Health 2.0 - 2009 (San Francisco) - Day 2

8:40am - 3 Health 2.0 CEOs & a President!

Adam Bosworth, CEO, Keas

The idea with Keas was to start small trying to help a small number of people and scaling from there. Chronic diseases are life style disease. Keas tries to address these issues.

Quest Diagnostics has been a great partner. We also have good partnership with MS Health Vault and Google Health.

Lessons learned: try to be modest, get out early your product and learn from your customers!




Roy Schoenberg, CEO, American Well

Bottom line: try to make our customers (e.g. the Pentagon) happy. We seems to be at the right place at the right moment, especially now with the Health Care reforms that are taking place. American Well for patient it is convenience (immediate gratification, cost etc ...), for the physician and the payers, the solution brings efficiency, more revenue and ROI.

In Q1 2010 we will deploy our application to more PCP and specialists networks.


Christopher Schroeder, CEO, Health Central

We offer a more holistic experience than other web sites, a sense of connection and empathy. We are more focus on the consumer side of the issues.

Alexandra Drane, President, Eliza

We have 43% click through from email. We have the ability to look at the data that we store overtime and improve our system. We had to acquire a company to quickly get the social network infrastructure and experience.

9:30am - The Consumer Aggregators
27% of American go online to seek HealthCare related information and services.

• Wayne Gattinella, WebMD - The market more mobile, more global and more personal! - Focus on continuity of care. Demo of WebMD on the iPhone. We need to demonstrate the utility of the Health 2.0 applications. Adoption is key.
  
• Roni Zeiger, Google Health - New launches: (e.g. Google flu trend) - Demo of MDLiveCare.
  
• David Cerino, Microsoft Health Solutions - Demo of My health Info.

11:00am - Data Drives Decisions - Panel

Tools and platforms to support decision-making by doctors

• Rex Jakobovits, McKesson - Upload online version of medical images / Pacs systems. Demo of MyPacs.net - more than 100K medical images. Fine grained search capabilities on images (CGI/perl based web site). Help radiologist to look at challenging cases to learn and solve related cases.
  
• Lance Hill, Within3 - Customers are hospitals, Pharma, Research centers. Demo of Within3 medical social network in the context of a medical conference (running on Amazon EC2). Issues with publishing abstracts of papers shared between peers before publication.
  

Tools and platforms to support decision-making by patients

• Sanjay Koyani, FDA - Pushing information to consumers and providing not only services but also a platform. - Show recalls database from FDA (4000 products) . The dailygreen.com integrated FDA widget (e.g. on Salmonella peanut recall). Collaborates with CDC as well. More than 20,000 sites are using FDA widgets.
  
• John deSouza, MedHelp - Online and mobile applications to help patients deal with specific conditions (e.g. breast cancer). Data can be shared with other patients. Mobile applications available as well.
  
• Hugo Stephenson, iGuard - Offer online and paper based tools related to drugs interactions - Launch in oct 2007 - 2M US citizen registered - 25 times more registered by paper! Demographic and statistic numbers available online on these patients. Includes recalls information. Business model based on revenue from clinical trials. Hope to have 3M users in the coming months.
  

The impact of Health 2.0 tools and platforms on clinical research

Kristin Peck, Pfizer

Alexandra Carmichel, CureTogether - Patient data sharing site - Lot of data on depression. Offers correlation (e.g. depressions & fibromyglia)

Jamie Heywood, PatientsLikeMe - Very detailed statistics on patients with similar conditions. Compare data with clinical trials.

Amy DuRoss, Navigentics - Comparison of personal and general population genetic information as well as risks factors.




12:30pm - IDEO design competition

• Finalist winner of the IDEO competition is LabCheck Plus (Satellite Laboratory Services) - The fastest growing dialysis lab in the US. Users are Nurses, Physicians, Patient care technicians etc. The process involved ethnographic field studies, focus groups and usability testing.
  

1:00pm - Launch

• Pathway Genomics - Genetic tests for $348 - Includes ancestry and health tests . Done by saliva.
  
• Remedy Systems - Web based Portal & Mobile Portal - ePrescribing application at the point of care
• AccessDNA - WebMD for genetic testing compare DNA testing providers. Offer personalized reports.
• CarePass - Online and Mobile solution
  
• TrialReach.com - Multimedia online tool to find and understand clinical trials.
  
• DNA Guide - Personal online genomic map (includes DNA Classifieds).
• Unity Medical - ultimedia online content to help diagnosis. Technology to push content to the desktop (e.g. videos relevant to the user). ***
  
• Livestrong - Help to determine how food can impact users/patients. Includes interactive graphs.
  
• Healthline - Web site offering health related content
  
• BiodiMojo - To help families who raise teenagers.Includes health and fitness tracking goals, journal. Send mojos by notifications and community tools related to teenagers.
  
• RelateNow - To help families that have children with autism, including reducing the cost of the therapy. Offer collaboration tools for the family and the health care professionals.

2:00pm - Innovations in Health 2.0 Tools: Showcasing the Health 2.0 Accelerator

Combined demos by:

MediKeeper - PHR with a portal look and feel including a health risk management.

change:healthcare - Cost saving alerts and analysis

Kryptic - portal integration hub

Sage - EHR integration tools and platform. Supports CCR imports





MedSimple - Online questionnaires to prepare medical encounters (electronic patient history).

PharmaSURVEYOR - Medication safety survey (interaction and toxicity of individual drugs).

Polka - Mobile observation engine - manage prescriptions and observations.

ReliefInsite - Pain management system.

Keas - Launch Keas Beta - Personalized care plan. Includes todo list, history of tasks and report cards. Uses CCR . Import data from Google Health and Health Vault.

Kinnexxus & MedSimple - Kiosk dashboard for elderly and online application for care givers. 3:30pm - Health 2.0 Around the world

See also:

• Day 1 - Health 2.0 - 2009 - SF

• Day 1 - Health 2.0 -2008 - SF
• Day 2 - Health 2.0 - 2008 - SF

• Fresh from Health 2.0: two dozen of the most innovative new health apps (VentureBeat)
  

Health 2.0 - 2009 (San Francisco) - Day 1

This year, the Health 2.0 conference 2009, San Francisco takes place at the Design Center Concourse at 635 8th Street (at Brannan). It is an old dark wood train loading station which contrasts interestingly with the image of health care in general where everything is supposed to be bright and clean. The setting is similar to last year with round tables of ten people that facilitates social contacts. On the back of the building on what was the loading platforms are more than 30 exhibitors. This year the crowd is roughly the same size, between 950 to 1000 people (got these numbers from Matthew and Indu). The conference was well organized as usual, expect the wireless connections that were very poor!

The focus of this year is the platforms for mixing and aggregating data, applications services and channels, including mobile devices, social networks , widgets and portal applications.

8:30am - Introduction by Matthew Holt and Indu Subaiya

• In the past, health 2.0 was essentially about user generated health care, then the issue of connecting to providers started to be important. More recently the partnerships to reform delivery was the focus. This year, as data drives decisions and discovery, tools and platforms seems to take more and more importance .

8:50am - Keynotes by Aneesh Chopra, Assistant to the President Obama & CTO, Office of Science & Technology Science.

• Building blocks of innovation: the US need a more modern and secure infrastructure
• How do we control costs?
• How to ensure that we have the skills professionals?
• The synergy of innovation between health care and energy, IT, green technology
• Promotion of enterprise creation since this is where the growth of productivity comes from
• Help promote public data sets (e.g. CMS, VA) as soon as possible
• Promotes innovations in various areas including mobile
  

9:15am - Panel Clinical Groupware and the Next Generation of Clinician-Patient Interaction Tools.

• Clinical Groupware is the next generation of EHR
• Panel includes people from Myca, American Well, RMD Networks (showing reachmydoctor.com), Vision Tree Software, Relay Health.
• A lot of demos focus on the communication aspect between patients and physicians.
• Payment reform is needed to promote these types of tools

9:50am - Adoption of Health 2.0 Platforms by Physicians on Main Street

• The bottom line is culture change for technology and tools adoption.

11:15am - Payers and Health 2.0

• Anvita : clinical Analytical tool data analysis
• Health Innovations - Focus is now to reduce cost from Ambulatory care, ER, CT, MRI etc.
  
• Blue Cross Blue Shield (BCBS)
• Cigna (8.5M customers in USA, 41M worlkdwide). Presence on Facebook, partnership with Intuit.
• State of Minnesota Management & Budget
• Kaiser Permanente - (8.5M users, 10 states esp CA) - Focus on chronic care management.

Including demos from:

• Adam Lee - Intuit (Health Expense tracker, claim assistant) - Very intuitive tools! available to 27M users by the end of the year! Partners with Cigna, United HealthCare, Medical Mutual. ***
  
• Fred Goldstein - US Preventive Medecine (thepreventionplan.com)
  
• Karl Ulfers - Optum Health HealthWorldWeb
• Daniel Kogan - HealthWorldWeb

12:00pm - Doctor Office special showcase demos

• The doctor channel (partner with publishers, lots of channels, videos, documentaries ..). Not clear what is the business model (compete with Youtube?). Should be part of a PHR.
  
• rxvantage (For providers Office tools, alerts, scheduling ) - Started in RI -
  
• Practicefusion (Web based PHR/EMR - on the Cloud for patient. Has a professional view - including scheduling). Based on Saleforce. Contains adds that can be removed for $100/month. The data does not belong to the patient.
• BoundaryMedical (Tool and framework, provider and patient portals - give the ability to create a product/project in less than 30 mn)
• Phreesia (streamline billing and payments - integrated with EMRs - for patient and providers) ***
  
• MdDigest - (Opens source platform and solutions for patient and physicians - .net based) - (e.g. Healthforge practice monitor)
• Spinal Disorders Registry - based on Microsoft HealthVault, integrate with Cisco video and Webex conference system - 50K patients - Seems a specific feature of an EMR
  
• Ozmosis - Tools such as Health Alerts (partner with Veratect)
• Phytel (Patient registry, reporting and analytics) -
  
• Doctations (Interoperability platform and tools? 3 tiers: Free, $33/mo, $1033/mo) - 22 partners
• Dr Chrono (Pratice Management + notifications reminder through voice over IP, IM etc) offer an App Store.

2:00pm - The Patient is in.
Highligthing the importance of personalization of the applications.

• Kaiser permanente
• Edventure
• Users of Health 2.0 applications - Video describing uses of various applications:
• Lifemojo
• Quitnet
• Sensei
• Care.com
• TheCarrot.com
• BioIQ
• 23andMe
• Metavante Health Manager

3:40pm - Breakout sessions

• Gaming and HealthCare
• Health 2.0 Tools for Administrative Efficiency
• Search and Content

See also:

• Day 2 - Health 2.0 - 2009 - SF

• Day 1 - Health 2.0 -2008 - SF
• Day 2 - Health 2.0 - 2008 - SF

• Fresh from Health 2.0: two dozen of the most innovative new health apps (VentureBeat)

Usability and Healthcare Portal Applications

A healthcare portal application is usually more than just an aggregation of portlets. To be really usable, a portal application needs a clear and well defined interaction model between the portlets. In addition to this, since speed and ease of use plays an important role in the quality of care for the patients and the clinical adoption of the solution, the performance of the portal application must be excellent.


Creating portal themes:
The theme of a portal application typically includes portal header, navigation (horizontal and/or vertical), portlet chrome, and footer for controlling the general look and feel of a portal application. It might also include CSS and JavaScript for controlling the look and feel of portlets.


The way themes are created varies from one portal server to another. Fortunately, the overall layout of a portal application and the look and feel of the individual portlets can be separated from the underlying functionalities of the portlets. This separation makes branding much easier and facilitates the porting of the application to other portal servers.

There are several approaches to creating a custom theme for portal applications. Certain vendors (e.g. IBM Websphere) offer portal theme builder, portlets that provide minimum functionalities to create basic themes. For more sophisticated themes and branding of a portal application, developers and designers will start with an existing theme and modify it (e.g. Liferay). Themes are usually a combination of HTML, CSS, images and javascript files. Designers typically use tools such as eclipse plugins, Dreamweaver, Photoshop, Fireworks, etc to modify these files.

Personalization in HealthCare Portal Applications:

Personalization is one of the key features of portal applications. If granted personalization rights, users can personalize their portal Web pages based on their specific roles and authorization schemes.

Themes and layout can also be changed manually by the user or programatically based on the user profile. Additional personalization mechanisms (e.g. using a business rule coupled with user profile matching engine) can also be integrated with the portal solution.

Personalization can be very valuable for care givers, as a means to organize the general views or dashboards associated with their daily tasks in the most comprehensive and efficient way. Personalization can also be important for patients. For example, diabetes patients might want to view medical content related to their diagnosis while cancer patients might want to see their treatment protocols on personalized portal pages.

Liferay Portal 5.2 Systems Development - Book review

Recently Packt Publishing Ltd sent me a copy of the new book from Jonas X. Yuan untitled "Liferay Portal 5.2 Systems Development" for review.

In this post, I would like to give my feedback including some input from my colleagues who have read parts of this book.

I personally read all the 12 chapters which cover a large variety of topics related to developing portal application with Liferay 5.2 including JSR-286 portlets, EXT and SDK, JSP/struts based portlets, portal pages management, tools, CMS and WCM, personalized community, Layout templates and themes, Inter Portlet Communication (IPC), collaboration features of Liferay, Staging, publishing and APIs.

Reading the book from the front to the back is probably not the best way to take full advantage of the content. I would rather recommend to use it as a reference to Liferay 5.2. application developments.

This book is particularly valuable if your project includes high level of customization, using Liferay Extension Environment and or the integration of Content Management System (CMS) capabilities, as well as Web 2.0/social and collaboration features. The content of the book is consistent with Packt publishing practice to "focus on producing cutting-edge books for communities of developers, administrators, and newbies alike".

If you are an architect, a graphic designer, developer or a build manager, you will find ample step by step configurations and recommendations, code sample, tips and best practices on developing portal applications with Liferay 2.5.

Sometimes, the content is so rich with code snippets, variable names and configurations paths, that the mix of various fonts makes the text a little bit difficult to read, or at least slows your reading. Fortunately, the granularity of the chapters is fine enough that you can jump directly to a very precise topic. The index is also very handy.

I like the fact that the author combine best practices that are specific to Liferay (e.g. Liferay has a property called theme.images.fast.load for performance optimization) and general good web site programming practices (e.g. the use of CSS sprites and the placement of javascript code).

The fact that most of the book describes the development of a specific and complex portal application (Sesame Workshop) is a good thing since you can see how every pieces of the solution are put together. You can even download code sample from Packt Publishing. However, additional examples would have been nice too. It would have been also interesting to see alternatives to JSP and Struts MVC framework such as development based on JSF, RichFaces and/or ICEFaces.

The chaper 9 on Layout templates and themes is very useful, although starting with EXT rather than the Liferay SDK is quite harsh. Also a discussion on the development process: how graphic designers and developers can work more efficiently together would have been very useful in this chapter.

Overall I highly recommend using this book as reference book if you plan or are involved in a portal project based on Liferay 5.2. Even though your overall configuration/architecture might be different, you will find practical tips and solutions to integrate and customize most features of a portal application.

If you are new to Liferay in general (developer or graphic designer) and want to learn the potential of the platform, you can also definitively use this book for specific topics.

How to update a TrustStore

When it comes to security, I often got questions from engineers related to truststore update.

Let say you have a truststore with a certain number of trusted certificates that are used for SSL authentication and you want to add or replace a certificate.

You will need a tool such as Portecle which is a java based is friendly GUI application for creating, managing and examining key stores, keys, certificates, certificate requests, certificate revocation lists and more.



















Open your initial truststore with Portecle:








































I then use Microsoft Internet Explorer (IE) to access, view and save your additional/new trusted certificate.

In this example, I am using ICW Lifesensor Personal Health Record (PHR) application because I want to add the associated certificates to my TrustStore (the goal is to to enable secure access to PHR accounts):

















































































































Use Portecle to import this new trusted certificate in your trust store:
















































Your updated truststore is now ready to use!

Community One 2009

This year Cloud Computing was really the buzz word at Community One in the West Coast (San Francisco)!

Cloud Computing was in fact the opening topic by Dave Douglas on the general session (the other topic was Open Solaris).

It was interesting to learn that SUN Cloud offer started only few months ago, but it has been quite successful with more than 3000 people using it every days.

Dave did introduce also a couple of interesting companies that offer applications that run on the SUN Cloud infrastructure:

• Moonwalk uses the cloud to save data for disaster recovery.
  
• Vertica : Column oriented DBMS with a version for the cloud.
  
• WebAppVM : Virtual Machine - to migrate from local machine to the cloud.
• Apache Hadoop a software platform that helps write and run applications that process vast amounts of data (using MapReduce).

Security is still a concern in the cloud. Sun seems to take security quite seriously. It participates to the Center for Internet Security and offer tools to encrypt data as well.

There also a very good material on programming languages and the Cloud from Ted Leung Principal Engineer at SUN who presented an overview of cloud computing architectures and the ways they interact with programming languages. He covered various topics : Security, Concurrency, Performance, Distribution, Operational Considerations and Domain Specific Languages (DSL).















Ted introduced some of the innovations in the Cloud infrastructure including storage and computing in the Infrastructure as a Service (aaS) layer, Virtual Machine Images (Stack aaS), AppEngine, Heroku, Zembly (Platform aaS), Salesforce (Software aaS).

Infrastructure aaS issues:

• No predefined Software Stack
• You have to do everything
• Languages cannot help

Stack aaS issues:

• You get whatever language is in the stack
• Depends on the quality of the stack interaction
• Languages can help, part of the stack interaction
• Services are not part of the stack

Platform aaS issues:

• Specialized high performance Data Access/Storage (CouchDB, Big Table, Key/Value Stores, Non Relational DB, Map Reduce)
• Identity
• Asynchronous messaging (XMPP, Queing)
• Payments
• You get whatever language is in the platform
• Platform inlcudes network services beyond language runtime
• Leads to a service oriented system
• Part of the difference is the quality of the integration

Software aaS issues:

• SaaS application may or may not be programmable
• The SaaS may have its onw language
• Learning curve/training
• Integration

Characteritics of the Cloud Environment:

• Multitenants
• Heterogeneous
• Scalability is a goal
• Elastic/Provisioned by machine
• Monitored/Audited
• Services Oriented

The most interesting part of the presentation was certainely the part dedicated to languages with a comprehensive overview of specialized programming languages for the Cloud.

Areas where languages intersect the Cloud:

• Security/Resource Control
• Performance
• Concurrency
• Distribution
• Operational Considerations
• Domain Specific Languages

There are two language models for the cloud:

• Sandboxing (Java, Pypy, Google AppEngine)
  
• Capabilities (Caja, Joe-E, E)
  

Projects and Languages targeted to address Cloud issues:

• Transactional Memory (Haskell, Clojure)
• Actors (Erlang, Scala, Axum/F# ...)
• Futures (Java, Python, Ruby libraries)
• MapReduce (Hadoop, Disco)
• Persistence Data Structures (Clojure)
• Tuple Spaces (Jini/JavaSpaces, GigaSpace, Blitz, Tspaces ...)

Monitoring and instrumentation is also an important issue in Cloud Computing. DTrace for example (integrated with the latest Open Solaris version) is a powerful tool to analyse resource usage/behavior (e.g. which files are accessed throughout the whole stack).


Other topics at Community One:

There were also other interesting topics besides Cloud Computing:

OpenSolaris:

• Network vitualization
• Snapshot using ZFS (very cool@!)
• Optimization of storage devices using Flash drives
  (these days, the bottle neck for a applications is data read/write on storage devices!)
• SUN 7000 Storage: New enterprise storage appliance - 800 customers in just 4 months. up to 1/2 Petabytes of storage!

SUN Master Data Management 6.2 - (presentation by Parijat Prosun Kar):

• To help managed the business context data of entities or objects involved in business transaction (great for Context Management!)
• Can be used in System aggregation/federation (e.g. portals)
  
• Just in time business models require agility and integration across the enterprise
• Help ongoing mergers and acquisitions
• Compliance and localized governmental requirements
• Includes a Master Index Studio, Data Integrator, Data Quality, Data Mashup/Services, Data Migrator
  
• see also Mural (Open source Master Data Management from SUN)

Atmosphere: a POJO based framework using inversion of control (IoC) to support Comet.















IceFaces / AjaxPush: updates on the J2EE Ajax framework presentation by IceSoft.
Here is an example that uses Liferay Portal platform.















Android: some good tips about the use of adapters, bitmap scaling, background refresh.
By the way, the next version of Android (Doughnout) is expected in Q3 of 2009.















JRuby: updates on the Java implementation of the Ruby.

Speech Technology and HealthCare

Recently, I was invited to participate to a meeting of AVIOS (Applied Voice Input Output Society) local chapter in Menlo Park, California to discuss the use of speech technology in HealthCare and Medicine.

Speech technology is not widely used in healthcare at the moment. The healthcare industry is still focusing on efficiency and cost saving by solving systems integration, re-wamping legacy systems and making paper based processes digital.

Dictation and transcription for EMRs

The most successful type of applications is probably dictation/transcription for electronic medical records (EMR).

Speech recognition, enhancing productivity and reducing medical costs as a result. In this domain, Nuance is one of the market leader.

The products and services of Nuance Healthcare are used at more than 5,000 hospitals and by more than 400,000 providers.

Nuance’s on-premise Dictaphone Enterprise Speech System (ESS) components support recording the dictation audio, managing the audio and the resulting transcription process, transcription document distribution, and online reporting.

Dragon medical is another product from Nuance with which physicians dictate in real-time into their EMR in their own words letting them instantly review, sign, and make their notes available for other clinicians. This include Medical Vocabularies, covering nearly 80 specialties and subspecialties and regional accent support.

Potential use for Care and Disease Management

Besides dictation/transcription there are some additional potential uses of speech technology in other domains related to heathcare. Care and Disease Managament is one of them.

Organizations/companies like Lifemasters have call centers where nurses help to help patients with chronic disease achieve optimal health by closing the gaps between recommended and actual care (evidence-based medicine) and encouraging patients to adopt a healthy lifestyle and reducing the overall cost of healthcare. Speech technology could be used to complement and optimize this type of services: virtual operators, voice activation services, automatic text-to-speech combined with voice-over-IP reminder and notifications (e.g. to take drugs, schedule an exam, do certain types of exercices etc ...). Companies like requall and Jott already provide this type of notification infrastructure that can be delivered on mobile phones for example.

Other Areas

Additional research areas in speech technology and healthcare include:

• Using speech/sound recognition to monitor eating behavior

• disease assessment (e.g. parkinson over the phone, although this disease is very complex and voice is probably not the most important factor)

• using speech recognition for medical transcript anonymization to be used as corpora

Conclusion

Overall, there is a big potential for use of Speech Technology in the healthcare industry.

The recent improvements in Text-to-Speech make it very attractive to healthcare, especially to non life critical applications.

Speech recognition accuracy is sometimes still a problem, but it is well suitable for sub-languages with specific vocabulary. It might be more difficult to be used directly by patients/health consumers, especially senior citizens where the language can be altered by their conditions.