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We’re Just Getting Started with an Internet of Healthy Things (Part 3 of 3)

Posted on November 27, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The previous sections of this article described the state of health care today and some of the impressive advances described in Joseph Kvedar’s new book, The Internet of Healthy Things. Now we’ll look at the possibilities for advancing further, and what stands in the way.

Futures postponed

Later in the book, Kvedar explores the promise of analytics. On a small scale, analytics can tie the results of traditional clinical research to recommendations for individuals. For instance, if the A1C hemoglobin of a person with diabetes hits a certain level that clinical research has established as dangerous, she can be notified. We also know what heart rates are best for exercising and other useful statistics. Walgreens and CVS also use data at this level to market their products to consumers who sign up for their fitness tracking programs.
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We’re Just Getting Started with an Internet of Healthy Things (Part 2 of 3)

Posted on November 25, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The previous section of this article described the dire condition of health care today. So where does Kvedar’s book, The Internet of Healthy Things,fit into all this? It encapsulates all those years of learning at his Center for Connected Health, set up by the Boston-area giant Partners HealthCare and now renamed Partners Connected Health. From these insights, the book pinpoints the areas where innovators can make headway. He shows the gap between how we approach chronic health conditions now–even among the companies experimenting with mobile health and patient engagement–and the ideal for which the Partners Connected Health is striving. In reviewing his suggestions, I’ll try also to shine lights into passageways he did not explore.

Lessons from the field

Kvedar divides the evolution of connected health into three broad phases. Most companies are now in the first phase of simply reporting statistics back to patients and doctors. You can find out from a mobile app what your blood sugar is, and from your fitness bracelet how far you’ve walked during the day. This phase can have some benefits on athletes and the small set of Quantified Selfers who love data, but has absolutely no appeal for the vast mass of people who most need support.

Partners Connected Health has entered the second phase and has its own data to show the great strides it has made. In this phase, you engage the patients by connecting him to his providers, family, and friends, making him feel watched (the Sentinel Effect) and therefore extracting healthier behavior. This starts to achieve the changes we want, but is still limited in the people we reach.

The third stage is to fit the intervention directly to the lifestyle and needs of the individual, a process Kvedar calls “hyperpersonalization.” If walking your dog is an important part of your life, the system should feed you messages encouraging you to do things that improve your endurance and walking ability. If you want to fit into smaller clothing for an upcoming wedding, focus on everything that can get your waistline down.

Kvedar’s vision does not seem to be the automated-intelligence utopia laid out by Vinod Khosla and others, where patients get automated diagnoses and treatment recommendations from the “cloud” and avoid physicians for most ailments. Rather, technology for Kvedar supports a strong relationship between patient and clinician. At the same time, the technology extends the clinician’s reach–and allows her to treat many more people with greater effectiveness–by bringing the treatment plan into the patient’s everyday life, throughout the day.

The first chapter of the book lays out a fantasy scenario for an automated coach that follows the individual around and sends messages right before he reaches for a cookie or is about to stay up too late at night. Kvedar unveiled the same scenario, which was quite amusing, in his introduction to the Connected Health conference. I covered the major aspects of this hyperpersonalization–automated, contextual, motivational, empowering, and incentivizing–in another article. It has to be done very careful in order not to appear intrusive and annoying, but it offers a greater promise to change behavior than anything else we know.

I already see one difficulty with organizations aiming at this vision of health care. Kvedar talks a great deal about apps–the little agents you download from the Apple Store or Google Play. But hyperpersonalization is not an app. It’s a whole environment for dealing with personal lifestyle–aided by apps, to be sure, but requiring a deep investigation into the patients’ needs and interests. What Kvedar is really calling for is not a prize-winning app, but a reconfiguration of our health system.

In the face of such a challenge, several organizations are stepping up. Among their ranks are scattered a few traditional health care organizations (providers such as Kaiser Permanente and Kvedar’s own Partners HealthCare, insurers such as Aetna) but most come from the outside. Kvedar concentrates on the clinics and wellness programs set up by Walgreens pharmacy. Their integration of convenience and support for ongoing behavior change is much more thorough than most people realize.

Another example of an integrated strategy is provided by a single teenager whose caretakers are monitoring his diabetes remotely. The process brings the teen’s doctor and mother into the picture with technologies that include an unusual skin sensor, Apple HealthKit, and an Epic health record. The solution is not an open one.

It’s great for Walgreen’s to fix sore throats and minor cuts, and even to start offering primary care. But people with serious health needs will eventually need to interact with a traditional clinic or hospital. If these institutions still can’t accept data from the urgent health clinic (some already can), the same old inefficiencies and errors will re-emerge. And this failure to evolve with the times is a danger even though, as Dr. Kvedar repeatedly warns, it threatens the continued existence of the traditional hospitals.

The final section of this article will look at the gap between where we are now and where The Internet of Healthy Things would like us to be.

EMR Focus, EMR Integrated Patient Data, and EMR Patient Safety

Posted on March 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


The last comment in this tweet is something I’ve hammered home over the years. It’s a simple concept when you hear it and everyone agrees. It also explains at least some of the frustration with EHR software in their current iterations. I’ve often wondered what an EMR designed for healthcare would look like instead of the EMR’s designed for revenue capture that we have today. I actually think we may get to see the answer to this in the concierge medicine area.


This article by one of the smartest people in this space, Dr. Joseph Kvedar, is really well done. I’ve long been interested in the pathway to integrating patient collected data into the EMR. I’m excited to read that Partners is close to making it a reality. It’s definitely just the first step, but that’s how it all gets started. Dr. Kvedar does make an extra observation in the article about the 5% sickest patients that they want to target aren’t using mobile devices and health trackers. That’s an important observation that’s worthy of deeper consideration.


These signs have always bothered me. I appreciate Dr. Nick tweeting about it. I know we put up a sign like it 9 years ago when I first helped do an EMR implementation. We didn’t go as far as this sign, but definitely wanted them to understand the delay. There’s a fine line between good customer service and freaking out the patients. My favorite signs I’ve seen tout the EHR as the second coming of quality patient care. I hope the practices that put up these signs can live up to that promise.