brown2020

In 1853 when Giuseppe Donati invented the classical wind instrument he called the “ocarina” in his workshop in the village of Budrio, Italy, people tended to know the daily activities of their neighbors. When someone in your neighborhood played the ocarina in his or her home late at night, not only could you hear it, but you also might have recognized the player and the tune. Maybe you would join in on your own instrument.

You would probably have much less of an awareness of the world beyond the vicinity of Budrio, not much past the big city of Bologna. But you knew your neighbors: Their stories, their experiences, their music, their relationships, and their gossip all had a place in your brain.

In the next century people would gain an ever-expanding awareness of the world beyond their local community through the virtual experiences of mass media. Starting with motion pictures, then television, 24-hour news channels, and the Internet, the world would become a lot smaller. We now live in a state of continuous awareness of the entire world. At the same time, we have become less aware of and connected to the people in our own local communities.

There has been much written lately about brain training and brain plasticity, and how we are entering the brain fitness age. If our experiences with the world can change the wiring of our brains, then how is our immersion into the constant stimulation of digital media affecting us? Is our continuous experience with the larger world through digital media impairing our ability to socially connect with our neighbors?

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For a decade now, just about every service industry has taken for granted the benefits of information technology: Increased productivity, faster and better service, and access to services from home. All actionable information is recorded and shared electronically so that ever smarter information systems can help us anticipate and prevent problems. Whether it is retail, financial services, or even fast food, productivity in everything has gone through the roof.

Every service industry except health care, that is.

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America’s core fiscal challenge, according to the Congressional Budget Office, is health care. In 2011, the first of 80 million baby boomers will hit Medicare. In the twenty years to follow, the Medicare rolls will nearly double. Future obligations based on current policies leave our country technically bankrupt, and something has to give.

New Ideas About Human Behavior in Economics and Medicine, Peter Orszag, Director of the CBO, October 16, 2008

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Phineas Gage

Growing up, I learned about Phineas Gage, the railroad construction foreman who survived an incredible accident in 1848 that shot a large iron rod through his brain, destroying the frontal lobes. Although Gage survived for another decade, his personality changed profoundly. The brain science books I read in the late 1980’s still used the over century-old example to introduce the idea that every function had a special location in the brain, and everything was hard-wired for life once you finished childhood. It turns out the hard-wired model of the brain was dead wrong, and academic opinion and dogma had led research down the wrong path for over 100 years.

Dr. Michael Merzenich, founder of Posit Science and one of the world’s leading brain scientists helped disprove the old “what you have is what you get” brain theories. In the 1980’s, Merzenich’s team developed the cochlear implant, a device that stimulates nerves in the inner ear with electrical signals that correspond to sound. With the “bionic ear”, people with profound deafness have learned to process the electrical signals and hear again. Merzenich went on to show that the brain can adapt and change based on all sorts of sensory input. How neurons wire together not only changes based on our experience with the world, but also based on our own thoughts. Posit Science applies this new knowledge of brain plasticity to brain training and brain fitness products that improve memory and processing speed to treat age-related cognitive decline.

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Google Sets is an interesting new tool from Google Labs that finds associations between words or phrases and related terms that we might not have thought about. Who could be better able to offer such a tool than Google: More than any other organization on the planet, Google knows what we are thinking. When something is on our minds, chances are that a significant sample of us are typing it into Google. The resulting data puts Google in a unique position not only to identify associations between words, but also to derive insights into human intentions and behavior.

Google Sets Home Health Monitoring Example

For obvious examples, type “Porsche” and “Mercedes” into Google Sets, and the site returns Ferrari, BMW, Audi and Lamborghini, among others. Type in “brain fitness” and Google Sets returns brain health, mind fitness, mental health, stress, cognitive neuroscience, brain training, and more.

For something less obvious, I challenged Google with the name of my old company, Health Hero Network. Google Sets accurately found AMGA, the acronym for the American Medical Group Association, the company’s partner on an important but not very well known Medicare chronic care improvement demonstration project. Google Sets also identified two of the company’s competitors, Viterion Telehealthcare and AMD Telemedicine, but missed the larger rivals Philips Telehealth and Honeywell HomMed as well as Intel Digital Health, the latest entrant into the home health monitoring market. Google Sets also didn’t pick up the fact that Health Hero Network is now part of Robert Bosch GmbH.

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EHealth consultant Sananet has been piloting the Health Buddy telemedicine technology in the Netherlands for several years, with encouraging outcomes in diabetes, COPD, and heart failure, as well as benefits for everyone involved in care: patients, doctors, nurses, health insurers and government agencies. Here is what telemedicine technology looks like in the Netherlands, recently posted on YouTube.

Sananet reports the following results from its telemedicine in chronic care pilots:

• 30% reduction in hospitalization for heart failure patients in a telemedicine study from the University of Maastricht.
• Reduction in length of hospital stay for COPD patients from 13 days to 9 days on average in a telemedicine study from the University of Utrecht.
• In diabetes patients with an HbA1c of 8% or higher, a reduction in HbA1c of 1.5% compared to 0.6% in the control group in a study in Almere.

Although many think of telemedicine and telehealth as the remote collection of data from blood pressure monitors, digital weight scales, blood glucose monitors, and respiratory monitoring devices, Sananet achieved all of these results using a telemedicine system focused on educating and supporting patients at home in a simple daily text-message health dialogue about symptoms, behavior and knowledge.

Related posts:

Dutch Ministry of Health Recognizes Health Buddy for Best Practice in Telemedicine

Telebegeleiding met Health Buddy

In Defense of Food

In his book, “In Defense of Food,” Michael Pollan traces the deterioration of the American diet to 1977, when dietary recommendations became political. A well intentioned Senator George McGovern had introduced the “Dietary Recommendations for the United States,” lamenting that the American diet had become full of fatty meats and sugary soft drinks that were causing disease. The report started a firestorm because every food has a powerful lobby. Discussion of actual foods had to be watered down only to mention mere nutrients. It was politically incorrect, for example, to distinguish between beef, chicken or fish. “Now the culprit is an obscure, invisible, tasteless – and politically unconnected – substance that may or may not lurk in them called saturated fat.”

Keeping the topic of nutrition close to and safe for the food lobbies, the 1977 Farm Bill placed our national nutritional authority with the US Department of Agriculture rather than an agency focused on human health. Our government and the massive agricultural subsidies that it doles out could now stop thinking about nutrition in terms of whole foods, which were too politically dangerous, and could shift to a reductionism that parsed food into a limited set of nutrients that could quantified, processed, and manufactured.

With food merely a vehicle for delivering nutrients, the age of manufactured and processed nutrients—Pollan does not call it food—could flourish. And the American obesity epidemic could begin.

Like every good manufacturing process that wins through ever increasing efficiency, our food supply raced toward the cheapest form of calories: Grains that could be mass produced and fertilized out of otherwise increasingly barren soil, to become concentrated and cheap forms of calories like high fructose corn syrup. We also shifted to feeding livestock with the same cheap calories. No more green leaves ever needed to enter our food chain. We always could add back in manufactured vitamins to fortify the products to meet the government recommendations.

But food is much more complex than the limited collection of nutrients that we currently understand. Each blueberry contains dozens and dozens of anti-oxidants balanced by hundreds of generations of natural selection. That’s just not the same as blueberry flavored high fructose corn syrup fortified with the singular chemical entity known as Vitamin C.

The reductionist approach to food as a collection of manufactured nutrients broke the longstanding connection between our food and nature. For eons, the act of preparing and eating food has been the primary and fundamental interface between our physical bodies and the nature that sustains us and of which we are part.

Where did it come from?

When the food chain was short, the foods themselves were complex, and we were reminded with every trip to the market of our connection to the natural world and to the soil from which our food originates. Food was something that we could identify: an apple, a banana, a chicken leg.

Now the manufactured food chain is long, with so many participants from so many places that we have no idea where the ingredients in the box of cereal we had for breakfast really came from. We no longer know what we are eating. It comes from a complex supply chain from around the world, a supply chain optimized by market forces for long shelf life and high margins, not for human health.

Michael Pollan’s advice is to leave behind manufactured processed nutrients and take a step back toward nature: “Eat food, not too much, mostly plants.” Sounds like good advice to me.

Intel Health Guide Blood Pressure Monitoring

After over three years of research, development, and market study, Intel announced the launch of the Intel Health Guide, an Intel-branded device for remotely monitoring and managing patients with chronic illness at home. From Intel’s demo one can see that the device is a laptop computer no keyboard and a reversed touch-screen. Patients can connect and upload blood pressure monitors and other medical devices to communicate results with remote health care providers. In addition to vital sign data collection, the health monitoring software also provides patient reminders, surveys, educational content, and other communication tools.

Although Intel appears to be targeting at the same chronic disease management market, the Health Guide from Intel adds features and functions far beyond its predecessor Health Buddy from Health Hero Network, now a division of Robert Bosch. It will be interesting to see whether or the enhanced functionality such as video conferencing and multimedia content will be the key to market adoption.

Intel Health Guide Home Health Monitor

The real barriers to adoption of remote monitoring and other chronic care strategies may be less about functionality than about institutional incentives and business models ingrained in our health care system. The health care market with Medicare in the lead still rewards health care providers far more for treating the complications of chronic illness than it does for proactive management and monitoring aimed at preventing them.

The incentive systems that determine the viability of new models of health care enabled by devices like the Intel Health Guide and the Health Hero Health Network Health Buddy could be about to change, however. With favorable results from the Medicare chronic care improvement demonstration project currently underway from Health Hero Network in Washington and Oregon, Medicare coverage for health care providers to offer home health monitoring services may be around the corner.

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Great design starts with empathy for human needs, and great designers gain their insights by immersing themselves in the world and looking at challenges through the eyes of their users. That is the philosophy of IDEO, one the most innovative and successful design firms in the world.

Yesterday, I had the good fortune to hear a thought provoking presentation on innovation and design thinking by the CEO of IDEO, Tim Brown. Tim described the lengths to which IDEO designers go to understand the point of view of their users and then to generate a stream of prototypes as they experiment and try out ideas. Prototyping is part of the learning process. Insights are more likely to come spending time with extreme users, the youngest and the oldest, and the most challenged.

Here is a presentation by IDEO from the First Conference and Intensive Training on User-Centered Design in May 2008 which conveys the IDEO design process and basic principles of design thinking:

Nowhere is the IDEO approach to human centered design more necessary than in health care, where we spend more resources than any other sector of our economy and yet we still have the greatest unmet needs. While I was CEO of Health Hero Network, we partnered with IDEO to design the first Health Buddy device for home health monitoring. Here is a sketch from the Health Buddy design patent that we received on the in-home appliance that served as the front end for a home health monitoring service:

Health Buddy Design Patent Sketch

Our goal with Health Buddy was to enable people with chronic conditions to effortlessly record health status information at home and share it with remote care providers over the Internet. We hoped to enable caregivers to identify problems early and do a better job of educating and supporting patients at home to prevent more serious problems that would lead to hospitalization.

The first design challenge that I gave IDEO was to enable my grandmother to communicate meaningful information with her nurse over the Internet using just one trembling knuckle. The second challenge was to use design to deliver a friendly, supportive and compassionate interface to remote caregivers so that patients would feel comfortable in sharing information daily about health issues that most people would rather not think about.

The collaboration with IDEO was tremendously successful in creating an better interface to chronic care from the home. The most common response from our users was that they “felt like someone was there for them.” Hospitalizations were reduced, patients adhered to treatment, and caregiver productivity improved. Now if only the design of the economic models of health care could catch up to advances in designing a better chronic care model!

Partners in Health has been improving chronic care in rural communities in Rwanda through an innovative model of care inspired by Paul Farmer. The regional hospital sees its mission as training community members to extend care into the community and monitor patients at home in order to prevent disease complications and the need for hospitalization. The hospital tracks symptoms and medications using electronic medical record (EMR) systems based on open source technologies. Meanwhile, the United States continues to neglect reforming our crisis-oriented health system because “we can’t afford it”, and the cost of chronic care continues to explode as the population ages. With far fewer resources, but with more creativity and courage, innovative leaders in Rwanda are creating new models of care based on prevention because they can’t afford not to. Maybe we can learn something from Rwanda.

President-Elect Barack Obama, November 4, 2008:

If there is anyone out there who still doubts that America is a place where all things are possible, who still wonders if the dream of our founders is alive in our time, who still questions the power of our democracy, tonight is your answer.

It’s the answer told by lines that stretched around schools and churches in numbers this nation has never seen, by people who waited three hours and four hours, many for the first time in their lives, because they believed that this time must be different, that their voices could be that difference.

It’s the answer spoken by young and old, rich and poor, Democrat and Republican, black, white, Hispanic, Asian, Native American, gay, straight, disabled and not disabled. Americans who sent a message to the world that we have never been just a collection of individuals or a collection of red states and blue states.

We are, and always will be, the United States of America.

It’s the answer that led those who’ve been told for so long by so many to be cynical and fearful and doubtful about what we can achieve to put their hands on the arc of history and bend it once more toward the hope of a better day.

It’s been a long time coming, but tonight, because of what we did on this date in this election at this defining moment change has come to America.

It’s the day before the biggest election in recent memory, and the Economy is the top issue as Americans have come to realize that the entire financial system at risk.

I typed the word “economy” into the search engine Google today, and saw that BarackObama.com is the third search result on the list out of 254,000,000 sites in the Google index. This is an amazing feat of Search Engine Optimization.

There are three fundamental ways to get attention on the Internet: pay for it, word of mouth, or through organic search results.

Paying for traffic by purchasing keywords from Google is expensive. It is so expensive to buy traffic that Google brought in a record $5.5 billion revenues for the three months ending September 30, 2008.

Word of mouth is the power of social networks like Facebook and Myspace. Information that we post travels through our newsfeed with lightning speed to our friends, even faster than we can email a YouTube video.

Organic search is perhaps the most important way of obtaining traffic. When we are seeking something, most of us start with a Google search. Traffic that comes in from a search result tends to be the most relevant. Rarely do we make it past the first page or two of Google results, however, before clicking on a search result or trying a new search term.

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In the book Click: What Millions of People Are Doing Online and Why it Matters, Bill Tancer provides an inside view into just how much data about our online behavior is routinely collected and what those clicks reveal about the thoughts and intentions of a population. As head of Global Research for Hitwise, a web analytics company now part of credit ratings giant Experian, Bill Tancer has at his fingertips a continuous datastream from 25 million Internet users, collected anonymously through Internet Service Providers (ISPs). It must be even more fascinating to see Google’s data, as the most common act we do when we are interested in something is to type it into a search engine.

After reading Bill Tancer’s book, I put some of the ideas to the test with my own research based on web analytics made publicly available for free from Google and from Compete.com. If Internet behavior is an indicator of the intentions of a population, then what can we learn about the current political campaigns of Barack Obama and John McCain? For a sense of perspective, I also included Hillary Clinton in my comparison. The Compete.com graph shows unique monthly visitors to BarackObama.com, JohnMcCain.com and HillaryClinton.com. Despite steady growth in visits to JohnMcCain.com in recent months, BarackObama.com led JohnMcCain.com in website visits for September by over 2.4 million monthly uniques visitors, with 5.5 million unique visitors to BarackObama.com compared to 3.1 million unique visitors to JohnMcCain.com.

BarackObama.com v. JohnMcCain.com v. HillaryClinton.com on Compete.com

On Google.com/Trends, Google reveals trends in the data it collects and records on what people have been typing into the search engine. I compared searches for Barack Obama, John McCain and again Hillary Clinton for all searches originating in the United States over the past 12 months. While searches for John McCain briefly overtook Barack Obama around the time of the Republican Convention, Barack Obama has had a steady lead.

Barack Obama v. John McCain v. Hillary Clinton in Google Trends

Zooming in to searches conducted in the past 30 days, we can see that interest in both candidates continues to increase as we get closer to election day on November 4. Barack Obama’s lead over John McCain in search traffic has accelerated, and by the end of October, Google searches for Barack Obama led John McCain by about 2.5 to 1.

30 Day Google Trends: Searches for Barack Obama v. John McCain v. Hillary Clinton

Google also gives us the top locations for search traffic, so we can easily see the top geographic hot spots for presidential candidate search terms, which should correlate to what people are thinking and talking about.

Top Regions for Presidential Searches on Google

Not surprisingly, there is a high overlap between the areas with the most searches for presidential candidates and the battleground states where the campaigns are the most intense. All of the key battlegrounds except Florida are in the top 10 regions in terms of presidential candidate search traffic, with the hottest races in Indiana, Ohio, North Carolina and Missouri at the top of the list.

Battleground States Map from New York Times

One of the insights Bill Tancer demonstrates in the book Click is how traditional television media can drive search traffic. A television advertisement can raise awareness of an issue, and then lead us or even explicitly give us a “call to action” to go to the Internet to dig deeper.

It is easy to jump to conclusions, because with the free web analytics used here, we don’t know what motivates the search behavior. It might easily be buzz about a parody of a candidate on Saturday Night Live, Steven Colbert, or the Daily Show with John Stewart, with a flurry of web searches to catch the clip on YouTube or Hulu.com. Some things we know for sure. First, the objective behavioral data of the Internet has proven many previously untested assumptions to be wrong. Second, despite the fact that campaigns produce more 30 second television sound bites than ever, our ability to dig deeper and learn more for ourselves means that it is a completely new world this time around.