Data Rich but Information Poor in Health Care?

I was recently in a power lunch session in a small room full of 20 people with a mixed-bag of Analytics and healthcare to start to ask some of the key questions around what healthcare analytics actually means to them.

I could think of some of the following questions, and by no means, intended to be an exhaustive list:

  • How do we make health care more affordable?
  • How do we improve quality of care and safety?
  • How do we better deal with capacity (access to care, man-power, and delivery capacity)?

It’s amazing how analytics is becoming the new norm in aiding draw strategic insights from existing data. I find two groups of people, one group that believes we don’t have enough data, while, the other group, believe we need to be smart with the data we currently have, which is far beyond what we had even as far as 5 years ago.

It’s amazing how much data we have about a patient, diseases, treatments, spend, etc across millions of data islands, and yet, lack the ability to sit across a room and discuss strategic insights from the data we have.


Personalized Care in an Impersonal Health Care world?

What does personalized care or personalized medicine really mean for you and me as a consumer?

Let’s first look at a very situation. Say you have just started to get a headache and a running nose, and you probably have a couple of things at home or something you could pick up at your nearby pharmacy you could pick up relatively simply. How nice would it be, if you could simply figure out what is sort of wrong with you, what to do next without significant disruption to your existing schedule and plans, and based on a combination of what makes you a you, and your preferences?

That doesn’t sound all that hard? After all, a lot of people have all their schedules in their calendar (eg, iPhone, Outlok Calendar), some of the critical meetings and deliverable, and you probably have one of those iPhone apps that can take your heart rate, etc using the iPhone camera. You have probably probably told Facebook more about you than you would tell your doctor or your mother, everything from your date of birth, time of birth, and every party you’ve visited, and plan to attend. All pretty much most information you need for the computer to help you make the decision about your lifestyle is certainly there. Just need to feed it your symptoms, go through a series of questions, and off comes the recommendation that says, “buddy, how about you get take 2 tabs in the next 30 minutes while you are having this chicken rice but please stay off that 2nd glass of wine. Suggest you go home straight after, sleep straight away, so you will most likely be all set for your 6am wake-up time. You have 2 options, shall I book the taxi for you to go home, and do you want me to set an alarm for you, or call up your girlfriend to wake you up since you will probably need some extra hand? Click here to approve the recommended breakfast in the morning I can send to your maid. You might want to pick up some orange juice since you have run out of it at home which might do you some good.

I am not going to give another example if I wanted to extend this story for a chronic disease patient but I think by now, you have an idea. I also haven’t elaborated upon about “what makes you a you” discussion because I plan to spend more time talking the details of your genetic make-up that also places a key role in tailoring the health care you need.

A lot of this is already possible given the technologies available today, and we certainly have a lot of data available “all over the place”, and not necessarily put to better use for helping us plan our health better.

Callum Bir

HL7 Standards – Non Healthcare Perspective

One of my colleague from a different division was helping me organize our training room in Singapore for the all-day HL7 certification / training. Out of curiosity, he looked up HL7 on Wikipedia which provided lots of information but still needed some context.

Here’s what HL7 is “sort-of” about vs. what it is, and somewhat to adopted for the local Singapore situation. This by no mean is intended to be an official statement

The general idea of hl7, is simple, to be part of a solution to solve the problem we have in healthcare, ie, how do we as the industry better coordinate care as patient moves around from points of care, second, how do we make delivery of care safe while improving quality and finally, do this while lowering cost. There are whole layers of standards to enable all of the above.

For example, in Singapore, we have the National Electronic Health Record initiative, this is enabled by underlying standard such as HL7.


I often get excited talking about self-care and chronic disease management enabled by some of  technology trends we are seeing with smart-phones and other connected devices, but almost always meet the objection around the argument that chronic diseases are for the elderly, and the elderly don’t use smart-phones, hence, this would never work for a variety of reasons.

Call me an optimist, and, I see we only a few years away, if not sooner, before everyone will have smart-phones that will be connected always to the Internet either by 3G/4G, and if not everywhere in the world, but at least in Singapore. If it isn’t a smart-phone, it be a smart-TV that will keep out citizens / patients connected. In a place like Singapore, over the past 6 months, I hear over 50% of all phone sold were smart-phone.

Looking at the concern holistically, the part that often get missed out in the debate is the care givers especially in the asian context. In Asia, the average age of the population is still relatively young and households still have access to those who are relatively technology savvy with relatively high degree of adoption of smart-phones. who also happen to form part of the overall caregiver support structure of Asian homes. Often less understood, is that they this segment is the market is far more demanding high levels of efficiency and technology led innovation.

I am further encouraged by how smart phones and devices have become far more intuitive since the start of iPhone. Usability and form-factors have really come a long-way and the barriers to using technology is becoming less and less of an issue. Once again, worst case, there’s often a Caregiver that can be trained.

So then, when I speak to the nay-sayers around Caregivers, I am surrounded by all the reasons why Caregivers could not be given any empowerment of information patient with the exception of the patient through some remote manner.

I should hope Caregivers and Patients combined could play a more active role in creating awareness and demand among the regulators and care providers to act more maturely and think through the innovation that’s already taking place right now as we speak.

Best regards Callum

Effectively Monetizing mHealth Services and Applications

Over the more recent year, I have been working on mHealth consulting projects for a number of companies including telcos, especially to help develop strategy to Monetize mHealth Services and Applications.

Couple of months ago, I was fortunate to have been invited to chair a C-Suite workshop that brought together the Health Care Providers, Regulators, Payers, Medical Device Companies, Telco and technology vendors from several countries. The objective of the workshop was to discuss some of the essential elements in formulating successful mHealth business model(s).

The following was the format of my presentation.

What do consumers want?
Who’s willing to pay for what?
Opportunities for health & wellness consumers
mHealth for Chronic Disease Management
Who will operate vs. Innovators?
What are some of the Plays in Asia?

I am also putting together a paper around Disease Management Organization (DMO) and how these would play key role in transforming chronic disease management, with mHealth is one of the key enablers.

In the meantime, there are a number of short-term opportunities, especially in Asia, that are currently a white-space, and I propose some potential models for consideration.

See below the complete slide.

Callum Bir

Singapore Healthcare posed for disruptive innovation through Social Media

Singapore continues to push ahead globally in terms of digital adoption and well poised to take a step ahead for some disruptive innovation to occur.
Some interesting statistics for Singapore:
  • 7 million mobile phone users. That’s like everyone, including babies has a phone, with 4.8 million 3G users in Singapore, mostly with >70% using iPhone.
  • 82% of Singaporeans online use Social Media
  • >2.4 million facebook users. Give it another year or 2 from the time of this post, this number might be closer >100% per citizen.
  • 83% of all household residents have at least 1 computer [Source: IDA 2009]
  • Singapore Government has taken bold steps with strategic investments to deploy the Next Generation National Infocomm Infrastructure (Next Gen NII). This comprises a nationwide ultra high speed fibre access infrastructure called the Next Gen Nationwide Broadband Network (Next Gen NBN) and a complementary pervasive wireless network, including the Wireless@SG Wi-Fi service which will be free until 31 March 2013
Some missing data points is around the citizen expectation from their healthcare system, their demand for technology enabled health care especially for those with chronic diseases.
I suspect given the trends around how many fans / likes on Facebook pages such as those from Singapore Health Promotion Board (HPB), Singapore MOH, and various hospitals, this trend is likely to be something hard to ignore.
I have also spoken on related topics as below which touches on some of these disruptive innovation below. It’s a pity I am so far not getting too many calls from clients in Singapore wanting to develop their social media strategy.
Callum Bir

Tired of hearing HL7 v3 has failed

The last thing I want to do here is to spark another debate around the so-called “failure” of HL7 version 3, instead, I want to provide some points of views to those who have not had exposure to anything beyond HL7 version 2.

So first, as I understand the debate, the blanket criticism around “HL7 version 3”, is largely around the HL7 version 3 messages. Often in the same sentence around HL7 version 3 also seems to suggest the success of CDA, Clinical Document Architecture, more specifically CDA level 3.

For those who have been around the block [HL7] for long enough, it’s pretty easy and straight forward to understand what is meant by this. However,  increasingly, I speak to people are just starting to get themselves acquainted to the realm of HL7 version 3, CDA, RIM, et al, some of the recent debates has created a confusion I am hoping to shed some light.

Perhaps one of the things to highlight is that HL7 version 3 isn’t just messaging as you have in the world of HL7 version 3.  It might be worth looking into some of the Foundation and Infrastructure components of HL7 version 3 that includes things like the Reference Information Model (RIM).

I also recently found it interesting that some of the newbies around CDA didn’t realize that CDA and v3 are related:

“CDA is based on the RIM (..), uses the V3 datatypes and methodology. The core of the CDA R2 body for machine processing (semantic interoperability) is the “clinical statement” model which is used across V3.” (Source: HL7)

“XML tags on their own do not have the precision required for clinical system interoperability. For example, does <provider> mean a person or an organization? Is it the person who created the document, signed it or performed some service? The XML tags in a CDA document are defined by the HL7 Reference Information Model (RIM) which is based on a variant of Unified Modeling Language (UML) and has been developed by literally hundreds of thousands of hours of collaborative work by practitioners, informaticists, vendors and implementers over the past decade. Each release of CDA is based on the version of the RIM current at the time of the ballot. The CDA specification details the relationship of the documents to the model and contains a refined model (RMIM) which takes RIM classes and further constrains them to define the precise parameters of a clinical document.” (Source: HL7)

With that background, the key question I ask, how is to do you actually work with CDA that’s meaningful for use for specific intentions?  Surprisingly, I see some of the newbies haven’t had the opportunity to understand the overall background to design by constraint or the overall Health Level 7 Development Framework (HDF).

Take CCD for example, which uses the framework and methodology of HL7 with CDA as the baseline to constrain for specific use, which is further constrained by ONC for the US.  “The Continuity of Care Document (CCD®) is a CDA® implementation of the continuity of care record (CCR), created by the American Society for Testing and Materials (ASTM). Disparate information systems can employ the CCD to exchange clinical summaries that contain key data about individual patients, such as diagnoses, medications, and allergies.” (Source: HL7)

Given the inter-relationship and dependencies, such claims perhaps need to more specific in nature to avoid confusion.

Callum Bir