Wednesday, November 12, 2014

Speech and Medical Intelligence – Allowing Doctors to Focus on Patients Not Technology

I am at Medicine 2.0 this week and will be participating on the panel Bridging the Digital Divide and will then be presenting: Speech and Medical Intelligence – Allowing Doctors to Focus on Patients Not Technology

This is an exciting time for mobile devices and while we know there is a discrepancy in the accessibility of mobile technology (I’ll be participating on the panel Bridging the Patient Digital Divide) some of this divide in access can be linked to the complexity of this technology.
With ubiquitous technology comes ubiquitous complexity - adn this is especially true for doctors who face challenging User Interfaces - captured here in this post: How Bad UX Killed Jenny. As doctors we feel we are loosing touch with the Art of Medicine


Which for many of us was the reason we started on the journey to being a healer. Physicians don’t go to medical school because they want to document and code clinical information. Doctors choose their path because of their compassion and desire to deliver care to patients in need. There are increasing physician frustrations with technology and their struggle to keep the focus on patients and not data entry.

Medicine is part science, part art. The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding but is followed by focusing on the patient not the technology. I will be presenting our prototype “Florence” that combines artificial intelligence and speech recognition to offer innovative new speech technologies that help capture and understand not just what the clinician says but what they mean. With new tools that speech enabled systems we simplify access and empower clinicians to capture information and thoughts as they occur. Through the innovative use of natural language tools, context awareness and the generation of high-value clinically actionable medical information clinical systems become efficiently integrated into care delivery process offering the opportunity for doctors to return to the Art of Medicine and focus on the patient.

Here’s a video showing off Florence



Tuesday, November 11, 2014

Bridging the Digital DIvide

This week I will be at the Medicine 2.0 Conference on a panel Bridging the Patient Digital Divide moderated by
Melody Smith Jones


and includes
Lauren Still

and
Nick Genes


The session was put together by Melody to take on the oft talked about but perhaps poorly understood “Digital Divide”. Patients spend less than 1% of their time with doctors - the balance of our time represents (lost) opportunity to interact with people helping them live fulfilling healthy lives and making the best possible choices.
On average, patients only spend 1% of their time in the clinical care setting.  Traditional medicine has focused upon patient engagement during that eight minute doctor visit.  Yet, it is the other 99% of the time, when patients are at home, at work, at school, and in their communities that matters most.  It is outreach to patients while they are living, working, and playing that determines how their overall wellness is managed.
We have seen a plethora of technologies that attempt to address this area with everything from diet and fitness apps to specific applications designed to address long term health issues.
But there is variability with access in the community to information technology preventing access and knowledge and skills necessary to derive the value from these tools. Melody has addressed this divide specifically focusing on apps doe Low-Income Mothers in her recent post: 3 High Health Apps for Low-Income Moms. Check out Melody’s top 3 picks for low income mothers - some great apps focusing on the Food stamps including clever use of Bar code scanning technology to check eligibility of food and the nutritional value and a novel use of simple text messaging to improve maternal and newborn health <----- approach="" font="" love="" of="" simplicity="" the="" this="">

As she points out many of us make assumptions about accessibility to technology in lower social economic groups- as she puts it
Many make an assumption that those with low income or low education levels would not have mobile technology to use in the first place
But despite the budgetary restrictions we see a very high level of adoption of mobile technology - this is true worldwide as demonstrated by the statistics of mobile phone in the world: More People Have Cell Phones Than Toilets, U.N. Study Shows.


Out of the world’s estimated 7 billion people, 6 billion have access to mobile phones. Only 4.5 billion have access to working toilets.

In one of my personal areas of passion - Africa that is replete with examples of successful use of technology to impact the health of the population at levels that we can only dream of here in “the West".  Here in this study: Text message reminders improve healthcare practice in rural Africa
and this piece in the Atlantic: Medicine by Text Message: Learning From the Developing World

It might seem counter intuitive to spend money on what some might consider a luxury or discretionary spend - but for some this is the only means of communication replacing the plain old telephone line (POTS) and these devices come with capabilities and a reach that was pervasively unavailable to many in our society. The statics suggest as many as 80% of low income consumers own a mobile device.

But despite this opportunity the technology and apps are often times targeted at the higher income who already have fitter healthier lifestyles. Some of this is because of the existing developer community (higher social economic group) who develop for the problems they perceive and the harsh economics - this is where the money is (or at least we think it is). Despite Malaria being such a big killer there is limited investment in prevention and treatment of the disease as it affects the poor nations with limited capacity to buy any solutions that are developed despite significant progress and the impact of World Malaria Day


This was covered eloquently by J.C. Herz at wired in this piece: Wearables Are Totally Failing the People Who Need Them Most. We are awash with wearables, new devices and new apps and buckling under a Tsunami of data but:
...developers continue flocking to a saturated market filled with hipster pet rocks, devices that gather reams of largely superficial information for young people whose health isn’t in question, or at risk. It’s a shame because the people who could most benefit from this technology—the old, the chronically ill, the poor—are being ignored. Indeed, companies seem more interested in helping the affluent and tech-savvy sculpt their abs and run 5Ks than navigating the labyrinthine world of the FDA, HIPAA, and the other alphabet soup bureaucracies.
There are some economic reasons for these current trends, some social aspects of the development community but these may be based on false belief of the economics when you consider the opportunity exists to shake up the $2 trillion annual cost of chronic disease….!
I’m with Kabir Kasagood, director of business development for Qualcomm Life who said
Go from the children’s table to the grown-up table...If you’re serious about this, embrace the FDA. Learn how HIPAA works... move away from fitness and go hardcore into health. That’s where the money is
Around 45% of US adults are dealing with at least on chronic condition and picking on one Diabetes and look at the market opportunity of $6.3 Billion spent on blood glucose strips gives you a sense of the economics of this market. These are motivated people for whom the quantified self can mean the difference between an (expensive) admission to hospital or managing and improving at home.
At some point, you’ve got to ask yourself whether it’s just the friction created by health-industry regulation—the HIPAA security rules and FDA approval (or waiver) process and the hassle of integration with legacy systems. Or is it too daunting for a twenty-something engineer to develop technology for people who aren’t like them at all? An obese diabetic on a motorized scooter? Or a frail old lady with memory loss? Or her caregiver? Someone who’s three bus transfers away from a doctor’s office? 
We plan to address these issues in our panel - if you can’t join us maybe you can join the conversation using the hash tag from the conference #Med2 here at Symplur

Monday, November 10, 2014

Dunkirk Spirit: How physicians support patients overcoming adversity

This article originally appeared on WhatsNext: Healthcare
One in eight U.S. women will develop invasive breast cancer over the course of her lifetime.  In 2014 alone, an estimated 295,000 new cases of invasive breast cancer are expected to be diagnosed.  That’s approximately 808 cases per day.

That’s ~640 cases per day or a little over 1 case per hour (26 per day)1

But these statistics don’t matter.  Whether it’s one-in-eight or one-in-3 million, the impact of the illness is what matters—not the numbers.  It immediately becomes a reality to you.  We can never forget that healthcare is personal, something my colleague, Melissa Dirth, articulated beautifully in her recent post “When 1 in 8” was no longer just a statistic to me.”


As a physician, sharing unfavorable findings and test results is always a sobering moment, no matter how many times you’ve done it before.  We all struggle to find the right words, and look for ways to be supportive as you allow your patient to handle the shock that accompanies such news.  We all have different viewpoints and our perspective on the disease is colored by our own life experiences and the individual circumstances.

What never ceases to amaze me, however, is the strength of the human spirit.  Despite the hard road stretching before them, so many of our patients face breast cancer with what the British would term “Dunkirk Spirit,” that inner strength that helps patients and their families overcome tremendous adversity.

Dunkirk Spirit



It is, in my opinion, one of the reasons that make cancer sufferers and survivors such an important and compelling tableau of courage.

Unfortunately, one of the essential elements that quickly becomes lost in the morass of technology is the Art of Medicine, and our ability as doctors to spend the time focused on our patient and their relatives.  As clinicians, we intuitively know the statistics associated with the disease and can interpret them to understand the impact the diagnosis we have just communicated with the patient is likely to have, but there is so much more to providing care.  We don’t just treat the condition, the physical body—we are caregivers and healers, and we seek to help the whole patient.

Technology can help in healthcare, but it is not the goal nor should it ever be the focus.  Yet, in some cases, it has detracted from our ability to provide care and compassion.  To deliver on the promise of great healthcare we have to return to the Art of Medicine and enable, not disable, our clinicians with the technology we develop.

To learn more about the role technology plays in the Art of Medicine, read: “There’s no room in technology in end-of-life care decisions"

Monday, October 27, 2014

The #EMR, #Ebola and #Bigdata - what Can We Learn

After all the hype and knee jerk politics and media I was delighted to read this piece Ebola US Patient Zero: lessons on misdiagnosis and effective use of electronic health records by Upadhyay,  Sittig and Singh (PDF file here)

A thoughtful piece that drilled in to the detail of events surrounding the arrival and subsequent consultations, admission and treatment of Thomas Eric Duncan

who sadly died on October 8 succumbing to the ravages of the Ebola virus

As the authors state
The mishandling of US Patient Zero is receiving widespread media attention highlighting failures in disaster management, infectious disease control, national security, and emergency department (ED) care.....also brought decision-making vulnerabilities in the era of the Electronic Health Record (EHR) into the public eye
Much of the commentary generated "fear, uncertainty, and doubt about the competence of our health care delivery system" and while there were problems I agree with the authors that this is a “teachable moment”  and a chance to identify the missed opportunities and key issues that we can learn from

The authors used the publicly available documents and testimony in their quest and it is important to note that they did not have access to the full record, the EMR used or indeed all the pieces of the puzzle and made up for this in some areas with educated guesses.

It is interesting to note that in the first visit to the ED the patient's temperature spiked to 103 degrees accompanied by pain described by the patient as 8/10 in severity.
This from a Malaria Study but typical of the Spike in Temperature found with this disease

He was diagnosed on initial discharge included sinusitis but "but that CT scans of “head and abdomen” ordered during the ED visit showed no evidence of sinusitis" and perhaps with more attention and importantly time made available to the clinical staff would offer them the opportunity to focus on the history and examination and less on high tech investigation. In many cases clinicians are forced into their use not by clinical practice but rather to meet the production pressures - as the authors put it
A host of system-related factors detract from optimal conditions for critical thinking in the ED, leading clinicians to lose situational awareness. These include production pressures, distractions, and inefficient processes
The upshot was a discharge and subsequent return days later at and even then:
even after the second ED visit which led to hospitalization, strict Ebola isolation precautions were not followed for 2 days, until the diagnosis was confirmed by the CDC
Offering a window into the events that is made so much easier with the benefit of 20/20 hindsight

The authors offer some learning opportunities that are worth highlighting

Top of the list in would be working with software developers to improve EHR usability
As this case illustrates, EHR-based clinical workflows often fail to optimize information sharing amongst various team members, leading to lapses in recognizing specific clinical findings that could aid in rapid and accurate diagnosis
As an interesting addition none of the systems (or incentives) have any form of feedback loop built in to allow clinicians to learn from their actions.

As for the process of information capture - we have lost site of the information that is relevant in the fog of billing and regulatory driven template driven charting.
Condition-specific charting templates, drop-down selection lists, and checkboxes developed in response to billing or quality reporting requirements potentially distort history-taking, examination, and their accurate and comprehensive recording.. Clinicians also tend to ignore template-generated notes in their review process; often the signal-to-noise ratio in these notes is low. EHRs can lead to less verbal exchange, which is all the more needed and more effective when dealing with complex tasks and communicating critical information 
Right on except to say this does not "potentially distort history-taking" - it does distort history-taking and
not "EHRs can lead to less verbal exchange" - EHRs do lead to less verbal exchanges

The data entry requirements place an enormous burden on our clinical professionals

who are tasked and measured not on clinical practice and the delivery of great care but on specific content of documentation that is mandated to capture clinical information in specific ways determined by the reimbursement, coding and regulatory system.
Other factors, such as heavy data entry requirements and frequent copy-and-paste from previous notes, detract from critical thinking during the diagnostic decision-making process... For EHRs to be most effective, they need to be able to automatically sort through patient data, identify the pertinent findings, and present them in an easy to understand manner. Computer algorithms could combine patient-specific information with the latest evidence-based clinical knowledge to help clinicians reach the correct diagnosis
This is the next frontier of Healthcare technology and in particular clinical documentation - we know we can sort through patient data, identify the pertinent findings - focused in these examples on quality of care and evidence based guidelines and we know computer algorithms can use patient specific information combined with evidence based knowledge to help

Technology can help but there are some fundamental flaws in the design and management of healthcare that are fed by the current incentives. Many initiatives attempting to improve patient safety and value-based purchasing but don't focus on accuracy and timeliness of diagnosis and in particular Outpatient reimbursement policies do not reward diagnostic decision-making, teamwork, or quality time spent with the patient in making a diagnosis.

What you incent is what you get and this needs to be changed as well.



Wednesday, October 22, 2014

Tracking #Ebola Effectively hindered thanks to #ICD10 (double) delay

This graphic
Offers a timely reminder that the US Government delayed a second time the implementation of ICD10 coding system that is used in the rest of the world

There is no code for Ebola in ICD9 - just a non-specific 078.89: Other specified diseases due to viruses which covers:

Disease Synonyms
Acute infectious lymphocytosis
Cervical myalgia, epidemic
Disease due to Alpharetrovirus
Disease due to Alphavirus
Disease due to Arenavirus
Disease due to Betaherpesvirinae
Disease due to Birnavirus
Disease due to Coronaviridae
Disease due to Filoviridae
Disease due to Lentivirus
Disease due to Lone star virus
Disease due to Nairovirus
Disease due to Orthobunyavirus
Disease due to Parvoviridae
Disease due to Pestivirus
Disease due to Polyomaviridae
Disease due to Respirovirus
Disease due to Rotavirus
Disease due to Spumavirus
Disease due to Togaviridae
Duvenhage virus disease
Ebola virus disease
Epidemic cervical myalgia
Infectious lymphocytosis
Lassa fever
Le Dantec virus disease
Marburg virus disease
Mokola virus disease
Non-arthropod-borne viral disease associated with AIDS
Parainfluenza
Pichinde virus disease
Tacaribe virus disease
Vesicular stomatitis Alagoas virus disease
Viral encephalomyelocarditis
Applies To
Epidemic cervical myalgia
Marburg disease

ICD-10 has one specific code for Ebola: A98.4 - Ebola Virus Disease
Clinical Information
A highly fatal, acute hemorrhagic fever, clinically very similar to marburg virus disease, caused by ebolavirus, first occurring in the sudan and adjacent northwestern (what was then) zaire.

Accurate tracking and reporting stop at the border of the United States

This is one of many examples of codes "missing" in ICD9 for conditions and care we are already delivering and dealing with

Wednesday, October 15, 2014

Connected Health and Accelerating the Adoption of #mHealth

I attended the Connected Healthcare Conference in San Diego yesterday
Accelerate mHealth Adoption: Deliver Results through Data Driven Business Models for End-User Engagement

Never has there been so much to play for in the mobile health landscape, a revolution is just round the corner with key players from the health care and consumer markets coming together to develop the mHealth industry. This Connected Health Summit will create a bridge bringing together hospitals, clinicians, providers, payers, software and hardware innovators, consumer groups and the wireless industry.

You can find the agenda here and the organizers will be publishing the presentations - there were many interesting insights

Andrew Litt, MD (@DrAndyLitt) (Principal at Cornice Health Ventures, LLC) opened the conference with a great overview of the industry and a slew of challenges and opportunities.

He sees our industry in Phase 1 - the Capture and Digitization of records
and we have yet to really move and explore Phase 2:
Move and Exchnage Data AND Analyze and Manage Data that is linked to Information Driven decision Making
And Phase 3:
Managing Patient Health
In our need to move from data to analysis and information he cited a statistic from a white paper: Analytics: The Nervous System of IT-Enabled Healthcare that sadly puts 80% of data in the EMR unstructured.
This is a fixable problem today with Clinical Language Understanding and we are seeing some results and a change in the industry to stop looking to doctors to be data entry clerks
He also cited Hospitals:
Technology offers tremendous scope to not only fix these problems but get ahead of the problem (as is done in other industries like the Airline industry that has rebooked your flights before you even land and miss your connection). As he suggested could we use data to understand who is likely to develop a heart attack in the next 2 hours and try and change this outcome

But integrating mHealth into our workflow requires an mHealth Ecosystem:

mHealth needs an ecosystem that improves workflow and integrates data to reduce clinicians workload. This is why doctors and clinicians are resisting mHealth - they don’t like the change to the workflow that has little if any positive effect (for the doctor - they may have a positive effect for the individuals health) of reducing clinicians workload

Interesting comment on wearables and the perspective of doctors on these devices:
What bothers the doctor - mostly the people who are buying and using wearable fitness/activity trackers are the people that are young healthy fit and want to prove to (themselves/others) that they are young fit and healthy?
His graphic on Security and privacy was on the money:


Essential to balance Privacy of Health with interoperability but trust is the imperative
The stats he presented were troubling (at best)

  • 96% - Percentage of all healthcare providers that had at least one data breach in the past two years
  • 18 Million - Number of patients whose protected health information was breached between 2009 and 2011
  • 60% - Proportion of healthcare providers that have had 2 or more breaches in the past 2 years
  • 65% - Proportion of breaches reported involving mobile devices
  • $50 - Black market value of a health record

The healthcare industry is under attack and is the most attacked industry today:


You might find these figures of the value of Healthcare data as it is valued on the black-market

Another interesting data point:

HIMSS records a total of 11,000 Healthcare Technology companies - less than 100 are large size and the balance of 10,900 are small business that are essentially capturing and scattering your data across many systems and data repositories...
Multiple other presentations and panelists that were all insightful. As always Jack Young (@youngjhmb) from Qualcomm Life Venture fund had some great insights - impossible to capture all of them but here are some:

Healthcare is moving out of the hospital into the home for many reasons but cost is a big driver:



and he suggested there was at least $1.5 Trillion in economic value as the industry shifts (shifting vs replacement?)



Many were surprised by his stat that users check their smart phone at least 150 times per day (just looking around my world this seems low) - in fact a quick check online suggests this is no longer valid and it is probably 221 times per day. Given this device is the one thing we will not leave home without and it now contains a range of sensors including:

  • Accelerometer
  • Gyroscope
  • Magnetometers
  • GPS
  • Cameras
  • Infrared
  • Touchscreen
  • Finger print
  • Force
  • NFC
  • WiFi/Bluetooth/Cellular

We have the potential for more passive compliance with our patients (and as many stated in their presentations likely more accurate as self reported data is notoriously inaccurate)
He predicted a a 10x growth in wearables from 2014 - 2018 with 26% of this growth attributable to smart watches (I know hard to believe at this point but I think if you looked back 4 years ago the iPad had nothing like the level of penetration it does today)
iPad Growth Rate

I liked his assessment of the werable market place by researching the eBay Discount against the price of the new device:
and even worse for Smart Watches


I also presented “mHealth Reimbursement - Who Will Pay:
You can see it here at Slideshare or below:





Friday, August 29, 2014

What can we learn from Robin Williams in life and in Healthcare

Like many people the death of Robin Williams

was sad on so many levels and while my connection with him was limited to the exposure I had through his canvas of work, I like others felt I knew him.

He was not only prolific in his work with a list of films, interviews and shows (and if you have NetFlix - here's all the movies available there), but could often be found adding color and charisma in the most unusual places - in this story related by Christopher Reeve talking about his friendship as they walked past a lobster tank in a restaurant
One evening we went out to a local seafood restaurant, and as we passed by the lobster tank I casually wondered what they were all thinking in there. Whereupon Robin launched into a fifteen-minute routine: one lobster had escaped and was seen on the highway with his claw out holding a sign that said, ‘Maine.’ Another lobster from Brooklyn was saying, ‘C’mon, just take da rubber bands off,’ gearing up for a fight. A gay lobster wanted to redecorate the tank. People at nearby tables soon gave up any pretense of trying not to listen, and I had to massage my cheeks because my face hurt so much from laughing.”

Bet you wish you had been there to listen in!

The outpouring of grief, sadness and accolades was no surprise and while he may not be everyone’s favorite actor or character it is hard to imagine people feeling dislike for him.

He was a serious actor who’s work included playing characters with flaws
Good Will Hunting
Insomnia


And a personal Favorite (for the teacher we all wanted to have - Captain, My Captain)
The Dead Poet’s Society

But is best known for his comedic genius and unstoppable energy that could light up any room or interaction and turn even the most somber of moods into smiles and laughter

And his comedic view of what Lobsters were thinking in a tank as he demonstrated when he visited his longtime friend Christopher Reeve and making him smile for the first time after his accident
“As the day of the operation drew closer, it became more and more painful and frightening to contemplate,” wrote Reeve. “In spite of efforts to protect me from the truth, I already knew that I had only a fifty-fifty chance of surviving the surgery. I lay on my back, frozen, unable to avoid thinking the darkest thoughts. Then, at an especially bleak moment, the door flew open and in hurried a squat fellow with a blue scrub hat and a yellow surgical gown and glasses, speaking in a Russian accent. He announced that he was my proctologist, and that he had to examine me immediately. My first reaction was that either I was on way too many drugs or I was in fact brain damaged. But it was Robin Williams. He and his wife, Marsha, had materialized from who knows where. And for the first time since the accident, I laughed. My old friend had helped me know that somehow I was going to be okay.”
The friend we all want to have...?

With that in mind it can be hard to reconcile that character with someone who would take his own life:
  • How is it possible that someone with what appeared to be so much joy and happiness who was surrounded by friends and family find themselves in such a state of despair to take an irreversible path and commit suicide?
  • How is it possible that someone who outwardly seemed to have such a sharp insight into people and laughter who could make us all laugh at the most unlikely of issues or discussions could take his own life?
  • How is it possible that someone with such a storied and successful career could drop into a state of depression with so much to live for and so many people who loved him and end his own life?
  • How is it possible that a smart, intelligent and gifted individual with so many positive aspects to his life could see no alternative to ending his life and commit suicide?

We can be surrounded by people but be all alone


In what seems eerily insightful he talked about this in his “report to Orson” in the show Mork and Mindy in 1981 where Mork meets a famous celebrity (in this case it the famous celebrity is Robin Williams): “Mork Meets Robin Williams”. You can watch part of it here
Mork learns about the nature of fame on Earth and the toll it takes on those who get swept up in it, or try this link

There has been some mention of Parkinson’s Disease and this may have had a contributing role. But the underlying challenge was his battle with depression. On many occasions he had shared his struggle with depression and substance abuse and the ongoing challenge he personally faced dealing with his disease.

The word depression is used frequently by people to describe their feelings and emotions but it has a very specific meaning in medicine and is used to describe a mood disorder:

Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a longer period of time.

Not to be confused with sadness which is a temporary feeling that is normally associated with some negative aspect of our lives or surroundings and passes

Our understanding of depression is still limited – our treatment of this disease is still in its infancy and mostly limited to broad-brush therapies that impact neurotransmitters that are implicated but not exclusively associated with depression. We have (mostly) moved past separating and isolating people from the general population (although some would argue that our prison system is the new version of the sanatorium). But our ability to treat or cure depression remains stubbornly missing.

Our understanding of the brain is limited and despite laudable attempts to jumpstart the process
The NIH BRAIN Initiative progress however remains frustratingly slow and leaves our society with a subset of the population suffering from varying degrees of debilitating diseases of our brain including depression, mania and schizophrenia and many others.

So what did Robin Williams teach us in Life

Laughter is the best medicine

It is hard to pick a single moment from his incredible repertoire, so I picked 3:
Mrs Doubtfire
Explaining Golf
 Or this medley tour of cultures and accents all done in less than 2 minutes
Laugh and laugh loudly

Being different is not just OK its what makes life worth living




Endless compassion



and the real Patch Adams


What did Robin Williams Teach us in Death


We need empathy, compassion and tolerance in our society
Empathy: The Human Connection to Patient Care

Social Media can help link people but even with these digital connections humans may still feel disconnected and alone despite outward appearances to the contrary and connecting, engaging and reaching out is even more important today in our “connected” world



Suicide is painful – not only for the unnecessary loss of life but for the trail of despair it leaves behind for all the people wondering
what if....
should have....
could have done….

I’ve experienced it with friends and still think about them. In fact I was reminded when I read about two more suicides in New York: Suicides At NYU And New York Presbyterian–2 Physician Interns Jumped To Their Deaths of two promising lives brought to a final and sad end.

Don’t let that be your legacy and reach out to someone today and remind them and yourself why life is great for both of you


Thursday, August 14, 2014

Speech and the Digital healthcare Revolution at #SpeechTek

Come join me in the conversation with my colleagues at the SpeechTek 2014 conference in Marriott Hotel in Time Square, Manhattan New York.

The Panel: C103 – PANEL: The Digital Healthcare Revolution at 1:15 p.m - 2:00 p.m. The panel moderator Bruce Pollock, Vice-President, Strategic Growth and Planning at West Interactive and on Social Media @brucepollock

I will be joined by Daniel Padgett, Director, Voice User Experience at Walgreens and on Social Media at @d_padgett and David Claiborn, Director of Service Experience Innovation at United Health Group.

We will be discussing the opportunities and challenges associated with the current digital healthcare revolution and of course how speech plays an essential role in integrating this technology while maintaining the human component of medicine that we all want. Rather than Neglecting the patient in the era of health IT and EMR

We have progressed from the world of Sir Lancelot Spratt


And the Doctor need to look at the patient not the technology perhaps in a cooperative Digital Health world like this



Is this future of Virtual Assistant Interaction good, desirable

Demo Video 140422 from Geppetto Avatars on Vimeo.

We will be discussing

  • What are the biggest obstacles to digital healthcare becoming a reality?
  • Where do speech technologies bring the most value to healthcare?
  • How will health providers, insurers, and payers provide patient support in the world of digital healthcare?


Perhaps the emerging Glass concepts improve this interaction as they are exploring in Seattle

Join us for analysis of the state of digital healthcare today and predictions for its future.

In the end

People forget what you said and what you did but they remember how you made them feel

Come join the discussion as we explore the digital technology and how it should be used in healthcare and how speech can help

Friday, July 18, 2014

Wearable Technology - An Exploding Segment

I attended a Wearble Technology conference today in Pasadena California: Wearable Tech LA

There was a wide range of technologies and innovations - everything from the mind monitoring by IntraXon’sMuse headband. Here’s their online demo video


One of the more interesting concepts takes the challenge we have all faced mastering the mechanics of walking, exercise, running and in some cases rehabilitation by placing sensors in the sole of shoes - Plantiga who have taken force analysis for our feet to a whole new level

The technology takes the static Force Plate sensor and turns into a continuous assessment 3-D tool offering an opportunity to apply this in specific sports and to help rehabilitate people who have been injured or have mechanical challenges (the side effect of capturing all this data is actually creating more comfortable shoes as they now have built in suspension and springs).
Better than this concept!

It might take a while to arrive in healthcare but in the meantime may well show up as another input device for the X-box or PS3 for a more realistic interface.

There was sensors to be placed all over the body for respiration, heart rate, muscle movement, acceleration/deceleration and even some to be ingested

A major challenge highlighted by several speakers facing all of the wearables genre was the issue of battery life
(and ironically it was the same problem I faced as I tried to capture and post social media)

The opening keynote was from Nadeem Kassam - CEO of BioBeats (Founder of Basis which is now an Intel company). His journey was one of classic rise from poor neighborhood in South Africa where he started his entrepreneur sporty selling oranges

He focused on three lessons - the first an essential learning point for everyone especially those facing healthcare challenges
Nothing is stronger than habit

He also suggested that those looking to succeed with innovation should:

  • Look for innovation outside of your industry, and
  • Don’t throw a big team or money at innovation

His story behind this was a classic one of engineers told to build a product who came back with his wearable watch that was a huge device that weighed down his arm and had a velcro battery pack under the arm!


He ended up finding his greatest engineers on Craigslist who’s references and Resume was a cardboard box full of devices that he had built.

The new concept of “Adaptive Media” which is bridging the divide between human emotion, data and the media we consume and should adapt to our mood based on our emotion. His new company has done some interesting research programs including an experiment with machines designed to allow people to hear their own heartbeat and have it set to music in Australia. When people heard their heartbeat for the first time it created a deeply emotional experience and many were moved to share very personal life stories.

They took this a step further and worked to gather heartbeats worldwide - a clever BIGData gathering exercise that amassed large quantities of rate, rhythm and details of millions of people around the world.


His overriding point was

We have to make health fun and engaging - merging it with entertainment to help people achieve what we all want - long tail of healthy life

There was a fascinating blend of the Entertainment industry and Hollywood and a slew of companies taking different approaches to these devices:

Epihany Eyewear tries to make wearables fashionable as well as functional (I’d say it not so much as fashion but blending into society)
















Optivent with  powerful wearable glass - but no mention of the interface
They probably had the most fun concept video

Les lunettes d’Optinvent voient plus grand que les Google glass from Rennes, Ville et M├ętropole on Vimeo.

Enlightened design had the most impressive on stage display with a jacket that had lapels that constantly changing color

Janet Hansen - Founder & Chief Fashion Engineer, Enlightened Designs
Sporting her jacket with lapels that constantly changed color


Sports and Wearable


Given the excitement over the last month wight he World Cup it was fascinating to hear from Stacey Burr from Adidas who revealed that most if not all the teams were using technology to help them train and track in extensive detail - she suggested that there is not a single team or sport that is not using wearable technology in some form or another.

You can see some of the gear below
GPS enabled ECG/EKG monitoring Units plug into the back around the neck area


Paired with watches to offer players feedback


Digital insides of a ball used to sense how well it is struck














These are the professional versions used by major teams but Adidas is releasing commercial versions that will be available to the general public but lack the GPS capability and the analysis tools they offer

Surprisingly the leaders from a sports and country standpoint are Rugby and Australia and New Zealand who are "light years ahead" of wearable tech in sports
They are ahead in Psyching out their opponents too!


Sensoria demonstrated an exciting interactive future for sports and wearables where we challenge ourselves, other people and are coached by virtual assistants


Sensoria Fitness Shirt with Heart Rate Sensors from Heapsylon on Vimeo.

One of the highlights:Seeing Dick Fosbury of the "Fosbury Flop” Olympic Gold Medal Winner from Mexico 1968 and it turns out he is a Cancer Survivor, has an aneurysm and fully engaged in the intersection between healthcare and wearable technology

Neil Harbisson - Co-Founder, Cyborg Foundation


who was born totally color blind was definitely at the edge of wearable technology. He has an implanted device that turns color into sound and this is directly fed into his brain. He described that it took 5 weeks for the headaches to stop with this sudden input of data and then 5 months before it just became part of him and he now sees in color.
Here's his TED Talk: I listen in Color

He also has a permanent internet connection in his brain so people cane send him colors and images directly (he joked the address is private - but I did wonder given the ease with which spammers seem to find new addresses how he protects this destination from spam!)
I don't wear technology I am technology, I can't tell the difference between the software & my brain

The healthcare focused panel: Emerging Wearable 2.0 Health Platforms:

The furthest along and well know was probably Misfit wearables (Sonny Vu, CEO) who try and make sensors “disappear” but still simple sensors

OMSignal (Jesse Slade Shantz - Chief Medical Officer) was the most interesting as they are trying to change the monitoring from attached sensors to using fabric that can be loose fitting but can capture physiological information.

Breathometer (Charles Michael Yim - CEO) focus on analyzing your breath and have a range of products directed at health (over and above their simplistic alcohol breathalyzer available today) that assessed fat burning (using acetone) and asthma

NeuroSky (Stanley Yang - CEO) offer a system that other manufacturers can integrate into their wearables. Typically found in mobile phones or headsets

LUMO (Monisha Perkash - CEO & Co-founder) offering a discreet sensor that is designed to help improve your body posture and works as a tracker.

It's an exciting future with some fascinating technology to come - one thing for sure - with ubiquitous technology comes ubiquitous complexity and your voice will become an essential tool for successfully managing and navigating. Dragon Assisatnt is one of several tools built to assist in using and navigating technology that is reinventing the relationship between people and technology