From the Archives: Written in September, 2009 - Online Consultations are an essential form of patient care

Online Consultations are an essential form of patient care   Doctors Provide the Service §  31 % of physicians reported using online communication with their patients in 2007, 25% in 2006, 24% in 2005, 19% in 2003 [1]   Payers Recognize the Service §  The top 5 health insurance companies ( United Health Group, WellPoint, Aetna, Humana, Cigna) cover online consultations [2] §  More than 100 commercial payers around the nation reimburse one or more telemedicine procedures  [3] §   The top 5 health insurance companies reimburse doctors for online consultations [4] Patients Like the Service §  76% prefer online consultations to interact with their doctors [5] §  62% of patients said the ability to talk to a physician electronically would affect their choice of doctors [6] §  57% of those with commercial insurance said they would use online consultations [7] §  75 % would like to be able to e-mail their doctors for consultations [8] §  1 in 2 consumers surveyed said they’d be likely to seek healthcare through online consultations [9] §  Patients ranked the virtual mode of online consultations as valuable as face-to-face consultations [10] §  35% of Medicaid respondents indicated they would likely use online consultations [11] §  37% of adult internet users are willing to pay to communicate online with their physicians, corresponding to $4 billion in 2002 [12]   Drivers to improve current state Online Consultation Technology -          50% of text based consultations yield an in-office visit o    Serialized, time-lapse communication impedes the Doctors ability to create a “differential moment” -          Doctors are motivated to maximize Online Consultations, thus freeing precious in-office visits for their most serious, and highest paying patients. They demand the most comprehensive form of Online Consultation available -          Much of the online communication with patients today is unreimbursable(email) because the structured communication necessary to meet Payer requirements is not conducive to effective patient care o    Doctors communicate without reimbursement because §  They care §  Customer Service/Competitive Advantage §  They want to keep their waiting room unclogged(but at the expense of not getting paid)   Why VR Improves Online Consultations -          Voice communication coupled with unlimited access to Charts & History, create a comprehensive, yet extremely efficient context for diagnosis o    Virtual Online Consultations can be as simple as quick Q/A, or as involved as complete EMR review with physiology simulations o    VR efficiently creates a real-time, multi-sensory, intuitive context for diagnosis o    If we agree that the best way to diagnose a patient is to consult with them in the office §  And if we can further agree that in-office visits could be improved for enabling diagnosis ·         Can we then say that an environment that simulates a doctor’s office, but vastly improves on shortcoming of the doctor’s office, would provide an environment capable of producing better diagnosis and treatment recommendations? o    Simulation(75% as good as in-office) + 50% VR Improvement(by doing things not possible in the doctor office) = %125 as good as in office §  Excluding diagnosis that require specialized equipment or visual exam -          Doctors who communicate online with patients in most cases are not reimbursed for the consultation o    Doctors are using available forms of communication, but are not getting paid for the service o    VR creates a structured environment in which a payable transaction occurs, and effective diagnosis and treatment can be administered -          Current State Online Consultations are rigid, and require the patient to do some self-diagnosis in order to begin the process: Fatigue, Sore throat, etc. o    In many cases, patients are not able to accurately self-diagnose, but are aware of a problem o    While statistically in may be true that many diagnosis can be classified into a few categories(Cold, Flu, etc.), this is the result of diagnosis, and not where the process begins.  A vast variety of symptoms may present, but after consultation can be slotted into a few categories -          Online Questionnaires are confusing to the patient o    Autonomous Virtual Nurse greets the patient, and solicits patient information using a combination of keypad entry and voice recognition §  A friendly voice, a clinical atmosphere, a person of authority/assistance o    This can be the reception when you arrive for a scheduled visit o    This can also be the new questionnaire Size of the Market §  70% of all doctor visits are for information only or for matters that can be handled over the phone [13] §  79% said that they would not like to use their mobile phones as an alternative method to contact their doctor [14] §  57% said that they would be likely to use an online forum or chat room monitored by their doctor technology for consultations[15] §  50% said they would be likely to access their healthcare via Internet or other computer technology [16] §  35% said they found getting through to someone via online methods the most Frustrating about e-Health Care Experiences [17] §  50% said they would be unlikely to access their healthcare via telephone consultations [18] §  25% said it takes more than 30 days to get an appointment with their doctors & 10% said they’ve had to wait 3 months or longer [19] §  90% of the visits patients made needed to be made in person. The remaining 10 percent fell into a category where the doctor’s diagnosis relied largely on a patient’s description of the ailment. (list included conditions such as headaches, certain urinary tract infections, dermatitis, and back pain)     Accessibility §  81% of household within the US have some sort of PC in their home, 92% of which have internet [20] §  90% of US physicians have high speed internet  [21] [1]  Manhattan Research Survey, 2007 ; EmaxHealth, 2006, TransformerMED [2]  PWC, 2009, etc. [3]  HealthCare Industry, 2008 [4]  Dallas News,2008 [5]  PWC, 2009 [6]  AM NEWs, 2007 [7]  PWC, 2009 [8]  Health Tracking, 2005; RelayHealth 2007; Business Tech, 2009; PWC, 2009; KP, 2009 [9]  PWC, 2009; 2006 Harris Interactive/Wall Street Journal survey [10]  Boston Globe, June 09; HealthCare Blog, April 2009 [11] PWC, 2009 [12]  Science Direct Text [13] PRLog, 2007 [14] PWC, 2009 [15]  PWC, 2009 [16] PWC, 2009 [17] TransformerMED [18] PWC, 2009 [19] PWC, 2009 [20]  PWC, 2009 [21] EmaxHealth, 2006

And in the begining there was....... The Étape Partners Credo from 2009

I have no idea why this is all caps, but I must have had a reason 5 years ago....

Étape Partners Credo 2009

Innovation does not go into recession

Good ideas are immune to depression

The economy does not inhibit leadership from the front

There is no suspension of business, only business as we know it today

While others are retreating and waiting for what they perceive to be the end of the modern world,

We also prepare for the dawning of a new day,

We prepare by sharpening our weapons, stretching our minds and feeding our instincts

Yes, we also see the sun rising on a new day.

 

The 10 Point Guide to Real Innovation in Medication-based Healthcare Services:

The 10 Point Guide to Real Innovation in Medication-based Healthcare Services:

1.      Don’t wait for change. Use Phases to achieve the Strategic Goal

a.      Regulations, Meaningful-use, Reimbursement Models,

2.      “Different” does not equal Innovation

a.      Innovation will be different, but Innovation will also deliver improved Outcomes

3.      Do not target “Behavior Change” as a critical Objective

a.      Better targets are those things that shape behavior

4.      Human Centric Design

a.      Think of your end-user as a person, not as an Agent

5.      The Elegance of Assembly

a.      Large amounts of anything inherently contain empowerment. The amount of this power that can be unlocked is a function of elegance.(kinetics and Conservation)

6.      Frictionless Processes

a.      The quickest path to effectiveness is the one of least resistance

7.      Digital Brand Personalities

a.      A dynamic set of digital instances that uniquely influences: Cognitions, Motivations, and Behaviors towards an Essential Transaction

8.      Put Patient Empathy into the Money Flow

a.      Drug Discovery, Adherence, Support = Empathy and Transactions

9.      Understand who measures success, and how they measure it

a.      Scientist, Sales, HCP, Patient, Payer, Government

10.  The common denominator of cohesion is not a compromise.

a.      The greatest innovations waiting to happen will be derived from a better understanding of ourselves, and the action we take with this new found wisdom

KnowledgeVenture – A Virtual Economy for Enterprise Knowledge Workers

Real Gaming, Real Markets, Real Corporate Value

Most Knowledge-worker driven enterprises are plagued by:

-          Large amounts of information with perceived value, but no method to realize this value

-          The perceived value is never realized because the raw materials are not converted into consumable Knowledge Products that are in demand

-          Workers are rarely compensated differently for output that is high demand vs low demand

-          Workers are often busy constructing low demand goods due to a misguided directive regarding actual demand or importance

-          In a segmented worker population information is generally not accessible universally, and thus high-potential Knowledge Products are never created

Hybrid Environments for Improving Student Outcomes: Contextual Innovation in Education through applications of Patient Adherence advancements in Medication-based healthcare services lifecycles

More from the Archives - 10/02/2009

From the Archives - 10/2/09, Hybrid Environments for Improving Student Outcomes: Contextual Innovation in Education through applications of Patient Adherence advancements in Medication-based healthcare services lifecycles

Pedagogy vs Adragogy

Centralization vs decentralization of learning

Technologies and online resources

From the Archives: Written in February, 2010 - Putting Patient Empathy into the Money-Flow: Improving Patient Outcomes through Technology Innovation

Putting Patient Empathy into the Money-Flow:  Improving Patient Outcomes through Technology Innovation

Abstract/Introduction

In our case study we start by taking a very hard look at the raw economic realities of Healthcare transactions.  We then carefully consider how Virtual Reality can solve a problem better than any other solution. Next we pitch the concept to influential industry leaders. Upon validation from, and contracting with, these industry leaders, we deploy our Virtual Reality solution into Healthcare. 

 

From the Archives: Written in June, 2009 - RULES FROM REVOLUTIONARIES, Considerations for the practical use of Virtual Reality in everyda Professional Environments

** This is a book chapter that I authored for book publication in mid-2009. We witnessed a few "quiet" years during which Virtual Reality was not a hot topic. Now, with the imminent ubiquity of consoles (Steam/Valve) and Innovative haptics (Oculus Rift), the topic may be here to stay. 5 year-old strategies and Conceptualized (and realized) implementations may now be poised for an audience that has caught up to the innovations described here-in.

As the title suggests, the objective was to define strategies for overcoming typical corporate resistence to raw innovation, regardless of the evidenced value.
  

CHAPTER 9: RULES FROM REVOLUTIONARIES

ESSAY 3: Brian Bauer, Étape Partners.

OVERCOMING OBJECTIONS

Objection 1: Virtual World Technologies are not “serious” technologies

Quite often technology that ends up becoming a valuable business tool did not start out that way

Public “chat rooms” and web forums also did not begin as business tools. (e.g.: AOL in 1992 was not focused on chat rooms for “co-worker collaboration”). Virtual Worlds can be as serious as you want them to be, but you must define your business objectives first, and rationally dissect Virtual World technologies to clearly and explicitly identify the components that will help meet these objectives. For example “implement a virtual employee lounge” is not a valid business objective

The Impossible Game ?

The Board Game of Contextual Dilemma, Can there be a Winner?

The game starts with 1 blank Game Board, 5 identical Playing Pieces, and 5 Players. 

1 player waits outside while the 4 remaining players “Construct” a set of tactical and strategic Objectives, and a set of Rules to govern them, such that the intent and structure of the finished game is not necessarily obvious to the 5th player.

Time is a sociological, cultural, and anthropological litmus test

Time is a sociological, cultural, and anthropological litmus test

Time is a sociological, cultural, and anthrpological litmus test effectively used to evaluate the cultural building blocks of a society. 

But time, seems to have the rather inconvenient characteristic of not wanting to stop, so for all of you so seriously litmusing and testing societal blocks to find out what time it is, best not to pause or lest you be left behind as time so indignantly waits for no "man". 

Because Someone Asked: What is the "Human Person?"

The "Human Person"

A tightly coupled ecosystem of physiological building blocks manifesting themselves in a tangible form-factor commonly recognized via sensory perception as that of a structure we call a human. 

It’s the Infusion of Meaning into words, phrases and sentences that may not carry as cleanly as the literal words and phrases.  Like the fuzz on the surface of a tennis ball causes the ball to carry differently than a ball that is identical, except has a smooth surface.

I imagine a tennis ball that is entirely smooth white rubber.  It is a clean, non-porous material, and is constructed from simple compounds that are “atomic level” ingredients.  It’s just a plain, white, rubber ball.  In language, maybe the equivalent is “blue dog eats chicken”.  Pretty simple compounds, not much room for misinterpretation. Blue. Dog. Eats. Chicken. This phrase does not need to make sense any more than a “smooth, white, rubber, ball”.  It only gets complicated when we project additional information into the compound because for some reason or other, we believe, based on a priori knowledge, that we think it belongs there.  This projection of additional information, may or may not correspond to the meaning that was “infused” (or not) by the speaker of these words.  It is this layer of potentially ambiguity that I think of as the fuzzy green stuff found on the outside of a new tennis ball.  The base compounds are underneath, but are layered over with a “fuzziness”, which is what we will always come into contact with first. As the ball moves from A to B, this fuzziness can cause, or be used to cause, behaviors that would/could not exist if it were just a “smooth, white, rubber, ball”.  A tennis ball left outside for long enough will eventually lose its fuzziness. And just be a ball.  The context has “worn off”.  The same is true in communication.

In my example I was attempting to demonstrate that “meaning” is a layer of communication which sits above words, phrases, sentences, etc.  Simple statements can be understood by different people, with different backgrounds to mean very different things.  I was saying that I think someone’s background, and current state, can be evaluated by questions that have no definitive right or wrong answers, and in some cases, can cause total confusion because the question is understood, but how to answer it is not, and can through the interviewees brain into something of a loop.  It’s in some ways a more conversational style of word-association.

So yes I understand that Linguistic Semantics is the Title of this Group, and that it is also a field of study, but I am also saying that it a mechanism for evaluation, and therefore potentially the basic structure for Psychological evaluation tools.  Not that LS needs to be used that way, just that it can be.

My Blade Runner citation seemed an appropriate example of how the meaning of a construct of words and phrases can be understood, or not, and the resulting reactions to the realization (or not) of the meaning, can be used to begin to “frame in” the Psych profile of the interviewee.

Expression through language will always have a “sender”, and generally have a “receiver”.  It is one thing to understand what was meant by the Sender, it is another to understand the meaning perceived by the Receiver.

Linguitsic Fuzziness

It’s the Infusion of Meaning into words, phrases and sentences that may not carry as cleanly as the literal words and phrases.  Like the fuzz on the surface of a tennis ball causes the ball to carry differently than a ball that is identical, except has a smooth surface.

I imagine a tennis ball that is entirely smooth white rubber.  It is a clean, non-porous material, and is constructed from simple compounds that are “atomic level” ingredients.  It’s just a plain, white, rubber ball.  In language, maybe the equivalent is “blue dog eats chicken”.  Pretty simple compounds, not much room for misinterpretation. Blue. Dog. Eats. Chicken. This phrase does not need to make sense any more than a “smooth, white, rubber, ball”.  It only gets complicated when we project additional information into the compound because for some reason or other, we believe, based on a priori knowledge, that we think it belongs there.  This projection of additional information, may or may not correspond to the meaning that was “infused” (or not) by the speaker of these words.  It is this layer of potentially ambiguity that I think of as the fuzzy green stuff found on the outside of a new tennis ball.  The base compounds are underneath, but are layered over with a “fuzziness”, which is what we will always come into contact with first. As the ball moves from A to B, this fuzziness can cause, or be used to cause, behaviors that would/could not exist if it were just a “smooth, white, rubber, ball”.  A tennis ball left outside for long enough will eventually lose its fuzziness. And just be a ball.  The context has “worn off”.  The same is true in communication.

In my example I was attempting to demonstrate that “meaning” is a layer of communication which sits above words, phrases, sentences, etc.  Simple statements can be understood by different people, with different backgrounds to mean very different things.  I was saying that I think someone’s background, and current state, can be evaluated by questions that have no definitive right or wrong answers, and in some cases, can cause total confusion because the question is understood, but how to answer it is not, and can through the interviewees brain into something of a loop.  It’s in some ways a more conversational style of word-association.

So yes I understand that Linguistic Semantics is the Title of this Group, and that it is also a field of study, but I am also saying that it a mechanism for evaluation, and therefore potentially the basic structure for Psychological evaluation tools.  Not that LS needs to be used that way, just that it can be.

My Blade Runner citation seemed an appropriate example of how the meaning of a construct of words and phrases can be understood, or not, and the resulting reactions to the realization (or not) of the meaning, can be used to begin to “frame in” the Psych profile of the interviewee.

Expression through language will always have a “sender”, and generally have a “receiver”.  It is one thing to understand what was meant by the Sender, it is another to understand the meaning perceived by the Receiver.

Truth may be where we find it but that does not mean that we will

Truth may be where we find it, but that does not mean that we will, but if we do, it certainly does not guarantee that anyone will validate what we believe we have found.

If we mean to propose that a Truth may be contained somewhere within the essence of an a posteriori synthetic proposition (Descartes + Kant + Aristotle)….the discernment of an essence (Descartes) may rely upon the a posteriori knowledge of the “truth seeker (Kant), whereas this “knowledge” is the combination of and intellectual organization of sensory and cognitive contributions (Aristotle), then possibly Aquinas said it best: (to paraphrase) “Truth exists wherever it is found”.  Which in my view does not mean that anyone can blindly stumble upon, and then recognize Truth after tripping over it, instead, I believe that many things which are readily available to be found, are not, because when they are “found”, the “finder” is not equipped to recognize the “finding” (and this is where we need our full team of philosophical explorers: Descartes + Kant + Aristotle). If we are satisfied with this logic, we might go on to say that a newly “found” Truth, although presenting itself, may remain undiscovered.  Hidden in plain sight I suppose.  This may be an argument for Truth seekers to travel in small groups.  But I think more practically, I will remain by what I said in an earlier post: that Truth is often highly individualized. 

Minds, Brains, Bodies and Souls….Oh my!

On the question of whether or not we can be certain of the explicit distinction between intangible, theoretical concepts and their commonly paired, physical and scientifically validated pairings.

I'd apologize for the typo, but just as anything could have happened, including the right grammar, my personalized wave form collapsed into the “wrong” outcome just as I was typing, and you know that WF collapses don’t negotiate.  But the real trouble started when my Mind studied Latin, and my Brain did not, and as “luck” would have it, it seems that Brains control fingers not minds, so I will save my fingers the embarrassment of telling them about their apparent accidental genesis of a word that never actually died with the rest of the language.....

So to address a few comments:

1)      Do we really have the option to really think out of language?  Yes.*

2)      How must we consider the co-existence of the Brain and Mind?  Yes. **

(* **just consider everything from here on a conjoined footnote [feetnote?])

Cogito Meipso ut Existens: Much more appropriate in my humble opinion than Cogito Ergo Sum.

Cogito Meipso ut Existens   

Much more appropriate in my humble opinion than Cogito Ergo Sum.

Less definitive certainly, but possibly more defensible

I think Myself into Existence....is very different than "I think, but, I do not exist"

Are You Paying Attention?

Language. Unlimited? Possibly. Perfect? Not Likely.

Three Lefts don’t make a Right, but they do make a Square, and may even be potentially responsible for the genesis of Digitized Circles

Lately I’ve been thinking a lot about little squares.  Little squares are easily constructed using very simple mathematics. If we agree( at least in the alien world of computer innards), that little squares, built by 0 and 1 constructors, are capable of manipulating sensory perception to such an extent that most people don't ever consider basic concepts like "curved is a sequence of straights".  "Arcs" are manifests of carefully arranged straight lines, with enough straight lines, we can create such a density of "straights", that Sensorially, we perceive what appear to be images that look nothing like squares or straight lines.