The New York Times reports that Consumer Reports (a consumer product research and rating agency) is readying ratings of surgical groups that perform heart bypass surgery. This is happening against the backdrop of Angie’s List aggressively promoting doctors ratings in much the same way they started with ratings of household services professionals.

The Los Angeles Times reported on the use of scribes to input data into the Electronic Medical Records. Pre-medical students and other volunteers serve as an intermediary between doctors and the EMR/EHR systems.  I think this an interesting way to overcome the adherence problem of EMR/EHR systems.  This info-mediary function is critical in the absence of proper incentives and commitment to using EMR/EHR systems, but pre-med student supply must be inconsistent at best.  This is a concern, because this function should not be treated in an ad-hoc manner.

Bring on the holograms and Isaac Asimov.  Robots have invaded hospitals and offices across the country.  The Los Angeles Times reports on the use of telepresence robots to act as an embodied stand-ins for remotely located professionals. Does mobility and a physical form (no matter how weird looking) add value to remote interactions?

I am sure that many of you have seen United Healthcare’s new ad campaign on TV – Health in Numbers.  United Healthcare is marketing health data as customer service and customer relationship management, which is quite different from other selling points of IT innovation in health.  See the YouTube clip of the commercial.

Projects succeed, projects fail. The successes are reported on, the failures are filed away. Or, in the case of most ICT 4 Development or Mobile 4 Development projects, pushed under the proverbial rug.

Well, its time to bring out the failures, with a sense of humor, and with an honest look at ourselves. So we are introducing the first-ever FAILFaire : A place where it’s ok to talk about what didn’t work.

The FAILFaire idea has been getting alot of play since the New York Times picked it up after the 26th July FAILFaire meeting in DC on ICT4Development sponsored by the World Bank. Mahad Ibrahim, who blogs for Global Health Ideas, is featured in the Times article, and presented results of his research on telecenters in Egypt to increase access to the Internet.

Think FAILfaire is the coolest thing since sliced bread, and want to do it at home? How to Roll Your Own FAILfaire

In my survey of public health innovators, my thesis advisor asked me to consider analysing some projects that actually failed. Well, those are quite hard to find unless they fail publicly and spectacularly.

But maybe that will change soon - Celebrating Failure to Learn from our Mistakes by Sarah Arnquist over at the Global Health Blog is a great piece (see especially the graphic on learning from failure). If we only know about what works, we don’t have a balanced view and can’t apply reason to solving problems. Instead, we are likely to be caught out when cold reality strikes us as it has done to all those who went before who kept their mouths shut, and their failures silent.

This idea of looking at failure is part of good business practice and total quality improvement – analysing faults, looking at airplane crashes, figuring out what failed so we can learn together and make good. In medicine, it seems to be verboten to talk about failures as the practice of medicine is a life and death matter, and admitting error could possibly lead to a potential lawsuit or disciplinary action that could end your career. But we need to talk, as “Medicine used to be simple, ineffective and relatively safe. It is now complex, effective and potentially dangerous.” – Sir Cyril Chawlte

Lucian Leape started the conversation with the groundbreaking Institutes of Medicine Report – To Err is Human: Building a Safer Health System which spurred the creation of the 100,000 Lives Campaign by the Institute for Healthcare Improvement, which evolved into the 5 Million Lives Campaign, and also the Safer Patients Network in the UK.

However, talking isn’t enough – you actually need to change the culture. In March 2010, Leape released Unmet Needs: Teaching Physicians to Provide Safe Patient Care which gets to this issue of how to prevent and discuss errors in medicine:

“Leape and his colleagues expressed a desire to move medical education away from what I’ll refer to as the elaborate hazing ritual model, rife with examples of disrespectful communications and humiliations, and forward into a model of education that is informed by teamwork, communication, conflict resolution, mindfulness, and asking for help when help is needed. – David Harlow at HealthBlawg full article

Here’s an interview with Dr. Leape where he highlights an innovative approach to medical errors at the University of Michigan with Rick Boothman

Let’s turn now to medical research, where you might wonder – Where does the negative result get published? For a long time experiments with negative results were swept under the rug, and doomed others to repeat them and waste energy and resources doing so – but now there is a Journal of Negative Results in several fields (here’s the one for Biomedicine). So wonderful.. we’re beginning to open up the freedom of information on scientific results and move away from publication bias.

and to end on a philosophical note, here’s Paulo Coelho:
Avoiding problems you need to face is avoiding the life you need to live/ Evadir problemas que necesitas afrontar es evadir la vida que necesitas vivir.

Big Tobacco using YouTube to circumvent bans on tobacco advertising. We talk a great deal about technology enabling better health, but what about technology enabling bad health habits such as smoking.  Regulation cannot keep pace with the proliferation of new media channels,

Oldie but worth a revisit.  Games for health. Has your office started an internal big loser club for losing weight?  What if video games were developed to support such efforts and encourage good natured competition towards desirable ends, such as losing weight.

At Global Health Ideas, we are suckers for the anything related to developing new medical technologies.  New drug development is a costly process with an uncertain outcome.  This  is especially true when the underlying condition is poorly understood.  Stress can kill and it can exacerbate the negative consequences of other aspects of our health.   See this Wired article about the search for a cure to stress.

MetroWest Medical Center has launched service that allows patients to receive emergency room wait times via text message.   Goal of the service is to improve patient volume and satisfaction.

iPhone/iPad in Medicine

San Francisco Chronicle explores the iPhone’s role in Medicine.  How will the release of the iPad extend or change the role of the iPhone in medicine.  Stanford Medical School gave 91 incoming med students an iPad as part of a new trail.  Several other universities are exploring the role of the iPad in education.

California launches telemedicine broadband network

As part of National Broadband Plan, FCC is providing $400 million a year to connect rural health providers.  Governor Arnold Schwarzenegger announced the nations largest “telehealth” system funded in large part by the FCC monies.

Results for Development (R4D) has recently founded the Center for Health Market Innovations (CMHI) in collaboration with three international partners–ACCESS Health International in India, Consultation of Investment in Health Promotion in Viet Nam, and BroadReach Healthcare in South Africa.  The center has a new take on the quest to improve global health – a focus on health markets rather than specific disease interventions or capacity building of health workers. Implicit in this approach is that properly functioning and innovative health markets can help governments deal with the challenges of delivering critical health services that are high quality and affordable for poor people.

At present, though, there are no comprehensive sources to learn about programs piloting health market innovations.  There are, however, no shortage of health service innovators in the developing world struggling with ways to improve their own health markets.  This is the space that healthmarketinnovations.org is trying to fill.

I discussed with Donika and Maria the recent public release of the website healthmarketinnovations.org.  The website is the public face of CMHI and is a tool to aggregate data, disseminate findings, and analyze health market innovations.

The definitive starting point at healthmarketinnovations.org is the about section.  It is here that we (the user) learn about the framework used to classify health market innovations.  This framework is the driver for everything else that happens at the website.

What is a Health Market?

Everything that allows health consumers to receive health services from health providers

What is the target market for healthmarketinnovations.org?

People running innovative programs in developing countries, what we call the implementer audience, will find our program database helpful to get the word out at the grassroots level about their approach and successes. They can learn from other implementers and join a community of practice.  And using the funder database, implementers can also learn about with potential funders who may help them scale up a health program. Funders can easily survey the different types of health market innovations that exist globally.  Through the database, funders can learn about programs’ approaches and needs.  Policymakers and researchers have access to a rich database of health market innovations that have been classified and tagged with pertinent metadata.

What is CHMI’s approach to health market innovation?

Identify innovations; Analyze market evolution, innovative models and measure performance; link programs to each other and to funders.

How does CHMI classify health market innovations?

1. By Innovation: Organizing Delivery, Financing Care, Regulating Performance, Changing Behaviors, and Enhancing Processes.  The categories are not mutually exclusive and certain programs exemplify multiple types of innovation.

2. By health focus: Classify each program by disease category (HIV/AIDS, tuberculosis, etc.) or level of health service delivery (primary, secondary, tertiary, etc.)

3. By geographical target for the program: rural, urban, peri-urban, etc.

4. By country of origin: The country of origin coupled with the location in country.

Who identifies and classifies the health market innovations?

Many of the existing programs were identified by CHMI’s staff and on-the-ground partners.  Our on-the-ground partners are currently located in India, Vietnam, and South Africa, but we are rapidly expanding our partner network.  In the next few months, we will add partners in an additional 6 countries.

Over time, CHMI would prefer most of the health market innovations to be entered directly by the organizations responsible for the underlying program via the healthmarketinnovations.org website.  Each program profile will be vetted by members of the CHMI staff, but the profile will be ultimately controlled and maintained by the organization that submitted it.

Can a program be added via mobile phone?

Not at present unless the phone is capable of interacting with normal websites.  CHMI is actively exploring adding his feature in the near future.

What is the incentive for organizations to use the healthmarketinnovation.org website?

Exposure to the global health community.  Learning from the innovative practices of other global health organizations.  Access to funders.  Building a community of practice with like-minded organizations all over the world.

What help do you need from the Global Health Ideas community?

Feedback, Feedback, Feedback! Currently, we are looking to build the programs database and to ensure an enjoyable user experience.  We would appreciate it if  Global Health Ideas readers could visit www.healthmarketinnovations.org; use healthmarketinnovations.org; and, provide feedback on their experience.

Please let us know:

1.  What were your positive and negative experiences working with database and other website features at healthmarketinnovations.org?

2.  How intuitive is the classification framework and what adjustments might you suggest?

3.  How useful is healthmarketinnovations.org to your own work? and how can the website be made more useful to you?

4.  How would you suggest that CHMI maintains the relevance of healthmarketinnovations.org to the global health community?

5.  What do you want to know more about regarding health market innovations?

We are keen to hear your feedback. Feel free to write a comment to this post, or email ddimovska@resultsfordevelopment.org.

This Guardian UK Special Report looks at the alarming increase of bacteria resistant to all known antibiotics  and the dearth of new antibiotics in the drug development pipeline.  One reason cited for this dearth is the economics of antibiotics with many short duration courses.

Atul Gawande, of the Checklist Manifesto fame, examines the complex nature of end-of-life care in the New Yorker Magazine. With the backdrop of the death panel talk that arose from the United States Healthcare Reform legislative battle, Gawande chooses to examine end-of-life decisions from the perspective of the patient and their families and not the cost implications.

Wired Magazine recounts Sergey Brin’s quest to improve the quality of Parkinson’s research.  He uses his money and approach from Google to collect massive amounts of data and search the data for patterns and hypotheses that can then be tested using more traditional scientific techniques.  Big Data vs. Big Science is the theme.

The future is the great unknown – “I never think of the future,” Albert Einstein once observed. “It comes soon enough.” Well, the prevailing winds are strong forces, and why not use them to shape your course?

“Confronted by the economic, social, and technological forces shaping the global business landscape, most managers assume that their ability to sculpt the future is minimal. But systematically spotting and acting on emerging trends [that are reshaping business] helps companies to capture market opportunities, test risks, and spur innovations. A McKinsey team that explored the key global trends defining the coming era has identified five forces, or “crucibles,” where the stresses and tensions will be greatest and thus offer the richest opportunities for corporate strategies.”

cool.. luxuriate in these ideas here at Global Forces home.

Why Trendwatching could save your business:

McKinsey director Peter Bisson explains the value behind tracking those global forces and how to build them into corporate strategy. check it out

But what really caught my eye today and that I had to post was this:

10 Tech Business Trends to Watch

• Distributed cocreation moves into the mainstream
• Making the network the organization
• Collaboration at scale
• The growing ‘Internet of Things’
• Experimentation and big data
• Wiring for a sustainable world
• Imagining anything as a service
• The age of the multisided business model
• Innovating from the bottom of the pyramid
• Producing public good on the grid

read all about it here and listen to podcasts of experts.

What do you think? Let’s discuss how these ideas could impact public health..

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It is a known fact that childhood obesity is on the rise, affecting one third of American children today. Alarmingly, researchers are predicting that for the first time in U.S. history, children may have a shorter life expectancy than their parents.

On July 13^th, I attended the “Innovation, Information and Technology for Better Health Outcomes” conversation event held at World Bank. Todd Park, the Chief Technology Officer of the U.S. Department of Health and Human Services (HHS) and co-founder of Athenahealth Inc., was one of three panelists at the event.

A key theme Park brought up was the impact technology and social media could have on healthcare for younger generations. “What if FarmVille were HealthVille?” Park asked. FarmVille, a real-time farm simulation game, has acquired 75 million Facebook users just within a year of being available. If games with the potential to reach this many were designed around health data, generations to come could grow up being more health conscious.

Park highlighted the 2010 Health 2.0 Developer Challenge, which is run by the company Health 2.0, and supported by HHS and its Community Health Data Initiative (CHDI), the new open government effort encouraging innovators to use health data made publicly available by HHS.  “Community Clash” is one of several new apps created to engage users in the health data available through CHDI.

“Community Clash” creatively incorporates HHS data in what Park calls “Healthcare Blackjack.” The online card game, launched by MeYouHealth, involves a comparison between your city and a “Rival City” on a number of health indicators from obesity rates to unemployment rates. Todd Park claimed he learned things he didn’t know by playing the game, adding “it’s incredibly addictive.” After trying the game myself, I would have to agree! I was surprised to learn that 68.1% of adults in Washington, DC eat on average less than the minimum daily recommendation of 5 servings of fruit and vegetables.

Charged by the excitement and new knowledge I had gained, I proceeded to search for initiatives on apps specifically for kids and found  that earlier this year, First Lady Michelle Obama had announced the Apps for Healthy Kids Challenge in conjunction with the USDA as part of the Let’s Move! campaign, asking innovators around the nation to develop video games and mobile applications to incite physical activity and promote healthy lifestyles.

One of the 95 final entries was developed by Alaka Sarangdhar, a Portland-based software engineer. Her application, called iNutri8, is an iPhone app designed to make nutritional information available at your finger-tips and show users how their daily eating compares to the food pyramid guidelines. This allows kids to be aware of the portions and food groups they are lacking or exceeding in, and how their eating habits can be improved. I was able to ask Mrs. Sarangdhar how she sees the tool affecting kids in the future, and she stated “I hope iNutri8 teaches the younger generation to be aware of what they are eating and its nutrition value. With this on-the-go tool, they can even try to evaluate their options before they eat to see what will give them an overall healthy diet…” You can vote online for iNutri8 and your other favorite entries in the Apps for Healthy Kids Challenge until August 14^th.

After browsing through the entries in the Apps for Healthy Kids Challenge, it became apparent that Todd Park was on to something. What if apps were created to engage kids in HHS health data? With something like “Community Clash” that is fun, appealing and adds a competitive element to useful information, kids could not only improve their own lives but be more aware of healthcare issues in the communities around them.

Enter: the “Why-Health?!?!” challenge. In this challenge – one of five on the Health 2.0 Developer Challenge platform – Whyville.net, a virtual gaming site with 6.3 million users aged 9 to 15, asks developers to design games and other interactive resources that cater to their young users and make health data “accessible, understandable and actionable.” You can submit your applications to the Whyville health challenge until September 15^th of this year.

Provided with the right tools to be more aware of health issues, today’s younger generations could build a better future for all of us.

*The quote used in the title is from the Talmud, and is displayed at the American Visionary Art Museum in Baltimore.

* Todd Park, Chief Technology Officer, U.S. Department of Health and Human Services
* Eric Rasmussen, President and Chief Executive Officer, InSTEDD
* Randi Susan Syterman, Director Governance and Innovation, World Bank Institute

What:

• The power of analytics in shifting the landscape of global health
• Stimulating the development of new applications for improved access to health-care
• Using competitions and challenge grants to motivate the public and private sectors, NGOs and communities to road-test ideas and solutions
• Open data, open innovation, and PPP to improve global health outcomes
• Using data and innovation to improve performance and spark action locally and globally
• Increasing transparency and accountability and greater citizen participation through innovation

When: July 13th, 9:30-11am

Where: World Bank J Building – 701 18th Street NW (Washington DC)

How: External Participants should RSVP to Selina Khan skhan8@worldbank.org

Todd Park (CTO, HSS) – using information to shift the landscape; empowering communities, enabling global action, improving lives

Todd Y. Park has been Chief Technology Officer (CTO) for the U.S. Department of Health and Human Services (HHS) since August 2009. Mr. Park Co-Founded Athenahealth Inc., in 1997 and served as its Chief Athenista from January 1, 2008 to August 31, 2008. Mr. Park served as Chief Development Officer and Executive Vice President of Athenahealth, Inc., since February 2004. He served as a Leading Management Consultant at Booz-Allen & Hamilton in New York. Mr. Park specialized in healthcare strategy, operations, and systems work at Booz-Allen, and served as a major thought leader on the evolving dynamics of the healthcare sector. Mr. Park’s accomplishments at Booz-Allen included: Development and implementation of “best practice” provider network, medical management, claims processing, operations, and systems infrastructure for multi-billion dollar clients; Design and rollout of innovative managed care products and services; Successful marketing and expansion planning efforts for high-growth healthcare networks and services; Development of groundbreaking strategic partnerships among major healthcare organizations. Before Booz-Allen, Mr. Park served as Director of Development for Summerbridge Cambridge, an Innovative Academic Enrichment Program serving gifted and underprivileged children. He served as Director of Athenahealth Inc. from January 1, 2008 to August 10, 2009. He focused on healthcare economics, business strategy and technological innovation at Harvard University. Mr. Park received his Bachelor of Arts degree in economics from Harvard University.

Eric Rasmussen (CEO, InSTEDD) – SMS to avert outbreaks, mobile technology, GIS and innovation for emergency response

Dr. Eric Rasmussen arrived as President and Chief Executive Officer of InSTEDD in October 2007. Previously, Dr. Rasmussen was both Chairman of the Department of Medicine within Naval Hospital Bremerton near Seattle, Washington, and an advisor in humanitarian informatics for the US Office of the Secretary of Defense. He holds academic positions at several institutions and has been a Principal Investigator for both the Defense Advanced Research Projects Agency (DARPA) and for the National Science Foundation. He sits on several advisory boards, including the Crisis Management Resources Board for the National Academy of Sciences and the US Crisis Response Working Group. He has a number of publications and has been awarded several personal, unit, and theater military decorations, including a Presidential Legion of Merit.

Dr. Rasmussen spent seven years enlisted in nuclear submarines before leaving the Navy to receive his undergraduate and medical degrees from Stanford University. After graduate work in molecular biology at Los Alamos National Laboratory and teaching in Haiti, he completed a Residency in Internal Medicine and re-entered the Navy as Chief Resident in Medicine at the Navy Medical Center in Oakland, California. Subsequent Navy positions included three years as Fleet Surgeon for the US Navy’s Third Fleet. Dr. Rasmussen served on the Afghanistan humanitarian support planning staff within US Central Command Headquarters (CENTCOM) in 2002, and later as a physician to the Iraq Disaster Assistance Response Team (DART) for the Iraq War in 2002-2003. As a member of the DART, he served as medical director within the International Humanitarian Operations Center in Kuwait and was later selected for the DARPA 2003 “Sustained Excellence in a Principal Investigator” award.

Further work as Director of the Strong Angel series of international humanitarian support demonstrations led to work in Afghanistan in 2004 and 2007, and in Indonesia as head of a Civil-Military Coordination Team for the tsunami response in Banda Aceh in early 2005. Later in 2005, he deployed with Joint Task Force Katrina in New Orleans, coordinating a small portion of the relief response after Hurricane Katrina. He was the medical lead for a UN mission to Tajikistan in 2009, and in 2010 he deployed to Haiti immediately after the earthquake for work within the UN’s Search and Rescue Dispatch Center on the Port au Prince airfield.

In addition to his responsibilities at InSTEDD, he currently serves as Permanent Advisor to the United Nations Secretary-General’s High-Level Forum on Water Disasters, as a member of the US Congressional Task Force on Global Biosurveillance, and as a member of Kofi Annan’s Global Humanitarian Forum in Geneva.

Randi Susan Ryterman, Director, Governance and Innovation, World Bank Institute
Ms. Ryterman, an American national, joined the Bank in 1998 as Senior. Public Sector Management Specialist in the Europe and Central Asia Region.  She has since held various positions, her most recent assignment being Sector Manager, Public Sector Governance, in the Poverty Reduction and Economic Management Network (PREM). Ms. Ryterman studied at Wharton, University of Pennsylvania, and received her PhD from University of Maryland.