Citizen-centered apps

The wave of making public data available continues as more countries adopt the model set by data.gov - latest is the UK's data.gov.uk. Expectedly, it did not take long before sectors like transportation and law identified areas to apply the data sources and build apps.

And now "data openness" has hit health care - see and here come the healthcare apps. With infrastructures like Healthvault and Google Health in place like the uptake should be faster and deeper. The question of privacy still remains, but I think once utility increases, so will security and privacy. This is the ultimate bottom-up consumer-centric apps design I had hoped for.

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Social media and healthcare

This weekend Aftenposten carried different stories around the cost of healthcare (for eg here and here - Norwegian texts). The technocrats and the bureaucrats will haggle about numbers and details while politicians extol the virtues of their party programs -- or more likely downplay the programs of rivals.

This dance is pretty obvious for most citizens, however, the voice of the citizen is absent in this discussion on the cost of healthcare and what we should be doing about it. I hope this is not for long and that the debate on cost of healthcare can be channelled inclusively and constructively to produce some creative solutions.

Last autumn in an article in a Norwegian trade journal, I talked about patient-driven self-service site Patientslikeme.com. Yesterday, the Aftenposten carried an article on a patient with ALS (or Lou Gehrig's disease) around the rising cost of healthcare. The individual interviewed described how ALS had almost destroyed his life but that state-financed healthcare made it possible for him to lead a meaningful life. The story behind Patientslikeme.com also has a link to ALS. Same conditions but different solutions.

I was struck by how in Norway, the state takes care of ALS-patients -- at a pretty high cost. In the US, beyond health insurance, there are mechanisms that catalyze innovation. It is useless pitching one system against the other since I'm concerned about finding how state-financed healthcare (in Norway) can drive innovation. I think a first step is in sensitizing people to the notion that resources (healthcare included) are limited and we all need to be active in finding solutions. Something like where the state can serve as a platform and that cultivates creative services.

I believe social media solutions have an important role to play - not as a technology in itself, but as a catalyst to socialize the ideas and complexities of healthcare for ordinary citizens. To raise awareness and then to get them to take a more participative, co-production role in health care services and to be part of the solutions. Utlimately helping drive inefficiencies out of the system and lowering the cost of healthcare.

In that respect it is good to see that the magazine of the Norwegian Medical Association carried an article on the role of social media in healthcare Tidskrift. I consider it a simple but significant start.

Innovations in service delivery

I have been spending a lot of time looking for innovations in service creation and come up with some very interesting cases. But none so impressive that could actually get me back to health care blogging.

Listening to the Aravind talk at TED India I was left speechless. Just earlier in the day I had attended a working meeting to structure a research project around service innovation. Earlier in the week, I had attended a similar meeting around service innovation in health care. Watching the video, I was struck by how innovation was happening in practice.

What was more startling was that they were addressing the same problem - just applying the similar technologies with a different mind set (and may be a different value system). Our health care, in the western world, need not be so expensive and so unreachable. Admittedly, we do not have large volumes, but we have the technologies like telemedicine but have not deployed them correctly. The real shocker was taking the McDonald-model to health care. More so, my own realization that there is a sense of job-protection at play when we restrain ourselves in thinking of doctors "flipping burgers" (or consultants for that matter).

The move by Aravind Eye care give themselves competition, by sharing knowledge to competitors and thereby raising the bar, is truly inspiring. And at the same time, daunting for many. Have we created a society where we must hang on to job-status at any cost? Not deliberatly at any rate. Service innovation can come from beyond intelligence and capability.

Or to quote Dr. G. Venkataswamy, the founder of Aravind "Intelligence and capability are not enough. There must be the joy of doing something beautiful".

Digitization of health care services

New Your times reported that Walmart is out there, marketing solutions for electronic health care records. What? That was exactly my reaction! Could the distribution strategy using Dell + eClinicalWorks trigger a tsunami for interoperability and standardization? I gues only time will tell.

But, the cat is out of the bag since the move signifies commoditisation and hopefully the much needed standardisation of information interchange. The next move is to expect these systems to "talk" seamlessly to Microsoft HealthVault and Google Health so that my doctor can actually syndicate data about me to my personal site, powered by HealthVault. HealthVault will not be run by Microsoft, but by the health care providers (but powered by Microsoft technology).

The Obama stimulus package can actually stimulate better services as a side effect. Now, I wonder when this type of services would arrive here in Norway? Today, I still have to look at the screen on my doctors PC to see the medication he prescribed or the results of the tests he has conducted..... and then I need to go to the hospital to see the records they have of me there.. and then to the Emergency ward to see what they have on me. I'm sure you get the get the picture.

I hope Walmart's strategy succeeds (I do not own any Walmart shares). Its just that we may then be able to see some creative services emerging.

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.