Improving health with prediction markets

Peter Nichol
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Improving health with prediction markets

Patients will soon be managing their chronic diseases as in-person support goes global and as collective wisdom produces clinical insights surpassing the knowledge of any single physician. Market predictions will be part of the future of health.

The wisdom of the crowd opens conversations around treatment options, symptoms, and options moving for improved patient care. Thinking and information processing (cognition), coordination (optimization of the utilization), and cooperation (how groups for networks of trust) applies to artificial intelligence, analytics, co-creation, and principles of the sharing economy. Social networks are creating new health information with disease association support groups (think crowd analytics). The collision of social media and healthcare create global crowds. These groups no longer need to be led by the smartest people. How clinical experience and insights are collected is changing.

Wisdom of the crowd

Are irrational mobs capable of wisdom that can be used to predict markets? In the age of social and global connected economies, can crowds make you healthier?

These principles are harnessed in the wisdom of crowds. The psychology of crowds is explained in James Surowiecki’s book, The Wisdom of Crowds. This captures his primary thesis on the wisdom of the crowd: the collective opinion of a group is superior to that of a single expert. Surowiecki, expanded on the 1841 work Memoirs of Extraordinary Popular Delusions, by Charles Mackay. Mackay is famous for saying. “Men, it has been well said, think in herds; it will be seen that they go mad in herds, while they only recover their senses slowly, and one by one.” Mackay didn’t see a lot of intelligence in crowds. Surowiecki took a differing perspective in response to Mackay’s work, saying that given the right circumstances, crowds or groups may have better information and make better decisions than even the best-informed individual. 

Crowd-enabled health

PatientsLikeMe is a great example of where connecting to people like you, learning from others, can improve your personal health. PatiensLikeMe provides a more efficient method for patients to share real-world health experiences to improve patient health and by connecting other patients like you with organizations that focus on your conditions.NursesRecommendDoctors is changing the way patients find quality doctors. The premise is that nurses know which doctors have the best reputations, the best technical skills, and the best outcomes. Why? They see it every day. Sermo is the number one social network for doctors globally. This crowd has ballooned to over 600,000 verified and credentialed physicians for big meetings of the minds. Sermos operates across 80 countries including US, UK, Mexico, Germany, Sweden, Canada, and many others. Patients, nurses, and doctors are creating crowds for wisdom.

However, as it turns out, not all crowds are wise. Surowiecki, breaks down four criteria that separate the wise crowds from the irrational ones:

1. Diversity of opinion – each person should hold private information.

2. Independence – individual opinions aren’t determined by the opinions of those around them.

3. Decentralization – individuals specialize and can offer local knowledge.

4. Aggregation – mechanism exists for turning private judgments into collective decisions.

Today, we rush to schedule doctor’s appointments, only to wait to be seen. If we apply Surowiecki’s thesis on the wisdom of the crowd to healthcare we can surmise it as follows: there is no need to chase the expert.

Forecasting markets

Social media platforms have helped to increase the collective knowledge of the crowd. These media platforms include wikis, blogs, social networks, video-sharing, online forums, and video blogs like blab.im. From WebMD to WEGO Heath, social networks are integrating into the healthcare delivery system.

Augur is the future of forecasting. Augur is a prediction market platform that rewards the users for correctly predicting the future events (a decision market to capture collective wisdom). Augur prediction markets allow users to purchase and sell shares in the outcome of an event. The current market share of an event is an estimate of the probably of an event occurring. On Augur, the price of each share adds up to $1.00 USD, so if you buy a share at even odds it will cost, $0.50 USD, and if you predict correctly, you’ll earn $1.00 USD for that share. Augur combines the magic of prediction markets with the power of decentralized networks to create a stunningly accurate forecasting tool. This all happens on the blockchain. In a centralized prediction market, one person has to report back on the outcome of the event. This encourages mistakes or even corruption. Augur, is decentralized and uses blockchain with thousands of users reporting on outcomes using reputation. With Augur, anyone anywhere in the world can create a market by asking about anything. Augur was one of the first applications built on Ethereum, a decentralized computing platform featuring digital contracts and a turing-completeprogramming language.

What if there was a healthcare market prediction platform that used the wisdom of the crowd, social media, and analytics to make everyone healthier by becoming an expert on their health?

Tomorrow’s prediction of markets

The global healthcare analytics market is expected to reach $29.53 billion by 2019 from $7.04 billion in 2014, at a CAGR of 33.2 percent over the forecast period 2014-2019, according toMarketandMarkets.com. While descriptive and retrospective analytics offer historical information, it’s the predictive and prescriptive analytics that will move the economics of global health forward. The predictive analytics market is going to impact everyone in the healthcare value chain value including payers, private insurance companies, government agencies, employers and private exchanges, providers, hospitals, physician practices and IDNs, ambulatory settings, ACOs, HIEs, MCOs, and TPAs.

Growth will occur across five core prediction analytics markets.

1. Clinical analytics

2. Population Health Management (precision medicine and health)

3. Quality Improvements (clinical benchmarking, operational and administrative analytics)

4. Comparative (effectiveness Analytics, clinical decision support)

5. Payment Integrity (fraud, waste and abuse)

Big data evolutions, mHealth, and customer centricity all disrupt health insurance and the business of health. Likewise, market predictions will be part of the future of health.

Is it possible to predict factors that have greater insight and influence over patients’ behaviors? Can we use prediction markets to forecast infectious disease activity? Will prediction markets help align incentives creating long-term behavioral change supporting healthcare payment reform? As the frequency of chronic diseases rise and we move toward outcomes and value-based-care can we use prediction markets to forecast the demand for hospital services? It’s going to be an exciting road ahead. Prediction markets will be part of the future of healthcare.

Surowiecki believed that groups are remarkably intelligent, and are often smarter than the smartest people in them. Let’s use the collective wisdom of the crowd to produce clinical insights and make the world healthier. Monumental change starts with believers.

Design thinking enlightened with mimicry

Peter Nichol
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Design thinking enlightened with mimicry

Innovation inspired by nature captures the power of design from nature’s observations. Today’s business architects must construct new business models for innovation. Visionary leaders begin with nature.

Solved first by nature, efficient business designs may drive the next technological innovations. Mimicry can advance innovation through design thinking. When balancing the power of design with design thinking adding in living things can teach new innovation principles.

Balancing the architect and scientist

According to the Biomimicry Institute, “Biomimicry is an approach to innovation that seeks sustainable solutions to human challenges by emulating nature’s time-tested patterns and strategies.” Why resolve problems that nature has already solved over thousands of years?

Steve Jobs, was quoted saying, “I think the biggest innovations of the 21st century will be at the intersection of biology and technology. A new era is beginning.” Maybe he wasn’t talking only about the advances of biotechnologies; he was talking about what we can learn from nature. Concepts and lessons that were in front of us, we missed because we were too busy recreating them. Janine Benyus, is a biologist focusing on innovation inspired by nature and has written two great books on the subject including Biomimicry: Innovation Inspired by Nature and The Secret Language & Remarkable Behavior of Animals. Benyus believes that designers can discover new powers of design by looking at nature. Michael Pawlyn, a TED speaker and author of Biomimicry in Architecture, summed it up well. “You could look at nature as being like a catalog of products, and all of those have benefited from a 3.8-billion-year research and development period. And given that level of investment, it makes sense to use it.”

Design thinking promotes the idea of visual thinking, to form practical and creative solution-focused thinking. It jumps ahead in the scientific method. Instead of defining all the parameters of a problem to construct a logical solution, design thinking starts with a better future in mind not with a specific problem to solve. This approach unlocks the mind and removes the mental obstructions for new growth. The conflict in design thinking challenges the [business] architect and the scientist. In 1972, Bryan Lawsonconducted investigations in the variance between the problem-focused solvers and solution-focused solves. What Nigel Cross, a British academic and Emeritus Professor of Design Studies at The Open University, the United Kingdom deducted was that scientist problem solves by analysis, using nature’s genius while designer solves problems with synthesis; design thinking uses both design analysis and synthesis.

Mimicry

Mimicry is the art of action or imitating someone or something. This is best described as WWND – What Would Nature Do?

This imitation could be represented with an animal’s deceptive behavior such as batesian mimicry (involving a palatable unprotected species, the mimic, resembling an unpalatable species e.g. a bubble bee-resembling a flower), mullerian mimicry (warning colors where both the model and the mimics are toxic e.g. a monarch butterfly resembling the viceroy butterfly), wasmannian mimicry (resembling the host structure e.g. a jumping spider representing an ant), and peckhamian mimicry (aggressive mimicry where the predator mimics it’s prey to capture it e.g. the bird-dropping spider hunting moths by producing the moth pheromones). Deceptive behavior or camouflage is often foremost on the mind when the topic of mimicry surfaces. There is, however, another form that applies to business.

The kingfisher’s design thinking principles

The Sanyo Shinkansen 500-series electric train was placed into production in 1997, and because of a maximum operating speed of 320 km/h or 200 mph, the travel time between Shin-Osaka and Hakata was shorted by 10 percent. What made this innovation successful was the design thinking principles applied used to achieve the world record speed at the time and meet strict noise standards of 70-75 dB(A) as measured 25 meters from the center of the tracks.

Eiji Nakatsu, the general manager for the Technical Development Department part of Japan Railway West and Japan Railway Kyushu, was charged with solving three train problems:

  1. Ground vibration during high speeds
  2. Aerodynamic noise generated by the body and the train’s pantographs (connecting the train to overhead wires)
  3. The sonic boom created during the trains exit from the tunnel.

The article, in the Zygote Quarterly (zq9) titled, Auspicious Forms: Designing the Sanyo Shinkansen 500-Series Bullet Train, is the most comprehensive article on this subject and well worth the read.

Problem one, pantograph vibrations, was solved by applying the principles of flight from owls. Specifically, how an owl’s natural concave face and down absorb the vibrations of movement with tiny serrations on its primary feathers.

Problem two, wind resistance creating aerodynamic noise, was solved reshaping the pantograph’s supporting shaft to look more like the body of the adélie penguin. This result was a shape like a spindle, lowering wind resistance.

Problem three, the sonic boom, was solved by understanding the bill of the Kingfisher – a revolving paraboloid shape. Trains in service before the 500-series had wedge-shaped nosecones; this shifted to a modern rotational parabolic body that changes areas by a constant ratio.

Living things teach innovation

The most efficient designs tested were from nature and taught efficient forms. New models developed from living things and the trend to apply mimicry to advance design thinking is growing globally. Germany’s BIOKON focuses on deciphering ‘inventions of nature’ and transferring them into technological innovations. France’s Centre Européen d’Excellence en Biomimétisme de Senlis (CEEBIOS) focuses on the development of biomimicry as a tool for scientific and societal transition at the international level. At the center they actively disseminate biomimicry information to innovators.

Ecomimicry, the practice of mimicking the natural world in the technological world, is merging with products, platforms, processes, and services to create new interactions and behaviors. As design thinking searches for new innovations, maybe the answer is hidden in nature. Will the most amazing technological advancement be traced back to mimicry?

Business can learn much from nature, and as Janine Benyus put it, “When we look at what is truly sustainable, the only real model that has worked for long periods of time is the natural world.”

Disintermediation and intermediation beyond theory

Peter Nichol
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Disintermediation and intermediation beyond theory

Bringing back the middleman for digital innovation. Disintermediation promotes disruption and intermediation fosters innovation.

Disintermediation removes the middleman from business transactions and by doing so improves the value of an existing product or service. Disintermediation is often accomplished by changing the perception of delivery. Inversely, intermediation injects a middleman between distribution channels e.g. a customer and businesses that previously sold directly to consumers. Intermediation gains traction when the platform is so large that companies can’t afford not leverage the platform to reach customers.

Coining the term

Let’s start with the history of the word, disintermediation, to guide our journey to the real meaning. Jonathan B. Welch, in his 1980’s article published in the Financial Analysts Journal, “Explaining Disintermediation at Mutual Savings Banks” describes the disintermediation of the mortgage market and the homebuilding industry during the 1960’s and 1970’s when the amounts withdrawn over a period exceed the amounts deposited. Contributing factors were interest rate differential between savings deposits and Treasury bills. However, the term disintermediation was coined in the mid-1960’s when consumers started to see government-imposed limits on interest-bearing savings.

Consumers responded by quickly investing in government securities, private stocks, and bonds that resulted in removing their prior investments from savings accounts. As a result, consumers began to explore borrowing capital from markets other than banks, circumventing banks as the middleman. Disintermediation is about removing the middleman in the distribution chain.

Unseating the middleman

A classic supply chain involves producers, wholesalers, retailers, and consumers. Disintermediation fractures the role of the middlemen between producers or avoids traditional distribution channels with intermediates such as distributors, brokers, or agents. In the case of disintermediation, one step is removed e.g. a producer goes directly to the retailer, therefore, eliminating the need for the wholesaler. Simplified, business goes directly to the consumer, although it could be the removal of any single point within the supply chain to make the process more straightforward.

The disruption generated by disintermediation can be significant and reshape entire business models as was the case with banking. The travel industry is another industry impacted by disintermediation. Travel agents were disintermediated by online travel websites such as kayak.com, expedia.com, hotwire.com, traveocity.com, andhipmumk.com. These online marketplaces unseated traditional travel agents, and the tourism industry was changed. Likewise, traditional publishing channels like Encyclopedia Britannica and Microsoft’s Encarta were disintermediated by Wikipedia.

Disintermediation can take markets by surprise. Banking wasn’t prepared, and neither was the music industry. The theme of digital disintermediation is harnessed well in the plight of the music industry with CD’s and their struggle to maintain active control over distribution. Consumers briefly loved CD’s until they hated them when during the 1990’s when consumers were forced to buy CDs with songs they didn’t need or want. Ultimately, the music industry failed and eventually, they awoke to realize that Apple controlled their inventory. Newspaper publishers, the music industry, and real-estate each has been on the leeward side of disintermediation with the likes of Craigslist, Apple iTunes, and Trulia. Disintermediators include Uber (freelance drivers and riders, removing cab companies),Airbnb (hosts and renters, removing the hotels), and Apple iTunes (viewers and creators, removing the music store). Business can be a disintermediator or intermediator, and they can even hold characteristics of both.

Disintermediation is bound to happen in healthcare. Where will disintermediation start in healthcare? The drug companies could directly reach consumers bypassing hospitals. Hospitals may opt to cut out private insurers and generate robust provider-sponsored plans offered straight to patients. Physicians may choose to circumvent hospitals and renegotiate compensation providing new care alternatives and structures through telehealth options with direct interaction with patients. Healthcare is on the cusp for disintermediation.

Intermediation

Almost more interesting than disintermediation – removing the middleman – is intermediation that adds the middleman back into the mix. Intermediation occurs when digital platforms inject themselves between the customers and a company. These platforms are so large that businesses can’t afford not to reach customers through these platforms. Intermediation creates a dependency and disintermediation removes the dependency.

The Digital Disruptive Intermediaries report published through the University of Sydney Business School captures the heart of intermediaries extremely well. Digital disruptive intermediaries are disruptors and can be categorized into eight archetypes:

1.       Digital stores (online e.g. amazon.com, expedia.com)

2.       Content hubs (consumer interaction e.g. Apple’s iTunes, Netflix)

 

3.       Sharing hubs (user-generated content e.g. Pinterest,YouTube)

4.       Promotor focus (best price to consumers e.g. Priceline.com,Groupon)

5.       Aggregators (comparisons in fragmented markets e.g.Unimall.de, Pizza.de)

6.       Discriminators (customer reviews e.g. reddit, Yelp)

7.       Crowd sourcers (customer sourced services e.g. Kickstarter,IndieGoGo)

8.       Matchers (linking supply and demand e.g. Airbnb, Uber, ore-Harmony).

Who’s an intermediary? The real definition is less glamorous; every business is an intermediator. Many intermediaries have become icons within their industries due to their disruptive impact, brand recognition amplified by the media, or word of mouth. Intermediaries include Facebook (between users and advertisers), Twitter (between companies and consumers), Apple Pay (between credit card companies and cardholders), and Apple HealthKit (between payers and members or between providers and their patients).

The digital innovators of tomorrow will forego the disruption that disintermediation creates for the innovation that intermediation fosters. Digital platforms are welcoming back the middleman.

Blockchain is not Bitcoin: Why unfamiliarity is slowing healthcare adoption

Peter Nichol
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Blockchain is not Bitcoin: Why unfamiliarity is slowing healthcare adoption

To absorb the massive virality and impact of blockchain, we must first address the hype. Hype, please square up.

Beyond the hype

The premise that blockchain is hype is false.

What is hype? The Oxford Dictionary defines hype as, “promoting or publicizing (a product or idea) intensively, often exaggerating its importance or benefits.” The simple version, the hype is an exaggerated advantage. A benefit that doesn’t align to the future reality of the product or service. As with many new technologies, there is excitement. However, the buzz and excitement around blockchain are more than hype; it’s the realization for the potential to transform industries.

Media weighs in

Thought leaders from Forbes and Harvard Business Review have bought into the value of blockchain technologies. For example, Jerry Cuomo, an IBM Fellow and Forbes contributor in his February 2016 Forbes article, “Blockchain: The Foundation For The Future Of Transactions,” stated that “Blockchain has the potential to become the technological foundation for all electronic transactions conducted over the Internet.” Amy Webb, in her January 2015 Harvard Business Review article titled, “The Tech Trends You Can’t Ignore In 2015” stated, “Even if Bitcoin itself never really gains traction, blockchain technology has enormous promise.”

Industry joins the party

It’s great that the media has received the mailer on the value of blockchain, but what about the industry? CISCO recently stated, “The next generation of the Internet is coming with Blockchain.” In February, Accenture launched a blockchain practice for financial services industry and entered into a partnership with announced a blockchain partnerships with Accenture, Broadridge & PwC showcasing that the “New practice will implement emerging technology that is projected to reduce financial services industry costs by more than $20 billion annually by 2021.” PwC on April 4, 2016, announced they have started a new global technology team to tap into the blockchain and have recruited 15 new leading technology and business specialists.

Deloitte has anticipated the tipping point of blockchain would not be until 2027. In a recent report titled, “Blockchain. Enigma. Paradox. Opportunity” Deloitte says that “Ultimately, the blockchain is not just about cryptocurrencies and faster peer-to-peer payments.” On October 2015, Deloitte partnered with Colu, to bring the startup into new global markets. Colu allows users to issue and track their digital assets on its platform.

The industry is unifying and joining the blockchain revolution. R3 (R3CEV LLC) leads a consortium consisting of 43 financial companies (including Microsoft as of April 4, 2016) in the research and development of blockchain usage in the financial system. However, the fabric R3 is proposing is industry agnostic. Todd McDonald, the co-founder and head of strategy for R3, likely wouldn’t refer to blockchain as hype either. The industry has taken notice of blockchain.

Historical perspectives on innovation hype

The fact that in 2015, large investors invested over 1 billion into the blockchain technology doesn’t persuade some colonialists. Remember the hype over the telegraph in the nineteenth century? The telephone has matured but hype? We all know how overstated the telephone was by the end of the nineteenth and start of the twentieth centuries. How about the buzz and overpromises of canals and railroads in the 1700’s and 1800’s? Hype probably isn’t the best word to describe the development of railroads that was one of the most important phenomena of the Industrial Revolution. The list doesn’t seem to end and continues with the likes of automobiles, radios and then the jet engine, rockets and atomic energy into the 1950’ and 1960’s with biotechnology, nanotechnology, and genomics. Do we consider the canals, railroads, telegraphs, automobiles and cell phones hype? If these hyped technologies landed us here, imagine how blockchain can change society in the future.

Hype Cycle

The Gartner Hype Cycle, introduced in 1995 offers useful insights into the promise of emerging technology. The July 2015, Gartner Hype Cycle for Emerging Technologies report, highlighted the phases of the hype cycle on emerging and collaborative tech. The five phases of the Hype Cycle include: innovation trigger (less than 2 years), peak of inflated expectations (2 to 5 years), trough of disillusionment (5 to 10 years), slope of enlightenment (more than a decade), and lastly the plateau of productivity (obsolesce is reached before the plateau). It could be argued that the Hype Cycle is not a cycle and that outcomes do not depend on the nature of the technology itself or that it’s less than scientific in nature without accounting for changes over time in the speed at which technology develops. However, it does effectively show how society feels about new technology and when historically inflated expectations and disenchantments should likely occur.

Cloud Hype Cycle

If we consider cloud to have started the innovation trigger phase in 2012, the phases of the cloud hype cycle would be the following: innovation trigger (2012 – 2013), peak of inflated expectations (2014 to 2018), trough of disillusionment (2019 to 2028), slope of enlightenment (beginning 2030), and lastly the plateau of productivity (if applicable, after 2028).

Blockchain Hype Cycle

If we consider blockchain’s innovation trigger phase started in 2014, based on when serious investors began to weigh in, the phases of the blockchain hype cycle would be the following: innovation trigger (2014-2015), peak of inflated expectations (2016 to 2020), trough of disillusionment (2021 to 2030), slope of enlightenment (beginning 2030), and lastly the plateau of productivity (if applicable, after 2030). The below charts illustrate the phases of the Hype Cycle showing visibility over time and expectations over time. If you’re looking for additional sources on the Hype Cycle Jackie Fenn and Mark Raskino, have an excellent book titled, “Mastering the Hype Cycle: how to Choose the Right Innovation at the Right Time.”

image1

Source:Wikipedia.org

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Source:Wikipedia.org

Beyond Finance

The paper, Bitcoin: A Peer-to-Peer Electronic Cash System, by the individual or group called Satoshi Nakamoto, was released in 2008. If this is the only framework used to evaluate blockchain, that would be a narrow view of blockchain’s potential. Minimizing the value of blockchain would be akin to stating in 1995 that the Internet would be used just for email.

Blockchain is much more than cryptocurrency, and the benefits of blockchain will extend well beyond the financial markets. For example, healthcare is ripe for disruption and applications may include:

  • Smart property for prescription drugs and regulated pharmaceuticals
  • Smart contracts between payer, provider, and doctor for decreased fraud and reimbursement
  • eBay type bidding for medical services (discrete and anonymized)
  • Health databanks (universal medical records, personal genomics)

Similar to the internet in 1995, we don’t know where blockchain will go. The one thing we do know is it’s not just hype. A quote that captures the sediment surrounding blockchain well is from Bill Gates a technologist, and philanthropist, stating, “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be lulled into inaction.”

How medical robots will change healthcare

Peter Nichol
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How medical robots will change healthcare

Stardust predictions get everyone talking, separating the mythical from the magical in robotics healthcare.

Robotics health threatens to challenge how patient care and treatment is performed redefining the word “preventative.”

All too often we hear about the benefits of mobile or 3D printing, but how often do you hear about medical nanobots or nanomites? The average life expectancy is increasing. In 1960, average life expectancy was 69.8 years, thirty years later that rose to 75.2 in 1990 and today it’s around 78.8 years according to the Centers for Disease Controls and Prevention (CDC). New approaches to medicine and treatment are no longer optional, they’re essential. Robotic health offers some answers.

From telemedicine (clinical health care at a distance) to bioelectronics (stimulate and monitor your nervous system), the health ecosystem is evolving quickly. The greatest medical achievement in the last 100 years is the advancement of personal genome sequencing mapped to repositories of population diseases: introducing the migration from population health to personal genome diagnosis. The N-of-1: one patient one trial. Combine this with nanobots, in a world where, nanoids, nanites, nanomachines, and nanomites all reference nanomachines and nanomotors at which time biological machines could be used to identify and destroy cancer cells. In this future world disease is not a setback but merely a distraction like a low oil light. The car isn’t sick. It just needs a repair or tune-up and quickly it’s back on the road.

Medical nanotechnology is expected to employ nanorobots that will be injected into the patient to perform work at a cellular level. Ingestibles and internables bring forward the introduction of broadband-enabled digital tools that are eaten and “smart” pills that use wireless technology to help monitor internal reactions to medications. Medical nanotechnology is just the edge of the cliff. Let’s jump off.

Dermables, digital stickers for the skin open a vast range of possibilities. Netatmo’s JUNE bracelet adds some class to UV monitoring and UVSunSense make monitoring sun exposure fun.

The day before something is a breakthrough it’s a crazy idea. – Peter Diamandis

Why don’t we hear about these advancements in robotics every day? How come the population isn’t demanding small pilots that will undoubtedly extend life? I honestly don’t know.

Stardust predictions get everyone talking – how to do we separate the mythical from the magical? We can start by understanding the stakeholders in robotic health. Hint: they are not only the mad scientists in labs looking for new breakthroughs. They are your wife, husband, daughter, son, grandmother, or grandfather – these are the stakeholders, and they all have similar goals. Their goal is simple, stay healthy.

In a draft journal article by Simshaw, Terry, Hauser, and Cummings titled, Regulating Healthcare Robots in the Hospital and the Home, the report suggests that family members and caregivers, healthcare providers, technology providers, aging or physically challenged individuals have similar goals. Their collective goal is to provide independence, preserve dignity, empower those with special needs and provide peace of mind to all of the stakeholders. These stakeholder’s goals are aligned, despite how rare this might be.

Recently the “Healthcare Robotics 2015-2020: Trends, Opportunities & Challenges” report was released by the Robotics Business Review, that provided strategic information for the global robotics industry. The findings in this report are intriguing and help segment the robotic health market. In the search for the value of medical robotics, there are three main areas of robotic health:

  1. Direct patient care robots: surgical robots (used for performing clinical procedures), exoskeletons (for bionic extensions of self like the Ekso suit), and prosthetics (replacing lost limbs). Over 500 people a day loses a limb in America with 2 million Americans living with limb loss according to the CDC.
  2. Indirect patient care robots: pharmacy robots (streamlining automation, autonomous robots for inventory control reducing labor costs), delivery robots (providing medical goods throughout a hospital autonomously), and disinfection robots (interacting with people with known infectious diseases such as healthcare-associated infections or HAIs).
  3. Home healthcare robots: robotic telepresence solutions (addressing the aging population with robotic assistance).

The Population Reference Bureau report, “Aging in the United States,” showed that Americans 65-and-older will more than double moving from 46 million today to 98 million by 2060. The growth of the total population 65-and-older population is projected to grow from 15 percent to nearly 24 percent. Who will take care of the influx of aging individuals, when timely healthcare today is already questionable?

Medical robots will change healthcare. They have to.

Blockchain gives music lessons to healthcare

Peter Nichol
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Blockchain gives music lessons to healthcare

Blockchain smart contracts provide the bridge, intersecting the music and health.

Music shapes culture, entertainment and technology. The passion for music spans industries refreshes ideas and introduces new concepts previously invisible. The music industries maturation into digital contexts and exploration of blockchain technology have uncovered lessons we can apply to healthcare.

Intersecting music and health

The world is growing, and the music industry is shrinking. Economies of scale exist, yet annually miss impacting healthcare for the better. The music and healthcare industries are managing the transition from the physical to digital. How will the music industries keep pace with the trends of instant access and play anywhere? How will the healthcare industry keep pace with the trends of instant access and view anywhere medical information? Blockchain is the answer. Smart contracts provide the bridge.

Musical revenue fragmentation

The music industry is getting a shakeup but continues to lose out in revenue. The end of 2014 marked the first year that the industry derived the same revenue from digital channels (46 percent) as from physical format sales (46 percent). According to the UN, Dept. of Economic and Social Affairs Population Division, there are 7.4 billion people in the world today growing at roughly 80 million a year. It’s disparaging to realize that the global recording music industry was a $40 billion business in 1997 and 2014 the music industry’s global digital revenues barely reached $6.85 billion, according to the International Federation of the Phonographic Industry (IFPI). The IFPI represents the recording industry worldwide, with over 1,300 record companies in over 57 countries are members.

More people are listening to music, and fewer writers and artists are getting paid for their work. Society needs a music industry that rewards people for creating great content. Not a scene where music companies wrestle over ownership rights.

Hitting the music industry with peer-to-peer

The introduction of the bitcoin peer-to-peer electronic cash system by Satoshi Nakamoto (sudo name) in 2008, immediately sparked the interest of the music industry. The wonder started with companies like Murfie, a music marketplace founded in 2011, that accepts bitcoins as payments for music downloads. Bitcoin as a payment method isn’t going to change musicians lives as a new financial standard for payment. However, the application of the blockchain technology to the music industry may change artist lives.

Blockchain has the potential to modernize every industry in the world. We just don’t know exactly how. It was common knowledge that blockchain could impact the music industry, but the full impact on the industry wasn’t articulated clearly to encapsulate the potential for positive change, until last month. In November 2015, Benji Rogers published on Medium, “How the Blockchain and VR can Change the Music Industry.” The article offers a powerful argument in support of the positive impact that blockchain technology (Etherium, Muse, Rootstock) would have on the entertainment industry. In February 2016, Roger published an update that provided substantive support both theoretical and technical on how this could be accomplished in part 2 of his post, highlighting four clear points.

  1. Smart contracts will be the enabler
  2. Blockchain will house a global Fair Trade Global Database of rights
  3. Every song will contain Fair Trade Minimum Viable Data (MVD)
  4. The new format will be called .bc or “dot Blockchain,” a non-replicable wrapper (.bc compliant systems)

Music ownership obfuscation

Will the music industry see the beauty in the blockchain scheme? Blockchain technology applied to your music means that everyone will pay for their use, driving transparency of music ownership. The artist would create a .bc file containing who owns the work and who to pay when used. The music enthusiast using a platform (YouTube, Spotify, SoundCloud, 8Tracks, Tidal, Pandora, Apple) buys and pays for music as they would today. The difference is the behind the scenes a digital ledger tracks ownership of the author and usage rights of the music enthusiast.

Roger suggests, defining the rules governing play at the time of encoding, by the artist and the music rights holders, as part of the song’s Fair Trade Minimum Viable Data. The author, composers, contributors, owners, and usage rights are defined as part of smart contracts enabled by blockchain technologies. The music enthusiast also benefits paying only for what they play, instant payment, and multi-platform accessible. The .bc was envisioned to replace DVD, Blu-Ray and support a new virtual reality (VR) format that has no standardized format or wrapper. This format would contain Minimal Viable Data using the W3C Web standard JSON-LD, illustrated in the dot blockchain concept illustration.

The music industry has struggled with digital rights management (DRM) for years. Blockchain provides a ledger as a means of payment, automatic royalty payment splitter, and simplified licensing using legal enforcement non-ambiguous smart contracts. This concept is more than DRM. Its is DRM+.

Intersecting music and health

Blockchain technology can improve transparency of ownership for music as well as health records. Music industry’s song ownership challenge parallels the healthcare industry’s problem with medical health record ownership. The U.S. life and health insurance industry reached $877.9 billion in 2014 according to statista.com. How much more transparency in your personal medical records have you seen in 2014 compared to 2015. I’ll share my experience between 2014 and 2015; I saw zero positive impact towards better visibly into my medical records. Personal health records continue to be as fragmented between providers and physicians as song ownership and royalty payments of the music industry. Platform scale, interoperability, and privacy are surmountable challenges. How do we transfer trust, when patients have no faith in the system? Payments don’t reflect treatment provided. We can’t blame patients for their lack of confidence when even experts have trouble explaining the circus we call today’s “healthcare system.”

Blockchain has the potential to give patients, like you and I hope, and restore trust in healthcare. Transparency and ownership of our medical health records are the beginning. New healthcare platforms will emerge returning medical record ownership back into the hands of the patient.

Blockchain applications for healthcare

Peter Nichol
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Blockchain applications for healthcare

Blockchain opportunities are changing healthcare globally – innovative leaders see the change. There are many blockchain applications for healthcare. The exponential growth of blockchain applications can benefit population health, medical records, and patient-generated data. Healthcare startups have already discovered how to leverage blockchain technology for healthcare.

The first industry to visibility take advantage of blockchain was financial services. Financial services had the courage to believe in the potential of blockchain technologies and grew a three tier model:

  1. Applications and solutions (brokerages, exchanges, soft wallets, hard wallets, investments, merchants, compliance, trading platforms, capital markets, microtransactions, money services, banks, ATMs, payroll and insurance, payments, trade finance)
  2. Middleware and services (services, software development, general APIs, special APIs, platforms, smart contracts)
  3. Infrastructure and base protocols (public, special, payment, miners)
    Healthcare is late to the show but also hasn’t missed the show. Blockchain opportunities are changing healthcare globally – blockchain is fitting into a new world.

Population health management

Health information exchanges (HIE) and all-payer claim databases (APCD) have become obsolete with blockchain. It doesn’t make sense to trust organizations to verify member’s trustworthiness when it’s not required with blockchain. Eliminating this prehistoric middleman increases data security and removes the cost, time, and resources required to prove that a party is doing what they say they’ll do. New models that share medical records are emerging.

In 2007, the government of Estonia joined forces with Guardtime, a leader in cybersecurity using blockchain’s Keyless Signature Infrastructure (KSI), to provide authentication on a massive scale. Their combined challenges were to verify the integrity of data-at-rest on a global scale. Estonia is among the few if not the only digital societies which have 100% of their medical health records online. Spending time and resources verifying members’ trustworthiness (e.g., HIE, all-payer claims database, local EMRs) no longer makes savvy business sense. Blockchain will leap frog population health by providing trust where none exists for continuous access to patient records by directly linking information to clinical and financial outcomes. Population health just got smarter.

Healthcare mobile communications and notifications

Tierion can collect data from web and mobile apps, record information in the blockchain and slingshot data to other systems by using REST API or HTML form submissions. Already have an existing mobile application? Leveraging REST APIs can extend functionality and provide a “safe” way to amplify your corporate innovation footprint. In October 2015, Philips Healthcare’s announced a joint blockchain project with Tierion. Tierion supports over 400 applications such as Google Sheets, Gmail, and Slack and also assisted the Department of Economic and Community Development of Connecticut surveying 200 top technology companies. Tierion can also handle medical, financial, and legal records through their blockchain integration and infrastructure platform.

PGHD meets wearables

Patient-generated health data (PGHD) has tremendous potential, but to-date hasn’t delivered the promised value. Mainly, because this data never makes it to the patient.

Under Armour HealthBox, Bragi Dash, Hexoskin smart shirt, OMSignal OMbra all generate industry excitement while playing safely on the fringe of patient transformation. Wearable tech is exciting, hip, and a great conversation starter. Value alignment is found at the intersection of wearable tech and integration of medical records. FHIR APIs, needed to connect the patients to EMRs, won’t be mainstream in 2016. The major EHRs vendors aren’t going to publish a complete service definition for FHIR profiles to share with software companies. Access to data is preventing adoption, not technology or even patient behavior. No data – no insight.

In 2011 at the World Economic Forum, personal data was declared a new asset class. Healthbank, based in Switzerland, is a global digital health innovator taking a radically transparent approach to health system transactions. Their approach is a new way of sharing data and uses personal data that is secured. A next logical step for healthbank would be to incorporate blockchain technology. The healthbank mantra is “my data, my choice, my healthbank.” Blockchain applications place personal and patient information into the hands of the individual. Doctor visits, sleep patterns, heart rate, glucose, and other IoT devices can all be polled and then stored using the healthbank blockchain. This innovative blockchain company is attending conferences and telling their story in Finland, Barcelona, and Brazil – the world is watching. Also, Noser Health (Germany) and Netcetera (Switzerland) have recently joined healthbank as partners to mature its global health data transaction platform.

Patient-owned

Once patient-generated data is owned by the patient from wearables to physician and clinical visits; a dramatic shift will occur.Trust is difficult to find in today’s global economy. The “cloud” is considered safe, well up until the point that your personal information is going to reside there. Blockchain technology can authenticate access to medical information, quickly and securely.

Innovative leaders can see the change. It’s happening now; the patient experience is evolving.

Why experts are slowing the emergence of digital health

Peter Nichol
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Why experts are slowing the emergence of digital health

Article originally published on CIO.com.

Digital transformation visions crumble from a lack expertise. Don’t let yours be one of them.

Digital health is the convergence of the Digital and Genomic Revolutions specifically health, healthcare, living and society. Personal empowerment is the heartbeat of digital health making our lives better by managing, tracking and improving wellness for a healthier tomorrow. The realization of this healthier and seamlessly connected future will require orchestration between the physical and digital world. This orchestration will be conducted by digital experts.

What does it take to be an industry expert? Is it pure raw intelligence or is there a subtler side to expertise? In some instances, experts that are required to transform organizations and tap into top-line innovation growth, may be the same experts preventing adoption of your organization’s digital capabilities. There is a lack of expertise when it comes to digital transformations and applying digital technology to dramatically improve performance of an enterprise in all aspects of human society. 

There is something sacred about the word “expert.” This role can’t be given; it can’t be won; and it isn’t issued with a promotion – it’s earned.

Two types of expertise

There are fundamentally two types of expertise: Routine and adaptive. Routine experts often assume that their current knowledge and their problem definitions are correct. Adaptive experts have the ability to apply knowledge to novel problems or atypical business challenges and reshape problem definitions.

Routine expertise

Digital transformation visions crumble because of a lack of experts or the wrong kind.  

Giyoo Hatano of Dokkyo University and Kayoko Inagaki of Chiba University” studied aspects of cognitive development in the 1980’s. The updated translation is that digital transformation is impossible when companies are made up of only routine experts.

Routine experts are unable to think beyond their models built on procedural knowledge. Routine experts rely on similar experiences from their past when building a solution framework.  When problems arise that are atypical and do not fit historical problems, they get stuck. For example, the problem may require a new model such as introducing digital disruption. 

Digital disruption occurs when new technology affects existing business models and how products and services create value. Those regarded as routine experts would apply the same models they have used for the last twenty years and find they do not work. This illustrates the real problem preventing digital disruption, attempting to solve new problems with procedural expertise.

That’s not to say routine experts are not effective. Procedural skills are used to efficiently solve everyday problems in stable environments. Unfortunately, stable does not describe the digital environment that influences business today.

Adaptive expertise

Another type of expert is the adaptive (or conceptual) expert. These experts not only retain procedural skills, the base of routine expertise, but they also understand the reasoning behind the skills they demonstrate. They internalize the need for invention and they have the desire to understand the meaning behind these procedural skills. Routine expertise has a pattern that is prevalent in every industry. The test is to be able to describe ‘why’ something works, not ‘how.’ The combination of the past knowledge and the reason why it works enables adaptive experts to grasp the full domain of information surrounding the skill. Taking this past knowledge, adaptive experts will then identify even more efficient methods of performing the skill.

Bottom of Form

In 1983 Gentner and Stevens introduced the concept of mental models, in their book of the same name. Mental Models help us visualize the theory with a series of short studies. They explain that individuals can run mental simulations and make predictions on conceptual outcomes. We can logically infer that conceptual experts step beyond the cultural limits procedural experts experience and are able to explore problems more deeply than with simple trial-and-error. The desire to learn unlocks new thinking, removes conventional mental barriers, exposing raw talent.

Consider the following exercise:

 “Two men played five games of checkers. Each won three games. How is this possible?”

Clearly, if the two men are playing against each other this problem is impossible to solve. Adaptive experts will already assume information is missing, constraints are flawed, and their problem is larger than what is being suggested.

After a few minutes most routine experts will realize the two men were not playing against each other and that the problem was indeed solvable. This example of restricted problem spaces, demonstrates how individuals build restricted definitions of problems. When you look at companies that are digitally innovative and companies that are not, the primary differentiating factor is the talent; each company defined the problem differently.

Growing digital innovation initiatives requires adaptive expertise to create a highly metacognitive organizational environment that promotes content knowledge, domain knowledge, and experimentation. Adaptive expertise is defined in the mind and fueled by the attitude that drives it.

The next time a team is assembled to deliver the next dermable (a type wearable that goes on your skin and can stand out like a tattoo, or blend into the color of your skin), swallowable, or nanobot, rethink who’s an expert.

Divergent thinking is essential for digital health creativity.

Healthcare’s Two Biggest Problems Going Into 2016: No Sugar Added

Peter Nichol
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Healthcare’s Two Biggest Problems Going Into 2016: No Sugar Added

Healthcare’s natural evolution from a fee-for-service to value-based outcome models will remain out of reach, until interoperability and payment reform are removed as barriers to provide patient care.

 

Interoperability

Overall, it’s widely accepted that the Health Information Technology for Economic and Clinical Health (HITECH) Act, as a policy was a success. It’s not surprising when the percentage of US Hospitals using digital records skyrocketed from 9.4% to 75.5% between 2008 and 2014, according to a recent brief by the Office of the National Coordinator for Health Information Technology. However, as we include the patient experience into the definition of success, perspectives change. For example, you have a simple annual checkup at your primary care physician locally, and then a week later you travel to a neighboring town and end up in the hospital. The hospital doesn’t have any record of your recent visit a week ago, no access to labs, and won’t even know to ask unless you mention it. Is it an effective meaningful use application? The primary challenge continues to be that providers and payers are not accountable for interoperability under HITECH. The result is a fragmented national healthcare that only hurts the patients we’re trying to help. HITECH was a significant investment with a staggering $35 billion committed for the program, according to Robert A. Sunshine, Acting Director Congressional Budget Office (CBO) in his response to Charles B. Rangel, U.S. House of Representatives, Chairman for the Committee on Ways and Means. The program initially committed to savings from Medicaid and Medicare of $12.0 billion between 2011 – 2019. Have the US consumers and patients realized that savings? Why of course not, there is limited interoperability when making clinical decisions with existing EMR technologies.

 

Interoperability is a monumental challenge that is rarely discussed nationally, and this critical issue needs to be confronted before costs are driven down opening access and allowing providers to explore models for improved quality in patient care.

 

Payment Reform

The method healthcare providers are paid must be changed from a fee-for-service payment system. Without heavy healthcare payment reform, the realization of better access to higher quality care at lower costs, will not happen. Payers won’t do it. Providers won’t do it. We as patients must spearhead this change. Otherwise, we’ll be passing the burden to the next generation.

 

The Center for Healthcare Quality and Payment Reform identified ten major barriers of healthcare payment reform 1. Continued use of fee-for-service payment models, 2. Expecting providers to be responsible for costs they cannot control, 3. Physical compensation based on volume not value, 4. Lack of data for setting payment amounts, 5. Lack of patient engagement, 6. Inadequate measures 7. Lack of alignment among payers, 8. Negative impacts on hospitals (inefficiencies), 9. Policies favoring large provider organizations, and 10. Lack of neutral convening and coordination mechanisms. These issues are complex and will require payers, providers and patients all working together for a healthier tomorrow. This realization will be nearly impossible without payment reform considering we have a payment system incented not to keep patients healthy and a dis-coordinated delivery system at the patient level.

 

In an effort to push down costs, consumers are demanding price transparency. Will healthcare transparency reduce costs? It sounds like it should. Price transparency protects consumers from unfair pricing, and helps to determine the true product evaluation, while building consumer trust. Empowering consumers with price allows, consumers make decisions based on cost and quality information, before care is obtained not after. Better decisions do save money. West Health Policy Institute’s latest analysis indicated, that price transparency could cut $100 billion over 10 years from health spending. However, there can be adverse effects of price transparency, and according to the Health Care Cost Institute, in markets where pricing is very transparent, pricing narrows and the average cost rises. As employers force consumers toward contribution models, selections become difficult and price transparency may not be the single solution. Price transparency creates behavior changes in employees and also in employers.

 

We can only hope the behavior changes in employers soon start to favor the employee.

 

 

References

HTA. (2015). Using The PCAT Formula During Conversational Hypnosis To Solve Problems (online image). Retrieved November 15, 2015, from http://hypnosistrainingacademy.com/using-the-pcat-formula-to-help-people-solve-problems-during-conversational-hypnosis/

 

Peter Nichol, empowers organizations to think different for different results. You can follow Peter on Twitter or on his blog. Peter can be reached at pnichol [dot] spamarrest.com.

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