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Say It Loud, I’m a Gimp and I’m Proud!

Apologies to James Brown for the title of this post, as his 1968 funk classic “Say It Loud, I’m Black and I’m Proud” (click here to listen) helped galvanize the civil rights movement in America, offering a joyous rallying cry to people who for far too long had suffered at the hands of racism and oppression. The song was not only a shout of protest, but an admonition to embrace the very thing that conferred minority status on an entire people and turn what for some had at one time been a mark of shame into a badge of honor. On top of all that, the song irresistibly generates the urge to get up and shake your groove thing. That is, of course, if you are able to get up at all.

Those of us whose disease has progressed to the point where shaking our groove things is a distant memory and has left us visibly disabled – reliant on canes, walkers, or wheelchairs – also find ourselves members of a minority group, the disabled, the inclusion in which leaves some feeling invisible, helpless, and diminished. Much of the world simply isn’t designed for people who don’t have full use of their limbs, and the fully functional folks who populate it can be insensitive, uncaring, ignorant, and sometimes even intolerant. Though much progress has been made in in the fight for the rights of the disabled, the struggle is closer its beginning than its end.

Throughout much of history, victims of chronic illness, particularly of the kind that deform or disable, have often been looked upon with scorn, as if getting sick was somehow a mark of shame, the afflicted somehow responsible for their own affliction.

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Reverse Innovation & The Cost Crisis in American Healthcare

The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. “Reverse innovation” describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States.

The traditional model of innovation has involved the creation of high end products by companies in industrialized nations and the spread of these products to the developing world by adapting them to function in low and middle-income countries. Reverse innovation reverses the direction of spread with the United States borrowing new ideas and products designed for less wealthy countries in order to deliver health care more efficiently. (1)

Resource challenged low and middle-income countries are different from the United States in at least six ways that can serve as catalysts for such reverse innovation: 1) affordability, 2) leapfrog technologies, 3) service ecosystems, 4) robust systems, 5) new applications, and 6) the absence of intermediaries. (2,3)

These nations can’t afford expensive goods so they have to find inexpensive materials or manufacturing options. They also lack 20th century infrastructure and so they have leapfrogged to newer technologies such as mobile phones or solar energy instead of landlines and petroleum based energy sources. Service ecosystems develop in developing countries because entrepreneurs have to rely on others for help by creating new partnerships like video-game cafés where gamers test new products. Emerging markets require products that work in rugged conditions, and customers in poor countries have few product choices, providing market openings for add-ons that update and extend the lives of existing merchandise. (2) Intermediaries such as venture capitalists, universities, and regulators are also often underdeveloped in poorer countries. (3)Continue reading…

The Doctor is Social

Doctors and hospitals are going social, adopting social media for professional and clinical use, based on surveys conducted in mid-2011 by QuantiaMD and Frost & Sullivan and the Institute for Health Technology Transformation (iHT2).

In Doctors, Patients & Social Media, dated September 2011, QuantiaMD and the Care Continuum Alliance report a high level of physician engagement with online networks and social media. Two-thirds of physicians are using social media for professional purposes, and see potential in the use of these channels to facilitate patient-physician communication. The survey found a cadre of “Connected Clinicians” who use multiple media sites to positively impact patient care. Over 20% of clinicians use 2 or more sites.

Only 1 in 10 physicians is familiar with one or more online patient communities, as the first chart illustrates. Among those who know about at least one community, a majority believe the sites have a positive impact on patients (either very positive or positive in the survey response). This is true across various condition categories, especially for rare diseases, cancers, chronic conditions, maternal and child health, and wellness/prevention. As one physician shared anecdotally, “Patients can share their stories, learn from others, spread knowledge, and instill hope.”

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Health Plan Nutritional Facts

It’s official now.  The government has proposed that descriptions of health insurance policies will resemble those nutritional labels on canned and packaged foods—the ones you look at to find out how much sodium there is in Birds Eye peas versus the A&P brand.  Instead of getting the scoop on salt or sugar, shoppers will learn what they have to pay out-of-pocket for various medical services.  They’ll also get some general information, like what services are not covered, and how much they’ll have to pay for maternity and diabetes care and breast cancer treatment, all organized in a standard format designed for easy comparison shopping.  Insurers will have to translate common insurance jargon into plain English.

The health reform law requires these “Coverage Fact Label” disclosures, and tasked the National Association of Insurance Commissioners (NAIC) with creating them.   The NAIC released some samples a few weeks ago.  Theoretically, consumers armed with this information will choose wisely, and as free-market advocates say, their choices will regulate prices that insurers will charge.   If consumers choose the low-cost plans, then prices will come down and policies with the best benefits will flourish.

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Who will be the Salesforce.com of Healthcare IT?


Last week was the massive Salesforce.com user conference Dreamforce (massive in that there were more attendees at Dreamforce then this year’s HIMSS!). We’ve been reviewing more than a few articles and writings written by those who attended the event. In the few short years of its existence (~13yrs) Salesforce.com has become one of the leading Customer Relationship Management (CRM) vendors in the market and basically pushed the previous leader Siebel to the brink and into the arms of Oracle. Salesforce is arguably the leader in the Software as a Service (SaaS) market and thus someone to pay close attention to on all things “Cloud Computing.”

So what makes Salesforce.com so compelling and what are some parallels to the healthcare sector?

Similar Market Demographics: From the beginning Salesforce has always been structured as a SaaS and targeted the hard to reach and highly distributed sales forces of companies of all sizes. Actually, they first targeted the small to medium business (SMB) market and once successful there, went after Siebel in big enterprises. In healthcare, the vast majority of care is provided by small, 1-3 physician practices that are highly distributed across the country – perfect target for a hosted SaaS offering.

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Decision Fatigue

We’re all suffering from information overload.  More projects with fewer staff on shorter timeframes mean more email, texts, blogs, online meetings, and phone calls.

We make more decisions and have more accountability than ever before.  Regulatory complexity and the need for risk management has increased.  We’re pressured to make decisions faster and there is less tolerance for mistakes.   Making all those decisions in a high stakes environment like healthcare leads to decision fatigue,  that numbness you feel at the end of an overloaded day when you decided what to spend, who to hire, and what to do, hundreds of times.

I believe decision fatigue is an escalating threat to our ability to manage the events of each day and keep balance in our lives.

When I think back on my early career as a leader, in the 1980’s, there was no email, no overnight shipping, and limited numbers of fax machines.

Issues were escalated by writing and mailing a letter.    The time it took to compose, type, mail, and deliver a letter meant that many problems solved themselves.  Since the effort to escalate was significant, many problems were never escalated.Continue reading…

Data to the User!


NEW YORK – Customer data is a concept that most companies, especially those involved with health and health care, see as a threat rather than an opportunity. Most companies associate consumer data with “privacy,” seeing only expensive disclosure requirements, constraints on their ability to collect information about their customers, and a potential source of legal trouble.

So they consult lawyers and IT risk specialists to consider their options. To protect against being sued, they write lengthy disclosure statements that cover every possible use of consumers’ data. They then hand these statements to their marketing departments, who hide them behind little windows in small type.

In general, these companies see consumer data as something that they can use to target ads or offers, or perhaps that they can sell to third parties, but not as something that consumers themselves might want. In fact, many so-called privacy advocates have the same constricted vision. Most pundits on either side don’t consider that  that rather than hiding from consumers or protecting them, companies should be bringing them into the game.

Over time, I’m convinced, successful companies will turn personal data into an asset by giving it back to their customers in an enhanced form – analyzed and visualized into something of value to the individuals themselves. I am not sure exactly how this will happen, but current players will either join this revolution or lose out.

Let’s start with the disclosure statement. Most disclosure statements are not designed to be read; they are designed to be consented to. But some companies actually want their customers to read and understand the statements. They don’t want customers who might sue, and, just in case, they want to be able to prove that the customers did understand the risks. A regretful customer is a vengeful one.  (The very best companies want this because they like their customers to understand what they’re getting.)

So the leaders in disclosure statements right now tend to be financial and health-care companies – as well as my favorites, space-travel and extreme-sports vendors. Right now,  some clinical trial operators and the “extreme” companies are doing the best job – perhaps in part because some of their customers actually appreciate the element of riskContinue reading…

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