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Saturday, November 16, 2013

NYeC 2013 Digital Health Conference Day Two

Day two, final day, actually. Wish they could do a 3-day conference. I think there's certainly enough material.

In the Grand Ballroom, A/V actually managed to fire up some overhead fresnel floods, though the above-stage banks of pars remained dark. Lighting was marginally better. Marginally.

NYeC Executive Director David Whitlinger kicks things off, introducing the day's Keynote Speaker, Obama 2012 Re-election Campaign ("OFA") Director Jim Messina.

The air was thick with anticipation: would he address the obvious question surely on all minds -- what about the rollout fiasco? We know you're hear to regale us regarding the brilliant Obama 2012 tech smackdown of the hapless Romney-Ryan presidential bid, but how can essentially the same people screw up the PPACA launch so miserably?

He dispensed with it jokingly right up front. He had nothing to do with He would go on to later point out the major problem that is federal procurement. There was no was to simply hand off PPACA HIX to the OFA techies.

Yeah. We know that. But, still, federal procurement is a venerable beast, a long-known quantity. To get blindsided by its upshot remains rather inexcusable.

But, not his gig. Not his purpose here.

He did, in fact dazzle us with power of adroitly captured, analyzed, and managed data, and OFA's adept, central use of social media.

Romney-Ryan never knew what hit them. In fact, reports have it that they'd not even prepared concession speeches, so hubristically certain were they of victory on Election Eve. Pride indeed Goeth Before a Fall.

Above, the money shot graph. While Gallup and the other mainstream political media polls showed wildly variable swings in relative Ups/Downs, internal OFA analytics had the President consistently way up. Messina said he told the President, as election day drew nigh, that he was sure that Mr. Obama would be re-elected in an Electoral College blowout, that their finely-tuned Big Data analytics could not be wrong. They could drill right down to the front-door level, precinct by precinct, and capture every available vote. They could ID every Facebook friend and Twitter follower of every Undecided and leverage them for "personal validation" (i.e., you are most amenable to persuasion by your circle of friends).

OFA nailed it. It is a compelling tale. Once NYeC posts the video of Mr. Messina's keynote, I exhort everyone to view it.

What he didn't say, but what had to have been a factor, was a slick Rope-A-Dope element. To mix my metaphors, Romney was playing checkers against a pool shark. The pool parlor hustler always seems to be lucky and just one ball better than you, as he patiently cleans out your wallet (this once happened to me, long ago). OFA was content to work this principle against the poignant Mr. Romney. Fine, let Mrs. Romney measure the White House drapes. Stroke those conceits, actually. Send her the catalogs, gratis.

What are the implications for health care?

Mr. Messina showed us a color-coded data visualization "enrollment" map of Manhattan. Again, can the Obama Administration use the OFA techniques in the service of PPACA enrollment ends?

We shall see. Things are not looking all that swell at the moment.

Off to JFK for my flight home to SFO. Been a great experience. Thanks to NYeC for having me.

But, first, before I go, apropos of well-being and Health IT...


Got home late Saturday night. Took Sunday off from computer stuff. It was a Lowe's, Bed, Bath & Beyond, and Target kind of day with my sweetie, one ending with some nice Cabernet, a great salad, and the Denver-Kansas City game.

Let me pick back up on Day Two thoughts.

Below, saw my friend Salim Kizaraly, Chief Corporate Officer & Principal Consultant at Stella Technologies. We met earlier this year at the HIMSS California State HIT Day event in Sacramento. Really nice man.

They were attending to promote their new Caredination continuity of care application. I wish them the very best with this effort.

Above, Google Glass Man was in attendance. First encountered him back at Health 2.0 2013 in Santa Clara. He apparently didn't get the attire memo.

Below, Rachel Davis, MPA of the Center for Health Care Strategies, spoke during the afternoon concurrent session "Power to the People: Bringing Technology to Medicaid’s Most Complex and Expensive Patients." Yeah, our costly "frequent flyers" a.k.a. "hot spotters."

I was reminded of the great lunch conversation I had with Karen Tirozzi of Their model:
When patients and their families seek medical care, they often face critical challenges in their lives at the same time – they have little food, they have no job, they struggle to keep up with bills for gas and electricity.  Not surprisingly, these challenges affect their health.

With Health Leads, doctors and other healthcare providers are able to ask their patients: Are you running out of food at the end of the month?  Do you have heat in your home this winter?

Health Leads enables healthcare providers to prescribe basic resources like food and heat just as they do medication and refer patients to our program just as they do any other specialty.  We recruit and train college students— Health Leads Advocates – to fill these prescriptions by working side by side with patients to connect them with the basic resources they need to be healthy.
That is a wonderful effort. I hope they bring it to the west coast. Our conversation, and Rachel's presentation reminded me of a Reporting on Health webinar I'd attended, which led me to this book, The Upstream Doctors: Medical Innovators Track Sickness to Its Source.
[P]hysician Rishi Manchanda says that our health may depend even more on our social and environmental settings than it does on our most cutting-edge medical care. Manchanda strongly argues that that the future of our health, and our health care system, depends on growing and supporting a new generation of health care practitioners who look upstream for the sources of our problems, rather than simply go for quick-hit symptomatic relief. These upstreamists, as he calls them, are doctors and nurses on the frontlines of medicine who see that health (like sickness) is more than a chemical equation that can be balanced with pills and procedures administered within clinic walls. They see, rather, that health begins in our everyday lives, in the places where we live, work, eat, and play. Upstreamists know that asthma can start in the air around us or in the mold in the walls of our homes. They understand that obesity, diabetes, and heart disease partly originate in our busy modern schedules, in the unhealthy food choices available in our stores, and even in the way our neighborhoods are designed. They recognize that depression, anxiety, and high blood pressure can arise from chronically stressful conditions at work and home, and that such conditions can even affect our DNA. And, just as important, these medical innovators understand how to translate this knowledge into meaningful action. If our high-cost, sick-care system is to become a high-value, health care system, the upstreamists will show us the way.
 Yeah. I have this in my Kindle reader on my iPad.
In this book, I argue that the future of health care depends on growing and supporting more “upstreamists.” These are the rare innovators on the front lines of health care who see that health (like sickness) is more than a chemical equation that can be balanced with pills and procedures administered within clinic walls. They see, rather, that health begins in our everyday lives, in the places where we live, work, eat, and play. Upstreamist practitioners — who may be doctors, nurses, or other clinicians — know that asthma can start in the air around us. They understand that obesity, diabetes, and heart disease partly originate in our busy modern schedules, in the unnatural food choices available in our communities, and even in the way our neighborhoods are designed. They know that ailments such as depression, anxiety, and high blood pressure can arise from chronically stressful conditions at work and home. They see how policies that afford or deny opportunity, fairness, and justice can be reflected in patients’ faces as well as in their DNA. And, just as important, these caregivers understand how to translate this knowledge into meaningful action. The upstreamist considers it her professional duty not only to prescribe a chemical remedy but also to tackle sickness at its source. I use the term “upstreamist” intentionally because I want to expose the shortcomings in the way we have come to define health and the role of medicine in improving it. There aren’t nearly enough of these pioneers, but if you look around in health care today, you’ll find them. They work in small practices and community health centers, in hospitals and large health care systems. Their stories are not widely known, though in some places these innovators have been around for a while as known and beloved neighbors. The upstreamists care for patients, but they also redesign the way clinics and hospitals improve health for people and entire neighborhoods. They leverage emerging technologies, build partnerships with patients and the community, draw on skills and approaches outside of medicine, and lead and participate in teams of health care professionals and community-based partners. Together, they demonstrate that medicine can do better when it works to improve health where it begins: in the social and environmental conditions that make people sick or well. If our high-cost sick-care system is to transform into a high-value health care system, the upstreamists’ paradigm and practices will make the difference.

I could not agree more with these sentiments.

Below, another excellent concurrent session I attended, the "Better Healthcare by Design" panel.

How Data Visualization, Behavior Change Techniques, and User-Centered Design Can Create Successful Products
You may have been hearing about the importance of ‘good design.’ But what does that really mean? How can better design make a difference in healthcare? How can it create more intuitive and delightful products, services, and experiences? What trends should you be paying attention to? This panel will feature lightning talks by four healthcare-focused designer-panelists, followed by discussion and a brief Q & A. Each speaker has a unique perspective with regard to healthcare: they are specialists in human-centered design, service design, behavior change, data visualization and self-tracking—some are patients, and some consultants—but everyone has had extensive experience designing for healthcare. Over the course of the panel we’ll explain why you should care about design, we’ll highlight a few inspirational examples of successful design in healthcare, and we’ll give you a few tips you can start using tomorrow to nudge your organization toward a design mindset.
 In sum, this was mostly about "usability," a word that implies much more than simply cute, easy-to-navigate apps UX. Panelist Steve Dean spoke in some detail regarding the need and methods for assuring "participatory design." One wishes that the EHR vendor community had paid more attention to this idea. A principal beef among clinicians remains the too-frequent IT-centric, workflow-clueless focus of Health IT (though, in fairness, things are better now than when I started with the REC initiative).


Starling Health was present, demoing their inpatient bedside "call button" app.


I'm still weeding through my stash of exhibit hall literature, looking for serious nuggets amid the predictable marketing hype.  

"Strategic Interoperability." Seriously?

Well, this conference went by quite quickly. Poof, it's Friday night. Off to ramble about mid-Manhattan.

I ended up in an Irish pub on W. 46th street, just across the street from where my 1964 band's manager the late Mort Browne had his office. What he saw in us naive 18 yr olds back then I'll never know.


On the bar in the pub was the day's edition of The New York Post.

Oh, yeah, that.

A Bushmill-fueled conversation ensued with the fellow sitting next to me at the bar. Duncan is a Morgan Stanley desk trader. He launched into a bitter tirade against Obama and the PPACA and government more broadly. It was equal parts textbook Tea Party, Wall Streeter anti-Democrat animus, and Ayn Rand. I just let him rant on; a little bit of Socratic probing here and there, but, it was clear I wasn't going to make much of a dent in his attitude, so I kept my responses and questions pretty non-combative. I was just out to have a bit of R and R anyway.

Man! the venom.

Whatever. "Duncan, I'm just in Healthcare Technology, man, I'm not in Policy."


He did ask me a tech question. He said he pays for concierge medicine, and is very worried that the feds will force his doc to go electronic even though the practice does no 3rd party billing.

Pretty paranoid. Pretty simplistic.


Fifty years before Obamacare, JFK had his own health care debacle.

In the spring of 1962, President John F. Kennedy launched a bold effort to provide health care for the aged—later to be known as Medicare. It culminated in a nationally televised presidential address from Madison Square Garden, carried on the three television networks. It was a flop. The legislation foundered amid charges that it was an attempt to socialize medicine and a threat to individual liberty—the same charges President Obama encountered over the Affordable Care Act five decades later...
...In the end, Kennedy's attempt to play both the outside game and the inside game failed. Such defeats led to the kind of appraisals that President Obama now faces as his approval ratings and personal ratings hit new lows. "There is a vague feeling of doubt and disappointment about President Kennedy," wrote James Reston in the New York Times. "He has touched the intellect of the country, but not its heart. He has informed but not inspired the nation. ... [H]is problem is probably not how to get elected, but how to govern." Fifty years later, it’s a fitting description of another president in the midst of his own health care fight.

Below, this is funny. SNL "Second Term Paxil"



Great conference, really appreciate the invite. The two keynote addresses alone were eminently worth attending for. Moreover, getting to meet the conference photographer Béatrice de Géa was a personal thrill. She is awesome. Some snips from her online portfolio:

See "A Conversation with Béatrice de Géa."
NP: Tell us a little about yourself.

BDG: I was born in the French Alps and partially raised in the U.A.E. I studied Art and Fashion Design in Paris. I met my first love in an airplane flying to California and few months later told my father I wanted to go study in California. I moved to Los Angeles in 1994. My desire was to become a reporter, but fell in love with photography after my first class. It was my way of writing.

NP: How did you discover photography?

BDG: By accident. I was under pressure to get a work permit so I had to quickly get my degree. I picked a photography class, remembering how much pleasure it was to use my mother's Foca camera when I was 13 to snap pictures of our family pets. I got an F on my first class. I didn't speak English well enough. The Depth of Field concept was first a grammatical mystery before a technical one. I met my mentor, a local photojournalist, when I was at school. He taught me a lot without telling me what to do...respecting my stubborn personality. I became very passionate about it, realizing I was really meant to do this. I felt constantly challenged and satisfied.
Lucky us.

Check this out. Béatrice:

Amazing, sensitive piece of work. Given that my late Dad spent seven years in nursing homes befuddled by ever worsening dementia, I can completely relate.


I have to confess to having been distracted and troubled during the week by the typhoon disaster in the Philippines. I remain aghast over the horror these people are enduring.

We go on about our comfy lives, attend our glitzy conferences, indulge in our entertainments (I watched the entire Alabama-Mississippi State football game from my JetBlue seat on the way back to SFO from JFK Saturday evening).

The lyrics in Sting's "Driven to tears" (which I have just about finished learning for my solo acoustic book) come to mind.
Hide my face in my hands, shame wells in my throat
My comfortable existence is reduced
To a shallow, meaningless party
Seems that when some innocents die
All we can offer them is a page in a some magazine
Too many cameras and not enough food
'Cause this is what we've seen
Driven to tears
Driven to tears
Driven to tears...

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