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

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.  


[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.
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”)
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.
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

[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 – 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

[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 – 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

[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.

[content title=”Latest Articles”]

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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

[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

[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.


[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

[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. 


[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
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.


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. 

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.


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.


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.


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.


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.


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.


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.


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.

Prashantha Sawhney

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

3 P’s framework – People are the key – Prashantha Sawhney

We focus on People – “who” do the work. While it is important to have a good efficient team, it is equally important to have some norms for them to be successful

This article is a continuation of my previous post – 3 P’s framework to be successful. We focus on People – “who” do the work. While it is important to have a good efficient team, it is equally important to have some norms for them to be successful.

One question that comes up as we look at staffing up or after we have staffed a team is  – will just getting a group of people make them successful in solving problems and making good progress? 

There are many books/ papers suggesting different ways of solving this. The approach that has worked well for me is CHASM. Well, as per the Cambridge dictionary, Chasm means “a profound difference between people, viewpoints, feelings, etc.” Interestingly, in a different perspective and useful way CHASM is an acronym, that I have used for approaching the people aspect:


In small as well as large organizations, we see how working in silos (teams/ departments) causes issues in quality and delivery. This also impacts customer experience, where he/she feels that nobody is really understanding them/ their issue or trying to solve their problem, but tossing the ball across to the next person or department. Collaboration is the key and is an action that the leaders need to demonstrate in their daily work and help inculcate in their teams. This aspect is more of an organizational behavior that individuals need to model.


In today’s world, everyone is trying to prove themselves every minute/second. In the process, we tend to focus a lot on ourselves, our team and trumpet our success. This may at times lead to having a superiority complex. While this is important, it is even more important to stay humble – so we can learn when we make a mistake or to seek help when we are stuck. It also enables team members to be approachable. This aspect is an individual trait and need to be practiced.


Having clear priorities and goals for different team members/ departments that align with the overall company goals is critical. When team members/ departments are not aligned, they can pull in different directions which can cause confusion to the rest of the team/ department. This is an area that the leaders need to work among themselves to get clarity first and then percolate it down the organization. This aspect is more of an organizational behavior.


When people have the right skills and are equipped with the right knowledge/ tools, they can be very effective. However in today’s world with plethora of knowledge sources and learning avenues, this is something that can be easily picked up/taught even after a team is formed based on the time available and nature of work. This aspect focuses on individual growth and can be substantially aided, with the right organizational support/ policies.


With all the other pieces in place, this is the last critical area. When people are aligned with the goals, are challenged at work and believe in the work they do, their motivation levels are the best, There are somethings an organization can do – to provide a good work environment, good recognition and rewards programs, competitive compensation and benefits. However in this aspect, a lot is also the responsibility of the individuals and how they deal with their own internal upkeep and self motivation.

Here’s wishing you have a team that is successful and is able to cross the chasm, from ordinary to very successful teams using CHASM approach.

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.

Prashantha Sawhney

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

Reducing Leakage in Admissions, Pharmacy and Diagnostics at Hospitals by Baljit Singh, @mtatva

Typical advised diagnostics in OPD in hospitals ranges from 20% to up to 50% depending on specialty and month of the year. You really need to see how many of these are being lost to competition nearby

Hospitals have two big challenges to stay profitable. First, they have to continuously work to get new patients to discover their hospital. Second, most important aspect, is to get as much revenue from each patient visit. The second one drives both top-line and bottom-line significantly, but is also the least understood process due to inherent limitations.

Many hospitals achieve great OPD inflow but very little sales in IP, diagnostics and pharmacy. If you are facing this problem, then this article is for you!

Typical advised diagnostics in OPD in hospitals ranges from 20% to up to 50% depending on specialty and month of the year. You really need to see how many of these are being lost to competition nearby.

Understanding patient flow at hospital

For multi-specialty hospitals, OPD is like a landing place where patients first land. Based on the treatment advised on OPD records (mostly prescriptions), patients can either use pharmacy, diagnostics or IP services inside the hospital or from other providers outside. For example, a patient coming to OPD with chronic pain would need to get scanning, medicines, surgical belts and physiotherapy. Patient could do these either inside the hospital or outside hospital.

Typical Patient Flow at a Hospital and Revenue Loss

Hospital would like patients to avail facilities inside the hospitals rather than outside. Hospital management is always worried about the losses due to patient going out of the hospital for follow-on diagnostics, pharmacy or procedures.

Need to measure leakage

Unfortunately with current set of tools available with hospitals, they cannot measure this leakage effectively and continuously. Although hospitals know very well on who is landing on their pharmacy, lab and admissions, they do not know who were advised one of these but chose to go out for fulfillment. If somehow their OPD records became digital they could measure this easily. But this does not happen and hence the fallout. 

What they actually need is digitization of their OPD records. The only option available to hospitals is using EMR which is very costly in terms of allocating resources or equivalent cost of doctor’s time for electronic-entry. Nor are the specialists and super-specialists inclined to do it.

The benefits of digitizing OPD records are obvious but how can this be achieved efficiently? How can this be done with no changes to current work-flows for the hospital and the doctors?

Proposed solution to reduce leakage

Do hospitals need to live with this till EMR becomes a reality? No! There is a solution.

Stop Admissions, Diagnostics and Pharmacy Leakage

Health-PIE service available as of now can digitize OPD records cost effectively. This solution uses artificial intelligence based technology to reduce cost. Also gives direct benefits of digitization to patients as well. Realizing hospitals are already overburdened, the solution comes with zero need of training to hospital staff or any major change in workflows.

Health-PIE helps hospital understand their OPD patients and flow, helping hospital with measurement of leakages and analysis. Health-PIE will also uses artificial intelligence to continuously communicate with patients through their treatment creating stickiness. This stickiness helps increase OP to IP conversion. This double-pronged approach of Health-PIE is a killer solution which can increase top line as well as bottom line of any hospital!

Baljit Singh, CEO, mTatva

Baljit Singh having more than a decade experience in variety of roles in Technology, business, strategy and management. He worked with multiple companies including one of top semiconductor companies as well as startups. Baljit is passionate to work in healthcare IT industry to solve some of key issues in primary healthcare. He also started SPOG

Why Do We Want #Interoperability? by @Matt_R_Fisher

Interoperability, to a large degree, comes down to having a fully unified healthcare system where data is always available

A lot of time and attention has been put into the notion of interoperability by almost every stakeholder in the healthcare system. Those interested in the issue include patients, providers, vendors and the government. Why has interoperability received so much focus, though? It may be possible to answer that question by stating that interoperability contains a large element of the common good.

Defining interoperability can be challenging, but a definition adopted by HIMSS in 2013 offers a good, comprehensive version: “the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.” Putting that into even plainer English, interoperability is the movement of data as expected and without hindrance. Ultimately, that likely expresses the expectation of many, individuals want data to be where it needs to be without a hassle.

Depending upon an individual’s role within the healthcare system, that individual may have a different perception as to the importance of interoperability. Patients want data moving without thought because patients expect seamless transitions in care. If a patient is traveling or goes from one provider to another, the medical data should be there. Other industries have mastered the ability to allow data to move around, but healthcare is still working on that issue. As such, the patient viewpoint on interoperability is that it should just exist.

Providers, much like patients, likely want to have all information about a patient available. For example, if a medication has been administered in one setting and a patient presents elsewhere, the subsequent provider wants and needs to know what has already been done in order to avoid a very easily preventable error. Additionally, providers want to know a patient’s full history, which may be more easily obtained from previous records than from the patient. The provider viewpoint on interoperability is that it forms a basis for good care and ensuring all data is available.

Electronic medical record and other HealthIT vendors may see interoperability as either a product challenge or potentially an impact on business. Clearly, the healthcare industry relies on vendors of products to build those products in a manner that permit interoperability. All the wishes for interoperability will go for naught if the tools being used are not set up to support it. That being said, are the right incentives in place? That question may be a bit unfair to the vendors because, optimistically, vendors are not necessarily trying to create public harms. Accordingly, the vendor viewpoint on interoperability may be a bit muddled, but at the end of the day should be favorable.

Given those potential viewpoints on interoperability, why is it so important? Interoperability is considered an essential element to succeeding with value-based care and/or population health, the government is turning its attention to the matter, and increasing patient demand. From the industry perspective, the value-based care and population health reasons are likely the most compelling drivers for wanting interoperability. 

Value-based care forms the basis for many alternative payment models, which is where the healthcare industry is quickly heading. If the right data are not available to understand how a provider is performing, then the likelihood of success decreases and in turn puts financial pressure on the provider. The government is also related to the push toward alternative payment models. 

The government, specifically the federal government through Medicare, is causing a seismic shift in the reimbursement system. The government wants these efforts to work, which means that all tools must be aligned. Rumblings have suggested that if interoperability is a problem, then the government may force the outcome it wants.

Ultimately, interoperability, to a large degree, comes down to having a fully unified healthcare system where data is always available. Thinking of the banking industry, this is true of account information because an individual can readily access it through an online account or at an ATM, for example, and then be able to access that money from almost everywhere too. Similar examples can readily be pulled from numerous other industries. The question continually comes back to why should healthcare be any different.

As suggested above, solving the interoperability conundrum comes down to a common good. Arguably everyone wants patients to be able to receive the best care possible. That means having data available and on hand.

Hopefully, this post results in an open dialogue about the issue of interoperability. I will be presenting at VITL Summit 16 on this same topic and welcome comments and thoughts that I can incorporate into my presentation. Please post in the comment section, email me, or engage on Twitter. If we can all focus on the issue and begin to reach a consensus understanding, that would be a good outcome.

Matthew Fisher

I am the Chair of the Health Law Group and an associate with Mirick O’Connell. I am also a member of the firm’s Business Group. I focus my practice on health law and all areas of corporate transactions. My health law practice includes advising clients with regulatory, fraud, abuse, and compliance issues. With regard to regulatory matters, I advise clients to ensure that contracts, agreements and other business arrangements meet both federal and state statutory and regulatory requirements.

Steps to Performance Transformation by Ritesh Dogra @Ritesh_Medium

Take a step back and think on the fundamental question – ‘Have I created enough value in my current business model?’

Since the last year, we undertook quite a few ‘Performance Transformation’ projects. This was a pleasant change – existing healthcare providers trying to transform themselves and this had nothing to do with increasing bed occupancy either! So what is performance transformation?

Simply stating, Performance Transformation is Creating Value in Existing Infrastructure which will differentiate an existing set up in the market. To understand this, lets step back and reflect on a familiar concept, the S-Curve.

Redefining the S-Curve
Quite often, a business model in its maturity reaches a stable state. The revenue and margins become stagnant and at this time the promoter is faced with a fundamental question – What Next? This is followed by expression of interest from investors to scale up or providers evaluate new business models. It is at this point of time healthcare providers should take a step back and think – Is this real or perceived S-Curve? And on going deeper, the answers can actually redefine the ‘maturity state’. It is our inherent biases and preexisting knowledge that prohibits us from doing this. In the following section, I will try to elaborate the key steps which can actually help an existing organization transform itself.

1.Start with Immersion and Eliminate the Structure
We are all familiar with the term micromanagers, how about creating new creed of people who we call ‘micro-observers’ and ‘micro-listeners’? Even the best of managers fail to observe and listen to real patient problems and quite a bit of this is attributed to our ability to structure every element of our life– right from structured feedback to structured questionnaire to structured problem solving. Structure is great but never works when you need to understand your customer! Let’s start with unlearning all structures and just immerse ourself, spending our valuable time sitting in lobbies and corridors to understand our customers and break preexisting notions. This will throw up a lot of questions and answers!

2. Stop Gossiping and Start Talking
Our employees right from frontline staff to executives are in midst of action everyday. In fact, few other industries would offer the type of action that healthcare does. Let’s start listening to them and avoid side gossips, else soon we could be competing with Facebook! Spending time with employees to understand problems – their and customers, rather than skimming the surface, in my experience has been really helpful.

3. Identify Problems, Brainstorm and Lastly Don’t be a Super Hero!
While the first two steps will throw out problems and some indicative solutions, go ahead and dig deeper. Only super heroes in movies can save the world! In real life, understand the implications of problems followed by quantification of loss and the impact which solving them could mean for you. Prioritize problems, it always helps. And this is the stage where you can get into your familiar territory – structured problem solving!

4. Make Change Personal
Go ahead and implement solutions; align everyone in organization to your ultimate goals, make them a part of the larger cause, in fact create a mission. For any change to be effective to the core, it has to be personal. Create sub parts of larger solutions and assign everyone an implementation agenda and plan. You will gradually notice a change in your organizational culture, a change for good. And for this to be effective, never create incentives for culture change- it can be suicidal; only offer incentives for results which come unexpected.

5. Create Value and Monitor the ROI
After all, we started with the S-Curve. Start monitoring the impact and you will notice a shift in the S-Curve. And this is the time when you should make a shift to communicating the change – to your employees, target segment, investors and everyone in the ecosystem. More people should benefit from the change- shouldn’t they? And ultimately all of this will reflect in your financial metrics; Revenue, ROI and EBITDA.

So the next time you start thinking of larger than life problems such as trends shaping healthcare or attracting investors for scale, it would be worthwhile to take a step back and think on the fundamental question – ‘Have I created enough value in my current business model?’

Originally published in Healthcare Radius, March 2016: http://edition.pagesuite-professional.co.uk//launch.aspx?eid=fe8b4971-300f-4a9b-b0a7-58ebb835c206

Ritesh Dogra

Ritesh has been a member of the Founding Team at Medium Healthcare Consulting. He has led a number of engagements in areas as diverse as market expansion strategy for a Fortune 500 medical equipment manufacturer to planning and commissioning of novel healthcare concepts to performance transformation of a leading hospital chains in South and East India. He has received numerous accolades from clients for his rare insights and extraordinary commitment.

The Current Status of 8 Future Technologies on Healthcare by @msharmas

It’s mid-2016, and here is a look at the current status of 8 Future Technologies that might be having a significant impact on Healthcare

Most if not all these technologies will make an impact on Healthcare, and hence it is important to understand the various scenarios and the stories detailing how the experts from across the world are incorporating these technologies in healthcare

1 Internet of Things

By 2020, there are expected to be 50B IoT devices with a total economic impact of $3.9Trillion – $11.0Trillion across all the industries, out of which $1.6 trillion impact in the “Human” segment.

Experts have identified the various areas in Healthcare, where IoT-based solutions can be implemented in healthcare. 

  • 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.
  • Dr. Vikram in his article on how IoT can transform healthcare opined the benefits of remote patient monitoring in emergency cases
  • Dr. Pankaj Gupta, noted in his article for IoT-based solutions to be aggregators of healthcare data from primary, secondary and supporting care market will begin to be aggregated. It will be in the interest of Insurance, Pharma and Govt to support IoT driven Healthcare Market Aggregation
Digital Health startups are working on the following categories as showcased in The Map of Healthcare IoT

  • Clinical efficiency, 
  • clinical grade biometric sensors/ wearables, 
  • consumer home monitoring, 
  • brain sensors/ neurotechnology, 
  • fitness wearables, 
  • sleep monitoring and infant monitoring

IoT platforms need to be created to ensure the utilization of data being generated by the IoT devices deployed in healthcare. Absence of platforms to aggregate IoT device data will result in loss of meaningful and contextual insights being drawn for the patients’ conditions.
Here is an Infographic, by Team HCITExperts, IoT in Healthcare, Types of Opportunities

2 Augmented Reality

Pokemon Go happened and augmented reality has triggered the imaginations of the innovators to work on bringing the technology to Healthcare

By 2020, an IDC report states AR – VR revenue will hit $162Billion by offering major applications for healthcare and product design.

In a recently concluded Intel developer conference, Microsoft’s Windows chief Terry Myerson announced a partnership with the chip maker that will make all future Windows 10 PCs able to support mixed reality applications.

For instance, Live 3D imaging is one of the hottest topics in optics today, transforming medical imaging capabilities and delivering the immersive experience behind augmented and virtual reality.  

Tim Cook in a recent interview indicated Augmented Reality to be a bigger market than virtual reality.

3 Virtual Reality

With VR technology projections reaching $3.8Billion by 2020, there will be an increase in the use of VR technologies in Healthcare

Virtual reality has an increasing number of implementation opportunities in Healthcare for education, training and patient treatment.

While the cost of using VR in healthcare is still something that needs to be dealt with, partnerships like the one with Intel and Microsoft only bodes well for bringing the technology mainstream and be cost effective.

VR tech is currently being used to 

  • virtually zoom around the patient’s brain to pinpoint an aneurism before the operation. 
  • 3D virtual renderings of the patient’s anatomy lets physicians get a very real experience before operating on the patient
  • the Virtual Reality is being used to present the patient a virtual human agent that replicates a Doctor & Patient communication, where patients can get their questions answered in an environment free from judgement
  • train surgeons how to use new or unfamiliar devices
  • presenting medical images such CT-Scans and MRIs as 3D renderings for improved accuracy of diagnosis 
  • and as an alternative treatment for seniors

4 Blockchain 
Interoperability in Healthcare is a big topic for debate and a sore unsolved puzzle. With the US HHS and ONC seeking research on Blockchain for Healthcare, there seems to be growing interest in the technology. 

For instance, “By combining the blockchain with the peer-to-peer business model, this creates the potential for a near-autonomous self-regulated insurance business model for managing policy and claims. No single entity would control the network. Policyholders could “equally” control the network on a pro-rata basis” 
– Cyrus Maaghul in Why out of hospital Blockchains matter

Blockchain technology is being researched to be the super secure healthcare data aggregator of EHR data and IoT devices data

Blockchain technology is supposed to benefit healthcare 

  • in population health and clinical studies, 
  • interoperability, 
  • patient centricity, 
  • security,
  • supply chain management 
  • Merck has already announced its exploring the use of Blockchain technology for clinical trials. For instance, if a patient is enrolled for multiple clinical trials, a single blood test common to all the clinical trials needs to be done only once and can be shared across the clinical trial studies the patient has enrolled for.
  • In a recently concluded challenge, ONC in the US announced 15 winners for the use of Blockchain in Healthcare

5 Artificial Intelligence
Artificial Intelligence has been a topic of research all these years, but with the advent of the Data Age, Artificial Intelligence is fast moving mainstream and presents a viable business opportunity. 

“By 2025, AI systems could be involved in everything from population health management, to digital avatars capable of answering specific patient queries.” — Harpreet Singh Buttar, analyst at Frost & Sullivan.

In a recently published report, AI adoption by enterprises is imminent. 38% of respondents are already using AI, another 28% will adopt it by 2018. 

The AI ecosystem is projected to be worth $5.5Billion by 2020

Artificial Intelligence ecosystem consists of:

  • Deep Learning
  • Evidence Based
  • Machine Learning Systems
  • Prescriptive Analytics
  • Natural Language Generation
  • NLP/ Text Mining
  • Predictive Analytics
  • Recommendation Engines

Artificial Intelligence has already started making its way into healthcare, with 90+ AI startups getting funding to deliver solutions like; 

  • helping the oncologist define the best treatment plan specific to each patient
  • a virtual nursing assistants, to follow-up with patients post discharge
  • drug discovery platforms, for new therapies
  • Medical Imaging and diagnostics 
  • The use of AI in diagnosing diseases, patient education and reducing hospital costs
  • You can also find a great discussion on machine learning, wherein how machine learning could replace/ augment doctors via the health standards podcast with Fred Trotter.

Some of the other areas where AI is being implemented in Healthcare. Microsoft, Apple, IBM and other major players are all looking to AI help in curing people. And they are forming a group that creates the standard of ethics for the development of AI.

Finally have a look at the AI in healthcare: Category Heatmap


6 3D Printing 
3D Printing in Healthcare is making fast inroads in many disruptive ways. The projected market size for 3D Printing in Healthcare as suggested in the IDC report:

“Global revenues for the 3D printing market are expected to reach $US35.4 Billion by 2020, more than double the %US15.9 Billion in revenues forecast for 2016.

This represents a compound annual growth rate (CAGR) of 24.1 percent over the 2015-2020 forecast period, IDC research reports that while 3D printers and materials will represent nearly half the total worldwide revenues throughout the forecast, software and related services will also experience significant growth”

Gartner expanded the number of profiles from 16 in 2014, to 37 technology and service profiles in their latest Hype Cycle for 3D Printing 

3D Printing in Healthcare is being used in the following ways: 

  • 3D Printing and Surgery. All surgical and interventional procedures with complex pathology, extensive resection and/or extensive reconstructions could benefit from this technology: Orthopedics, Cardiovascular, Otorhinolaryngology, Abdominal, Oncology and Neurosurgery.
  • A bespoke 3D Printed model of the patient’s forearm changed the standard course of a 4 hour surgery to a 30 min less evasive soft tissue procedure
  • Affordable prosthetics
  • the FDA has touted the use of 3D Printing in personalised medicine, ans has already cleared 85 medical devices and one prescription drug manufactured by 3D Printing.

Researchers are also exploring the use of 3D Printing which could come mainstream in the future such as Printing prescription drugs at home, Synthetic skin, 3D Printing and replacing body parts.

7 Drones

Last year in a conference a researcher proposed the use of Drones for delivering healthcare in much the same way Katniss receives medicine in the Hunger Games movie or for that matter in the movie Bourne Legacy, UAVs are shown to retrieve the blood samples of Jeremy Renner.

The worldwide market for drones is $6.8 billion anticipated to reach $36.9 billion by 2022

Similarly, there is an active interest in the use of drones to be monitoring traffic, to delivering pizza and products ordered online. 

In context of Healthcare, UAVs are being field tested for transporting samples and blood supplies, medical drone manufacturer Vayu is using UAVs to deliver cutting edge medical technology in Madagascar. In Rwanda, estimated 325 pregnant women per 100,000 die each year, often from postpartum hemorrhage. Many of these deaths are preventable if they receive transfusion via drone delivery in a timely manner. 

In India, Fortis hospital plans on using drones during Heart Transplants, to cut the travel time and save lives. An estimated 500, 000 are in need for organ transplants in a year in India.

Drones & UAVs are also being tested for delivering emergency medical supplies during accidents and natural disasters.

8 Robotics

Robotics in healthcare has been used for sometime now, for instance the Da Vinci surgery system is being used for a myriad of surgeries. 

Just the other day i came across an article on robots being used for some of the tasks at the reception of the hospital.

“Cloud robotics can be viewed as a convergence of information, learned processes, and intelligent motion or activities with the help of the cloud,” the report explains. “It allows to move the locus of ‘intelligence’ from onboard to a remote service.”Frost and Sullivan report on Cloud Robotics.

The overall world market for robotics in healthcare will reach $3,058m in 2015, and expand further to 2025.

The global robotics industry will expand from $34.1 billion in 2016 to $226.2 billion by 2021, representing a compound annual growth rate (CAGR) of 46%.

I was reviewing the articles on Robotics in Healthcare and came across this very comprehensive article Robots/ Robotics in Healthcare by Dr. Bernadette Keefe, MD which provides a comprehensive look at the current and future trends.

Other areas robots are being used in healthcare in addition to the above scenarios are: 

Forrester’s Top Emerging Technologies To Watch: 2017-2021 http://bit.ly/2dmVRkZ  via @GilPress

And there you go, we look forward to you sharing your experiences and thoughts regarding these Future Technologies and share them with our community of readers. 

We appreciate you considering sharing your knowledge via The HCITExpert Blog

Suggested Reading

  1. The Future of Healthcare Is Arriving—8 Exciting Areas to Watch | Daniel Kraft, MD | Pulse | LinkedIn http://ow.ly/KrGS304kGjs
  2. Why the A.I. euphoria is doomed to fail | VentureBeat | Bots | by Evgeny Chereshnev, Kaspersky Lab http://ow.ly/CMKu304kGyU
  3. Looking Back At Today’s Healthcare In 2050The Medical Futurist http://ow.ly/4Dl6304kVZZ
  4. Incisionless robotic surgery offers cancer patients better chances of survival: StudyTech2 http://ow.ly/gpMS304l3wq 
  5. Robots/Robotics in Healthcare | Bernadette Keefe MD http://ow.ly/wRbb304lz44
  6. By 2020, 43% of IT budgets will be spent on #IoT: Jim Morrish, Machina ResearchThe Economic Times http://ow.ly/VKuT304lFi9  
  7. Forrester’s Top Emerging Technologies To Watch: 2017-2021 http://bit.ly/2dmVRkZ  via @GilPress
  8. Are killer bots about to do away with smartphone apps? – http://www.bbc.com/news/technology-37154519 
  9. Where machines could replace humans–and where they can’t (yet) | McKinsey & Company http://ow.ly/v9BY100dNn6 
  10. 2016’s hottest emerging technologies | World Economic Forum http://ow.ly/Jq2R100m4AS 
  11. The Top 10 Emerging Technologies 2016list, compiled by the Forum and published in collaboration with Scientific Americanhttp://www3.weforum.org/docs/GAC16_Top10_Emerging_Technologies_2016_report.pdf 
  12. Rwanda’s hospitals will use drones to deliver medical supplies http://money.cnn.com/2016/10/13/technology/rwanda-drone-hospital/index.html?iid=hp-toplead-intl 
  13. 4 Trends Shaping The Future Of Medical Events https://t.co/rUUUJ7oqkK #digitalhealth #hcsm https://t.co/KuPgGW4k9Z 
  14. Post-PC Tech Rules at Intel Developer Forum 2016 https://lnkd.in/fKux3Ek 
  15. House MD vs Doctor #AI- Who will turn out to be the better by @RoshiniBR http://ow.ly/elXy304mYpv


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    Manish Sharma

    Founder HCITExpert.com, Digital Health Entrepreneur

    Connect with me via any of my Social Media Channels

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    Social Media Survey Report for Dental Practitioners in India by @drvikram and @drmayurdavda

    • 63% of respondents say they use social media professionally but only 28% have a budget for investing in it
    • 70% of respondents use social media to connect with peers; only 51% use it for patient education

    Dental practitioners are reluctant adopters of social media for professional use, according to a survey report by HealthCare in India and The Dental Education. While 90% of survey respondents said they used social media for personal use, only 63% indicated that they used it for professional purposes such as connecting with peers (70%), raising awareness of their practice (61%) and educating patients (51%).

    “With the government of India’s healthcare policy emphasizing on preventive healthcare, medical practitioners and hospitals have to find new ways to reach and educate patients to stay healthy. In this context, social media can be a game changer, especially for specialist care providers such as dental surgeons, ophthalmologists, dermatologists and ENT specialists,” said Dr. Vikram Venkateswaran, Founder and Editor, Healthcare in India.

    The survey report, possibly the first of its kind in India, outlines possible reasons for low social media adoption as ranging from limited understanding of social media; lack of skills needed to create compelling content on social media; uncertainty around how regulatory bodies such as the Indian Dental Association perceive social media use; and absence of well-known peers using social media.

    “As an education provider and a practicing dentist, I have seen interest from dentists to use social media for professional purposes. But the rigors of running a practice means they seldom have the time to invest in familiarizing themselves with this medium,” said Dr. Mayur Davda, Founder, The Dental Education. Other salient findings of the report include the following:

    • The top social media platforms used by respondents for professional work include Twitter, LinkedIn and Blogs (in that order)
    • 42% of respondents spent an average of one to five hours a week on social media pertaining to work. About 33% spent less than an hour a week.
    • Only 28% of respondents had a budget for investing in social media activities

    According to the report, social media can be used to educate, promote, interact and advise patients. To this effect the report also includes a section on five commonly asked questions and actionable insights to help medical practitioners build their social media presence credibly

    About the Survey

    Conducted between August and December 2015 last year, the survey received responses from 114 dentists, of which 52% were women.  The responses were fairly distributed between professionals with less than five years of experience (40%), those between five and 10 years of experience (35%) and those over 10 years of experience (25%)

    About Healthcare in India

    Healthcare in India is a social movement for better health. We believe that revolutionary health care outcomes are possible only when patients, care providers, local communities, businesses and the government are all deeply involved in the cause for better health. We run a blog for all these stakeholders to share different perspectives on health to allow individuals to make better informed health decisions. We provide advice to healthcare organizations on their digital, marketing and social media strategies.

    About The Dental Education

    The Dental Education was established by Dr. Mayur Davda so that every dentist/ dental student / dental associate (like dental hygienist and dental ceramist) could get quick and easy access to the vast knowledge of dentistry on the go. The Dental Education is aiming to be as resourceful to dental students and para dental staff as it is for the dentists and offer educational services at free / subsidized cost. Dr. Davda is also President of the Dental Photography School (pioneers of Dental/ Medical Photography Training And research in India) and a Photomentor at Canon India & GPS Smile design, Las Vegas, USA. 

    Key contacts 
    Dr. Vikram Venkateswaran (drvikram@health-in-india.net) 
    Phone: 9686569928 
    Dr. Mayur Davda (thedentaleducation@gmail.com) 

    To receive the complete Social Media Survey Report for Dental Practitioners in India, please leave us your email id below #mc_embed_signup{background:#fff; clear:left; font:14px Helvetica,Arial,sans-serif; } /* Add your own MailChimp form style overrides in your site stylesheet or in this style block. We recommend moving this block and the preceding CSS link to the HEAD of your HTML file. */

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    Dr Vikram Venkateswaran

    Dr Vikram Venkateswaran is a healthcare thought leader who writes and speaks about the emerging healthcare models in India and the role technology plays in them.

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    Dr Mayur Davda

    The Dental Education was established by Dr. Mayur Davda so that every dentist/ dental student / dental associate (like dental hygienist and dental ceramist) could get quick and easy access to the vast knowledge of dentistry on the go. The Dental Education is aiming to be as resourceful to dental students and para dental staff as it is for the dentists and offer educational services at free / subsidized cost. Dr. Davda is also President of the Dental Photography School (pioneers of Dental/ Medical Photography Training And research in India) and a Photomentor at Canon India & GPS Smile design, Las Vegas, USA.

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    How to create a winner marketing plan to your hospital by Dr. Hesham Dabah

    Healthcare’s facility directors and top executives who are in charge of the execution of hospitals and health services are confronting a test of how to get their facilities more profitable and make them more productive

    The article was first published in Dr. Hesham Dabah’s LinkedIn Pulse page (link below). The article is published here with the authors’ permission.

    Acquiring new patients to the practice is the lord of administrative practices,  pulling in more individuals requiring your service is what all health care business administrators should consider at into their daily operating systems.

    In a perfect world talking, every single utilized specialist should run in beneficial status , be oriented with the expenses of their workplaces and practices. If not, we need to take an approach to make utilized doctors to move from the comfort zone to the dynamic one.  

    Marketing is of course known to have positive benefits for enterprises of all kinds, including health care. It may even be an essential driver for some of the hospital’s prestige services and big revenue generators, such as open heart surgeries and liver transplantation, etc

    It may, however, be less well understood that marketing can also be implemented in a way to have a direct influence on the patient choice and hospital branding as well.  

    In fact, marketing can be highly effective in this way, contributing to the improved profitability of all services while also increasing market share in the health system and growing referrals to the hospital 

    It’s never been an easy process, the Marketing team responsible for that file in hospital, having a hard time competing in the market with other well established hospitals in the nearby neighbors. 

    What’s more, the marketing department additionally seeking association’s with different offices, and the middle management managers and supervisors in charge of the productivity of these hospitals, are not completely mindful of the maximum capacity of viable, vital integration of the marketing efforts with other departments in the hospital  to specifically pull in new patients to these specialties . 

    However, they know the potential, yet they don’t have the enough knowledge about the how a strategic marketing plan component ! 

    Making the challenge even greater is the common scenario of un-specialized hospital marketing departments, which have to support all hospital service lines. Taking an example of the pharmaceutical industry, they realized too early the necessity of developing different lines of marketing teams for different line of production, make it more efficient and easy to follow cost with the results.  

    Unfortunately, the hospital managers and top executives overlooked that , using the same old way of thinking and hospital marketing is often at or near the bottom of their list of competing priorities and internal constituencies. A piece of the issue is that the chiefs of other administration lines in the  hospitals have a “louder voice” when seeking resources, but it is expected from the marketing department to come up with results !  

    Another thought is that hospital marketing team is usually less capable and non-experienced in branding the doctors in practices and the health service lines. 

    Eventually, numerous hospital executives and directors who are in charge today of the day by day hospital operations unwittingly wrong determined by general spending plans of marketing not indicating each service expense. How would you enhance execution without sufficient promoting assets, there is a difference bt. mastery and clear technique! 

    • What would you like to wind up with ? 
    • What’s more, where would you like to go? 

    Basically answer these 2 questions and you will discover it is not an advanced science to make sense of your marketing strategy to begin a winner one. 

    The first step is to find a common definition of marketing in your hospital setting. For this, marketing should be defined as the process of  communicating the value of your services in-order to increase its profitability. At the same time, this kind of marketing requires identifying, anticipating and satisfying patient expectations.  

    Your operation role in  this, marketing strategy ought to be characterized as the procedure of integration of all your administration’s power together to get the results you want. 

    To develop your strategic plan for the marketing, simply first apply the The 5 Ps of the marketing techniques to develop your marketing strategy that meets your requirements.

    The 5 P’s of Product Marketing

    • Product – In this case, it’s the hospital services being sold.
    • Place – In healthcare, refers to the Hospital facility.
    • Price – Competitive? Expensive? Affordable? We think of that as an end value the patient will receive when pays for it.
    • Promotion – The choices in messaging and communication channels to deliver a clear message to target clients.
    • People – All people in the organization, especially those in direct contact with patients and patient’ families (and other “clients,” including hospitals, doctors, insurers, regulators etc.)

    In this way, marketing is more than just exposure of the facility.it’s comprehension of procedures and duties for me and my association.  

    I should understand that successful marketing does not just drive business. It also drives reputation and branding to my facility. This is why it is called a marketing strategic plan.

    Identify my position in the market

    Every situation is unique and should be considered on a case-by-case basis. We need to determine and define our position within the marketplace. 

    Clearly, well-identify our value proposition, develop a single statement that will serve as the guiding theme for my efforts. This positioning statement should be clear , memorable, unique and — most of all — TRUE. 

    Once positioning is born, the hospital manager and executive should consider many steps to help my marketers to get the results from their work:

    1. Develop my brand.
    2. Be there; on consumers’ comfort zones
    3. Answer all inquiries in no time
    4. Build a happy referral network
    5. Include your physician in your marketing strategy
    6. Hire thousands of agents in your city for free

    1 Develop my brand

    Be Disctinctive ! 

    An effective, consistent branding for healthcare organizations, particularly the private hospitals, is very critical. The organization should have a brand that represents who it is and what it stands for.  It is the sign on your building, the voice on the phone, the words said to patients, the quality of care and the level of service. 

    It’s the organization’s personality, presence, reputation,type of chairs, uniform of my team, style and smell when you walk in. It is very useful to think of branding as reputation by style, it’s a part of the overall organization’s brand, print outs and also different from the competitors, and vary from specialty to specialty and even clinic to clinic, but all have something in common which is the line of my organization’s brand. 

    Convey a clear and unique message, provide trustworthiness, connect with prospects psychologically, motivate the patient to come again and create loyalty

    2 Be there: on consumers’ comfort zones

    Go to your target clients when they don’t need you, don’t wait them till they come to you hospital should have a role in people life , a useful one,  present in daily needs and activities, not just banners on buses and yellow boards in building or paid articles in newspapers.  

    Be a part of their life, share with them their happy moments , add value to their life , let them come to ask about your promotions and then convert them to loyal customers! make to your hospital a permanent part of their life, not just a one time service utilized by a shopping client,, let them want you, follow you , fall in love with you  and always deliver the right message to them that you are there to meet their needs and always ready to take the extra mile to keep them happy, let them know that you are happy because they have a good health and happiness.  

    Always check, do I get the right target people? Did I address the right points? Did I succeed in developing my right branding? Am I Different from competitors? Ask them what could be my next service they need and can’t find anywhere else?

    3 Answer all requests in the blink of an eye

    Fill the need of the patients to know more about their sickness 

    Nowadays, Web advertising is crucial, an unavoidable source of information. And they are expanding utilizing it to settle on their health choices. So, they have questions about their illness and they want answers to feel better about themselves and their conditions.  

    In hospital strategic marketing plan , it’s extremely important to have all around well prepared office staff  that can answer questions, no big surprise, I saw one time on an IVF health care facility ” Adam Centers – in Cairo ” utilizing new graduated doctors as a part of the front office to listen precisely to patient inquiries and answer each and every one.  

    Staff individuals speak to your image with every connection, they must to be exceptionally very much arranged with my image and convey as a piece of their standard work in each collaboration with patients and their families. 

    The object of the strategic marketing campaign is to drive new patient request and reservations, and your front office staff is the individuals who will be doing that, undertaking and making the early introduction of your hospital to the new patients. 

    That impression will either fortify or undermine the first presentation testing your delivered message and the interchanges you got from your strategic plan. Business speaking,they will be the person who will turn a checker to a client. PERIOD. 

    Promoting, will make prompts you , yet changing over guests into new patient arrangements are of high importance. That is the reason it’s so imperative vital that front office staff are going to play an important role with my marketing team and up-to-speed and arranged to handle the stream either via telephone or face to face in the front office. 

    Staff should be prepared to a point of high transformation rate, which will just happen subsequent to giving staff individuals the instruments, training and abilities, including how to empower make a new patient reservation and adherence to a suggested script of answers is the key.   

    An extraordinary Client service is the first line of your association, and where you will see results if you invest on them appropriately

    4 Build a happy referral network

    Build a referral network 

    Build trust and associate with the doctors in your city , or go further on the off chance that you have an in number of doctors exceptionally well in their specialties and broaden your affiliations with specialists everywhere throughout the nation.  

    This is essentially imperative for your hospital. Business talking , drawing in doctor referrals is one solid reason doctor’s facilities and healthcare organizations have been purchasing little practice offices, bringing new doctors to their network , and one reason why pays rates of doctors hit the sky sometimes.  

    But, you got to know that building referral is not a 1-2-3 steps process to follow !  

    Because the existing referral arrangement is difficult to break, and new referral relationship is a harder job, require a significant amount of information to collect. Just keep in mind that like any other relations in life, it has peaks and bottoms. Any referral arrangement between the doctor you want to win and a competing hospital , will have a moment of tension or dissatisfaction from time to time, so your consistency and continuous presence with the right offer and solution in front of the doctor you want to attract will allow you to be at the right time to win the game with your competitor.  

    You need the help of your doctors in your facility to you build that network system, you can recognize how you will fortify yours to take a part in this procedure either in view of their dedication to your clinic or for whatever other thought process you can include in your marketing strategy. It works and it pays for its expense and this key cooperation can turn into a primary wellspring of your incomes in the event that you do it right.  

    A week ago I made a visit to a doctor’s facility that I’ve generally known about, however ever been there, the chairman and the CEO of of that hospital  ” Dar Al Shifa ” in Cairo – Egypt , has shared with me the inpatient log of that day,  incredibly he had patients referred to him from 8 different countries at his 44 ICU bed unit. They all had an open heart surgery in the hospital, all got through his effectively implanted referral system throughout the years.  

    You have to measure and estimate the association and union you need to put resources into , then need to create particular, viable strategies to convey properly to plainly set the win to win circumstance anticipated from that connection.  

    You can consider likewise the referral offices , not just doctors’ offices. Which happen to have a huge significance now for healthcare business.  

    The referral-building should be taken care of with a member team has a lot of perseverance, astounding correspondence , the abilities to follow up continuously , and has a great communication skills. With the right one to do it with the right abilities and character attributes for the assignment you can build a good one

    5 Include your physician in your marketing strategy

    Use the best people in your organization 

    They can be a vital vehicle in your marketing campaign, that incorporates likewise their engagement with your endeavors to help build your referral system with partnership specialists.  

    Truth be told, the doctor contact part is so essential to hospital business, you’re extremely well prepared group is your doctors, so utilize them whenever it is possible and appropriate.  

    They represent your image with their own fellows outside your work space with their families,and communities. They have the capacity to make you look different from different hospitals ,identify your abilities, style of administration and care and your ways to deal with making the additional move to fulfill a patient and win a good specialist to join your team. 

    You can know you succeeded when a well reputable specialist from a competing hospital  comes to you and request to join your team of doctors, at exactly that point you know you are destined for success. PERIOD.  

    It’s about persuading and inspiring them without much speaking,they are very smart and they will know whether you want to make their hospital a good one, or you only there to have a huge compensation at the each end of the month.  

    For that, you need to make sure that your physician not only know what to say about your efforts , but also well presented and have enough materials to leave behind and always be in the right place at the right time. Put a system to encourage every department to have some medical research to present in medical gathering , shows their accomplishment in meantime if new techniques they have applied in your facility to help more patients live healthy.  

    The right materials handled by doctors can have a great impact in the general population and fill the gap of information about it , empower intrigued referrals to come to you and ask how they can utilize your facility services.  

    These  materials can be in numerous structures, including business cards with the website address, data analyses,decent flyers,public relations team going with your specialist while he/she present a paper at a medical gathering ,,,and so on

    6 Hire thousands of agents in your city

    YES, as the old saying says “word of mouth ” 

    Your own patient population of your hospital are a treasure, their part is still under-assessed or undiscovered potential, unless a marketer has effectively worked in another industry than health facilities and know how to use.  

    Building up a key arrangement for inside advertising to existing patients been of awesome significance in numerous commercial ventures, for example, accommodation , restaurants , time share,credit card providers,,,,etc.  

    Unfortunately, most or lets say numerous health care executives did not experience these tremendous commercial ventures of transforming their customers into non paid agents to them without acknowledging they are helping you build your image and making more benefit and just for the expense of pennies.  

    Without a doubt numerous patients who need to get some medications still get some information about a decent one , from family members receive medical services frequently.  

    If we consider that the overall people who never came to my hospital, they don’t know much about me or what i can do to them.  

    In this way, by speaking reliably and keeping a good communication channel with my patients, will be the one who introduces my hospital’ services  to their families and companions.  

    Communicating with my patients can be very simple… yet very effective 

    Patients promoting methods that we can apply to our marketing strategy can be very simple, as basic as requesting that fulfilled patients refer their companions, sending birthday congrats with some informative print out , short SMS, ask offer some discounts to them that they can pass to anyone they want.  

    Much obliged to you for coming to that point and taking the time to read my article that I trust I had the capacity share with you some of my strategies that I tried myself and I know it lives up to expectations flawlessly.  

    My last word, it’s never been the marketers alone duty to bring you new business; and on the off chance that you quick to manufacture an unmistakable medicinal services office, you need to construct a good marketing strategy for your hospital, survey commonly with different departments till you totally fulfill with it, afterward demonstrate and help your marketing team to apply your strategic plan  

    Furthermore, most importantly to be an enthusiastic to succeed, bar any individual who says it can’t be done, in light of the fact that nothing is impossible in the event that we work right and make enough commitment to do it. 

    Thank you. 

    Thank you for reaching that point, please feel free to leave a comment , share your thoughts, start a discussion that can broaden our minds or share the article and invite your friends to read

    Dr. Hesham Dabah

    Healthcare & Hospital expertise – Entrepreneur. Dynamic, confident and professional healthcare leader with strong ability to engage people positively and motivate them to embrace and work toward the vision for the organization

    Why Out-of-Hospital Blockchains Matter by Cyrus Maaghul @Pointnurse

    Bitcoin and blockchain technology will be game changers too

    This article was first published in Mr. Cyrus Maaghul’s LinkedIn Pulse post here . The article is published here with the author’s permission.

    I bought my first bitcoin in May 2013 while on a vegan retreat in Asheville, North Carolina. Going through the purchase process reminded me of when I first downloaded Mosaic and surfed the net. I thought to myself, “this is going to be a game changer”. It was.

    Bitcoin and blockchain technology will be game changers, too.

    Bitcoin, its underlying blockchain and evolving peer-to-peer networks with Turing-complete smart contracts such as Ethereum will have a disruptive impact on many industries for years to come. Financial services, payments, supply chain logistics, insurance, and healthcare are just a few that will be disrupted with these new technologies.

    Out-of-hospital blockchains

    Healthcare will be a primary beneficiary of these new technologies, especially outside of the walls of hospitals.

    As more and more health and preventive care is provisioned in virtual environments, at home, in cars, at work, etc, the need for open and accessible tracking, verifying and provisioning of care will become extremely critical for patients, payors, providers, scientists and regulators.

    These new out-of-hospital (OOH) blockchains developed in the non-clinical community will set the pace for how patient behavioral and inter-clinic visit vital data is tracked in the future for provider reimbursement, regulatory compliance, safety monitoring and patient adherence.

    The blockchain is a near-perfect technology (not necessarily the current implementations) to securely and safely make OOH data easily accessible with relatively minimal privacy and hack risk to all patient stakeholders, including the patient themselves, family, caregivers, clinics, providers, insurance companies and all those with a stake in their patients’ health.

    Each and every one of these stakeholders or network peers approved by the patient can easily join OOH blockchains as either nodes or buyer or seller of tokens or payments to gain access to patient data, utilizing a variety of open access methods and smart contracts that store and monitor real-time contractual conditions agreed to by and between various stakeholders.

    There will be many OOH blockchains developed to address the myriad of use cases in healthcare, including tracking the development of drugs, doctor and nurses credentialing, real-time population health data analysis and alerts, insurance peer-to-peer risk pooling, telemedicine and home health visit data sharing, decentralized autonomous organizations, verification and audits, and remote device monitoring commonly addressed today under the Internet of Things category.

    These open and viable peer-to-peer healthcare blockchains will open the door to new business models in healthcare, including analytics-for-healthcare products and services, flash malpractice insurance and friction-less claims processing hence shorter revenue cycles.

    Healthcare insurance claims processing

    It is no secret that healthcare claims processing is a nightmare for all parties involved. Reimbursement is opaque, fraud is prevalent, and transactions frequently difficult to reconcile.

    For example, home health, a great OOH blockchain example, is possibly one of the greatest sources of fraud in the US healthcare industry today. Smart contracts powered by a blockchain could provide consumers and payors with the means to manage claims in a transparent, immutable and responsive fashion.

    Insurance contracts, premium payments and their respective claims could be recorded onto a blockchain and validated by node consensus, preventing fraudulent claims from being processed. Smart contracts could enforce claims triggering payments when due or dispatching specialists, nurses or doctors to follow up with patients when anticipated claims are not recorded by presumptive dates.

    Managing “super-utilizers”

    The term super-utilizer describes individuals whose complex physical, behavioral and social needs are not well met through the current fragmented health care system.

    These individuals go from emergency room to emergency room, to admission and re-admission, in a chaotic and costly manner. Mental health, substance abuse, poverty and education are frequently cited as common characteristics of many but not all in this group. Many researchers and experts postulate how more “community support” and “real-time engagement” is needed to manage this socially isolated population of healthcare super-utilizing consumers.

    Smart contracts powered by an OOH blockchain utilizing the bitcoin payment system could be used to create a rewards and incentive system to manage super utilizer behavior.

    Behavioral contracts could be developed between payor and patient to trigger rewards denominated in BTC for attending support groups, regularly engaging a telehealth professional, reporting health conditions (possibly at kiosks with bitcoin point-of-care devices), and meeting agreed upon health goals.

    Payors would fund reward payouts via efficient BTC accounts established at commercial digital currency exchanges. A smart contract would trigger a reward payment (or loss) when goals are met near real-time to the patient’s public bitcoin address which in turn could be tendered at local participating outlets equipped with BTC point-of-contact devices including community centers, supermarkets and apartment complexes to pay bills, purchase healthy foods and meet rent obligations.

    Medical malpractice insurance DAOs

    In theory, decentralized autonomous organizations (DAOs) are entities that are self-governing. DAOs on a OOH blockchain could enable trust and provide an immutable record and audit trail of an agreement without a single controlling body.

    Doctors and nurse practitioners could collaborate to establish a peer-to-peer malpractice DAO and record each peer’s premium payments and claims on the blockchain. All premiums paid in would create a pool of capital to pay claims.

    By combining the blockchain with the peer-to-peer business model, this creates the potential for a near-autonomous self-regulated insurance business model for managing policy and claims. No single entity would control the network. Policyholders could “equally” control the network on a pro-rata basis.

    But, these are just a few examples of how bitcoin and blockchain technology will change the face of healthcare in the future.

    The blockchain is a new and exciting technology, and we are now just beginning to see both small and large players dip their toes into the water. I personally would discourage any entrepreneur from pursuing the use of blockchain technology inside the walls of clinics and hospitals today, as the those lanes are laden with painful obstacles – the OOH blockchain is your winning lane today

    Cyrus Maaghul

    Cyrus Maaghul is a thought leader in healthcare, technology, and finance with experience in markets around the globe. He is keenly interested in the blockchain, cryptocurrencies, and healthcare particularly the intersection of physical and behavioral health and provider empowerment

    @IFTTT you could in Healthcare by @msharmas

    Was reading this article published in a leading newspaper sometime back,

    Naturally, I tried thinking of usecases to apply the technology in a Healthcare setting. 

    About IFTTT
    IFTTT works with a series of simple recipes using channels.  

    IFTTT stands for IF this then that

    Channels are “connected” apps, like Gmail, Google Calendar, Google Contacts, Twitter and many others supported by IFTTT. You can download IFTTT for android or iOS and start connecting channels to your account.  

    IFTTT allows you cook up your own recipes. Recipes are composed of this and that. Once you have connected the apps to your IFTTT account, you can start creating recipes. 

    “this” in the recipe stands for a Trigger Condition or criteria, much like the IF condition you would create in an excel sheet, or in code.
    “that” is the action that would be performed when the Trigger condition is met. Based on this condition being TRUE, IFTTT will execute that Trigger Action.
    Lets take an example now, assume you are attending a conference and you would like to keep a list of tweets that you liked, and you want to retweet these out later or incorporate these in a blog. Given this scenario, you could do the following steps in IFTTT

    1. Download the App on your phone and create an account
    2. In the IFTTT app enable the Twitter & Google Drive “channels” by connecting to your Twitter and Google Drive credentials
    3. Once you have connected the channels, lets head over to Create a recipe
    4. Click Create recipe and it will ask you for a Trigger Channel, select Twitter
    5. Next, select the Trigger Conditions from the list of possible options provided by IFTTT based on the channel selected
    6. For our usecase we will select “New Liked Tweet by you” as the Trigger Condition
    7. Next we want IFTTT to save the “Liked” tweet in an excel file, for that we will select the trigger Action channel as Google Drive
    8. And we will select the Trigger Action as “Add row to spreadsheet”
    9. IFTTT will keep adding all the tweets you liked to the spreadsheet that you have selected

    IFTTT you consider Healthcare Use cases 
    OK, so we now have some understanding and agreement in terms how we are able to very simply, and with no coding, able to create a logic statement and get some work done. In fact you have just “Integrated” two apps and got them to “interoperate”

    Lets now assume, IFTTT you could use in Healthcare use cases, What would you do?

    What IFTTT offers is a set of features that allows for the end-user to create some of the rules based on their day-to-day circumstances. Lets say a nurse wanted the EHR system to Alert a doctor based on a certain specific parameter, but incorporating that logic would require a “code-change” to be done by the EHR vendor. The process is long-drawn to bring in such changes. 

    Instead IFTTT the EHR system can incorporate the ability for the nurse to create her own recipe by providing Channels corresponding to various modules in the EHR system, and also provide the end users Trigger Actions  and Trigger Conditions (pre-defined by the EHR vendor).

    Lets consider some of the usecases that can be enabled for an IFTTT type functionality in Healthcare

    • appointment reminders for doctors based on urgency of care
    • reminders to the nurse to change patient medication dosage based on doctors suggestion of lab results
    • pharmacy requisitions based on quantity on hand value defined
    • checking and validating medical actions for medical errors
    • patient discharge process alerts to all departments

    IFTTT app allows for the end user to create her own “recipes” and “share” these within the community. And considering every patient’s treatment circumstances are different, clinical teams can setup trigger and action criteria that are active for a particular patient and can be continuously changed based on patient condition. Additionally, it also provides the end-user the ability to make enhancements to the system’s in-built logic by enabling customisation at the user end and instantaneously.

    Once the patient gets discharged the clinical staff can have the ability to save all the tasks related to similar disease “patients like” scenario, to be templated for future

    IFTTT you could Connect Healthcare Devices
    Thinking a bit ahead to the future, one could control certain medical devices based on trigger based activities. So imagine, the nurse comes along with the doctor for the ward rounds and she is able to adjust the IV flow based on a doctor’s recommendations

    IFTTT patients’ could

    Patients too can be allowed to use IFTTT-like functionality by allowing them to create a folder in her google drive that contains all her electronic records emailed to her or her doctor

    Patients can also setup reminders for their appointments since their hospital app enables the IFTTT-like functionality.
    Patients can be sent alert notifications on their wearables or phones, about daily Medication reminders using IoT-based devices that dispense their medications

    The power of IFTTT is in the simplicity and custom trigger and action criteria it provides it’s users

    While writing the above article I recalled the time I was working in a Healthcare IT Product development company in Bangalore and we were looking to incorporate an Alerts & rules engine into our HIMS product. While defining the requirements for the solution, we had discussions with our end users in terms of how they would like the notifications from the system to be delivered. They all reported “Alert Fatigue” to be a factor in terms of how they went about using the system. They wanted to be able to control what alerts they saw and how they would like to view these alerts. 

    An IFTTT-esque functionality incorporated within EHR systems will go long way in helping the end-users “customise” the solution based on their current requirements. They would be able to create focussed alerts based on their daily work. 

    Afterall, the workflows in the hospital undergo a constant change and an EHR should be able to allow the end-users to incorporate customised workflow and rules


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    Manish Sharma

    Founder HCITExpert.com, Digital Health Entrepreneur

    Connect with me via any of my Social Media Channels

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    House MD vs Doctor #AI- Who will turn out to be the better by @RoshiniBR

    House MD vs Doctor AI- Who will turn out to be the better diagnostician?

    Do a google search for “all-inclusive beach holiday” and all you see for the next weeks are advertisements for all-inclusive holidays following the virtual you. Google knows you better than your family or friends- creepy but true! Whether or not we realize it, we have made the decision to donate our data to the virtual world.

    Can we put our data to better use – to improve healthcare on a scale unimaginable a decade or two ago?

    Artificially intelligent systems in healthcare

    AI systems feed on big data. Big data is nothing but a massive amount of data, the sheer size of which makes data analysis a challenge. AI systems are being developed to analyze and recognize meaningful patterns out of this complex data. Of particular significance is deep learning, a branch of AI which attempts to mimic the thinking part of the human brain. Several startups are now attempting to put AI, particularly deep learning to meaningful use in healthcare.

    Diagnosing diseases: Clinical diagnosis is essentially a data problem, says founder of Enlitic, a machine learning startup focusing on data-driven medicine. They aim to revolutionize clinical diagnosis by helping physicians to automatically screen for specific diseases using their proprietary technology. Another startup, Deep Genomics, is approaching diagnosis from a genomic perspective. They capitalize on machine learning technology to link genetic variations to diseases. As a cherry on top, a study published as recent as last week reported that AI-enabled automated cancer detection perform as well as approaches that require costly clinician input.

    “We think that its no longer necessary for humans to spend time reviewing text reports to determine if cancer is present or not”- author of the study, Shaun Grannis M.D., M.S.

    Educating Patients: IBM is teaming up with the American Cancer Society to create an adviser for cancer patients, powered by IBM’s Watson health – health division of its AI brain. It would be designed to provide cancer patients or their caregivers with personalized guidance based on the patient’s particular disease stage and treatment. Watson would sift through countless digital sources like health websites and draw relevant and trustworthy information catering to individual needs. 

    Improving clinical trials: Many clinical trials fail because patients fail to take their medications. AiCure is addressing this issue using AI to monitor medication adherence thereby increasing trial success.  They directly monitor patients using artificial intelligence on mobile devices via an app which collects real-time dosing data on a centralized and cloud-based platform. IBM Watson is trying to solve another issue facing clinical trials – enrolling patients. Watson would sift through clinical trial data at Mayo Clinic and in public databases, such as ClinicalTrials.gov. and match patients more accurately and consistently to clinical trial options.

    Using Watson’s cognitive computing capabilities, Mayo Clinic can consistently offer more cutting-edge medical options to patients and conclude trials faster”  – Mike Rhodin, senior vice president, IBM Watson Group.

    Accelerating drug discovery: Drug discovery is a lengthy, complex, and costly process, rooted with a high degree of uncertainty that a drug will actually succeed. Several machine learning startups are trying to solve this long-standing predicament in pharmaceutical drug development. Berg Health combines systems biology with its proprietary artificial intelligence machine learning analytics program to bring down the time for cancer drug development to almost half. Atomwise’s drug discovery AI platform “learns like a human chemist” using deep learning algorithms and supercomputers.

    “Simulating billions of virtual medicines to find potential commercial candidates in weeks? That’s what we call truly transformative.”- Matt Ocko, Managing Partner of Data Collective, a venture firm backing Atomwise

    Reducing hospital costs: Readmissions are costly for hospitals as payers are reluctant to reimburse preventable readmissions. Hindsait, an artificial intelligence technology provider, helps identify patients who are nearing the end of their stay and suggests whether keeping them might in fact be more cost effective than risking readmission. It does so by applying AI based data analysis to large health datasets.

    These and many more upcoming developments in cognitive computing in healthcare leaves us with the thought – will AI systems perform better diagnosis than out best diagnosticians. Google’s AI program, AlphaGo beating Go world champion and IBM’s Watson beating humans in Jeopardy seems to suggest so.

    Note: Interestingly, there were many recent publications that influenced the direction of this article. Application of AI technologies in healthcare is growing with new collaborations being made at this very moment. Interesting times indeed for all those who influence and follow these developments. 

    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.

    Ransomware Prevention 101 – Expert Tips by Nicola Whiting @CyberGoGiver

    Whether you manage your own systems and devices, or rely on third-party hosted systems (i.e. ‘in the cloud’), your Ransomware risk is real, constant and growing….

    Below are some key actions, that you can put in place now, to significantly reduce your Ransomware and Cyber Crime risk – they cover prevention, instant response during an attack and recovery

    What to do first?

    Set up regular data backup procedures – then ensure they happen
    Backups are ESSENTIAL in protecting data. If you are successfully attacked with Ransomware your backup is the best, possibly only, option for saving your data and ability to do business. Backups also help you recover from many other forms of damaging malware attacks and even hardware failures. Some Ransomware variants, such as Cryptolocker, will also encrypt files on drives that are mapped. This includes connected cloud file stores, attached network drives and USB thumb drives. Action: Backup often, to an external drive or backup service (one that is not assigned a drive letter) & physically disconnect it from the computer between backups. Make sure the Backups are tested and are usable!

    Setup your defences

    Cyber Essentials Controls 
    CESG spent many years determining which security best practices would remove the most risk. (a Cyber Essentials version of the 80/20 rule!)Following Cyber Essentials guidance can reduce your risk by 80%. In addition to being a great security guide, some Cyber Essentials checks can help to prevent Ransomware. The following is a list of those checks:

    1. Installing the latest software patches and updates can help against known security issues being leveraged by malicious software.
    2. Installing and keeping up to date the latest anti-malware/virus software can ensure that known bad executables, and potentially software behaviours, are stopped.
    3. Disabling auto-run can prevent malicious software being transferred between systems using storage technology such as USB pens.
    4. Do not use Administration-level accounts for day-to-day tasks. As well as being good security practice, this will help restrict the impact of any malware infection.
    5. Access privileges should be used to limit access to resources and systems.
    6. As above, this should also help to restrict the impact of any malware infection.
    7. Firewalls should limit network traffic to only approved source / destinations and service types.
    8. Malware protection, possibly in the form of APT / IPS, can prevent potentially malicious software from calling home or propagating on your systems.

    You can check some of these controls using the FREE Risk Assessment Auditing Tool (www.titania.com/risk-assessment-tool). It provides key risk analysis in 21 areas, includes step by step mitigation suggestions and automates some of the manual configuration reviews, needed for Cyber Essentials. 

    Automate Defence (when possible)Patch or Update your software 
    Keeping your software up to date is a security essential, it significantly reduces your risk. Ransomware authors frequently rely on people running outdated software with known vulnerabilities, which they can exploit to silently get onto your system. If you make a practice of updating your software often it can block their access. (As a triple bonus it also helps defend against other Malware and makes it harder to hack into your systems!). Action: Enable automatic updates, especially on major vendors such as Windows and Adobe.If you can’t auto-update go directly to the software vendor’s website (good practice as Ransomware / Malware creators can disguise Phishing attacks as software update notifications). 

    Filter EXEs in email 
    If your gateway mail scanner can filter files by extension, you may reduce risk by denying mails sent with “.EXE” files, and “*.*.EXE” files.  Users who then legitimately need to send or receive executable files could use password-protected ZIP files or via secure cloud services. Naturally this is not fool proof and you may want to consider other options (a 7-Zip vulnerability was recently discovered and patched). 

    Re-enable showing full file-extensions 
    Window’s default behaviour hides known file-extensions. Re-enabling showing full file-extensions will help your team spot & avoid clicking on suspicious files – e.g. those with unexpected “.EXE” (executable) extensions often used by Ransomware. 

    Use a reputable security suite and keep it updated 
    Ensure you include anti-malware software and a software firewall, they will both help identify threats or suspicious behaviour.  Ransomware developers frequently send out new variants, (to try to avoid detection) multiple layers of protection, will reduce their chances of success. If you run across a Ransomware variant so new that it gets past anti-malware software, it may still be prevented from executing, or be blocked from connecting with its Command and Control server (to receive its encryption instructions) by Software Restriction Policies (SRP) or your firewall… 

    Firewalls/Proxies and APT/IPS 
    Once something malicious is running inside your network, you do not want it to communicate with the outside. Firewalls should be configured to restrict network traffic going in both directions, not just inbound traffic. Web browsing should also be limited to prevent access to known malicious websites. Internet proxies can be used to help prevent access to malicious content, or user access to websites by content type. Advanced Threat Protection (APT) / Intrusion Prevention Systems (IPS) can also detect and prevent software from accessing or performing potentially malicious activity. 

    Windows Policy Updates 
    There are a number of Windows group policies that can be deployed to help prevent running malicious code. e.g. The user application data folder is often used by Malware developers, as a location to launch malicious software. 

    Software Restriction Policies (SRP) can be used to prevent the execution of software from that folder. Computer Configuration/Policies/Windows Settings/Security Settings/Software Restriction Policies To prevent execution of programs within certain types of files, they can be configured under the following policy tree: 

    User Configuration/Windows Settings/Security Settings/Software Restriction Policies 

    On the latest versions of Windows you can take this further by configuring AppLocker policies to restrict the execution of software. 

    This is a complex subject in its own right and Microsoft has provided lots of details in the following TechNet article: https://technet.microsoft.com/en-us/library/ee619725(v=ws.10).aspx An example would be to configure policies to only permit the execution of signed software.

    Train your People

    Train your people to detect what “suspicious” looks like and what to do in the event of an attack. Help them by giving sensible policies, “attack reaction” training and showing hidden file-extensions.  

    Email Attachments: 
    Before opening email attachments, you should first check the emails validity. Potential malicious software is often attached to emails in the hope that someone will open it. The malicious emails can range from very simple and obvious through to sophisticated and less obvious. 

     These are fairly obvious…


    Yet another example…

    With emails that have “Invoice Attached” or something similar may be harder for someone in an accounts team to ignore. However, there are simple checks that you can perform to confirm details about the email. If you are unable to confirm any of the details, then try getting in touch with the sender to confirm its validity (do not use any of the contact details supplied in the email – they could be fake). Also check the attachment type, would you normally have an invoice attached as a ZIP or Executable file? 

    It is important that everyone is trained on what to look out for in emails. And remember, banks do not send emails asking you to login to your account using a link contained in an email (or they should not). Also, Inland Revenue send information in the post, not via email. Be aware of what you are opening, clicking on and viewing.

    What if the worst happens?

    You’re in the middle of an attack or your files are being encrypted – what can you do? 

    Disconnect from WiFi or unplug from the network immediately
    This technique may not always help, but training your people to “immediately disconnect the system and notify IT” if they think they’ve clicked on a malicious attachment, can (if done quickly enough) limit your risk, damage and costs. Depending on the breed of Ransomware this action may cut off communication with the attackers’ server and localize the data encryption to just one machine (which may be far easier to recover from).   

    It normally takes some time to encrypt all your files, so even if you’re not quick enough to outpace the malware spread, disconnecting from the network and notifying IT – will give your team valuable response time. It may help to isolate an infection. 

    Restore or Recover
    If you have System Restore enabled Windows, you might be able to defeat a Ransomware or Malware attacker. However, some versions of Ransomware (e.g. Cryptolocker) may delete the System Restore files, before you can return the system to a known clean state. If that is the case, then your best option would probably be a full restore from a clean back up. (You’ve got a clean backup and tested the procedure already…right?) 

    Pay or Don’t Pay?
    If you have any other option open to you, my advice would be don’t pay for two main reasons:

    1. You have no guarantee you will get your data back. In many cases the decryption key is never received, it fails to work or only partly decrypts the data.
    2. You’re then a proven “paying customer” which increases your likelihood of future re-targeting!

    If you leaning towards paying… 
    You can normally do a very quick google search to determine if you have viable option for recovery and often whether the criminals in question have a track history of delivering your data back. Some Ransomware variants such as Cryptolocker & Jigsaw, now have payment timers (after which time the price for your decryption key, or damage, goes up significantly)At time of writing, you could “beat the clock” with Cryptolocker, by setting the BIOS clock back to a time before their 72 hour window was up – resulting in a lower Ransom payment demand. In every case, if you’ve decided to pay, it’s worth quickly investigating your potential actions first… 

    One Final Suggestion…. 
    For the policies and practices you put in place to remain effective in protecting you and your business they must be enforceable, measurable and consistent. User training on cyber / information security procedures can be made part of your HR on-boarding process and refreshed regularly. For System Settings, firewall rules and policy enforcement, I would recommend using detailed system / configuration auditing tools such as the award winning Nipper Studio and Paws Studio

    Useful Links & Free Tools

    Cyber Essentials 
    Government-backed walk-through on protecting yourself against cyber threats
    FREE Risk Assessment Auditing Tool 
    The Risk Assessment Auditing Tool, created by Titania Ltd, automates the auditing of 21 key security risks (such as unpatched software, missing anti-virus updates and poor password enforcement) that would leave your business vulnerable to attack. It will significantly reduce the time of hardening your system against Ransomware attacks. 

    Cryptolocker Prevention Kit
    Cryptolocker Prevention Kit created by Third Tier to help automate making a Group Policy to disable files running from the App Data and Local App Data folders, as well as disabling executable files from running from the Temp directory of various unzipping utilities.


    Nicola Whiting

    Communication Strategist, Technology Speaker, Chief Operations Officer, Diving & Kayaking Enthusiast

    Social Media Technographics – A way to engage your audience by @msharmas

    “Taken together, the Social Technographic groups make up the ecosystem that forms the groundswell. By examing how they are represented in any subgroup, strategists can determine which sorts of strategies make sense to reach their customers.” – Forrester

    As part of a successful social media campaign, its important to know the audience with whom we are sharing the content and creating the content for. 

    I came across this insightful categorization from Forrester, that provides a categorisation of your Social Media users, using the Social Technographics ladder on the basis of their level of activity on your Social Media Channels

    To enable an engaging social media strategy, it will be important to guide your followers across the various steps in the ladders, leading them from being Inactives to being Creators of thought leadership content.

    By examining each sub-group, social media strategists can determine which sorts of strategies make sense to reach their target customers. Companies that can understand the typography of their end customers can therefore better target their audience with topics and articles of relevance.

    Based on the Forrester Social Technographic ladder of engagement, the people participating and engaging with your content has been categorized by Forrester with the percentage for each type of person.

    Suggested Reading

    1. Forrester: Consumer Technographics https://www.forrester.com/data/consumer/dashboards
    2. Forrester: Consumer Technographics https://www.forrester.com/data/consumer/reports 
    3. How To Create A Social Media Marketing Plan In 6 Steps http://ow.ly/USsyb 
    4. The Data Digest: Twitter And Social Technographics by Reineke Reitsma | Forrester Blogs http://blogs.forrester.com/market_research/2010/01/the-data-digest-twitter-and-social-technographics.html
    5. The Data Digest: Introducing Forrester’s Empowered Customer Segmentation http://blogs.forrester.com/anjali_lai/16-07-12-the_data_digest_introducing_forresters_empowered_customer_segmentation 
    6. The Social Marketing Playbook For 2016 https://www.forrester.com/The+Social+Marketing+Playbook+For+2016/-/E-PLA124 

    How do you plan on using this categorization for your Social Media Strategy for your own brand? I look forward to hearing back from you with your thoughts and insights.

    We are using the following interactive Word Cloud to understand the conversations our readers are having around Digital Health topics


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    Manish Sharma

    Founder HCITExpert.com, Digital Health Entrepreneur

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