Uncategorized

FHIR, Health data APIs, webinar notes

I recently listened to an informative webinar from Mulesoft: Unlocking Electronic Health Records (EHRs) with Application Programming Interfaces (APIs).  I learned a lot (and also generated a lot of questions) and thought I’d share a few notes from the webinar.  I had hoped to make this more of a comprehensive review but my notes will have to suffice.  I’ll update this topic with more posts over time as I further synthesize what it all means.

Here’s the link to the webinar:

I’ll skip over the general info material on why APIs are important in modern commerce (surely you already know that part…), and get right to some of the healthcare specific info that caught my attention.

Why has healthcare not seen as much API-driven innovation as other industries?
1. The large number of entrenched EHR and healthcare infotech vendors (over 1200).  That’s a very fragmented market, more than I realized even after working on the fringes of it during my time at Intel (probably because we focused on a dozen big EMR vendors).
2. HL7 Version 2 currently dominates the industry, but under this standard the  data structure & meaning can change for every trading partner relationship, so the opportunity to “code once – connect to many” is missing.
3. HL7 V3 -has been slow to implement  due to complexity.
4. Healthcare systems have traditionally relied on VPN connections for authentication – very non-consumer friendly, and requires custom point to point implementations.  Just as the modern enterprise has become more flexible with cloud services that don’t require VPN, and which are mobile friendly, healthcare will do the same.

A 2014 JASON report details why a fundamentally different architecture is needed.
– “CCD” – continuity of care documents require it, and
– SSO, authentication, and improved user experience are becoming more important

Environmental changes that make the adoption of a new standard important:
1. Consumer expectations – both in app quality and in the ability of the clinician to utilize all the data available
2.  Transition to value based care, not fee for service, as driven by legislation – here’s a reference on MACRA.

Meaningful Use Stage 3 requirements  are driving greater patient access to data and greater exchange of data, which means APIs will be even more important.

The goal of SMART on FHIR is to allow a developer to write an app once and expect that it will run anywhere in the healthcare ecosystem.  Think of it as an enabling protocol for an “app store” for health apps.

FHIR = Fast Healthcare Interoperability Resources – defines resources (e.g., allergies, care plans, medications), exposed as semantic RESTful APIs.   Formalized, computable mechanism for extensability to resources which are not part of the core definition.   Developed by HL7.

SMART = Substitutable Medical Apps and Reusable Technologies –
– OAuth 2.0, based on HTML & other standard, familiar web technologies
From an API management standpoint,  SMART and FHIR are a subset of the overall API management function.
OK that’s enough notes, more synthesis to follow…

A few references:
ICOE Group – API focused consulting group, a Mulesoft partner
Mulesoft – API management and system integration solution, a leader in the market
Software Development, Uncategorized

FIT-C Podcast on APIs in Fitness

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After a long hiatus I am back to blogging, here’s a link to my recent podcast with Josh Trent of the Fitness Industry Technology Council (FIT-C) of which SYSTEM3 is a member:

I hope you find it informative.

 

Fitness & Training, Wearables

Quantified Self Expo, Part II

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Here’s my second installment from the Quantified Self Expo in San Francisco over the weekend.   It’s too bad I have other work to do because I could write about this all day.

1. Vinod Khosla – The famous Silicon Valley investor spoke about the rise of algorithms as a contributor to our health care and their ability to help doctors and other caregivers deal with the massive quantity of data becoming available.  Psychiatry was a field he picked on as having a horrible model of using very small data sets (self-reported by the patient, no less) to make important decisions.  This is changing fast.  He commented that the FDA has been fairly progressive in trying to move faster on some of the new technologies, citing the example of AliveCor, which got approval within 6 months for its mobile ECG app.  He also referred to a meta-study of medical publications which found that fully half of them contain erroneous results – something that big data and artificial intelligence ought to help fix.  Bryce Roberts, in his Q&A with Tim Chang, seemed to lean more toward my own view of wearables + analytics + big data, saying that there would be a subversive (I love that word…) aspect to how it affects health care and the medical establishment.

 

2. In my first installment I mentioned Tim Chang of Mayfield Ventures.  He made several other good points about the development process, the most important of which was that you need a really strong VP of Systems engineering to ride herd over the hardware, firmware, and web service guys who want to point the finger at each other.  One idea he discussed was that of giving away the device and selling the data services around it.  I absolutely believe this is the future for a whole host of reasons.  As Bryce Roberts pointed out, it is very hard for hardware companies to give up the device revenue and make this jump.  I believe there is an opportunity for a middle-man to step in and offer up the data services and coaching around the idea of free devices with a monthly coaching commitment.

 

4. DataSense – There has been much talk about the need to aggregate and make sense of data, and Intel’s Research Lab cooked up a web service to do just that.  There is nothing particularly health focused about it, it’s really a very generic tool for pulling data together and displaying it in creative ways, but they happen to have chosen a few health trackers to start with.  I’m playing with a beta version now.   My favorite feature was the super intuitive slider for adjusting the time-binning of data so that you could smooth out noisy looking graphs.  Any former acoustician/signal processing buff has to love that.

 

5. Inside Tracker – a more user friendly and advanced form of blood testing than you might have used in the past (say SpectraCell), with more accurate reference ranges for values (like hormone levels) based on your age and activity and specific guidance on foods that can help correct imbalances.   Interestingly, during a presentation on the product Gil Blander pointed out that they sometimes end up telling customers to stop taking supplements, because they are overdosing on specific nutrients.

 

6. uBiome – there’s been a lot of focus in the last few years on the microbiome (that collection of bacteria in your gut and other places on the body) and the importance of keeping it healthy.  We’re now getting the ability to measure and catalog these bacteria, although when I spoke to Alexandra Carmichael she admitted that the science on this is still very early on this, and the ability to tailor behavior and diet in a deterministic way with these data is limited.  uBiome will tell you how your biome looks compared to others with particular lifestyle or dietary habits (Vegans, Paleos, etc.), which I think this is pretty cool.  As Khosla pointed out during his talk, much of your serotonin comes from your gut, so what happens there is pretty important to mental health.

 

I have a few specific posts in the queue following up on some of these themes, it was a great expo and I am already looking forward to next year.

Fitness & Training, Wearables

Quantified Self Expo, Part I

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My notes from the Quantified Self expo in San Francisco will require two posts, so here’s Part I, with an emphasis on topics that might be of interest to trainers, fitness center managers, and coaches:

1. Tim Chang of Mayfield presented lessons learned from his experience as an early investor in Basis, since acquired by Intel.  I could write a whole post on the topics Tim mentioned but I’ll first share two things stood out at me.  One was his focus on (essentially) the very same behavioral feedback loop that I’ve written about before – taking data and aggregating it across devices and activity areas to drive insight, then modifying behavior.  The other was his view that even as we get more machine learning and more data, there will always be a need for a human somewhere in that loop to help the consumer.  I think this is where personal trainers and coaches can play a much bigger role in what is essentially the health care system, and they can make an impact at much lower cost than hospital networks and big pharma.
2. Spire – this is a small device that goes inside the waist of your pants and measures your breathing rate.  I’ve long been interested in breathing patterns and this device has a nice design that I can imagine wearing all day.  Although it is not quite ready for prime time when it comes to exercise and training, due mainly to the motions and jarring of movement, it could be very useful in every day settings where you want to maintain a peaceful, present mind, such as meetings, stressful conversations, sitting in traffic, etc.  The app has built in reminders and encouragement to help guide you towards better breathing.
3. Sleep trackers – Sleep tracking is all the rage, for good reasons.  A lot has been written about the wrist worn devices (Basis seems to be the leader in this category) but I much prefer not to wear a watch to bed.  Beddit and emfit both have sleep trackers that slide under the sheet and monitor your movement, HR, respiration rate and HRV through the night.  Beddit seems to be a slightly slicker design, it’s a bit smaller and it interfaces to the smartphone over Bluetooth.  The app has an alarm function that will wake you at the optimal time.  It’s easy to travel with as well, for all you road warriors out there.  emfit is very similar, but without a smartphone in the loop (and without the associated alarm functionality).  It connects directly to the cloud over WiFi in your home.  I can see benefits to each approach so it’s nice to see them both on the market.
4. Genetrainer – Ralph Pethica spoke about the work they’ve done in relating your DNA to your athletic propensities.  Of particular interest is the ability to know what type of training you might most respond to.  Anyone who has struggled to dial in their training program might find some answers in their DNA.  This is a very active field of study, as Ralph scrolled through the backlog list of specific genes that he is analyzing to see if they matter to some athletic parameters.  One of the coolest things about this expo was talking to the folks with their sleeves rolled up doing research – this is definitely not a CES like show where, for the most part, everything is fully baked and ready for the masses.
5.  Body x Labs – they are building a software platform to do full 3D body scanning via commercial devices.  I can see so many applications for this, from motion analysis (golf swing, running gait) to bodybuilding (muscle growth, fat loss) to selling clothing (the perfect fit, every time, or better yet, custom clothing).
Overall there are a lot of tools – both devices and services – that are rapidly expanding the opportunities for knowledgeable experts to build business models and new services around.  If you are serious about training people and want to stay relevant and increase your value over the long term, you owe it to yourself to think about how to take advantage of these capabilities.
In my next installment I’ll share thoughts on other devices and presentations that are less oriented toward trainers and more toward self-monitoring or more health-care related aspects of the show.

 

Wearables

Churchill Club Wearables Forum – My notes

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Last week I attended the Churchill Club‘s forum, Wearable Technology: The Next Frontier (yeah, I’m behind on blogging).  It was my first time to attend one of their events and my only disappointment was in not doing it sooner.  Good conversation, great forum participants, good food, all 20 minutes from the house.
Here are my notes on comments or discussions that I found interesting or noteworthy, in no particular order:
1. Monisha Perkash, CEO of Lumo, said that  we are at or very near the novelty to necessity inflection point for wearables.  I think for a lot of folks we are getting there.  Someone defined necessity by the “turnaround factor”, IOW would you turn around to go get a wearable if you forgot it.  I was at that point as an athlete some years ago with my HRM, and I have to wonder what percent of the population will ever be that hooked on wearables although I think it’s a great goal to have as a product designer.
 2.  Justin Butler of Misfit used an analogy that I use a lot , which is that we have a lot of noise to turn into signal in terms of getting useful info out of our devices.   Combined with one of his other comments (which I also tend to agree with) that much of the hardware is commoditizing or getting close to it, and I think the smart money is focused on analytics and data analysis, which gets you a step closer to the holy grail of behavior modification.    Lately I’m playing with the Lark app, which is headed in that direction with a very easy to use conversational angle on coaching, but it’s not super advanced.  Exist.io is next on my list.
3.  I think it was Mike Bell of Intel who said that the market will likely remain fractured just given  personal desires and, just as importantly, the image that people want to project with their things.  This sort of contradicts the commoditization story and I think that it will be category dependent, for example watches will remain fractured but other devices, say adhesive backed HR sensors, will become commodities.
4.  The topic of data access, ownership, and platform openness came up several times.  Perkash said that Lumo had recently done an integration with Validic.  It’s clear that the apps and platforms (like HumanAPI) looking to do this are either not getting the word out, or folks have tried them and found them wanting.
5.  I think it was Yves Behar who made the distinction between “basic” vs.  “smart” wearables by whether there was third party access to the data, and I think this is a useful distinction.  Another way to slice it would be to say that if the device is paired with an analytic capability that guides behavior, it qualifies as smart even if the data are in a walled garden.   I can imagine niche applications that would fall into this category, especially where the device vendor might be leading the way in data analysis.
6.  The moderator asked which industries are not thinking about wearables but should.  Responses were aging in place, disaster response , injury prevention, and aggregating data across populations.

 

Wearables

Wearable World Congress Notes

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The Palace of Fine Arts was home to the Wearable World Congress expo this week so I made the drive to the city to look around.  It was a smaller expo than I expected but I had several interesting conversations and saw a few interesting products and platforms.  Wearable World recently became part of the ReadWrite media organization and is one of my go-to sources for news.

1. Muse – they’ve been shipping their brain sensing headband since last summer and I had an interesting chat with Andrew Parr, a pro golfer who works for Muse to take the capabilities of the device to the golf course to improve mental focus during competition.  I’ve long been interested in the nervous system as the next great frontier in sports training and we are just now getting the devices and data in place to be able to push this forward.  Combined with an understanding of breathing patterns, HRV, and muscle activation patterns there is really a lot of progress to be made here.

2. Nuheara – billed as the world’s first “adaptive augmented hearables”, they are building out a software + hardware platform for a slick looking, wireless set of earbuds that are smartphone controlled and offer a ton of features.   They really want to more seamlessly merge your physical, digital, and auditory experiences.  The device is still about a year out from production, and the team is based in Perth, Australia.   Surely they win the longest plane flight prize for the conference.

3. Panasonic – GoPro must be watching out as the cameras Panasonic showed off were incredibly small, light, and immaculately made – three things the Japanese still do as well as anyone.  They had a new one that’s not yet released which weighs 45 grams including the battery and built in WiFi.  Here’s the wired older version that’s already on the market.  Having raced mountain bikes through the night in many 24 hour races with a headlight on my helmet, I can tell you that small & light wins the day in helmet mounted devices.   If I were shopping for one, I’d definitely give Panasonic a look.

4. Ayo – Anyone who has read the Four Hour Body knows about blue light as a way to regulate energy and sleep patterns.  Ayo’s product looks like the top 2/3 of a pair of eyeglasses, but with little blue lights to stimulate your eyes and bump up your energy and help you regulate melatonin production and fight jetlag.  Assuming you don’t already wear glasses (like I do), you can wear these while working or doing household chores, so you needn’t be stationary with a blue light shining at you.

5. The Wearables Store – pretty simple, a e-commerce shop devoted to wearables.   Some new stuff there but there were enough important brands missing that we can’t call it a superstore just yet.   Speaking of webstores, at the Muse site I found the mindTec store which is focused exclusively on bio and neuro-feedback products.

6. Strap – Unfortunately I did not get to speak to anyone at their booth, because these guys are going after exactly the problem I wrote about a few weeks back – namely, how do companies extract the massive marketing value of all these wearable devices to drive better customer engagement.  The goal of their platform is to make wearable data accessible and meaningful to marketers, although the list of compatible devices/services they identify on their website is pretty short and I did not see any talk of an API for developers to use to leverage their capabilities.   Definitely one to keep an eye on though.

7. meMINI – another take on the wearable camera.  The idea is that you video your whole life and tap the device to tell it when something interesting happened, so that snippet of video gets sent to the cloud and everything else is erased.   Seems pretty handy for skiing and other outdoors events where you need a small camera (their device was a bit bigger than a matchbox) and don’t want to comb through hours of video when you’re done having your fun.

8. Amby – a watch for your kids to wear so you can keep track of them and interact with them.   It’s a wearable designed for the kids to wear but give the parents piece of mind.

Beyond specific devices, I was reminded of the importance of crowdfunding in driving wearable innovation forward, and of how great it is to live in San Francisco or Silicon Valley.  Several international companies had only one employee in the US, and they were almost always located in Northern California.   This event was obviously no substitute for CES and its more comprehensive set of vendors, but if you want to keep an eye on what’s new and not yet on the market, it’s worth it.

 

Fitness & Training, Uncategorized, Wearables

Feedback Loops and Fit-Tech Framework

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With so many product launches and so much investment activity in the digital health & fitness arena it helps to have a framework for understanding the meaning of it all.  This post is the first in a series in which I’ll share the frameworks I use, with a few notes on some of the companies I see doing really interesting work across the entire ecosystem.

I always start by considering any new product or technology with a behavioral emphasis.  At the end of the day, it’s consumer/patient/athlete behavior that really matters when we talk about improving health, reducing costs, or improving performance.  I have another framework to look at things from a technology stack perspective which I’ll share in the next installment.

I’ve run this simple diagram by countless people, inside and outside the fitness-tech arena, and everyone seems to get it right away, so it’s been useful for me.  It’s simple, and maybe obvious, but I always find it worth stating.

Feedback_Loop

This picture is informed more by my background as a coach, athlete, and lifestyle design enthusiast than by any market study or tech trends.    The Action step is where the rubber meets the road, but it’s hard, complicated, and can take a long time to move the needle.  It’s also influenced by many factors beyond the fitness or health care arena.

A lot has been written about wearables, so I won’t say much about the data collection step.  As I’ve mentioned in previous posts, it’s really not the things that are interesting but the data they provide and the services they enable.

When I consider Expertise + Analytics box I’m including machines & people.   Some users are curious and enthusiastic enough to dig into physiology and learn how to interpret their own data, but that’s a fraction of the fraction of people who actually keep using their wearables (the percentage may be high, or maybe not), so the emphasis here needs to be on professional service providers of one sort or another.   IBM’s Watson and health focused providers like Vivametrica, and even more niche companies analyzing specific data sets like power data from bicycles are all contributors to the more algorithmic, machine based contribution the to this arena.

Finally, motivation is critical and many social, financial, mental health and other factors play into this.  It’s surely the hardest nut to crack and it’s also where a lot of the personalization of health care comes into play.   Some of the most interesting apps focus in this area so I’ll devote a whole post to this soon.  The opportunity for fitness clubs and other activity-related social groups to contribute here and leverage the technologies already on the market is substantial, and I believe still vastly underutilized.

As always, I welcome your comments and feedback via email or the comments section.  Follow me on Twitter or LinkedIn to make sure you get all the updates to the blog and subsequent articles in the series.

 

 

Uncategorized

It’s All About Who You Know – Recommended Reading

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Many years ago as I was transitioning out of the military into civilian life, I worked with a recruiting firm that placed JMO’s (junior military officers) into corporate America.  At one of their career fairs Roger Cameron asked everyone to share their favorite motivational saying and we all went around the room.  You can guess that in a room full of young, ambitious military guys (it was probably a 90% male group) the contributions ranged from inspirational to blustery, some as short as one emphatic syllable .  I hadn’t given the question any real thought and when it came my turn, I reflexively blurted out the ancient Greek aphorism “Know thyself“.  It sort of fell flat in that room, like I was answering the wrong question or something.  Twenty plus years later I see the truth revealed in how I answered that question, as self-knowledge has been one of my strengths and great stumbling blocks.  I’m old enough to see the experiences in my life where it’s been one or the other.

With that in mind, my recommended reading for this month is Peter Drucker’s timeless HBR article, Managing Oneself.   At the foundation of managing oneself is knowing oneself, and this article addresses the topic in some specific areas that are important at any stage of life or career.  It’s worth your time to read the article but more importantly, turn it into a homework assignment and write down answers to the questions posed.   I did it about a year ago and I still refer to the notes occasionally to make sure I got it right and that I am working on the right things.

 

 

Marketing / CRM

Marketing, Fitness Data, Missing Links

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I spent a day this week in the city (that’s San Francisco for those of you not in the “Bay area”) and besides the fabulous weather I enjoyed meeting with the head of biz dev at one of the industry’s hottest fit-tech/wearables companies, as well as checking out the Marketo Summit.   In case you don’t know who Marketo are, they are one of the leaders in marketing automation.   When you get an email from a company every month and the content is tailored based on the products you’ve ordered before, or when you click a web page and a few days letter magically get an email offer for the product you looked at, that capability is provided by some marketing automation solution.

Marketing automation tools rely on insight into customer behavior.  This can come from lots of sources – social media, data providers (it’s a bit scary how much data about you is for sale), records of buying behavior, as well as more direct interactions with the customer, such as click behavior on your website, engagement with customer support, etc.   One of my guiding viewpoints is that all that data being generated by fitness wearables presents a huge opportunity to gain customer insight, and although the Marketo show was a very horizontally targeted I did not see anyone talking about this opportunity.   One challenge is getting the customer to agree to give you access to the data – but if you are a trusted advisor (say a gym with personal trainers who can use the data to help the customer) that’s a surmountable challenge.  And if your marketing is smart and value-added, it will be well received.  This is an area of ongoing study for me, so I hope to share more on it as I go.

As long as I’m sharing info on what I learned at the show, here’s a handful of other (somewhat random) companies I checked out that I found interesting for one reason or another:

Bedrock Data – SaaS integration and data push/pull, targeted at the SMB.  Sort of a Snaplogic or Dell Boomi but priced and spec’d for the little guy.

Elixiter – Marketo consultants / implementation experts.  Based in Montana, tech center of the US.  Ha ha.  Seriously, I bet they all have a better quality of life than 99% of the people in Silicon Valley.

Spear Marketing – Just some nice guys in the marketing business.

Inside View – data aggregation to drive better customer insights and lead scoring.  B2B focused.  These guys provide a lot of that user data that I mentioned above to help you mage your sales funnel and do lead scoring.

Sprinklr – Hootsuite for the enterprise.

PFL – they merge your online and offline  with mailers and other customer engagement tools.

LeadMD – Scottsdale based Marketo (and Salesforce) implementation consultants.  If you are considering moving business apps to the cloud but think you need help, there’s a whole ecosystem of companies who can help you.  LeadMD is one such company.

Marketing / CRM, Point of Sale

Choosing a SaaS Solution

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I’ve spent a lot of time researching SaaS apps that can help you manage your business, and it’s certainly a big and often confusing market.  It helps to have some guides and while I haven’t found a single one that covers it all, there are a few I found that are really useful.  Here they are, with a few of my own comments.

Getapp – one of the best, with lots of customer reviews.  Broad set of product categories.

ISV World – Cool service, covers all software vendors not just SaaS apps.  Useful for those in the analyst & investment arena as it aggregates financial data on the vendors.  Thanks to their machine learning capabilities the database is very large.

Merchant Maverick – More focused on the transaction and financial apps, especially merchant accounts and POS.

Capterra – Decent number of customer reviews and 300+ categories to help you search.

Cloud Showplace – Run by SaaS thought leader Jeff Kaplan, this directory splits up providers into the SaaS/PaaS/IaaS stack so it provides a view on the “cloud services” market that some of the others don’t.

IT Centralstation – A bit more of an enterprise focus with more input from “IT pros” as opposed to SMB owner/operators who lack IT staff.  You can create a free account or sign in with your LinkedIn account.

And there you have it.  A few really helpful resources to help you navigate the SaaS world.

 

Focused on the intersection of my three favorite topics.