[ This post is written for the WCIT2010 blog and cross-posted here ]

“A hospital is no place to be sick”, Samuel Goldwyn (from MGM) once said.

And he was right. Because ultimately nobody wants to be in the hospital. But we cannot deny the fact that everyone will be a patient sooner or later. Maybe short and only irregular if you’re lucky – or for long periods and often, if you are the not so lucky.

Healthcare is an industry. An industry that affects billions and employs millions. An industry means a business. And businesses are there to help their customers and offer products and services that they want. Well, they should.

The healthcare industry, and the medical field in general, has always been keen on technical innovation. During the last century some amazing technical innovations have seen the limelight: penicillin, the artificial kidney (invented by a Dutchie) or robotic surgery, just to name a few. And technological innovation growth seems to be exponential. Which means that we now see the developments in mobile (mhealth) and nan technology changing the face of healthcare.

But there are two even more important changes in healthcare (in my opinion).

The first is that healthcare is not about the patient – which is “bon ton” at the moment (search for patient-centered). Delivering and receiving healthcare is about a network of people involved: patients, e-patients, family, caregivers, insurer, colleagues etcetera.

The second import change is about the people that change healthcare. It is no longer only in the hands of professionals only (research, decision makers, CEOs). More and more often patients take control in creating the best healthcare experience there is. Wonderful examples of this can be seen in the stories of ePatientDave or Maarten Lens-Fitzgerald.

(checkout out the stories of ePatientDave of Maarten Lens-Fitzgerald).

Therefore innovation in healthcare is innovating the whole service: service design (with agencies like IDEO or 31volts showing the way). Technology is a part of an experience created by and for people. This thinking in networks, services and sharing has recently resulted in a new name that rightfully reflects what the future of healthcare is really about: participatory medicine. The Society of Participatory Medicine (and the accompanying Journal of Participatory Medicine) provide inspiration and pratical examples of how people together, information and technology can co-create a better future for healthcare. Because in healthcare you’re not alone.

Check out this presentation that shows Maarten Lens Fitzgerald story:

Related posts:

1. Reshape 2009: Thoughts on Changing (Dutch) Healthcare

Probably most ambitious people are starved for the sort of encouragement they’d get from ambitious peers, whatever their age. [...] Which means one of the best ways to help a society generally is to create events and institutions that bring ambitious people together. It’s like pulling the control rods out of a reactor: the energy they emit encourages other ambitious people, instead of being absorbed by the normal people they’re usually surrounded with.

Paul Graham makes these and other excellent points about determination and what drives people. It’s an insightful read about why some succeed and others don’t. Makes you reflect.

Disclaimer: I’ve blatantly stole the idea for this post from Jen’s excellent blog, so all kudos for digging up this gem go to her!

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Every Thursday evening we come together. The #momoams team: @vangeest @panman @marcfonteijn @samwarnaars and me. I like those meetings – a lot. They’re personal, on the edge and energetic. Trends, future scenarios and the latest gadgets all are part of the conversation (and we also do some event planning in between too :-)

Last week on our mailinglist @vangeest mailed a link to an article on Edge.org from Frank Schirmacher called The Age of the Informavore.

I watched the video and I’m blown away.

Really. It’s an more than excellent talk about how technology influences people and our society. It may seem like dry stuff, but really after watching this video you might very will think different. (On of the funny things in the video, considering the topic, btw is the sound of new mail coming in every now and then at Schirrmacher’s computer :-)

I have added the video below and added paraphrases of some of my favorite parts of the interview also (I can’t take credit for any of the content, they’re all Frank Schirrmacher’s, just see them as my highlighted parts). But actually, go over to Edge.org and read the full article (including excellent links and more info)! It’s more than worth it. Thanks again to @vangeest for sharing!

• There seems to be an explosion of ideas, but not enough brains to cover them
• When you view attention as food for information, we are now in a food crisis. That’s when dynamics of Darwinian selection kick in. Which ideas survive? Which thinking succeeds and which doesn’t?
• The human is an informavore, it’s eating information. But just as with food it has to decide what take, what not to take, whether something has good or bad calories, whether it’s healthy etcetera
• We are experiencing a cognitive revolution, much of what we are thinking is stored less in the lived life and more in systems linked to knowledge: Facebook, blogs etcetera
• In the 19th century it was talked about that muscles had to adapt to the machines, in the 20th century we see the same question but now with the brain. We face issuess with e.g. multi-tasking.
• There will be major issues with the tools developed, especially predictive search versus free will. Issues about the way we predict and the way we ARE predicted
• Three important 19th century principles return – but in a different way – regarding information and society: Darwinism (who survives in the Net), Communism (question of free), Taylorism (people see themselves not capable anymore of keeping up with the system)
• The realtime nature of the information has #iran already competing with @parishilton. You also already information cascades to influence this not only by humans, but also by bots
• Kafka and Shakespeare in their time translated reality into literature – we need to find people that can do this on the level of software. George Dyson e.g. has done this very well in the article Turings Cathedral about his visit to Google: “Despite the whimsical furniture and other toys, I felt I was entering a 14th-century cathedral — not in the 14th century but in the 12th century, while it was being built.”
• People tend to forget heuristics, e.g. the ability to calculate as machines will do that for us.

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Recently I’ve applied for a GroenLinks membership – a Dutch green left-wing political party. Why? Because they asked relevant and very to-the-point questions in parliament about the Buma/Stemra fee for embedding online content (the plan was canceled mostly by the Buma/Stemra quite soon after)

@groenlinks (their official Twitter account) twittered about their questions and I decided (together with my general idea of the party) that was a good reason to sign up. They even retweeted my decision to sign up.

But now I’m having second thoughts.

Why? Let me explain. Most of my involvement with the party is online (I follow their Twitter account and that of some of their politicians). I focus on some of their issues (free standards, green deal, better social structures), rather than the party as a whole. But it’s still a party organisation and that’s a problem.

I signed up online, because of online issues (Buma/Stemra). And what do I get? Paper. Loads of it.

I’ve gotten flyers, brochures, party programs. The lot. And I’ve never asked for any. If would want to read those I would go online and download them. But what’s more: I’m interested in specific topics: online rights, new deal, social structures – what about those?

There’s no personalization. But the paper forms do ask me for a lot of other things: help them campaign, spread flyers etctera. I feel that with signing up I seemed to have gained the status someone-we-can-use-as-free-campaigner.

I know I signed up for your organisation. But what I’m interested is in your people, your specific issues. The issues I can sympathize with. Just like with the Buma/Stemra one.

I’m an online person. I don’t like paper. Others might. I don’t. So, where is your Twitter? Facebook? Online forms? Google Docs? Live stream?

Political parties need VRM – Vendor Relationship Management. It’s not about them pushing all their party issues on to me. It’s knowing who I am and linking their issues to my person. That’s personalization – that’s the new campaigning.

I’m ditching all the papers and I’ll wait for a response that fits my way of working (I’m @mdbraber).

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With the introduction of Mac OS X 10.6 (Snow Leopard) many cool features were introduced and at least one not so cool feature: whenever you press the Play/Pause button your keyboard when you have e.g. Spotify running, it opens up iTunes. Anyway, nothing we cannot solve with a little hacking, right?

First start by downloading this script and save it somewhere on your computer. (DISCLAIMER: This script was taking from this thread on Apple Discussions). The contents of the script are listed below. When the script is launched it checks if another program that uses the multimedia keys is running. If there is it ignores the request to start iTunes, otherwise it simply proceeds with starting iTunes. You can change the apps setting to list more apps that you want to prevent iTunes from launching.

#!/usr/bin/env python
import sys, os, subprocess
 
launch = True
blocker = ""
apps = ["Ecoute", "Spotify", "Songbird", "Mplayer OSX Extended", "Mplayer"]
 
ps = subprocess.Popen("/bin/ps -x", shell=True, stdout=subprocess.PIPE)
 
for line in ps.stdout.read().split("\n"):
        for app in apps:
                if app in line:
                        launch = False
                        blocker = app
 
ps.stdout.close()
 
if launch :
        os.spawnvp(os.P_WAIT, '/Applications/iTunes.app/Contents/MacOS/iTunesX', sys.argv)
else :
        print "Not launching iTunes while %s is running." % blocker

Next issue the following commands in a Terminal (of course replace <downloaded-script-location> with the directory where you downloaded the script to (e.g. /Users/myname/Downloads).

cd /Application/iTunes.app/Contents/MacOS
sudo mv iTunes iTunesX
sudo mv <downloaded-script-location>/iTunes.py iTunes
sudo chown root:admin iTunes
sudo chmod 0755 iTunes

Et voila, this should fix it. You can check by opening up Console to check the logs for the message “Not launching iTunes while is running”.

Comments, tips and suggestions welcome!

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Today I attended a presentation at the Dutch Design Week by Marcel Zwiers from 31volts about Service Design. It’s a subject I’ve become more and more interested in over the last few months. If we take so much time designing products, what about services? And what value could it add? Especially for healthcare I suspect there might be significant gains in exploring the methods used. I will do a post on that later, first I’ll list my key take-aways about service design in general.

Don’t evolve. Design.

A service consists of technology + business + people. Service design focuses on the people. Important principles are design thinking, a holistic approach and people centeredness. So more buzzwords – what will that help us? It makes us think, that’s what I believe is most imporant. Evolving services is the normal route. If it’s not what or how the customer wants it – we’ll change it later. That’s a major FAIL.

Services are far too often becoming patchwork. While their are tools and techniques available that help to build a service that connects better to both the user and the provider. Service design as Marcel explained takes two important things at heart: create value (for the user) and use a design process.

It’s not what you think it is.

Service design is like solving crosswords. Or a visual illusion for that matter. It’s seeing one thing, but knowing that there’s something more – a deeper layer. Rijkswaterstaat is not about laying tarmac, it’s about  giving the people the opportunity to meet and connect. Staatsbosbeheer (Dutch Forest Reserves) looks like being about trees, but owns the countries’ largest fitness space. Think twice. What’s it you’re offering to your users? How can you do that? Take a look at the presentation below for an idea of what a service designer does.

Service designs need a business case.

When you have a company interested in doing a service design project you’re lucky (often heard response: “it’s always been okay, hasn’t it? why change it?”). But the key take away I got from the presentation – and some of the articles in SDN Touchpoint – is that these designs are in need of a good business case. There are different levels these ideas/designs need to be communicated and rightfully so someone is going to ask the question what value does it serve – is service going up, is it going to make more people use the service, will they light up green and do a happy dance? And you better have an answer, if you want to go beyond sketches, visualizations and ideas. That’s where designers and strategies can meet. There’s a good article about that in SDN Touchpoint issue, by James Moed (business strategist, IDEO) and Fran Samalionis (head of Service Design, IDEO).

Crippling?

Service design is no panacea in any form, but it gets a lot of things right. We must not let it cripple in what direction we can improve services, let alone saying that it is the way to go. @fackeldeyfinds stated that well in a Twitter discussion: let people think again. Service design can be one the ways we can help that along.

Oh and yes, we need to think about more titles like Chief Customer Officer. Or Chief Patient Officer :-)

I’ll write some more on this in future posts – I’d love to hear your thoughts! Thanks to @marcfonteijn for inviting me to attend the presentation!

Service Design door Marcel Zwiers – Dutch Design Week 2009 from 31Volts on Vimeo.

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Yesterday I attended Reshape 2009, a Dutch Health 2.0 conference organized by @zorg20 and others – it was put together very well (kudos to the team!). There was a good vibe and for me personal it was good to meet with national and international good friends. Some of my thoughts on the day and what’s happening to Health 2.0 (in The Netherlands and abroad).

One of the prevailing thoughts is that the audience is changing – luckily! 1.5 years ago I co-organised the first Dutch Health 2.0 event, together with what later became the Nexthealth crew (@jensmccabe, @fackeldeyfinds, @martijnhulst, @shakingtree, @jeroenkuipers, @hout) From a bunch of pioneers and enthusiasts, we’re now gradually getting to the stage where more and more suits attend. Yes, that IS a good thing :-) But we still need all the nurses, patients, family and others that are concerned with care also there.

The slogan for Reshape 2009 was “Healthcare communication is changing” – but during the day my main interest is how healthcare is a whole (not only communication) can be changed. Below I have summarized some of my main thoughts this, based on the excellent talks and workshops and Twitter responsed during the day.

My key take-aways from the sessions and talking to the speakers and attendees.

• People. People. People.
• Visualize!
• Build bridges and ignore everybody.
• Education is key.
• Impact matters, not cost.
• Data. Data. Data.
• Too few valid business models.
• Too many projects, too few startups.

Let me explain those a bit.

People. People. People.

Really, it’s not about the technology. Sure iPhone apps are great and Layar is cool and all. But what problem are you solving – and have you asked the people? (tnx @marcfonteijn). There is value in experimenting and trying stuff. But don’t pose tech stuff as a solution if there’s no real problem you’re solving. Ask the people who care (literally).

Visualize!

The picture and the thousand words story, you’ve heard it before. But really – go and ask any person who is involved in optimizing healthcare processes how long it took them before they knew what they were optimizing in the first place. All people suffer from tunnel-vision, not everybody needs or wants / to know how the whole experience looks. But it matters if you’re the one experiencing it. And we have excellent tools that help visualization. Get a Flip Video for all your patients and doctors (tnx @leeaase) and let them film their experiences. Then be sure to get a drawingboard, you’ll need it.

Build bridges and ignore everybody.

Healthcare is hierarchic. Sometimes it looks even immune to change. But when it comes from the right person it can change. Most doctors accept more from other doctors. Patients from patients. So bend it your way: get the right persons with vision and network on your team. And let them move in their network in ways that fit the network. If that’s publishing journal articles, fine. If it’s twittering, also fine. But when you’re on it: ignore everybody (tnx @gapingvoid). You’re telling a story some may not want to hear. But if you are certain it’s the right story (People, People, People, right?) – stick with it.

Education is key.

Why does (it look like) a younger generation picks up this internet stuff quicker than their parents? Because they’re raised with it. Education of medical professionals is still lacking greatly in terms of introducing health/medicine 2.0 related subjects. Training all medical professionals in their evening hours after they’ve finished regular education won’t work – sorry. The positive example here is by @berci (keywords: bright, honest, works-damn-hard) with his Medicine 2.0 course at the University of Debrecen. Seriously, why is this stuff not obligatory in every medical training? @jknl (professor Jan Kremer, gynecologist) already said once: we need to take out a year of text-book training and learn our students how to use these tools.

Impact matters – not cost.

There was ample talk on how much changing healthcare communication would cost – mainly focusing on social media such as Youtube, Facebook, etcetera. The answer: nothing (or almost: nothing). That’s not true (think: time, strategy, hardware). But the best thing: it doesn’t matter what it costs. You should choose those things that really impact what you’re doing. If that letting patients share their stories through a blog – great. If that blog is free – even better. The main take-away is that all this free internet stuff is apparently having a far greater impact on how care is given, hospitals are perceived, experiences are shared etcera. That’s why you should care. Impact, not cost.

Data. Data. Data.

Yes I know, it sounds just like People, People, People. That’s because it’s equally important. Data is key to understanding diseases, recognizing quality and improving services. Many have already understood that it’s worth more to open up your systems rather than close them down (think Google Maps or check data.gov). When you open up, people can validate, check, improve beyond what is possible if you would keep it closed. Just check the story of @epatientdave and you’ll see what I mean. @hout did an excellent session on HealthCloud, trying to get different healthcare parties open up their data. When opening up data, then the important thing can happen: building an healthcare ecosystem. People will built relevant apps fitting their own needs and beyond what is possible/imaginable from within one party.

Too few valid business models.

During #reshape09 and also outside, I see many Health2.0 related initiatives pop up. I remembered that when I was @boltyboy’s (Organizer Health 2.0 Conference) place in 2008, I saw the volunteer t-shirt from the 2007 edition. And I noticed how many sponsors had disappeared comparing the 2007 and 2008 shirts. Many startups and new ideas fail. Sometimes because of bad luck or wrong timing, but far too often from simply not having a valid business  model. I see lots of start-ups on a shoestring who add great value, but struggle to make it stick financially. In a financial complex healthcare system such as the Netherlands this is particularly hard. But this doesn’t take away the need for a valid business model for healthcare (DISCLAIMER: I did my thesis on hospital business models). It needs all the elements: from what value it adds, to how it’s financed. It’s hard but relevant. Who said that healthcare is not a business?

Too many projects, too few startups.

In Dutch healthcare there’s an explosion of healthcare innovation projects. Many of these projects take place inside current organizations. Some are real innovations, some are improvement or optimization projects. Disruptive innovations often don’t thrive well within existing structures. That’s why we need more startups that  take on the healthcare system from the outside, such as SOS-arts. Disruption takes a long time, especially in healthcare and that is not possible without the proper investments. For that we need VCs. It’s a chicken or egg problem: we need people that dare to build a healthcare startup and we needs VCs to invest in them. But one won’t go without the other.

I’d love to hear your thoughts!

Related posts:

1. In Healthcare You’re Not Alone

San Francisco. Feels a bit like being home (Amsterdam that is). You can just walk through the streets here and not have to take a cab for every place you want to go to. That’s nice! And in some ways it’s even better than Amsterdam: they have a a proper Apple Store :-)

Yesterday Jen and I had dinner round Fisherman’s Wharf after we arrived here in SF. Pretty weird eating seafood at 6.30am Amsterdam time… but it’s a nice place. Unfortunately it was too dark (and I was too jetlagged) to take a stroll around, but I will definitely do that the next few days.  Maybe the best part of the evening: the cab ride over to Fisherman’s Wharf from UN plaza. My! I know that San Francisco was a kind of a ‘hill city’ but it’s extreme! Walking in that part could easily be compared to mountain climbing (well in The Netherlands for sure, where we have like, no mountains. :-) The cabbie told us the breaks on the cabs get replaced every 10 days! Thankfully he just charged us for the ride and not a new set of breaks :-)

Today is pre-conference day packed with meetings and parties. There’s rehearsal stuff going on this morning and then lunch at Soluna cafe with more healthcare tweets. After that there’s the Health 2.0 accelerator meeting, more preparing/rehearsal at The Marriott and than the VIP party after that. Well yes it’s hard being in SF, no doubt :-)

I’m very much looking forward to meeting all the people coming over. Already on Twitter there’s lots of people are queuing up at airports or already in town (look for the tag #health2con). I’ll be volunteering at the conference but I’ll definitely try to cover it live where I can (on Twitter, on Nexthealth or here). There will be lots of demos and interesting apps being shown, but I’ll also be on the lookout for the larger scheme changes in healthcare, connecting online and offline and patient with professionals. I think there’s lots of inspiration here to do a followup on the Nexthealth paper: reaching consumer-centric care.

Let me know if you’re in town and like to meetup! Also for your European people: I’d love to talk with you about what we could use in Europe… Is there room/interest for a conference like Health2.0 (focusing on entrepreneurs) or are there different needs?  Speak out here or IRL at the conference!

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Finally – it’s been a struggle but I’ve made it! My thesis presentation and the rest of my colloquium went very well. The presentation was fun to give and it was a blast to be able to finally present to all those of you who have shown their continuing interest in my research (and the process leading up to it). And the best part: I’ve graduated with 8 (as has Joost!)

Thanks again to all of you who have attended my colloquium (in person or online in any form). I’m really stunned by all your nice reaction and congratulations!

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Lots of you asked and finally they’re here: the document and presentation of my thesis. Today at 10.30am I will be presenting and if all goes well you can follow the live-stream here (from 10.30am GMT+1). For now you can download the final document or read it on Scribd. The presentation is available on Slideshare (although I can’t guarantee that I won’t make any additional changes this morning before presenting :-)

When the presentation is done I’ll update you with the grade and devote a proper posting to the topic afterwards to summarize the findings. After lots and of sleep and party first I guess… (not in that particular order :-)

Thanks to the University of Twente and The Decision Group for making this research possible.

Related posts:

1. Nexthealth presentation and paper available