Tag Archives: open platform

May #DSMA Blog Carnival: People trump Proprietary.

May 27, 2014 – 9:13 am

The May DSMA Blog Carnival topic has required a lot of thought on my part. And to be honest, I’m not through thinking about it yet:

This is a grassroots initiative calling for diabetes data and device interoperability — so that we PWDs have full access to our own data, can share it as we like, and can use on whatever apps or platforms we choose without being locked into some proprietary product from just one manufacturer. For the month of May, we’d like to know:

Why does open D-data & device interoperability matter to you? How might your life improve if open data were the norm?

I originally wrote about this in a story about an interoperability conference I attended back in February.

To me, the problem with “proprietary” software (or “proprietary” anything else, for that matter) is the very ideal of proprietary: To continue sole ownership of and profit from a device, or an algorithm, or something else, forever. Or at least until the next proprietary thing can be developed that will replace the original. By nature, something proprietary is designed to be kept proprietary by its owner not just now… but for generations to come. Never ever shared.

But these companies paid for their product to be developed, right? They should be allowed to profit from it, as much as they want, right? Who am I to suggest they open up their code?

I’m all for profit. I love profit. Proprietary and profit go together like bacon and eggs.

Unless you keep kosher. And there’s the rub with “proprietary”.

Not everyone is the same. Some of the people in the world are blessed with bodies that have fully functioning pancreases. Some are not, and they are People With Diabetes.

Some People With Diabetes are blessed with wonderful insurance plans that pick up a large part of the cost for a new insulin pump, continuous glucose monitor, or test strips. Some are not, and they struggle to afford even the daily insulin they need to survive.

Some people never have to worry about where their blood glucose is headed at any given time. But there are People With Diabetes who deal with hypoglycemic unawareness, something that keeps them from being able to recognize life-threatening lows and treat them in time. For these people, a continuous glucose monitor, the best one they can lay their hands on, is a daily life-saving instrument that they cannot do without.

Some people are lucky enough to have access to world-class healthcare resources, where doctors and nurses can look over them whenever necessary to help them manage those times when they might wind up in the hospital. And some people wind up in the emergency room, waiting desperately for care, because the hospital they have access to still writes down every last statistic about every patient, then manually enters all of that data into a computer, then photocopies the paperwork and files it away in a vault somewhere… instead of accessing a standard system that includes all of the patient’s medical history, their prescriptions and doses, pump and CGM data, and their doctor information, leaving doctors and nurses free to, you know, actually practice medicine.

The thing that profit-protectors fear, I think, is that we’ll suddenly go away as customers the minute they open up their platforms. But here’s the thing: I would still want to wear an insulin pump. People would still want CGMs to monitor their blood glucose. I’m going to need insulin as long as I live with Type 1 Diabetes.

Your customers are not going away, profit-protectors. But… How would the lives of both groups of people described here be changed, if the standard of medical software development was focused on the patient… No—On all patients? What other discoveries (and sources for profit) could be discovered by playing with the rest of the kids in the sandbox and making people healthier?

Understand me: Profit is great… capitalism is a good thing. But not at the expense of any of my fellow People With Diabetes. People trump proprietary every time. But don’t fear, profiteers. Open platform or not, your products, and your customers, are not going away anytime soon.
 
 
This post is my May entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetescaf.org/2014/05/may-dsma-blog-carnival-4/
 
 
 

By StephenS | Posted in DSMA Blog Carnival | Also tagged , , | Comments (2)

#IGNITEInterop – Let’s all communicate (Part 2).

February 11, 2014 – 9:41 am

DSC01377
Since it’s only 40-some miles away (though a two hour commute) from home, and I got enough advance notice, I headed to Washington, D.C. last Thursday for HCI-DC 2014: Igniting an Interoperable Health Care System.

The event was co-hosted by two different groups: The Gary and Mary West Health Institute, which, according to its website, “is an independent, non-profit 501(c)(3) medical research organization whose mission is to lower health care costs by developing innovative patient-centered solutions that deliver the right care at the right place at the right time.” And the Office of the National Coordinator for Health Information Technology (trust me, it’s an actual government office).

The idea of the day was to get as many people in the room as possible to talk interoperability in health care. Not just, “Can I get my CGM to talk to my pump”, although there was some of that. But there was also a lot of talk about how to push for standards in medical record-keeping, and making them accessible to health care professionals, in the same format, worldwide. Imagine this: I have an accident in another city, I get rushed to the ER, and a doctor could pull up all of my medications and doses, and my pump settings, etc. Today, all of that might be on paper somewhere, and depending on the timing, a doctor may or may not be able to get access to it right away. You get the picture.

There were things I liked about this conference, and things I didn’t like. I hope I can explain a bit here. Yesterday, I talked about the things I liked. Today, things I didn’t like.
 
 
What I didn’t like:

Unless they were hiding under a chair or something, there were no manufacturers present at this gathering. I don’t know if they weren’t asked to attend, or if it was too long a trip from California or Europe or wherever they are, or if they just didn’t want to talk about interoperability at all.

If it’s that last thing: Let me just share something I mentioned in a conversation with someone over lunch that day.

I’m sure that the cost of the CareLink software is baked into the overall cost of my Medtronic insulin pump. But if Medtronic, for example, decided to make their code available to all, or if they agreed to adhere to a standard software protocol with future products, I would still want an insulin pump. And you know what? If they did get on board with interoperability, I might actually want to buy their pump even more. Insulin pumps and CGMs won’t go away once their data is “democratized”, to borrow a phrase I heard that day. Each patient will buy what’s best for them at the right time, but they will still want pumps and CGMs. And if manufacturers finally move toward a standard for device interoperability, they would finally be free to spend less time worrying about how to make their software proprietary, and spend more time worrying about how to make a better product (disclosure: I’m perfectly happy with my insulin pump right now, even if I see it as less than perfect).

There was something else that touched me that day. I want to move delicately around this subject. But… here’s the thing: There were a few female presenters (like, three). All the rest were male. Nearly everyone in a panel discussion or presenting was white.

Now, I realize that even if there was a concerted effort to bring more diversity to the stage for HCIDC 2014, there probably still would have been an overabundance of white people facing the audience. That’s just the way it is. But the fact is, the audience was pretty diverse in itself. Enough so that there were a couple of tweets from others who noted the steady stream of people walking onto the stage wearing a dark jacket, white shirt, and a tie.

Washington is a very diverse city. America is an amazingly diverse country. For next year’s event I kind of hope the presenters, or the members of panel discussions, will reflect that diversity just a little more.
 
 
So, now my overall take on this event:

I liked it. I really liked what I heard from everyone, onstage and off. I’m encouraged by where the discussion about interoperability is headed in the future. The will to make this happen, or at least get down the road a little farther, is really starting to crystallize.

But without manufacturers becoming part of the discussion, we’re not going to get very far. As Malcolm Gladwell alluded to in his keynote address, “No one will work toward interoperability in health care unless it is framed as urgent, imperative, life or death”.

Well, guess what? It is. Interoperability isn’t everything. But it is a game changer, because it would 1) Free up already overworked people from writing and entering so much data that can’t be shared anywhere else but at the point of care; 2) Lower costs for manufacturers, because once a standard is in place that everyone can follow, work on proprietary software will be minimal; and 3) Help improve patient outcomes, due to devices working together to ensure safety and optimal results for the patient, rather than being in their own silos just so they can generate more imagined revenue for the maker.

I agree… the time is now. We have the means and the determination to make interoperability in healthcare a reality. I hope this event comes back next year, and I’m looking forward to what kind of changes will happen between now and then.
 
 
 

By StephenS | Posted in Healthcare | Also tagged , , | Comments (2)

#IGNITEInterop – Let’s all communicate.

February 10, 2014 – 9:38 am

Since it’s only 40-some miles away (though a two hour commute) from home, and I got enough advance notice, I headed to Washington, D.C. last Thursday for HCI-DC 2014: Igniting an Interoperable Health Care System.

DSC01339The event was co-hosted by two different groups: The Gary and Mary West Health Institute, which, according to its website, “is an independent, non-profit 501(c)(3) medical research organization whose mission is to lower health care costs by developing innovative patient-centered solutions that deliver the right care at the right place at the right time.” And the Office of the National Coordinator for Health Information Technology (trust me, it’s an actual government office). The idea of the day was to get as many people in the room as possible to talk interoperability in health care. Not just, “Can I get my CGM to talk to my pump”, although there was some of that. But there was also a lot of talk about how to push for standards in medical record-keeping, and making them accessible to health care professionals, in the same format, worldwide. Imagine this: I have an accident in another city, I get rushed to the ER, and a doctor could pull up all of my medications and doses, and my pump settings, etc. Today, all of that might be on paper somewhere, and depending on the timing, a doctor may or may not be able to get access to it right away. You get the picture.

There were things I liked about this conference, and things I didn’t like. I hope I can explain a bit here. Today, I’ll give you the things I liked. Tomorrow, things I didn’t like.
 
 
Things I liked:

The first panel discussion covered Perspectives from the Point of Care. It was an interesting discussion moderated by the Chief Medical Officer of the ONC (Office of National Coordinator for Health Information Technology). The panel included some great voices from a healthcare provider point of view, and from the patient point of view, including Anna McCollister-Slipp, Co-Founder of Galileo Analytics and a fellow Type 1. A large part of the discussion centered around Anna’s Type 1 diabetes, the devices she uses, and these two facts: 1) None of her devices talk to each other, and 2) Her healthcare providers cannot, due to rules coming down from the healthcare system they’re working in, download any information from her pump or CGM. From first-hand knowledge of the conversation, I can say that everything Anna said, and everything she advocated for, was right and correct and she was a super advocate for PWDs everywhere. I wish you could have been there to hear it.

Pretty much every discussion during the day was like the one above. There was a real feeling that the time is right to move toward interoperability in health care. One of the photos that really brought the point home was when we were shown someone in an ICU room, with about ten different machines at work helping to keep the patient alive. And none of them talked to each other, or shared their data with any system in the hospital. So doctors or nurses needed to view what was happening with each machine, then write the data down in a chart or a folder, then enter some of that data into the hospital’s system. How much time does that take? How much care is not being given to the patient while a doctor or nurse is compiling data like a drone?

I liked the following statements that were made (please understand that most of these are paraphrased):

Anna McCollister-Slipp: “An A1c is helpful, but kind of like using The Farmer’s Almanac to plan your afternoon. My endo needs to be able to see my CGM data”.

Stephen Jones, President and CEO, Robert Wood Johnson University Hospital and Medical Center: “If health care systems develop uniform standards, we can then use our buying power to drive interoperability, and force the issue with manufacturers and vendors”.

Dr. Michael Johns, Chairman of the Center for Medical Interoperability: “We need to move now, or we’re letting down the next generation”.

There were many comments like this throughout the day.

Also, I very much liked the keynote speech from Malcolm Gladwell, best-selling author of The Tipping Point and other books, and a former writer on the medical beat for the Washington Post. Which, he reminded us, meant that if he were still at that job, he’d be covering the event this day for the paper.

He used three examples of how interoperability in other arenas allowed for increased outcomes for consumers and businesses, not less. How the interoperability wasn’t always made possible by the people who designed the parts that inspired the interoperability. And how the time is now… the moment is right for pushing this cause forward. He mentioned how there are three roadblocks to interoperability: Culture, meaning how things are done today and how people expect them to be going forward; How to frame the message, because sometimes it’s more than shouting, but rather getting people to understand when, and why they have reached a critical moment that requires change; and the concern over Consequences to change. Maybe one part of a business does suffer, but another part of the same business grows as a result of the implementation of interoperability. There was a good recap of the speech written at Healthcare IT News by Diana Manos, and I will refer you there for more:
http://www.healthcareitnews.com/news/gladwell-interoperability-war

A couple of the things he said that resonated with me:

“The time for deep thinking about interoperability is over. We already know it’s important. The resources are there. Now we need to act.”

“No one will work toward interoperability in health care unless it’s framed as urgent, imperative, life or death.”

Tomorrow, more on this event, especially what I didn’t like, and my take on a few things.
 
 
 

By StephenS | Posted in Healthcare | Also tagged , , | Comments (2)
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