Reflections on change.gov and the health care ecosystem

So, its here. Obama Barack has been elected as the next US President. At change.gov they have outlined the agenda for "health care for all". Their approach is consistent with the approach during their campaign i.e departing from the traditional either-or mindset. It's an approach that looks at problems and opportunities in the context of thinking about the correct things to do by asking simple questions. (simple is not the same as easy). This approach is in contrast to the approach of viewing things as being leftist, rightist, or centrist -- that's what politicians think, ordinary people seldom do. (see this Web 2.0 panel that put me on that track).

Why? Well, the idea of the National Health Insurance Exchange on Change.gov appears seems to be heading in the direction of national insurance schemes like I know in Norway or in Sweden. Providing health care services as a basic right to its citizens. By the way, in Norway, where I live, the philosophy behind the insurance scheme is about ensuring that people have the means to take care of themselves - inntektssikring - and is broader in scope than just health care and covers even unemployment. The welfare state is a different and larger discussion for a different forum.

What is interesting to read on Change.gov was the approach of "making insurance work for people and businesses -- and not just (securing profitability) for insurance and pharmaceutical companies". I would prefer to include medical professionals and institutions to draw a holistic picture of the "provider <-> customer" relationship. In such a context, the insurance and pharmaceutical companies are very much part of this health care ecosystem. I believe that it is government's role to secure transparency in the procurement, provisioning (delivery) and payment of services that occur in this ecosystem.

Transparency will provide me as a "consumerzen" (a term I use to describe the consumer-citizen) insight into what services I am entitled to and what services I can augment by purchasing these on the open market. The government must provide this transparency. One way to ensure such transparency is the provision of a societal digital infrastructure that includes standards to secure organisational and technical interoperability, technology can provide tools to support the enforcement. Beyond ensuring transparency, such standards will help players of this ecosystem to innovate and create services that consumerzens can chose from. Building such an SDI requires an investment, but then at every stage of our history, infrastructural investments have driven innovation and generated prosperity.

I guess the trick is in educating consumerzens on the realities of the service economy and creating conditions that will help newcomers to the ecosystem to thrive (which means we need newer ways of educating people ... see this. The system will be able to generate funding once there is sufficient awareness, involvement and opportunities to generate prosperity.

User-centric healthcare is taking shape

I recently came across the Health 2.0 conferences and just last week, the 3rd Health 2.0 conference concluded in San Francisco with some very interesting topics being discussed. The user-centricity approach is refreshing and only reinforces my thinking around the citizen-centered society in general. I have only read the agenda and some blog entries for the San Francisco conference and I am fascinated by the increased focus on the patient -- and not only on the doctor or insurer (employer). In particular, the collaborative patient-to-patient approach was very encouraging, as also the notion of leveraging user-generated health care data.

I toured the site of PatientsLikeMe.com, to understand just how these ideas are put together in an operating model. Taking the role of a mediator, they facilitate the sharing of information between patient, health care provider, insurer and pharmaceutical or life science vendors. Using collaborative technologies and information management concepts they are creating horizontal networks i.e. between patients which have all the potential to reduce bureaucracy and increase the "time to solution" for all parties involved.

In an earlier post I toyed with the notion of crowdsourcing of diagnoses based on my health care data. This conference has triggered many thoughts on solutions in this space and I even more convinced that Norway can turn these notions into practical ideas since they already have the institutions in place to make this a reality. See this post.

Next level of outsourcing ..Medical tourism

The Open Source software movement started as a means to offer choice and at a price-point advantage, and since the OSS movement has evolved as a way of enterprise with some interesting business models. As software takes to the clouds, the provisioning of services is also evolving.

The Economist summarises in this well documented article the hype and trend of medical tourism that is very real and getting even more real. Is this is good thing for the country of the tourist? Is it a good thing for the country offering the service. As the economics of healthcare weigh in, the trend is here to stay. But can this be a win-win? I believe so (even before reading the article), but it requires more than my belief or other like-minded individuals. The political will and wisdom will be needed to see beyond the pure economic benefits and giving in to trade unions. Will the medical professionals see this as a chance to truly be "doctors without boundaries"? Technology has a significant role to play.

Crowdsourcing my medical data

Consider this. What if I did all the tasks for capturing my medical data? i.e. tasks that an amateur can do using consumer-affordable technology. I am thinking of the consumer profile of an owner of a mobile phone, digital camera or even a flat screen TV.

Then, could I post this medical data to a site and invite doctors or clinical technicians (or whatever they are called) -- who could mine this data to propose healthcare advice. Preventive care as well and diagnoses. The power of the network of doctors, who may have treated these illnesses in other parts of the globe, could be very valuable to me (persons posting this data). I could compensate the doctor providing this service in much the same way I would compensate my regular doctor.

It should make sense if we can solve the privacy and commercial challenges associated with this service. Useful, yes! But it shakes the foundations of the societal and commercial models we are used to. Will it work?

Visiting your doctor digitally

At the Telemedicine conference in Tromsø this year, an interesting paper was presented. Meeting your doctor using a webcam and an LCD screen is no rocket science however, the requirements of privacy and integration are critical.

Being able to meet my doctor this way would save me a lot of time -- 45 mins to be exact; which is the time I have to spend to make the detour to visit him. If I could upload my bloodtest results before I met him, it would have saved me even more time. But then again, updating my Electronic Medical Record (EPJ in Norwegian) calls for robust and flexible privacy and integration solutions. I think this is a solution that should be made available to the public. The challenge is getting my local politician to push the case and getting others to push him too.

Microsoft's Global Healthcare director Bill Crounse visited the telemedicine conference and posted this article that echoes my sentiments -- Norway can be a test bed for digital health and well-being.

While writing this post, I recalled my earlier post on using videoconferencing to improve the quality of life for digital nomads (like me). In such a scenario, I would like to be able to choose a channel on the remote and automatically be connected to my parents' TV and be able to see them and talk to them. This is the videophone we have been talking about for decades. Only thing is it is not one device, rather it is a collection of independent devices brought together by a service -- a service that a well-being service provider will offer. I hope fellow baby-boomers will be just as impatient for such solutions. After all, I would like to digitally meet my children whereever we are.

The death of distance as Frances Cairncross put it is going to be very real.

And today, for us in the northern hemisphere, the days start getting shorter. Have a great summer!!

Accelerating health care services

As I write this, it appears that Barack Obama has won the nomination as the Democrat's presidential candidate. Whether he does what he says in his health care program is left to be seen (see my previous post).

However, the health care industry seems to be coming together in a strong way. Both the combination of health care providers and telecom providers teaming up to create use cases that set the context for solutions. Continua Health Alliance is such a forum.

Creating such use cases with consumer-citizens at the center -- or consumer-citizen centered design -- can significantly help accelerate the process of creating solutions where software and services meet. See also this post on my other blog

Microsoft is agressively building the Amalga brand. This is definitely a space to watch as they attempt to link the enterprise and online worlds (hospitals and consumer). Expect more acquisitions in the health care sector.

Can the Nordic model for health care scale up?

As Google Health and Microsoft's Healthvault solutions get out there and as health care devices hit the market I see the Nordic model being challenged to meet newer forms of interaction between medical professionals and consumers. Can the model scale?

"Scaling up" and "scaling out" are terms with origins from the IT world (see scalability). However, in a non-IT context like health care, these terms have the same meaning and implications. What Obama plans to do with his health care plan appears to be taking the Nordic model (20 million people in 4 countries) and scaling it up to meet the needs of the US (approx. 300 million people).

Can the Obama health care plan deliver? on what timeline? I am not a political pundit but I am more interested in the implementation challenges in making such a thing happen. Therefore I think it would be mutually innovative for an Obama (or Clinton) administration to collaborate with the Nordic countries - to swap practices and develop new concepts for health care and insurance.

The Nordic model could do with an overhaul with input from a commercial, privatised perspective and the Democrats model can learn from a time-tested governmental welfare model. The welfare model as practiced in the Nordic countries, gives its residents a legal right to healthcare (in Norway this is legislated through Chapter 5 of the Folketrygdeloven - social insurance law, in Sweden there are similar laws.)

Innovations in healthcare and well-being

As I have captured my thoughts on the Digital Society over the last few years, I felt I had touched on so many topics that it was time to split my blog into more focused themes. My posts have talked about various aspects of the Digital Society but has favoured topics centered around Education, Healthcare and software trends in general. There has also been a strong undercurrent of posts on "social enterpreneurship". I have been inspired by the classic from 1999 From Spare Change to Real Change: The Social Sector as Beta Site for Business Innovation

So the first spilt of my blog is on "Digital care and well-being". I believe this area poses the most commercial potential due to the aging baby-boomers. The choice to include well-being in the title of this blog was to highlight the fact that healthcare is more than being ill and also includes the preventive and quality-of-life perspective.

So what better way to start this blog than comment the British NHS' bold "Connecting for Health" initiative. With the recent change at the top, there appears to be a focus on using the initiative to drive innovation. See this comment. And while the perception that Healthcare in the US is poor, there are a lot of innovations that could come from the legislation that is driving standardisation and interoperability. See the HHS' priorities here.