The KHIT Blog: "Refactored" - a jam-packed two days in Mountain View

Monday, May 13, 2013

"Refactored" - a jam-packed two days in Mountain View

Up at 5 a.m. (ugh), zip down the 680 from Walnut Creek to the Nimitz and over to the 101 and the Computer History Museum for a day in UberGeekIstan with the Cyberscenti.

www.computerhistory.org

So, "refactored" is software development slang basically synonymous with Lean/Rapid Cycle PDSA, maybe even "Agile." This conference is focused on helping health IT developers become more adept at shaping the future of health care via information technology advances. As reported in the Sacramento Bee:

"Health:Refactored not only serves as an impetus for developers and designers to leverage their skills and creativity to build and create, but it also provides a portal into the future of health technology," said Indu Subaiya, Co-Chairman & CEO of Health 2.0.

Here are the predictions:

"Technology will catalyze dramatic system-wide cost savings and efficiencies. Out of $500 billion spent annually in the U.S. on doctor visits, $125 billion translates into unnecessary costs since 25% of the visits are strictly informational. Technology will serve these patients the information they need without the physical appointment." --Sean K. Mehra, Head of Product, HealthTap

"In 10 years, human-centered data collection of medical records, observations, labs, etc., will go away in favor of body-worn health sensors that will be woven into fabrics, built-into our mobile phones, integrated into homes (e.g. toilets, sinks, etc.), and even embedded under our skin." -- Shahid Shah, HIT Expert/CEO, Netspective

"The 'wall-less hospital' will meet the empowered patient. As sensors and devices increase their power and accuracy, doctors will be able to monitor and adjust treatment approaches in real-time." -- Jan Gurley, MD, Physician and App Designer, DocGurley.com

"Food, physical activity and sleep recommendations will be personalized based on health risks, biomarkers, environmental factors, preferences and budget. They'll be prescribed by doctors and dietitians in the grocery store assisted by cutting-edge health technologies, and directly by apps." -- Jason Langheier, MD, MPH, CEO & Founder, Zipongo

"Telemedicine will allow hospitals to extend care well beyond their four walls. Consumer diagnostic devices and wearables will empower patients to proactively monitor and manage their health and physicians can transition from passive managers of health to active, ever-present participants in patients' health." -- David Chao, Senior Product Manager, MuleSoft

"In 5 years, when data is more portable and expectations are that data follows me and my care, rather than hide from my view....well, then things gets really interesting! Then we can really start getting deep, meaningful insights from all our shared data, and the pace of innovation in digital health will grow exponentially." -- Geoffrey Clapp, Co-Founder, Better

"We will shift into a synchronous 'care stream' which values preventative care over treating symptoms." -- Mike Cuesta , Director of Design and Community, CareCloud

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UPDATE: SHOTS FROM MORNING ONE SESSIONS

Some random pics...

Above, Health 2.0 co-founder Indu Subaiya

L to R: Jean Luc-Neptune, Jessica Goldband, and Edbury Enegren

Brian Sivak

Above: legendary philantropist and VC investor Esther Dyson moderates a panel discussion featuring Jim Kean and Anmol Madan.

I missed this fellow's name. He's with Microsoft. Wincingly, his slide deck would not launch. He made some anxious remark about "all of the whiteboards in the room" -- i.e., all of our MacBooks.

Atlantic Monthly journalist and author David Ewing Duncan

Health 2.0 co-founder Matthew Holt

Above and below, my hero, Doc Gurley

Ethan Prater, Castlight Health

John Mattison, MD, CMIO Kaiser

Brad Weinberg, MD, Venture Capital Investor

Again, Health 2.0 co-founder Indu Subaiya

Dr. Jean-Luc Neptune of Health 2.0

Edbury Enegren, Health 2.0

Esther Dyson

Jim Kean

The fabulous Doc Gurley

A great first day. I dressed "business professional/casual" and felt way over-dressed. While the look was totally loose and hip, the aggregate intellect on display was both humbling and inspiring. Nice summary here by Kim Krueger:

If Subaiya’s survey is any indication, the Health:Refactored crowd is pretty heavily weighted on the technical and entrepreneurial side with maybe a slightly smaller representation of designers. Attendees also seemed evenly distributed between health care veterans and health care newbies (exciting, welcome new friends!). These buckets were hardly mutually exclusive though as most everyone seems to dabble in business, and the brave seem to dabble in everything.

The questions continued throughout the day, and with the right combination of imagination, lighting, and squinting you could almost see the raised hands shape shifting into ven diagrams. We are software developers and MBAs, but on a broader scale we are patients and stakeholders interested in fundamentally changing the world...

Indeed. The fermenting mixture of optimism and applied expertise was palpable.

KP's Dr. Mattison made some interesting observations. First he noted that his son, just graduating medical school, had received virtually the same medical education that he had. The pedagogy is stuck in neutral. Brings to my mind some observations of Messrs Weed in "Medicine in Denial"

VIII. Medical Education and Credentialing as Barriers to Progress
A. Extending the health care reform agenda to medical education and credentialing

1. A century of stagnation

...Were Flexner to return today, he would find that current knowledge has he power to confer vastly greater advantage than it did a century ago. But he would not find that society reaps a greater fraction of that advantage. “Between the health care that we have and the care we could have lies not just a gap but a chasm,” the Institute of Medicine has found.

Failings in medical education and credentialing are a central reason the chasm exists. These failings are rooted in Flexner’s embrace of the university model of formal education. This model was seen as the only way to bring scientific advances to medical practice...

2. The medical school experience

According to the Institute of Medicine, “many believe that, in general, the current curriculum is overcrowded and relies too much on memorizing facts” and that “the fundamental approach to clinical education has not changed since 1910.” [pp 195 - 197]

Beyond that, looking forward Dr. Mattison proffered five fundamental areas of improvement concern:

The prevailing perverse incentive model;
Uncoordinated care / lack of prevention effort;
Opacity of pricing;
End of Life care (he cited the UK's much higher "% of deaths at home");
Lifestyle disorders.

Pretty much a recitation of the litany we've mostly all increasingly heard across the past 4-5 years.
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More shots...

Joe DeLuca, Health Care Investment Visions. Joe said "there's not much new in ObamaCare," and admonished the developer community regarding the potential for patient harm via HIT done poorly.

Jeff Schox of Schox PLC Patent Group. Excellent speaker. Looks like he's 16. He presented on patent / intellectual property protection issues for progressive health/medical apps.

Deven McGraw, CDT. Nice to see and talk with her again.

My new friend Leslie Kernisan, MD, MPH, Geriatrician, frequent THCB contributor

SATURDAY 18th UPDATE: JEFF SCHOX

I'm watching his 1st Patent / IP lecture. Excellent. Free.

Share Information, Sell Services.
___

More to come...

1 comment:

KevinJMay 17, 2013 at 3:56 PM
Great shots Bobby!
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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Monday, May 13, 2013

"Refactored" - a jam-packed two days in Mountain View

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