Tomorrow I’ll be speaking on a panel at Microsoft’s Innovation and Policy Center about the need for more coders in healthcare. It’s a discussion about the importance of computer science education and the need for it in healthcare in particular. When I worked at ONC, we had $118 million workforce training program which helped to build curriculum, train students, and establish testing criteria for them. This is all very important. In addition, though, it’s critical to help the tech community better understand healthcare and the policies that shape it. I work with a number of technology startups–and more established companies–that are entering healthcare with little knowledge of it. It’s so important to build links and understanding both ways: healthcare is more complex and deeply integrated with the federal government than many people realize–government is a regulator, payor/provider, employer, researcher, and the biggest all around mover of the healthcare market.
This article is cross-posted on The Health Care Blog.
The best healing takes place when the patient or consumer is engaged…
About a week ago Dr. Seymour Papert passed away at the age of 88. The world lost a great thinker, teacher, and mathematician, but his spirit lives on in many former colleagues and students, including (with gratitude), me. Seymour cut an eccentric figure, with a bushy grey beard, a rumpled tweed jacket, and a thick South African accent. However charmingly quirky, he was the real deal: a visionary, a trailblazer in the world of technology and its application. He spoke softly, but his words quickly cut to the heart of the matter. His ideas about technology and engagement are as critical today as ever.
Seymour was an inventor of the LOGO programming language, a founding faculty member of the MIT Media Lab, and a pioneer in Artificial Intelligence (AI). His ideas continue to shape mainstream culture, from the movie Inside Out (based on a theory developed by Seymour and his close collaborator, Marvin Minsky) to LEGO bricks. Seymour advised the LEGO company for decades, particularly on their technology-based toys such as Mindstorms.
When I studied with Seymour at the end of the 1990s, he had already retired from teaching, but he agreed to take me on as a graduate student. He proved to be a quirky but life-changing mentor. There was no formal structure for our work. Instead, I would get an unexpected call from his assistant every couple of months: “Seymour will be at Logan airport tomorrow at 3:00 PM—meet him there at Legal Sea Foods to check in.” My graduate study with him was focused on supporting the successes of developing countries in using computers in schools and to boost their economies: I travelled to Peru and Costa Rica to meet with Seymour’s contacts in academia, business, and government, and to plan interventions and derive generalizable lessons based on what I found.
After graduate school I continued to put Seymour’s work into practice through the ed tech startup MaMaMedia, run by another of his students, Dr Idit Harel. MaMaMedia was in some ways a precursor to Minecraft—-an online environment in which kids could build and exchange their creations. During this time I travelled to Seymour’s family home in Maine to sort through cartons and stacks of his paper archives to extract decades worth of his manuscripts and digitize them.
Though Seymour focused more explicitly on the education system than on health, his intellect was wide ranging, and I appreciate now, 15 years since I studied with him, how much his ideas continue to influence my own work in health and healthcare. One of his greatest contributions was in defining “Constructionism” – the theory that people learn best by actively doing and interacting, not just passively ingesting facts. Seymour was convinced that, as he put it, “the best learning takes place when the learner takes charge,” and I am equally convinced that the best healing takes place when the patient or consumer displays a level of agency, too.
Seymour also taught by example that it’s OK to color outside the lines. He would forge ahead into new areas, making up words and phrases (like “hard fun” or “kitchen math”) for concepts he developed along the way. Just a few years ago, the idea of empowering healthcare consumers, or rewarding them financially for success, felt similarly “out of bounds.”
In Seymour’s mind, digital technology was a catalyst of change, but never the full story. As he said, “Nothing could be more absurd than an experiment in which computers are placed in a classroom where nothing else is changed.” The very same can be said of the healthcare system, as well as for the day-to-day environments of the patients and consumers around whom it should, I believe, revolve. You can’t just add EHRs to hospitals without healthcare payment reform, or expect that wearables will transform Americans’ behavior without access to green spaces and healthy food.
Many thanks to Seymour Papert for his creativity and fearless spirit—and may we do his memory justice by ushering in a new age of empowered individuals, who, along with their families and caregivers, use technology to improve their own health and wellbeing.
I recently had the opportunity to record a podcast interview with Chad Johnson and Jennifer Dennard for their HealthStandards HITcast series. Check it out, along with other podcasts from some terrific colleagues and innovators. Click the image below:
This piece is cross-posted on the Health Standards blog.
A few days ago, a group of e-patients gathered in rural Grantsville, Maryland, to share work and ideas, create art, and improve our broken healthcare system. Cinderblocks 3: The Partnership with Patients was the third in a series of conferences organized by artist and activist Regina Holliday.
Part of the event was the dedication of a permanent physical structure for The Walking Gallery of Healthcare—a movement in support of patients’ rights through which artists paint patient stories on the backs of jackets that people wear to medical conferences.
Though I’m not a “Burner,” Cinderblocks 3 felt more like how I imagine Burning Man than like the typical healthcare conference, and not just because of the fire dancing or the communal painting activity under a tent. At its core was a generous spirit of inclusiveness, and a genuine desire to improve healthcare for all. I feel refreshed and re-energized by being a part of it, and I wanted to share my main takeaways.
At the dedication of Salt and Pepper Studios, home of The Walking Gallery. At the dedication of Salt and Pepper Studios, home of The Walking Gallery.
It’s all about the patient. No, really.
Though a few years ago this wasn’t remotely the case, nowadays, healthcare leaders publicly extol the virtues of patient centeredness and patient engagement at nearly every conference, yet so often the healthcare system and mainstream healthcare conferences themselves continue business as usual. At Cinderblocks 3, by contrast, the patient and his or her story is the starting and ending point, not a marginal flourish. When an individual stands before a group to share intimate details of his or her life with HIV, loss, discrimination, or a suicide attempt, there’s just no room for bullshit.
As e-patient Casey Quinlan puts it, “don’t let propriety stand in the way of truth.”
Whole person health
Many participants in Cinderblocks 3 underscored the integral role of mental health in overall health. As speaker Robb Fulks said, “If I don’t believe I can heal from the inside out, I won’t heal from the outside in.”
Yet he and others vividly described the stigma associated with mental health, and how today’s model of treatment, which generally requires a diagnosis prior to authorization of payment for care, discourages people from seeking help, and magnifies the risk of discrimination. Many of those who can’t access good mental health care end up getting some kind of treatment eventually, he said… in jail.
Art is a powerful communicator
Diverse arts lend themselves to storytelling, and to healthcare. Marsha Goodman Wood presented evidence on the healing powers of music (hers can both lift the heart and wash the hands). Health IT rock star Ross Martin performed his unique blend of songs on love, policy, and health data. There were poems, a voice performance by Brian Be, and plans by artist John Magnan to build towering sculptures to raise awareness of clinical trials. Oh, and fire dancers (no FHIR yet—maybe next year when Mark Scrimshire and Carly Medosh successfully convert CMS’s Blue Button function to the emerging standard).
Taking action is its own medicine
One of the best parts of the conference was the opportunity for unhurried one-on-one conversations. At the first Cinderblocks conference, such a conversation led then strangers Diane Stollenwerk and Pat Mastors to form the Patient Voice Institute.
This time I found myself in a long conversation with the poster boy for patient engagement, e-Patient Dave. (I’m allowed to tease him about that, since I put his handsome face on everything from posters to coasters when I worked at ONC.) We were talking about the many benefits of patient engagement, including better information for providers. Another often-overlooked benefit is the power of agency. Awful things happen to everyone, but feeling powerless multiplies their impact; taking action—whether in improving your own health or that of the country—brings a sense of satisfaction, optimism, and purpose.
Regina Holliday chose the name “Cinderblocks” for the conference in reference to an experience from her childhood in which her elementary school class, lacking basic infrastructure, built its own shelves for books. Looking back, she said about it, “We loved those shelves because we overcame adversity and made that which we needed. It wasn’t pretty, it wasn’t perfect, but it was ours.”
Yes, please. More of that.
This piece is cross-posted on The HealthCare Blog
At the annual South by Southwest (SXSW) conference a wide range of industries and creative artists come together to explore transformation through interactive technology. It’s not just healthcare people talking to healthcare people!
One of my favorite presentations this year was by Max Levchin, one of the founders of Paypal. He began by challenging the audience to focus on big problems, Problems That Matter. (I’m presuming the job a guy I shared an Uber with told me about—managing the social media profile of a dog—wouldn’t qualify.)
Levchin highlighted four key trends in business and technology—waves the audience could ride to catalyze meaningful change. Though I was consciously stepping outside of the healthcare track, nearly half of Levchin’s points explicitly referenced opportunities in health and healthcare, while it was easy to draw relevant lessons from the ones that didn’t. Big trends include:
1. Beneficence (AKA “doing good”). Increasingly businesses are providing value and benefit to consumers, even at the expense of higher profit margins. For example, Levchin most recently launched Affirm, a lending service focused on millennials, that specializes in transparency: clearly telling consumers how much they are being charged for financial services. While competitors typically obfuscate their fees (often unbeknownst to consumers), Affirm is in the business of doing well by doing good.
Just imagine the parallel opportunities in healthcare: we could clearly convey to patients the risks and benefits of procedures, costs, or the vested financial interests many doctors and companies have in performing interventions or prescribing drugs, regardless of their efficacy… so many possibilities!
2. Human Assisted Artificial Intelligence (AI). Levchin said the future lies in “cogifying it,” pretty much whatever the “it” is. He suggested that the audience make stuff smarter by using computers that work closely with humans to leverage the strengths of each. His example: healthcare! Specifically,telemedicine. As an avid biker, Levchin sends photos of his biking cuts and bruises to his doctor via phone for evaluation. Many of us wish we also had that arrangement. By why not take it a step further and also send those pictures to multiple providers, feeding their collective wisdom into an AI engine to train it to evaluate the severity of wounds on its own? Human healthcare providers could weigh in on an as-needed basis for the borderline cases.
3. Software Eating Older Software. Per Levchin,twenty year-old software dominates the banking industry, creating slices of opportunity to replace it with something more elegant and efficient.
Fortunately there aren’t any outdated or poorly designed systems in healthcare, so I guess this one doesn’t apply. (Kidding!)
4. Regulatory Opportunities. Levchin explained how regulation creates pools of capital in the form of federal subsidies. He went on to illustrate the point with… Meaningful Use, and the opportunities it will open up for businesses in healthcare, particularly with the integration of APIs into EHRs.
Levchin didn’t get into the details: that more than $30 billion Meaningful Use dollars have already been spent, and that the money flows directly to eligible providers and hospitals only, many of whom have used it to pay well-established EHR vendors (perhaps even some offering that 20 year-old software he told us about?). Nevertheless, the point holds that Meaningful Use should create many downstream opportunities to fuel the growth of creativity, via progressive EHR companies, data analytics companies, and consumer app developers. Even more important, efforts under the ACA to shift payment to value based care will put a business emphasis on health outcomes and enable consumers to play a more active role in shaping and benefitting from the healthcare marketplace.
Levchin’s talk was one of many at SXSW that drew parallels between health and finance. There is certainly much to learn from other industries, too. Another reminder to get out of our healthcare echo chamber and collaborate with a wide range of other problem solvers.