state of affairs. These workflow models can represent and compensate for interruptions to necessary care task handoffs. During workflow execution, “enactment” in BPM parlance, workflow state is made transparently visible. Finally, workflow data “exhaust” (particularly times-stamped evidence-based process maps) can be used to systematically find bottlenecks and plug care gaps.

In light of the fit between complex event processing detecting changes in patient state, and BPM’s automated, managed workflow at the point-of-care, I see no alternative to what I predicted in 2010. Regardless of whether it’s rebranded as care or healthcare process management, business process management is the most mature, practical, and scalable way to create the care coordination and population health management IT systems required by Accountable Care Organizations and the Affordable Care Act. A bit dramatically, I’d even say business process management’s royal road to healthcare runs through care coordination.

This was my fifth and final blog post in this series on healthcare and workflow technology


Additional Blog Posts by the Author
  1. Five Guest Blog Posts On EHR & HIT Workflow, Usability, Safety, Interoperability and Population Health
  2. Interoperable Health IT and Business Process Management: The Spider In The Web
  3. Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible
  4. Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!
  5. Population Health Management and Business Process Management
Author

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Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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Workflow, Usability, Safety & #Interoperability Perspectives by Dr.Charles Webster, @wareflo – Part4 #AMIA2016

Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions! : Part – 4
“Workflow is a series of tasks, consuming resources, achieving goals.”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

When you took a drivers education class, do you remember the importance of mental “awareness” to traffic safety? Continually monitor your environment, your car, and yourself. As in traffic flow, healthcare is full of work flow, and awareness of workflow is the key to patient safety.


First of all, the very act of creating a model of work to be done forces designers and users to very carefully think about and work through workflow “happy paths” and what to do when they’re fallen off. A happy path is a sequence of events that’s intended to happen, and, if all goes well, actually does happen most of the time. 

Departures from the Happy Path are called “exceptions” in computer programming parlance. Exceptions are “thrown”, “caught”, and “handled.” At the level of computer programming, an exception may occur when data is requested from a network resource, but the network is down. At the level of workflow, an exception might be a patient no-show, an abnormal lab value, or suddenly being called away by an emergency or higher priority circumstance.
 

Developing a model of work, variously called workflow/process definition or work plan forces workflow designers and workflow users to communicate at a level of abstraction that is much more natural and productive than either computer code or screen mockups.
 

Once a workflow model is created, it can be automatically analyzed for completeness and consistency. Similar to how a compiler can detect problems in code before it’s released, problems in workflow can be prevented. This sort of formal analysis is in its infancy, and is perhaps most advanced in healthcare in the design of medical devices.
 

When workflow engines execute models of work, work is performed. If this work would have otherwise necessarily been accomplished by humans, user workload is reduced. Recent research estimates a 7 percent increase in patient mortality for every additional patient increase in nurse workload. Decreasing workload should reduce patient mortality by a similar amount.
 

Another area of workflow technology that can increase patient safety is process mining. Process mining is similar, by analogy, to data mining, but the patterns it extracts from time stamped data are workflow models. These “process maps” are evidence-based representations of what really happens during use of an EHR or health IT system. 

Process maps can be quite different, and more eye opening, than process maps generated by asking participants questions about their workflows. Process maps can show what happens that shouldn’t, what doesn’t happen than should, and time-delays due to workflow bottlenecks. They are ideal tools to understand what happened during analysis of what may have caused a possibly system-precipitated medical error.
 

Yet another area of particular relevance of workflow tech to patient safety is the fascinating relationship between clinical pathways, guidelines, etc. and workflow and process definitions executed by workflow tech’s workflow engines. Clinical decision support, bringing the best, evidence-based medical knowledge to the point-of-care, must be seamless with clinical workflow. Otherwise, alert fatigue greatly reduces realization of the potential.
 

There’s considerable research into how to leverage and combine representations of clinical knowledge with clinical workflow. However, you really need a workflow system to take advantage of this intricate relationship. Hardcoded, workflow-oblivious systems? There’s no way to tweak alerts to workflow context: the who, what, why, when, where, and how of what the clinical is doing. Clinical decision support will not achieve wide spread success and acceptance until it can be intelligently customized and managed, during real-time clinical workflow execution. This, again, requires workflow tech at the point-of-care.
 

I’ve saved workflow tech’s most important contribution to patient safety until last: Interruptions.
 

An interruption–is there anything more dreaded than, just when you are beginning to experience optimal mental flow, a higher priority task interrupts your concentration. This is ironic, since so much of work-a-day ambulatory medicine is essentially interrupt-driven (to borrow from computer terminology). Unexpected higher priority tasks and emergencies *should* interrupt lower priority scheduled tasks. Though at the end of the day, ideally, you’ve accomplished all your tasks.
 

In one research study, over 50% of all healthcare errors were due to slips and lapses, such as not executing an intended action. In other words, good clinical intentions derailed by interruptions.
 

Workflow management systems provide environmental cues to remind clinical staff to resume interrupted tasks. They represent “stacks” of tasks so the entire care team works together to make sure that interrupted tasks are eventually and appropriately resumed. Workflow management technology can bring to clinical care many of the innovations we admire in the aviation domain, including well-defined steps, checklists, and workflow tools.

Stay tuned for my fifth, and final, guest blog post, in which I tackle Population Health Management with Business Process Management.

Additional Blog Posts by the Author
  1. Five Guest Blog Posts On EHR & HIT Workflow, Usability, Safety, Interoperability and Population Health
  2. Interoperable Health IT and Business Process Management: The Spider In The Web
  3. Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible
  4. Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!
  5. Population Health Management and Business Process Management
Author

[tab]
[content title=”About Dr. Charles Webster”]

Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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Workflow, Usability, Safety & #Interoperability Perspectives by Dr.Charles Webster, @wareflo – Part3 #AMIA2016

Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible : Part – 3
“Workflow is a series of tasks, consuming resources, achieving goals.”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

Workflow technology has a reputation, fortunately out of date, for trying to get rid of humans all together. Early on it was used for Straight-Through-Processing in which human stockbrokers were bypassed so stock trades happened in seconds instead of days. Business Process Management (BPM) can still do this. It can automate the logic and workflow that’d normally require a human to download something, check on a value and based on that value do something else useful, such as putting an item in a To-Do list. By automating low-level routine workflows, humans are freed to do more useful things that even workflow automation can’t automate.


But much of healthcare workflow requires human intervention. It is here that modern workflow technology really shines, by becoming an intelligent assistant proactively cooperating with human users to make their jobs easier. A decade ago, at MedInfo04 in San Francisco, I listed the five workflow usability principles that beg for workflow tech at the point-of-care.

Consider these major dimensions of workflow usability: naturalness, consistency, relevance, supportiveness, and flexibility. Workflow management concepts provide a useful bridge from usability concepts applied to single users to usability applied to users in teams. Each concept, realized correctly, contributes to shorter cycle time (encounter length) and increased throughput (patient volume).

Naturalness is the degree to which an application’s behavior matches task structure. In the case of workflow management, multiple task structures stretch across multiple EHR users in multiple roles. A patient visit to a medical practice office involves multiple interactions among patients, nurses, technicians, and physicians. Task analysis must therefore span all of these users and roles. Creation of a patient encounter process definition is an example of this kind of task analysis, and results in a machine executable (by the BPM workflow engine) representation of task structure.

Consistency is the degree to which an application reinforces and relies on user expectations. Process definitions enforce (and therefore reinforce) consistency of EHR user interactions with each other with respect to task goals and context. Over time, team members rely on this consistency to achieve highly automated and interleaved behavior. Consistent repetition leads to increased speed and accuracy.

Relevance is the degree to which extraneous input and output, which may confuse a user, is eliminated. Too much information can be as bad as not enough. Here, process definitions rely on EHR user roles (related sets of activities, responsibilities, and skills) to select appropriate screens, screen contents, and interaction behavior.

Supportiveness is the degree to which enough information is provided to a user to accomplish tasks. An application can support users by contributing to the shared mental model of system state that allows users to coordinate their activities with respect to each other. For example, since a EMR  workflow system represents and updates task status and responsibility in real time, this data can drive a display that gives all EHR users the big picture of who is waiting for what, for how long, and who is responsible.

Flexibility is the degree to which an application can accommodate user requirements, competencies, and preferences. This obviously relates back to each of the previous usability principles. Unnatural, inconsistent, irrelevant, and unsupportive behaviors (from the perspective of a specific user, task, and context) need to be flexibly changed to become natural, consistent, relevant, and supportive. Plus, different EHR users may require different BPM process definitions, or shared process definitions that can be parameterized to behave differently in different user task-contexts.

The ideal EHR/EMR should make the simple easy and fast, and the complex possible and practical. Then, the majority/minority rule applies. A majority of the time processing is simple, easy, and fast (generating the greatest output for the least input, thereby greatly increasing productivity). In the remaining minority of the time, the productivity increase may be less, but at least there are no showstoppers.

So, to summarize my five principles of workflow usability…


Workflow tech can more naturally match the task structure of a physician’s office through execution of workflow definitions. It can more consistently reinforce user expectations. Over time this leads to highly automated and interleaved team behavior. On a screen-by-screen basis, users encounter more relevant data and order entry options. 

Workflow tech can track pending tasks–which patients are waiting where, how long, for what, and who is responsible–and this data can be used to support a continually updated shared mental model among users. 

Finally, to the degree to which an EHR or health IT system is not natural, consistent, relevant, and supportive, the underlying flexibility of the workflow engine and process definitions can be used to mold workflow system behavior until it becomes natural, consistent, relevant, and supportive.

In the next blog post in the series, I’ll discuss workflow technology and patient safety.

Additional Blog Posts by the Author
  1. Five Guest Blog Posts On EHR & HIT Workflow, Usability, Safety, Interoperability and Population Health
  2. Interoperable Health IT and Business Process Management: The Spider In The Web
  3. Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible
  4. Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!
  5. Population Health Management and Business Process Management
Author

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[content title=”About Dr. Charles Webster”]

Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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Workflow, Usability, Safety & #Interoperability Perspectives by Dr.Charles Webster, @wareflo – Part2 #AMIA2016

Interoperable Health IT and Business Process Management: The Spider In The Web: Part – 2
“Workflow is a series of tasks, consuming resources, achieving goals.”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

Just in time for the 2016 AMIA Symposium, I’m delighted that Manish Sharma, the force behind @HCITExperts, is republishing my five-part series on workflow technology in healthcare. Thank you Manish!

Dr. Charles Webster

If you pay any attention at all to interoperability discussion in healthcare and health IT, I’m sure you’ve heard of syntactic vs. semantic interoperability. Syntax and semantics are ideas from linguistics.


Syntax is the structure of a message. Semantics is its meaning. Think HL7’s pipes and hats (the characters “|” and “^” used as separators) vs. codes referring to drugs and lab results (the stuff between pipes and hats).

What you hardly every hear about is pragmatic interoperability, sometimes called workflow interoperability. We need not just syntactic and semantic interop, but pragmatic workflow interop too. In fact, interoperability based on workflow technology can strategically compensate for deficiencies in syntactic and semantic interoperability. By workflow technology, I mean Business Process Management (BPM).
 
Why do I highlight BPM’s relevance to health information interoperability? Take a look at this quote from Business Process Management: A Comprehensive Survey:
 

“WFM/BPM systems are often the “spider in the web” connecting different technologies. For example, the BPM system invokes applications to execute particular tasks, stores process-related information in a database, and integrates different legacy and web-based systems…. Business processes need to be executed in a partly uncontrollable environment where people and organizations may deviate and software components and communication infrastructures may malfunction. Therefore, the BPM system needs to be able to deal with failures and missing data.”

“Partly uncontrollable environment where people and organizations may deviate and software components and communication infrastructures may malfunction”? 

Sound familiar? That’s right. It should sound a lot like health IT.

What’s the solution? 
A “spider in the web” connecting different technologies… invoking applications to execute particular tasks, storing process-related information in a database, and integrates different legacy and web-based systems. Dealing with failures and missing data. Yes, healthcare needs a spider in the complicated web of complicate information systems that is today’s health information management infrastructure. Business process management is that spider in a technological web.

Let me show you now how BPM makes pragmatic interoperability possible.

I’ll start with another quote:

Pragmatic interoperability (PI) is the compatibility between the intended versus the actual effect of message exchange.”

That’s a surprisingly simple definition for what you may have feared would be a tediously arcane topic. Pragmatic interoperability is simply whether the message you send achieves the goal you intended. That’s why it’s “pragmatic” interoperability. Linguistics pragmatics is the study of how we use language to achieve goals.

“Pragmatic interoperability is concerned with ensuring that the exchanged messages cause their intended effect. Often, the intended effect is achieved by sending and receiving multiple messages in specific order, defined in an interaction protocol.”

So, how does workflow technology tie into pragmatic interoperability? The key phrases linking workflow and pragmatics are “intended effect” and “specific order”.

A sequence of actions and messages — send a request to a specialist, track request status, ask about request status, receive result and do the right thing with it — that’s the “specific order” of conversation required to ensure the “intended effect” (the result). Interactions among EHR workflow systems, explicitly defined internal and cross-EHR workflows, hierarchies of automated and human handlers, and rules and schedules for escalation and expiration are necessary to achieve seamless coordination among EHR workflow systems. 

In other words, we need workflow management system technology to enable self-repairing conversations among EHR and other health IT systems. This is pragmatic interoperability. By the way, some early workflow systems were explicitly based on speech act theory, an area of pragmatics.

That’s my call to use workflow technology, especially Business Process Management, to help solve our healthcare information interoperability problems. Syntactic and semantic interoperability aren’t enough. Cool looking “marketectures” dissecting healthcare interoperability issues aren’t enough. Even APIs (Application Programming Interfaces) aren’t enough. Something has to combine all this stuff, in a scalable and flexible ways (by which I mean, not “hardcoded”) into usable workflows.

Which brings me to usability, tomorrow’s guest blog post topic.

Tune in! 

Additional Blog Posts by the Author
  1. Five Guest Blog Posts On EHR & HIT Workflow, Usability, Safety, Interoperability and Population Health
  2. Interoperable Health IT and Business Process Management: The Spider In The Web
  3. Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible
  4. Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!
  5. Population Health Management and Business Process Management
Author

[tab]
[content title=”About Dr. Charles Webster”]

Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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ICD to SNOMED CT Mapping: Observations and Inferences by Dr. SB Bhattacharyya, @sbbhattacharya


The Concepts presented in this article are as proposed by Dr. SB Bhattacharyya and presented in the HCITExpert Blog with permission from Dr. SBB – sbbhattacharyya@gmail.com

The Concept related to CSets are proposed by Dr. SB Bhattacharyya and presented in the HCITExpert Blog with permission from Dr. SBB.

Author

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[content title=”About Dr. S B Bhattacharyya”]

Dr. S B Bhattacharyya

Digital Health Influencer, Medical Doctor with experience in the healthcare industry in the fields of clinical practice, hospital administration, and medical informatics with particular focus on clinical data analytics.

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Workflow, Usability, Safety & #Interoperability Perspectives by Dr.Charles Webster, @wareflo – Part1 #AMIA2016

BPM-based Population Health Management & Care Coordination: Part – 1

“Workflow is a series of tasks, consuming resources, achieving goals.”

This article has been re-published with the authors permission. The article was first published by Dr. Charles Webster on his blog here

Just in time for the 2016 AMIA Symposium, I’m delighted that Manish Sharma, the force behind @HCITExperts, is republishing my five-part series on workflow technology in healthcare. Thank you Manish!

– by Dr. Charles Webster

I blog and tweet a lot about healthcare workflow and workflow technology, but in this first post I’ll try to synthesize and simplify. In later posts I drive into the weeds. Here, I’ll define workflow, describe workflow technology, its relevance to healthcare and health IT, and try not to steal my own thunder from the rest of the week.


I’ve looked at literally hundreds of definitions of workflow, all the way from a “series of tasks” to definitions that’d sprawl across several presentation slides. The one I’ve settled on is this:
“Workflow is a series of tasks, consuming resources, achieving goals.”
Short enough to tweet, which is why I like it, but long enough to address two important concepts: resources (costs) and goals (benefits).
What is workflow technology?
Workflow technology uses models of work to automate processes and support human workflows. These models can be understood, edited, improved, and even created, by humans who are not, themselves, programmers. These models can be executed, monitored, and even systematically improved by computer programs, variously called workflow management systems, business process management suites, and, for ad hoc workflows, case management systems.
Workflow tech, like health IT itself, is a vast and varied continent. As an industry, worldwide, it’s probably less than a tenth size of health IT, but it’s also growing at two or three times the rate. And, as both industries grow, they increasingly overlap. Health IT increasingly represents workflows and executes them with workflow engines. Workflow tech vendors increasingly aim at healthcare to sell a wide variety of workflow solutions, from embeddable workflow engines to sprawling business process management suites. Workflow vendors strenuously compete and debate on finer points of philosophy about how best automate and support work. Many of these finer points are directly relevant to workflow problems plaguing healthcare and health IT.
Why is workflow tech important to health IT?
Because it can do what is missing, but sorely needed, in traditional health IT, including electronic health records (EHRs). Most EHRs and health IT systems essentially hard-code workflow. By “hard code” I mean that any series of tasks is implicitly represented by Java and C# and MUMPS if-then and case statements. Changes to workflow require changes to underlying code. This requires programmers who understand Java and C# and MUMPS. Changes cause errors. I’m reminded of the old joke, how many programmers does it take to change a light bulb? Just one, but in the morning the stove and the toilet are broken. Traditional health IT relies on frozen representations of workflow that are opaque, fragile, and difficult to manage across information system and organizational boundaries.
Well, OK, I’ll steal my own thunder just a little bit. Process-aware tech, in comparison to hardcoded workflows, is an architectural paradigm shift for health IT. It has far reaching implications for interoperability, usability, safety, and population health.
BPM systems are ideal candidates to tie together disparate systems and technologies. Users experience more usable workflows because workflows are represented so humans can understand and change then. Process-aware information systems are safer for many reasons, but particularly because they can represent and compensate for the interruptions that cause so many medical errors. Finally, BPM platforms are the right platforms to tie together accountable care organization IT systems and to drive specific, appropriate, timely action to provider and patient point-of-care.
The rest of my blog posts in this weeklong series will elaborate on these themes. I’ll address why so many EHRs and health IT systems are so unusable, un-interoperable, and sometimes even dangerous. I’ll argue that modern workflow technology can help rescue healthcare and health IT from these problems.
Additional Blog Posts by the Author
  1. Five Guest Blog Posts On EHR & HIT Workflow, Usability, Safety, Interoperability and Population Health
  2. Interoperable Health IT and Business Process Management: The Spider In The Web
  3. Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible
  4. Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!
  5. Population Health Management and Business Process Management
Author

[tab]
[content title=”About Dr. Charles Webster”]

Dr. Charles Webster

HIMSS14, HIMSS15, and HIMSS16 Social Media Ambassador! If you’ve got a healthcare workflow story, I want to tell it, blog it, tweet it, interview you, etc. Dr. Webster is a ceaseless evangelist for process-aware technologies in healthcare, including Workflow Management Systems, Business Process Management, and dynamic and adaptive case management.

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Healthcare #IoT, what the future holds by Arnab Paul, @iArnabPaul

Things in healthcare, its popularity is undeniably on the rise in other industries


The world is continuously growing and changing. Various advancements have also occurred when it comes to the technology used in rendering healthcare services. Thus, there is no doubt that the healthcare industry has improved in the last decade but what are some of those improvements.  

The technology has also played a big role in patient registration and data monitoring. Before, people need to go seek a doctor and visit them personally for a consultation but now, it is very much possible for them to consult a doctor in the convenience of their own homes by allowing them to talk with their doctor through a video chat, as Telehealth has been introduced. 

Apart from that, there are also technologies that allow a healthcare provider to monitor their patients in their own mobile phones. It’s not only that for they are also now capable of sending and receiving patient’s information in their mobile phones as well. All of these have been made possible, as wireless connectivity exists. 

Devices that can help monitor one’s health of the one wearing it have also been highly available in the market.  As a matter of fact, there are even sensors that are capable of collecting data that would of course help their doctor be informed in case there is something abnormal with their patients. This allows them to provide the right medication and treatment to their patients fast. On the other hand, although great improvements have been made in the healthcare industry, one can still expect that a brighter future awaits in the next years or decades.  

Within five years, the majority of clinically relevant data will be collected outside of clinical settings. It has been said that healthcare in the future would become more personal. Thus, one can expect that personalized medicines or medicines that have been created specifically for an individual would be available. The way doctors diagnoses their patient’s disease and provides treatment to them would also be changed as data would become more accessible in the future, combined with the use of more hi-tech devices. As more people are being conscious of their health, one can expect that more tools and equipment would be available in the future.

Internet of Things

in the IoT paradigm everything in the world is considered as a smart object, and allows them to communicate each other through the internet technologies by physically or virtually. IoT allows people and things to be connected Anytime, Anyplace, with anything and anyone, by using ideally in any path/network and any service.Internet of Things could be the driver for health care’s new visage and revolutionize patient care transcendentally. Few ways how IoT can be used in healthcare industry  

1) Remote patient monitoring

Remote patient monitoring (RPM) uses digital technologies to collect medical and other forms of health data from one individual in one location and electronically transmit this information to the health care providers. RPM can help reduce the number of hospital readmissions and lengths of stay in the hospitals. 

2) Clinical care

Hospitalised patients whose physiological status requires close attention can be constantly monitored using IoT driven, non-invasive monitoring. Sensors are used to collect such information and using cloud to analyse data and then send this analysed data to caregivers. It replaces the need for the doctor to visit the patient during regular intervals for check up. This will also help to improve the quality of care through constant monitoring.

3) Device monitoring

An IoT connected device metal device can notify when there is a problem with a device.  This will prevent the device from shutting down and avoid patient rescheduling.

4) Outpatient Monitoring

This IoT solution enables doctors to capture health parameters and advice patients remotely. The patient’s hospital visit is therefore limited and needs to visit only on need basis. This solution helps hospitals manage hospital beds and consequently increase revenues while at the same time delighting customers.  

Although, IoT implementations will likely raise concerns around data privacy and security. While most of today’s devices use secure methods to communication information to the cloud, they could still be vulnerable to hackers. 

While we have yet to see a huge number of adopters of the Internet of Things in healthcare, its popularity is undeniably on the rise in other industries.

The article was first published in Mr. Arnab Paul’s LinkedIn Pulse post. The article is reproduced here with the authors permission. 

Author

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[content title=”About Arnab Paul”]

Arnab Paul, CEO, Patient Planet

Globally-minded systems thinker, action-oriented and inspired toward optimizing health outcomes through innovation, creativity, cooperation. Passionate about facilitating the alignment among technology, people and processes to ultimately improve patient experience and the functioning of healthcare.

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Enactment of Healthcare Reforms, Including PPCA, Drives the HCIT Solutions Market by Deepa Tatkare

According to the Bureau of Labor Statistics in the U.S., about 1.2 million vacancies would be available for registered nurses from 2014 to 2022. 

The demand of home healthcare is expected to increase and drive the healthcare IT solutions & services such as telehealth, telemedicine, and mHealth during the forecast period to meet the demand-supply gap


Enactment of Healthcare Reforms Including Patient Protection and Affordable Care Act (PPACA) Drives the Healthcare Information Technology (HCIT) Solutions Market 


Healthcare information technology (HCIT) deals in creation, design, development, and maintenance of information systems for healthcare organizations. It is expected to improve medical care, curb costs, minimize manual errors, and enable the optimization of reimbursement for ambulatory and inpatient healthcare providers.

Many government healthcare policies promote the use of both non-clinical and clinical solutions, especially electronic medical/health records (EMR/EHR), mHealth, and telehealth. While, EHRs benefit healthcare organizations by curbing treatment costs; mHealth utilizes mobile phones and communication devices to provide immediate care to patients. Increasing number of patients have adopted mHealth, as it is economical, and provides insights on preventive health care services, chronic disease management, disease surveillance, epidemic treatment support, outbreak tracking, and reducing overall healthcare cost. 

Patient Protection and Affordable Care Act (PPACA), commonly termed as Obama’s Health Care, is one of the most important healthcare policies that has affected the adoption of HCIT solutions. 

This law is effective in promoting enrollment of uninsured population, boosting use of HCIT solutions & services, and stimulating the adoption of electronic medical/health records. There are nine major separate legislative titles under PPACA, which include:

  • Affordable health care for all Americans
  • The role of public programs for the implementation of this act
  • Improving the quality and efficiency of health care facilities
  • Prevention of chronic diseases
  • Organized management of healthcare workforce
  • Transparency and program integrity
  • Improving access to innovative medical therapies
  • Community living assistance services and support
  • Revenue provision

For complimentary access to more information on this research: https://www.alliedmarketresearch.com/healthcare-information-technology-market

Some key sections of PPACA that are expected to impact healthcare information technology market are:

Section 2401: 

offers home- and community-based medical services for qualified individuals. These services assist patients to accomplish regular life activities and ensure continuous care for them. This section will have a direct impact on the HCIT industry, as it guides patients on their health status via telehealth or mHealth, enabling them to be in real–time communication with their doctors. 

Consequently, the demand for such services has significantly increased, which stimulates the adoption of telehealth and mhealth market. In fact, Telehealth segment is expected to grow at a CAGR of 33.27% during the analysis period.

Section 2703: 

provides home-based medical services for patients with chronic diseases such as cardiac condition, cancer, diabetes, and others. This section promotes the use of IT–based care management systems and stimulates the integration of IT in healthcare industry. 

The subdomains of healthcare include laboratory management, practice management, financial management, patient, and billing management, payment management, and others. Increasing incidence of chronic disorders among individuals has posed a key challenge to healthcare organizations. 

Hence, different management solutions are available for different levels in the market. This act stimulates the demand for healthcare management solutions & services, thereby driving the market growth.

Section 10410: 

establishes national center’s for treating depression. It is anticipated that EHRs would be used. It also promotes the use of telemedicine.

Section 4103: 

mandates medicare patients to have an annual wellness visit. It is expected that these visits would encourage patients to self-manage their medical problems. Moreover, they would be trained in self-management through the use of healthcare IT.

Section 2717: 

aims to establish quality reporting for both group and individual health insurers. This section focuses on regular reporting of healthcare insurance companies about their performance, and promotes the implementation of different healthcare payer solutions such as claim management, fraud management, and others. Stringent government rules for proper and timely reporting of healthcare-related financial documents have fuelled the demand for IT-based payer solutions.

These sections would propel the growth of EHR market in North America; affecting the world HCIT market. Moreover, dearth of skilled medical staff in healthcare facilities has hampered the market growth in the region. 

For instance, according to the Bureau of Labor Statistics in the U.S., about 1.2 million vacancies would be available for registered nurses from 2014 to 2022. 

The demand of home healthcare is expected to increase and drive the healthcare IT solutions & services such as telehealth, telemedicine, and mHealth during the forecast period to meet the demand-supply gap.

The article has been published with the Author’s permission
Author
Deepa Tatkare

Deepa Tatkare, has an experience of more than 3.5 years in market assessments and forecasts in healthcare & medical device industry. She is actively involved in providing critical insights on business research to clients with her subject matter expertize. Her profile includes planning, commissioning, and executing syndicate as well as customized research projects. She has successfully analyzed and presented data for studies related to medical devices, biotechnology, and pharmaceutical domains

What 2017 has in Store for Physicians? by Aiden Spencer, @aidenspencer15

The coming year is going to be tough if you’re a physician. There are several things that are going to change. It is important to be prepared about the coming changes in regulations, and what is required from a practice. This article will provide a brief summary about the coming changes, and what you can expect from 2017.


Before 2017

The year hasn’t completed ended yet but the healthcare industry has been bombarded with changes. The recent ending of the ICD-10 grace period has been the first major change leading into 2017. It has effected many practices in a number of different ways. It should be remembered that in the long run going electronic will benefit the entire industry. 


The possibilities are endless in the future, collaborative studies using patient data, the entire industry coming together to create something that could very well change the way the industry has worked for many years. 

Of course in the short run there will be certain problems especially as practices get used to the changes. Many physicians have even expressed concerned over productivity dropping because of all the regulations that have been imposed. These are minor setbacks in the grand scheme of things, and productivity is bound to rise in the long run.

Conclusion of Grace Period

The ICD-10 changes are something that every practice needs to know about. There have been almost around 3000 code changes starting October 1st. The biggest problem for practices is how to deal with the advent of these new codes. It is important to have a medical billing software to get through the paperwork. Whether your service provider has complied with the recent updates is a good question to ask. However if there hasn’t been an automatic update than you need to think about changing your service provider.

There are practices which still do not use a medical billing software, and it is important for them to know which family of codes has been changed and whether the changes affect your practice. The practices that aren’t totally electronic yet are going against the tide, and it is recommended that they shift if they wish to keep afloat in the long run especially with Medicare Incentive Payment System, and the changes that will entail. 

Claim Denials

The new ICD-10 codes, and the end of the grace period means that a practice can no longer use unspecified codes. This many have said will increase claim denials in the short run, and this could upset the budgeting of many practices. However practices that have medical billing software from reliable companies and vendors will not have to worry about claim denials going drastically up. Practices that aren’t using a software, should make sure they know the code changes especially the ones that effect their practice.

Elections

There are other changes that a practice needs to be aware about. The upcoming elections will truly decide the fate of the healthcare industry. Both the candidates are going in different directions. While Hillary Clinton wants to ‘tweak’ the Affordable Care Act (ACA), and keep going in the same direction, the Republican nominee Donald Trump wants to repeal the ACA. 

It is imperative that a practice be prepared for both outcomes. Whether that means more regulations, or less. In a Trump presidency, not only will the ACA be repealed, but insurance would be sold across state lines. This could potentially open up companies to more competition. Whereas a Hillary Clinton presidency would support state-based public option, and even limit covered consumers out of pocket liability.

Both the parties have disagreed on a problem of fundamentals. The future of healthcare industry hinges on the basic problem of how much spending should be done on federal level? The republicans have the view that there is too much spending currently on healthcare and not enough revenue. They plan to fix this by relying on the private market, which through competition would reduce costs.

The Democratic Party suggests that the amount of spending is not too much, it is however a problem of extracting revenue. This could be done according to the democrats by improving current government programs.     

What does this mean for a Physician?

For a practicing physician there isn’t much of a change as far as the elections are concerned. This is because it is important to first see the results of the elections. However one rule of thumb that we can go with is that there will always be regulations. This would mean that a practice should have meaningful use and HIPPA compliance. There are many Electronic Health Records (EHR) software that have integrated all updates, including the changes in the ICD-10 codes.

With the addition of Medicare Incentive Payment System, or MIPS, there will be a significant increase in transparency since reporting on performance measures will begin in 2017. Although the composite performance score (CPS) will be calculated and posted in 2019 it is important that all practices pace themselves along with these changes. The future of the healthcare industry is electronic, and regulated. Thus physicians should prepare accordingly. However after November 8th we will have a clearer picture as to which direction the healthcare industry is going towards. 

The article has been published here with the Authors permission. 

Author
Aiden Spencer

Aiden Spencer is a health IT researcher and writer at CureMD who focuses on various engaging and informative topics related to the health IT industry. He loves to research and write about topics such as Affordable Care Act, electronic health records, Medical Practice management and patient health data.

3 P’s framework – 7D’s Process Foundation by Prashantha Sawhney

focus on Process as it relates to the “how” the work is to be done


This article is a continuation of my previous post – 3 P’s framework – People are the key. We now focus on Process as it relates to the “how” the work is to be done.

There is a plethora of options in terms of processes one can follow to be successful. Across software literature one come across many variations and combinations of the “D..” verbs typically used in software development. One that is simple to use and remember is called 7D’s.

These can be easily understood by asking the quintessential questions of Why, Who (whom/ whose), What, When, Where and How.

Discover

Why are we doing this feature/ product? The other question to answer is for Who(m) is this required? These are the hard questions that need to be clearly answered on what the problem/ solution space is and the potential customer base being looked at. This is generally addressed by Product Managers or Portfolio Managers.

Define

What is the expected functionality? This corresponds to the requirement analysis phase and there are different methodologies that can be used for capturing and validating the requirements or use cases. This is generally addressed by Business Analysts, Product Managers or Product Owners.

Design

How are we going to achieve the requirements? This corresponds to the design phase and based on the organization approach, the level of documentation required can vary. Some level of prototyping is also done in this phase to help validate the designs. This is generally the forte of Technical Architects, Development Leads.

Develop

How is this to be developed given the requirements and design? Focus is on coding/ development, additional steps involved include testing, debugging, documentation and demos before this is considered complete. The development and Quality Assurance teams handle this important phase with help from Project Managers and Scrum Masters.

Deliver

When and how is this expected by the customer? Additional questions that need to be clear are the mode of delivery (packaged build on a disc or digital delivery), any requirements specific to on premise/ Cloud/ SaaS deployments, any specific requirements from a platform perspective (Windows/ Linux/ Apple/ Android/ Xbox/ PlayStation etc.) that need to be addressed? The Configuration Management Team manages this with help from the development team.

Deploy

Where is this tool/ product to be deployed? After the delivery has been made, the actual deployment is done and it is the critical step to get the tool finally in the hands of the customers. There are quite a few projects that do not get past this stage though due to different reasons and sort of lie on the shelf. In case of SaaS/ Cloud offerings, internal DevOps teams manage this phase. In case of on premise installations, this is handled by the customer IT teams along with specialist Implementation Consultants who understand both the product and the customer environments.

Delight

Whose Success is it that we aim for? It is obviously for both the end customer as well as the product teams who have toiled to give a final shape to an idea/requirement. There are sometimes roll-out related challenges, performance and stability issues, hard to reproduce issues and sometimes silly defects, but if we keep the Delight of our customers in mind, we work hard towards debugging and resolve the issues. This is best achieved by having a good communication channel between customer and product teams and is built on a strong foundation of trust.

Remember a delighted customer will come back to you and you will have many more cycles starting again from the Define phase.

The article was first published in Mr. Prashantha Sawhney’s LinkedIn Pulse post. The article is reproduced here with the authors permission. The views shared by the author are shared in his personal capacity.

Author
Prashantha Sawhney

Results-driven engineering professional with ~17 years of experience in leading high performance product teams
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