5 takeaways from AHIP 2014 & Digital Health Experience

Earlier in June I got an opportunity to attend AHIP Institute 2014 showcase and the Digital Health Experience launch event.

AHIP stands for America’s Health Insurance Plans. It’s the trade association representing about 1300 member companies and the health insurance industry. From the show floor you can clearly see that two things were on top of the mind for this group :

  1. Accountable Care Organization (ACOs): Every organization had a way or a solutions for health plans to participated in the shared risk aspect of accountable care organizations. Some took an approach of accountable care plans with a plethora of care co-ordination tools. I think the market offering is still evolving here.
  2. Health Exchanges: On the other hand, nothing can be as concrete as a shopping cart product for purchasing health insurance! Number of companies had private, public and employer enabled health insurance exchanges. However the work for public organization like ONC, and others with agencies like IDEO really caught by eye — http://www.ux2014.org/. UX 2014 is an effort to drive a standard enrollments and a user experience for health insurance exchanges! The work is very impressive and complete, which they had a reference implementation as well!

Digital Health Experience (DHX) was a side event for AHIP and had an impressive line up of talks from folks from academia and industry. The event distributed a copy of the book ePatient 2015, which is good resource of all things happening around patient engagement in digital health. Among other trends the book highlights care hacking as a mechanism in which consumers are trying to take control of their health. Among the talks at Digital Health Experience, following are my top 3 takeaways –

  1. Academia is innovating in health care and actually closing an end to end loop for new models of behavior change.
  2. Reward platforms are hitting critical mass with retails health offerings. Channels do matter
  3. Health plans are thinking about behavior chance driven by real time data from – shopping habits to clickstream!

mHealth–Mobiles can fuel a big change quickly!

I was at mHealth Dec 2012 and have been following the conference on twitter this year. The major topics and number upstarts seems to be trending along the lines of –

  • Wellness / Behavior Modification
    Last year I spoke to numerous startups working on consumer solutions for nutrition, weight management, diabetes management – MyGlucoHealth, FatSecret and others. This seems no different there is continued momentum in this category.
  • Patient Engagement / Hospital Mobility
    Various companies offering concierge medicine and enabling communication with the patients – coretext, tigertext, celltrust, mHealthCoach, medhelp and others. Solutions targeting meaningful use 2, readmissions management, medication adherence and care collaboration. This year healthloop is creating fair bit buzz with its recent 10M funding round.
  • Consumer Devices / Self Tracking
    Rewards platforms like kiip, socialwellth, everymove; device ecosystems like Qualcomm 2net, strava; gaming in health like zamzee, lumosity. This year seems like healthrageous folded but rest of the crew is continue to make buzz with renewed push from wearable devices.

There are number of technologies fueling healthcare at the moment but mobile devices and cellphones in particular are poised to make significant impact as they are driving use from end users!

Notes from Direct Boot Camp

On Aug 13-14 2013, ONC hosted the second Direct boot camp. For me this was a great venue to connect with partners, customers, team members and like minded folk in general! It was also great to see that conversation on Direct had graduated from learning to demonstrate what the community is doing to drive adoption of the communication standard and bring it to scale!

Among other things following were the key items discussed at the boot camp –

What it takes to get accredited?
Among other things DirectTrust and its members talked about the accreditation process for Direct and how its members have successfully gone through the process. Since the boot camp DirectTrust with ENHAC  has published the guidelines for the process and a number of entities are ramping up for accreditation.

Update: Alan Viars has open sourced his Direct CA project, which in conjunction with the Direct reference implementation can be used to create a complete open source HISP, CA and RA. Additionally, Digicert also has made its certified Direct CA offering publicly available.

What are new technical developments in the Direct project?
The Direct project introduced two key technical achievements – Trust Bundles and Policy Engine. Both these capabilities allows fine grained control of how certificates are utilized. Infact, Direct trust has its trust bundle available here and the blue button project has its available here.

What’s next?
I’m hoping to write more about the the Direct project, Blue button and associated technologies. What would you like to know more about? Provider Directories, Certificates, CCDA ? Hopefully I’ll get a chance to cover a bit of those in coming posts.

Public Cloud for Healthcare–The odds and ends

As computing and storage becomes more ubiquitous, its natural to ask when can regulated industries utilize the quality and economies of scales. Maybe utility computing could  have alleviated some aspects of healthcare.gov by flipping the switch to an alternative powergrid, if you will. However there are number if interesting challenges and nuances for public clouds to offer utility computing and storage to healthcare customers.

So what are the problems?

  • Security & Privacy: Unlike electricity, utility computing is too ingrained in to processes and innovation for existing businesses.
  • Compliance: Utility companies to be able to comply with data audit policies as well as have a business structure which enables signing of business associate agreement.
  • Lock in and interoperability: Developing a solution too ingrained in to a utility architecture can effect the core business of a company
  • Co-innovation: In past decade most businesses have innovated by adopting IT strategically. We see a CIO as part of every organization, to continue that innovation the public computing utility needs to offers ways to co-innovate easily.

So what are the current solutions?

  • Well most cloud-based healthcare organization keep maintain their own cloud infrastructure.
    • The data is encrypted at REST either by Database Transparent Data Encryption (TDE). Both Oracle and SQLServer support it.
    • File system encryption
  • Healthcare organizations sign a HIPAA BAA and most data centers are certified to one of the standards – (SAS 70, ISO etc.)

What’s needed?

  • More public cloud vendors should sign HIPAA BAAs – Microsoft Azure, AWS and most recently Google Cloud already do.
  • Co-innovate for security and compliance solutions like AWS CloudHSM
  • Make encryptions at rest easy – blob store keys are a great start.

Nerve pain


For about 3.5 years, I have suffered tingling in my left hand pinky and ring finger. I know that It’s not carpel tunnel because that would be in the index and middle finger. The pain is not too bad but it always leaves me feeling like something is wrong.

Three years ago, I did see a neurologist who did a battery of tests and said I should give it a year to heal and its not appropriate to do any nerve surgery and that the nerve in question is probably brushing against a bone at the elbow or in the neck. After that, I did physical therapy and chiropractic visits for three months, but over the years the situation has not changed.

Recently I saw a new personal physician who recommended that I do nerve tests and perhaps a small surgery is in need.

I’m a bit skeptical at this point and I’m looking for ways to learn about this problem. I wish there was a “patients like me” section for this condition which I don’t that a name for — some ulnar nerve contraption of sorts I guess.

Thoughts / suggestions ?

EHR Meaningful Use 2 and ONC Direct Secure Transport

This is a series of blog posts touching on a few pertinent curiosities from HIMSS 2013.

Meaningful Use 2 mandates Electronic Health Records to support secure health transport to specifically fulfill the following measures:

  • Measure #1: Providers should send a summary of care for more than 50% transitions of care and referrals.
  • Measure #2: Providers should electronically transmit summary of care for than 10% transitions of care and referrals.
  • Measure #3: At least one summary of care document sent electronically should be to a recipient with a different EHR vendor or to CMS test EHR.

Continue reading

At HIMSS 2013

HIMSS 2011 was my first big healthcare industry conference. The trade show is one of a kind and the largest gathering of folks interested in HealthCare IT in United States. In 2012, I attended the conference virtually and this year I’m back on the show floor. This is a coming out event for the product I have been working on at Optum – Optum Direct! Optum Direct is a secure messaging platform built on the ONC sponsored Direct Standard. If you want to know more, stop by our booth #7041 on the show floor I would love to show it in action. Additionally, our early adopter customer Santa Cruz HIE & Physicians Medical Group is showcasing this product with connectivity to Microsoft HealthVault and others in the interoperability showcase.

Having said above, among a plethora of sessions and events I’m looking forward to following events at the conference –

  • Interoperability Showcase : A real-life standards play in action!
  • Brian Ahier’s – Developing Trust in the Health Internet as a Platform
  • ONC’s HIE Seminar
  • Exhibit Show floor buzzed with words like – ICD-10, Meaningful Use, ACO, etc.

Editor of my book – Programmable Self with HealthVault, Andy Oram will be covering the conference along with others for O’Reilly. Brian Ahier has a good preview of the coverage.

If you are at the conference or are virtual (@ #HIMSS13) please drop me a note as I would love to connect!