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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.

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

FIT-C Podcast on APIs in Fitness

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.

 

Feedback Loops and Fit-Tech Framework

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.

 

 

It’s All About Who You Know – Recommended Reading

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.

 

 

IoT Applications in Health & Fitness

“When you look at the Internet of Things, the things themselves are not interesting,” said Dave Sobel, director of Community at MAXfocus and a self-professed IoT enthusiast. “We’re all focused on the ‘things,’ but that’s not where the opportunity is.”

That’s a quote from an article on The VAR Guy, and I could not agree more.  The article is interesting on its own (I’ll share some thoughts later on cloud services, IoT, and the channel) and if you are trying to get your hands around IoT and what it means to business, it’s worth a read.  For today I wanted to share a few thoughts that this quote generated in my head.

1. Running shoes – what happens when they are instrumented?  When the data from the shoes (pressure maps, gait data) get integrated with other info (running mileage, terrain)?  Suddenly your running shoe retailer (or your gym, or your coach, or whoever you allow) has tremendous insight into when you need to replace your shoes, what type of shoe will work best for you, muscular imbalances you might need to work on, etc.

2. Gym equipment – Combine a beacon on the equipment with a wearable and instrumentation on the machine to automatically log the user’s reps and upload them to a service for tracking exercise.  Integrate the coach or trainer in the gym into this loop for a rich and very sticky engagement with the customer.   Imagine all the marketing  value of knowing which members are using which equipment, and overlaying that on their class attendance and demographics.

3. Sleep data – Mash up your sleep data from a wearable from the temperature data on your Nest (lots of data point to the connection between temperature and sleep quality).  It sounds great but what’s important is how the thing (thermometer) enables a better life (better sleep = better life, no two ways about it).   Let the athletic coach or health care expert see these data so they can understand how they might impact response to medication or training load.

Selling things is getting less and less interesting as a business.  If you are in retail, and you really view your role as just having a thing on the shelf for someone to walk in and buy, you are competing directly with Amazon, Walmart, and every other e-commerce site that exchanges things for money.   Being close to the customer and building a comprehensive relationship with them means being able to leverage the data from the things more effectively than a far-away website and truly move from selling a product to providing a service.

I’d love to hear your favorite ideas for how to merge user data and device data to deliver better solutions to customers.

 

 

 

Fitness Industry Tech Usage Survey

I came across this presentation from the Fitness Industry Technology Council on LinkedIn and found it pretty interesting.  I could talk about a lot of the results at length but one that jumped out at me was the fact that only 30% of fitness facilities are using technology to track member workouts.  The data are a little bit old but I bet it hasn’t budged a whole lot in the last year.   There’s enormous opportunity here to improve member results, reduce customer churn, and get your members to do your marketing for you.  We all know people like to brag on social media, and when they brag you should make it easy for them to let everyone know they are bragging about a workout they did at your gym.   That’s just one small example.  We use FitLinxx at the Y where I teach a few classes and even though we are fairly advanced I think we still leave a lot on the table.

Calling all fitmob instructors / gym managers

Fitmob has gotten a lot of buzz lately and rightly so – they are seeking to really disrupt and change the model of gym membership and fitness class participation.  If you haven’t heard of them, you can think of them as an “Uber of fitness classes”.  You can find a lot of consumer reviews of the service on Yelp but I’m really interested in fitmob from the trainer or gym manager’s perspective. If you’ve used fitmob in your business and are willing to spend 5-10 minutes sharing your thoughts on it, please shoot me an email – karl@fitbusinesstech.com.   Thanks!

March’s Recommended Reading

I like to share ideas and content that have been powerful or useful in my career and life in general.  Today I’ll share one of my favorites – it’s a blog by a former private equity guy turned elite triathlete turned coach and blogger, Gordo Byrn.   Check out his blog here.

To get you started, here are two of my favorite recent posts.

Behavior not Protocol – I’ve always told athletes “the workout you’ll do is always better than the one you won’t do”.  Too many folks obsess on the details of this plan or that plan, but they won’t execute either plan consistently, so it really doesn’t matter.  Byrn elaborates on this more eloquently than I can.

The Freedom of Not Knowing – Selective ignorance is a valuable thing.  There are a lot of things I choose not to be informed on, because they just don’t impact my top priorities in life.   At best they are time sinks, at worst they are a cause for anxiety and unnecessary emotional arousal (this was a big factor in my decision to delete my Facebook account earlier this year).

Byrn also writes a lot about financial planning for families, and his own experiences as a father.  If you are looking for a blog to add to your regular reading list, you should consider his.

 

 

Power measurement for runners

I still remember when a little German company called SRM came out with this ghetto looking crankset that measured power on a bicycle.   It was so novel even some expert physiologists wondered what you’d do with the data.  Back then heart rate, cadence and speed were considered the benchmarks of training data and even the measurement of those was not widely adopted, never mind the training methods and protocols to get the most out of them.  Fast forward a couple of decades, and no serious cyclist would consider training without power.  Even the spin bikes at my local YMCA feature a power meter (calibration questions aside), and we are working on programs to utilize these data more comprehensively so that even casual riders can maximize their workout value and track their progress.  Mainstream companies like Garmin and Polar have joined and been driving forces in the the ecosystem around cycling power measurement.

Of course bicycles lend themselves to the instrumentation that provide power, but other sports not so much.  Enter Stryd.  They have a campaign on Kickstarter to fund a power meter for runners.  This could be huge – the ability to quantify not the runner’s speed or exertion, but the actual rate of work output – accounting for gradient, wind, etc.  Given that I spend more time running than cycling these days, I just might have to get in on the campaign and be an early adopter.

More broadly I think this points to the ongoing desire to quantify health & fitness activities, and just like with cycling it will spawn a new generation of data applications and experts to make sense of it all.  The forward thinking fitness businesses will be ready to capitalize on this when it goes mainstream.

You can learn more at their official website.

Internet of Things and the SMB

If you pay any attention at all to the tech world you’ve surely stumbled across the term “internet of things” (IoT) many times, and perhaps wondered what the heck it means.  I define it this way: it’s the vision of all physical objects as devices that have some kind of network presence, whether as input devices (say a temperature monitor on a refrigerator, or a security video camera accessible on your iPhone), or as input/output devices (Nest is a great example – it sends you data over the internet, and you can control it remotely).   Those of us who have been into “wearables” since before they were called wearables (you know, that Polar HRM we were using back in the mid-90’s) have been particularly interested in how these locally monitored sensors can eventually be web enabled, and how those data deliver value via web services to various ecosystem partners.  For example – your HRM is valuable to you as you regulate your workout, but it can also be of value to your coach, thousands of miles away, who can use the data to guide your training.  I believe this whole arena presents great opportunities for savvy SMB owners in the health and fitness arena and will be exploring this theme over time.   In the meantime, this article from Laurie McCabe covers a few angles on IoT for the SMB.  Laurie covers a lot of technology themes around the SMB, her content is worth spending some time on.