Navigating Healthcare – Patient Safety and Personal Healthcare Management

Treating Mental Health

Posted in Uncategorized by drnic on July 6, 2017

Don’t judge my path if you haven’t walked my journey

Mental Labels

Just the term “Mental” induces reactions and responses from every corner of our society, and mostly they are not positive. Perhaps part of the problem can be attributed to the broad and different definitions applied to the term that includes its use as an adjective relating to the mind or disorders of the mind but it also has an informal us as “insane” or “crazy”

It’s no wonder that when we refer to someone as having “Mental problems” or a “Mental Condition” – so perhaps we need to change the terminology to start addressing “Mental” health as part of our overall health. The precision of language and terminology is important but we have a tendency that appears to be increasingly misused, or perhaps it just appears that was because it is magnified by social media and the 24/7/365 news cycle. For example, the term “Depression” is a clinical diagnosis that has some very specific symptoms and durations but the term is used excessively in place of sadness, misery, or sorrow. SO for this article, I will refer to “Diseases of the Brain” rather than “Mental Disorders”


Part of Physical Health

A recent article by John Campo, MD, Professor, and chair of the Department of Psychiatry at Ohio State University pointed out the mismatch between the prevalence and impact of diseases of the brain and the lack of legitimacy as a “real disease

The treatment of mental illness has long been held back by the sense that disorders of emotion, thinking, and behavior somehow lack legitimacy and instead reflect individual weakness or poor life choices

Some of this likely stems from our lack fo understanding relative to brain disorders evidenced in history by the way we viewed and “treated” anyone deemed to be unusual or different. These attitudes date back to at leat the 13th Century and “St. Mary of Bethlehem” in London built in 1247 and used as an institution for the insane. It was colloquially referred to as “Bedlam” hospital (yes that is where the term “Bedlam” came from) that featured horrific treatments from “rotational Therapy”

Imagine being stuck on the Mad Hatters Tea Cup ride at high speed for hours


And extended to beatings, bloodletting, and starvation! This sordid history is covered by the Museum of Healthcare Blog. This attitude extended into my medical school training where we were dispatched to Friern Hospital (formerly Colney Hatch Lunatic Asylum) that at its peak was home to some 2,500 patients with disorders of the brain. My clinical experience there included a harrowing personal experience that still shapes my behavior to this day.


Long corridors with Wards radiating out


Moving to Whole Care


The disconnect between the specialty of Psychiatry and the rest of medicine is rooted in our inability to observe and explain the workings of the brain. Even some of our treatments work but we struggle to understand why or how. This manifests in the challenge of honest acceptance of having a disease of the brain and being able to find help to treat that condition. For most people, our exposure to this world is limited to the Hollywood lens, like “Awakenings” starring Robin Williams and Robert de Niro



It is sad to note that Robin Williams suffered a sometimes public struggle with a brain disorder and ultimately committed suicide secondary to his suffering of Lewy Body Dementia

Based on the true story and book “Awakenings” written by Oliver Sachs – the British Neurologist, naturalist, and author who died back in 2015. He was a prolific writer who wrote with such eloquence and mastery of language you can lose yourself in his books.

Papa would tell me,
‘is not a science,
but the intuitive art
of wooing Nature.’

The Art of Healing – W.H. Auden


Science is Helping

The good news is that technology and science are helping as we unlock some of the mysteries of the brain’s function and the diseases that impact function. In fact, in many instances, we are discovering that the brain plays a much larger role in many diseases and we ignore this at our peril. We continue to unlock the chemical and physiological functions in the brain and as the science advances so too does the integration of the specialty psychiatry under the same roof as the rest of medicine.

There are now a number of initiatives working to expand our understanding, coordinate research, results, and findings that included the 2013 announcement by President Obama for the “BRAIN Initiative” (Brain Research through Advancing Innovative Neurotechnologies) that is homed at the National Institute of Health (NIH) and complemented by the The Human Brain Project from the European Union. The initiatives are not without problems and uncertainty of funding continues to challenge progress but understanding, science, and data remain a central requirement to progress.

There are some areas of progress from industry and Arshya Vahabzadeh, MD, the Chief Medical Officer at Brainpower has been championing Virtual Reality and Augmented Reality as a tool to help the growing population of Autism patients handle the complex world of emotions and human interactions. As he highlighted Virtual and Augmented Reality was a hot topic at the recent American Psychiatric Association Meeting


And was featured in this Medscape article: Virtual Reality a Game Changer for Psychiatry (Medscape)


Incremental Improvements in Brain Disorders

As Dr. Campo pointed out

Better understanding of the human brain and the biological nature of the mind will help, but it won’t be enough. How we think about mental health matters. When mental health is ultimately recognized as essential to physical health, not an extraneous element of it, then we will have access to true, complete, modern medicine

Changing the narrative and words may seem trivial but for any change to take place we need education and awareness that removes the stigma and fear associated with disorders of the brain and deliver the same compassion and care that patients with cancer or heart disease receive.

So my thoughts for some incremental improvements you can make addressing disorders of the brain

  • Words Matter – it’s not “Mental Health/Disorder” – it is Disease or Disorder of the Brain
  • Ask, listen and most importantly digest and be there as we interact with others – read Maneesh Juneja  blog – Being Human
  • From a clinical perspective – the clinical history and the detail of the Presenting Complaint and History of Present Illness remain the mainstay of diagnosis and understanding
  • Read or listen to Oliver Sach’s – you can find his books – or watch his TED Talk, or hear him on Science Friday or NPR or read one of his articles


What small change have you seen that makes a difference in the support of people with disorders of the brain. What one thing could we do that would have a big impact in this area?

You can also follow me here on medium, on twitter, or on facebook




MasterChef in Healthcare: Integrating Social Media

Posted in #hcsm, #mHealth, Healthcare Technology, HealthIT, HIT, HITsm by drnic on April 15, 2015

Social Media is rapidly becoming an integral part of our lives. Despite the pervasive nature of the communication channel healthcare remains a technology laggard. This presentation from HIMSS15 Wednesday Apr 15) will offer insights to help understand why healthcare professionals should join the community, participate in the discussion and how can do so successfully.


I presented this topic at HIMSS15 on Wednesday Apr 15 – you can find the listing here. As promised I am posting a summary of the points as well as a link to the Slideshare for that presentation

You can find the presentation on my slideshare (nvt) here

Master chef in healthcare- integrating social media – @DrNic1 from Nick van Terheyden




Technology is all pervasive in our lives and Social media is everywhere – in fact in a recent survey of 3,000 people conducted in the US, UK and Germany to help counter the limited time with their physicians, patients are seeking information and embracing technology outside of the doctor’s office to come to appointments prepared. Approximately 80 percent of patients feel engaged in their own health:

  • 68 percent of patients bring a list of questions to each doctor’s consult;
  • 39 percent have checked WebMD or another online source in advance; and
  • 20 percent bring personal health data from outside monitors.



You can see some 87%o f US adults are online in this Pew internet research so if you are not on board you are missing a huge opportunity but more importantly your patients are forming an opinion about you before they meet you




 What is Social Media

  • It’s a conversation, not a lecture
  • It’s an extension of everyday interactionCollaboration
  • It’s group driven, not top-down
  • It’s messy, disorganized & hard to control
  • It’s a tool, not an end-point
  • But most of all…



If you have not already – go to twitter and sign up for an account

What to Tweet

  • What you have read that you want to share with others
  • When and where you are speaking
  • Something you post on your blog
  • A link to a Web site that you find interesting
  • Listen to conversations happening online using keywords (hashtags, lists and searches) – learn from your colleagues, friends and patients
  • Befriend people – and then earn their trust by solve problems, answering queries, helping and providing useful information
  • Share information, valuable content with them
  • Questions and Requests for information and help – crowdsourcing answers
  • At a minimum – Lurk, Listen and Learn

There are many HashTags to follow and starting by assign friends and colleagues what they follow is a a good start but then get involved – join an online chat and community and take a look at the listing of healthcare hash tags from symplur. Listed below are a few of the healthcare hash tags I follow:

#hcsm (h/c social media)
#HCLDR (healthcare leaders)
#HITsm (health IT social media)#MedEd (medical education)
#eolchat (end of life/elder chat)
#BCSM (breast-cancer social media)
#LCSM (lung-cancer social media)
#BTSM (brain tumor social media)
#S4PM (Society for participatory medicine)

But I received a aggregated list when I polled my followed that included all these:


#POWHIT – People & Organizations improving Workflow w/HIT


#JACR 4th Thurs 12pm EST
#LCSM Every other Thurs 8pm EST
#BCSM Mon 9pm ET
#HCLDR Tues 8:30pm EST
#MedEd Thurs 9pm EST


@twubs @hashtracking or @tweetreachapp


My thanks to all my twitter friends who contributed

@HealthcareWen @HIMSS @lsaldanamd @sjdmd @HealthcareWen @DrJosephKim @dirkstanley @dlschermd @Docweighsin @RossMartin @CraigJoseph @RobertWahMD @ishakir @SteltsMD @JenniferJoeMD @StevenChanMD @CIBR_News @Jim_Rawson_MD @aussiclydesdale @ACRselect @AdamFuhriman @Gregmogel @ruthcarlosmd @techguy @MandiBPro @HITshrink @ahier @RandaPerkinsMD @motorcycle_guy @wareflo @susannahfox @Lygeia @ePatientDave @CMichaelGibson @Colin_Hung @annelizhannan @MelSmithJones @Paul_Sonnier @JennDennard @HIStalk @JohnNosta @2healthguru @lsaldanamd @lisagualtieri @EricTopol @ShahidNShah @DanMunro @Daniel_Kraft


Put yourself somewhere on the Social Media Adoption Curve



Add LinkedIn and Facebook – they offer a different channel and voice – Facebook tends to be more social and LinkedIn tends to be more professional/business orientated

There are some good examples already out there

The Mayo Clinic has several properties and their own published guide book to social media and the University of Maryland Medical Center that has blended many channels

What Not to Do

The JAMA 2012 report Online posting of unprofessional content by medical students highlighted a high proportion of violations and problems and there are plenty of examples of people who failed use basic common sense – I personally like the 12 word Simple Social Media Policy from the Mayo

Don’t Lie
Don’t Pry
Don’t Cheat
Can’t Delete
Don’t Steal
Don’t Reveal



  • Social Media for Physicians is a Game Changer
  • Social media, when effective, will establish a physician’s brand and connect him/her with those in need of their services
  • With increased deductibles, more consumers will “shop” using social media sites.
  • Social Media will Expand the Physician’s Role with Patients
  • Social media is shaping patient encounters with physicians and that impact is expected to increase significantly
  • Extending the patient experience will foster existing patient relationships and improve patient outcomes, especially for long-term chronic conditions.


Where are you on the social media ladder and are you going to climb higher?




MasterChef in Healthcare: Integrating Social Media was originally published on Dr Nick – The Incrementalist

Interviews Live From HIMSS 2019

This week I am talking to several guests live at HIMSS 2019

The Incrementalist Graphic HIMSS19 Part1

Rasu Shrestha, MD EVP & Chief Strategy Officer Atrium Health (@RasuShrestha), R. Hal Baker, MD SVP, CIO Wellspan, and Aneesh Chopra, President, CareJourney (@aneeshchopra)

Listen in to hear their thoughts on the latest innovations at HIMSS, what’s coming, the importance of shared values, bringing the humanity back to healthcare and the importance of bipartisan consensus on interoperability.

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.

### Check Links ####

Listen along on HealthcareNowRadio or on SoundCloud

Interviews Live From HIMSS 2019 was originally published on Dr Nick – The Incrementalist

Has Kindness Gone?

Posted in behavior, Compassion, Empathy, Incremental, Inspiration, life, social media by drnic on February 25, 2019
Dalai Lama
No Better example of Kindness in Action

Where has the Kindness Gone

As someone remarked to me just recently

The kindness has gone

It can certainly feel that way sometimes and while my general position is to think like a proton – always positive it has been challenging over the last few months to maintain this position.

I posted this over the weekend: “You don’t have to attend every argument you are invited to”

And around the same time, Linda Stotsky (@EMRAnswers) posted this: “In a world where you can be anything, be kind.” #SundayThoughts #SundayBrunch #SundayMorning

Both received a fair amount of (mostly) positive endorsements which affirmed my view that there is a desire of many/most to be positive, but was followed by some posts from Casey Quinlan (@MightCasey) and Dave DeBronkart (@ePatientDave) highlighting this horrific expose on the people employed to do content moderation that reads like a horror movie (The Trauma Floor).

However it was the piece on NPR Radio: Anger Can Be Contagious – Here’s How To Stop The Spread by Alison Aubrey (@AubreyNPRFood) – which in some respects feels titled incorrectly because the ultimate point is that:

Kindness is transmissible

That reaffirmed my belief that the kindness is there is just not getting through.

I’ve lost count over the last few months of the repeated instances of individuals and groups jumping in, oftentimes absent facts excoriating the latest target and the inevitable mass of people who then jump in on both sides, certain of their position and argument. In some cases, the action or behavior was mean or unkind and the mob certainly made sure to let that individual know often succeeding in trashing someone’s personal and work life creating meme’s that live on forever. There are plenty of examples but I see little point in calling further attention to them, the individuals and groups but rather focus on how we can all perhaps contribute to a kinder world


Almost every time these instances occur I am reminded of an advert (Points of View) from the 1980’s for the Guardian newspaper, that thanks to the wonders of the internet time machine are available to view. At the time it hit a resonant note with me emphasizing the importance of perspective and the lens we all view life through – everyone’s lens is different and shaped by personal experiences, connections and emotions many of which are invisible to others

Incremental Steps to a Happier Kinder World

Taking a page form my daily meditation teaching and one of their guidance points as you start to feel overwhelmed or anxiety approaches they say


  • S is for Stop
  • T is for Take a breath
  • O is for observe, referring to observing whatever caused the stress or anxiety
  • P is for Proceed


2) Try to Put Yourself in Someone Else’s Shoes

And I’d add another step in the process – try and imagine yourself in the other person’s shoes. I always encourage taking a walk in someone else’s shoes in an attempt to get a sense of what might be driving their thoughts and ultimately their behavior. We are all imperfect (at least I know I am and there are plenty of opportunities for improvement and reflection and my life is replete with mistakes and things I regret in hindsight).

If you observe something or someone behaving badly – it might be hard to imagine yourself in their shoes and to explain the behavior or actions but if nothing else trying to do so will always inform you and any response you have.

3) Do Something Nice for Someone Else

Given that kindness is transmissible try being kind to people online and in person. A simple smile aside from helping lift your own mood helps lift others moods and in most cases, people respond by smiling back which lifts your mood further.

Take a leaf out of the “Pay it Forward” movie and find something to do for someone else – you might be surprised at how good it makes you feel

Anger leads to more anger. But a single act of kindness can help stop the spread. story at

Has Kindness Gone? was originally published on Dr Nick – The Incrementalist

Tagged with: , , ,

Design Thinking for Healthcare and Medical School

The Incrementalist Graphic Clay Johnston

Design Thinking for Healthcare and Medical School

This week I am talking to Dr. Clay Johnston, MD, PhD (@ClayDellMed), Dean, Dell Medical School and Vice President for Medical Affairs, UT Austin. Dr. Johnston has been the inaugural dean of Dell Medical School and is working towards a vision to create a new model for academic medicine that accelerates innovation to improve health and reduce inefficiencies in health care.

Find out how they set their vision and as Dr. Johnston describes the importance of making this a worthy vision and the associated difficulty with achieving that goal and what that means to your incremental steps to getting there. You can hear about their new Design Institute lead by Stacey Chang, who came from the innovative design house IDEO to run the design institute. You incremental learning point from the Design Institute:

“Don’t Assume you know”

You can hear about the Dell Medical Schools unique recruitment methods that help them find the students who are well suited to the new age of medicine – hint its not your MCAT score, how they screen and then how they have changed up the medical curriculum to offer a whole new system to nurture innovation and new thinking in our future doctors so they are well equipped to work in our new world of DigitalHealth

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


Listen along on HealthcareNowRadio or on SoundCloud

Design Thinking for Healthcare and Medical School was originally published on Dr Nick – The Incrementalist

HIMSS 2019 Mix Tape

Posted in Healthcare Technology by drnic on February 1, 2019
HIMSS 2019 MixTape

I love music – it always manages to lift my spirits no matter the mood and right selection of songs can get people up and dance. I know, that was the main aim when I was a Disc Jockey (DJ).

So it is with anticipation I look forward to Colin Hung’s email each year asking for song recommendations for his annual MixTape – now in its fifth year. Every year its tough to make a single selection and it gives me an opportunity to think about tracks I’ve discovered or sometimes re-discovered in the past 12 months. You can see the full post and selections for 2019 here

For 2019

This years winner was:

I wanna Try – MOUNT & Nicolas Haelg



I wanna try something good
I wanna try for you
I wanna give, wanna give something good
For you to do

But I went through several others:

“Break Free” by Taryn Southern, which is entirely composed and produced with #AI, which for Healthcare this year seemed almost perfect:

I wish I could see
Beyond what I can see
…There’s more to who we are
There’s more than what we could be

And I certainly felt like I needed:

Give me Your Love – Club Electric

Give me your love, I need it
Give me your heart, I need it

For a dig into the past you can find the previous submissions and posts:


Ordinary Love – U2


Probably like many people I feel like I’m in the Line of Fire [Junip]…”What you choose to believe in, Takes you as you fall, No one else around you, No one to understand you, No one to hear your calls”. In fact “This world at times will blind you, Still I know I’ll see you there” – Come a Little Closer [Cage the Elephant] but “I found my nirvana in a friend of mine” with the edgy “H” [Lawrence Rothman]. But ultimately “the world I love, the tears I drop, To be part of the wave Can’t Stop” [Red Hot Chili Peppers] and I end up with Ordinary Love – U2

The sea throws rock together / But time leaves us polished stones / We can’t fall any further / If we can’t feel ordinary love


Shine – Camouflage

After many potential choices ranging from the deep and dark Wadruna by Helvegen through “America” by Young the Giant that celebrates the immigration to the uplifting dance song that captured what seemed to transpire for the year was “Don’t Stop the Madness” by DJ Hush and featuring Fatman Scoop (what an awesome name) I settled on Shine. That captured the spirit of what I need this year:

This is the world where we have to live / there’s so much that we have to give / so try to Shine Shine Shine within your mind / Shine from the Inside / if you Shine Shine Shine within your mind.


Heroes – David Bowie

Because I love that track and was sad to see David Bowie leave this universe. But also: We need to be heroes for Healthcare and I hope Healthcare Technology can beat the madness of our system and Ch-ch-ch-ch-change the world:

A million dead-end streets / And every time I thought I’d got it made / It seemed the taste was not so sweet…… / We can be Heroes, just for one day / We can beat them, for ever and ever …

ICYMI – I blended the lyrics from David Bowie’s Changes with Heroes”



Time – Pink Floyd

And then one day you find ten years have got behind you No one told you when to run, you missed the starting gun. Hanging on in quiet desperation is the English way…”


HIMSS 2019 Mix Tape was originally published on Dr Nick – The Incrementalist

Applying AI in Healthcare for Iterative Efficiencies

The Incrementalist Graphic Falgun Chokshi

Applying AI in Healthcare for Iterative Efficiencies

This week I am talking to Dr. Falgun Chokshi, MD (@FalgunChokshiMD), a Neuroradiologist and host of the podcast “Looking Around the Corner”. Falgun’s vision is to connect a healthcare innovation ecosystem that creates collaboration and focuses on a novel but importantly practical solutions.  He has experience in bioinformatics (machine learning/AI) and advanced technology assessment (AI/Blockchain).

Hear what this neuroradiologist thinks about the impact of Artificial Intelligence will be on radiology, imaging, and medicine in general – its more about supporting radiologists getting to the “gestalt” of information and insights vs replacing them with technology.

His incremental step in improving healthcare

“Iterative Efficiencies”

Listen in to find out about his experience with Intermittent Fasting and the positive impact it had for him on will power and consistency of purpose.

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


Listen along on HealthcareNowRadio or on SoundCloud

Applying AI in Healthcare for Iterative Efficiencies was originally published on Dr Nick – The Incrementalist

Stemming the Tide

The Opioid Epidemic

Drug Overdoses and Prescription Misuse
The Opioid Epidemic by the Numbers

130 people die from an overdose of an opioid every day in the United States. Death from overdoses reached a staggering 47,600 people in the United States in 2017 – to put that into perspective that’s a 130 people per day, or 1 person every 11 mins, and now in the top 10 causes of death in the United States. The problem has been getting worse with an increase in preventable opioid deaths of 26% in 2016 which is only overshadowed by the 544% increase we have seen since 1999.

The background and causes to the problem are varied but in many cases, the start of addiction begins with medically prescribed medication and far too frequently end tragically with death from overdose. With the rising incidence, the epidemic is having a wide impact with barely anyone left untouched.

Opioid Epidemic
Jim Kopetsky and his Parents

For some struck by tragedy, such as Ed Kopetsky, the CIO for Stanford Children’s Health, Lucile Salter Packard’s Children’s Hospital, they have turned devastation into a drive to action. Ed sadly lost his son, Jim, to an overdose following a history of exposure to opioids that dated back to high school. Take a look at the video of two of the stories from CHIME members here.

“If we can save just one more person from that addict path by speaking up and using our voices and using the power of CHIME and the power of the people all united to try to change, I think we will make a difference”

Together with his colleagues and friends from CHIME they formed the CHIME Opioid Task Force. Their mission is to harness the unique insights and assets of their healthcare leaders and institutions to make a real difference to address the crisis. They are united in their goal of combatting the increasing addiction and growing mortality of the Opioid Crisis by raising awareness, publicizing leading healthcare practices, providing data for medical research, policy advocacy and leveraging our leadership talent in unique and powerful ways.

NTT DATA Give Back

NTT DATA has a long history of giving back to worthy causes and this year at HIMSS19 as joined forces with The CHIME Opioid Task Force, DisposeRx (who offers a unique and safe method for disposal of unused or expired medications) and Luster Mosaics to create a mosaics picture from individual user-contributed pictures posted on Twitter and Instagram.

For every post using the hashtag #NTTDWhyICare NTT DATA is donating $5 (up to 15,000) to the CHIME Opioid Task Force and will use the pictures to create a unique mosaic image live on the show floor. To get involved, simply snap a shot, post it to Instagram or Twitter using #NTTDWhyICare with a statement about why you care.

You can click here to create a tweet with the correct hashtag

Or this link:

Join in at HIMSS 2019

Stop by booth #3301 at HIMSS19 in Orlando to see the mosaic as it gets put together and see if you can find your picture. While you are there, pick up a DisposeRx packet and see how easy and effective it is to safely dispose of any medication in your home.

Come join us for a reception on Wednesday, February 13 at 5:00 pm EST at the NTT DATA HIMSS19 booth #3301 as NTT DATA and DisposeRx present a check and reveal the completed hashtag-driven social media mosaic art to the CHIME Opioid Task Force.

If you’d like to donate directly to the CHIME Opioid Task Force, you can do so here


Stemming the Tide was originally published on Dr Nick – The Incrementalist

Saving Healthcare Quality

Saving Healthcare Quality

The Incrementalist Graphic Fred Trotter

This week I am talking to Fred Trotter (@fredtrotter), CTO CareSet Systems – the first commercial Medicare Data company. Fred has a long and fascinating background that unlike many healthcare Cybersecurity experts started in the security field and transitioned to healthcare and healthcare data. You can read his musings on Hacking Healthcare here.

We talked about Fred’s coordination of the Save the Agency for Healthcare Research and Quality (AHRQ) data project that took off online using twitter and other social channels as an unofficial mechanism. The AHRQ and the National Guideline Clearinghouse (NGC) was expected to be taken offline earlier this year as part of budget cuts and there was a significant concern that the 1,500+ clinical guideline summaries currently available would disappear forever. Some of us might think its a simple thing to copy content thus preserving the material but as Fred explains it was not that simple


In fact he contributes to the Internet Archive project (aka the Way back Machine) on a regular basis as one fo the important community projects that is workmen to preserve the digital history fo the web. Listen in to find out why the internet archive copy that was stored on this site was not enough and how Fred and the others used the insights and data from the Archive site to improve their data capture and storage. You can access the data on Guidelines here and the Quality Measures here – all sourced from this GitHub Project

We also talk about his history and involvement in the Health Care Industry Cybersecurity Task Force that was convened under President Obama’s administration by the DHS in March 2016. They issued their report to congress June 2017:  Report on Improving Cybersecurity in the Health Care Industry. Listen in to hear about the experience of bringing this diverse group together as they attempted to predict future attacks (Hint – many of the things they predicted came true that same year!)

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.

Listen along on HealthcareNowRadio or on SoundCloud

Saving Healthcare Quality was originally published on Dr Nick – The Incrementalist


Keys to Successful Conferences

How do you describe the CNS Summit and what it offers – the word impossible springs to mind. Even the name can be a little misleading especially for medical folks who might look at that and think “Central Nervous System” but actually its stands for Collaborating for Novel Solutions

CNS Summit Collaborating for Novel Solutions

This coming year will be the 10th year of the event and it continues to get better – testing new ideas and concepts for conferences to make the event valuable on multiple levels. The history and experience reminds me a lot of friendships and how they develop – the first interaction can be awkward and uncertain but intuitively you get a sense that the person you are talking to is someone who will be a friend pretty quickly (science suggests it is not minutes or seconds but a 1/10th of a second). Over time the relationship deepens and you learn more, and understand more, and how much you enjoy working with, learning from, sharing and sometimes just hanging out. So it is with the CNS Summit or more frequently know as “Summit”.

Photography Techniques from Experts

Where else can you come to a conference and get clever new ideas and techniques on how to use your mobile phone camera in interesting and creative ways from the incredibly talented and inspiration photographer Asa Mathat (recommend instagram @AsaMathat to get a sense of his incredible lens on the world and people). He is a renowned Photographer to the stars, creator of the big pink ribbon and at Summit – photographer for attendees as well!).

(Hint – Don’t think in traditional planes of movement and use your volume buttons as triggers and when you reach the end of your panorama, just reverse direction to switch it off).

CNSSummit Asa Mathat Photo Booth
Asa Mathat Photo Booth at Summit

Areas Covered

It hard to categorize the conference into a bucket – it benefits from being not too big so as not to overwhelm but large enough to attract an impressive diversity of participants and speakers. The mix includes leaders from the Pharmaceutical Industry, digital health, medical and device companies and technology companies.

Insights continued from cancer survivors who parlayed their personal experiences to focus on taming the data mountain in healthcare and science, the pharmaceutical executive who nearly died from a side effect of a drug that had a life changing effect on the personal trajectory that allowed for a rethinking the model of industrial production of pharmaceuticals.

CNSSummit WoodyWhisky
Woody’s Whisky Tasting Selection

Of course for this Whisky Librarian, there is even a special highlight put on by Woody Woodaman – the whisky tasting that raises money for a fund set up in his wife’s name Betty Jean Memorial Scholarship Fund to support nurse training. The conference floor is always offers new concepts and technologies – everything from taste experiences to the highly popular hugging booth set up by friend and colleague Andrew Chacko.

Each year is an eye opening experience full of surprises that Amir Kalali the conference Chief Curator keeps close to his chest like a proud parent who know’s he’s picked the best birthday gift for their child and can’t wait to reveal it.

This year there were many mind blowing presentations – for me “Breaking the Logjam in Medical Imaging” by Mary Lou Jepsen from Openwater that pushed the boundaries of wearables by offering a path to an MRI wearable. Sounds far fetched – not if you approach the problem with a different lens and understand that our photo sensor chips have reached a sensitivity of a micron – the wavelength of infrared. Combine this with the fact that our bodies are translucent to red and near infrared light – but red light scatters but this is not random, it is deterministic and reversible if you can record a hologram of it. So with some clever use of relatively old technology that allowed us to move from overhead foils

CNSSummit OverheadFoils
Remember these Devices?

to LCD projectors we are all accustomed to. This now allows the generation of ultrasound waves from small devices and using the change in phase of the light as it passes through the red light (you all know the doppler shift experiment you learnt in physics at school) they are now able to find vasculature at higher resolution than MRI and fMRI and even have additional capabilities to differentiate between oxygenated and non-oxygenated blood as achieved with the fMRI

Absorption of Hemoglobin for fMRI
Mapping Oxygenation of Blood in Real-time

But the resolution is now down to a few microns which is at the size of neurons, meaning they have the ability to see into our bodies at the detail of our nervous system… real time!

Image Resolution of Neurons
Neuron level granularity of Imaging

Combined with the early science that shows we can reconstruct what we are thinking and seeing based on analysis of our brain activity (Reconstructing visual experiences from brain activity evoked by natural movies, Nature – pdf). Most exciting the project is driven by a challenge to deliver a low cost, better imaging solution, to everyone, given that 2/3 of humanity lacks access to imaging.

Final Conference Day


The highlight for me was the last day – which according to my research and discussions with others, is just like every other conference poorly attended with many people missing the best elements.

It included two amazing presentations by the compassionate and gentle Daniel Friedland (Leading Well from Within), the wonderful, funny and insightful Chris Hadnagy (Social Hacker and previous guest on my radio show) and Stephanie Paul’s fun and eye opening Improv experience and included Asa Mathat participating and recording the activities with his unique eye. This picture captures the fun and learning we had as we learnt and connected

CNSSummit LastDayFun

So my Incremental step for you is set aside Oct 31 – Nov 3, 2019 for Summit 2109 (It is the 10th anniversary so I’m imagining Amir and the guiding council is thinking hard about making this event super special) and you to will have the learning opportunity and fun as you find a new friend in CNS Summit

CNSSummit AsaMathatandNick

And one more Incremental step – if you are taking the time to go to a conference, don’t head out before it finishes but rather plan to enjoy the last sessions where organizers often try to save the best till last.

Summit was originally published on Dr Nick – The Incrementalist

Consumer Rights Driven Data Access

The Bluebutton Innovator


The Incrementalist - Mark Scrimshire

This week I am talking to Mark Scrimshire (@eKiveMark) a fellow Walking Gallery member and Entrepreneur in Residence at NewWave and on assignment as Medicare Blue Button 2.0 Innovator at CMS where he is designing and implementing the new API to enable 53 million Medicare Beneficiaries to share their claims information with the applications, services and research programs they choose to trust.

His work extends back to 2010 when the initial concept of the Blue Button was conceptualized but it took several years before this started to really take off with the concept of View, Download and Transmit. One of the key Incremental Steps to get this interoperability rolled out centered on changing the positioning of HIPAA from a barrier to sharing and portability to an enabler. Ironic when you consider that it stands for “Health Insurance Portability and Accountability Act”! Listen in to find out the details behind the change and a key incremental step to progress – changing the messaging

Part of this changed messaging centers on the Office of Civil Rights (OCR) and the clear guidance to direct consumers to have the right to access their data in electronic format. As promised in the broadcast here is the Rights to Access Memo they issued in September 2015 and something I carry with me to all my medical appointments.

He shares his view on how to move toward interoperability and his incremental step connected with the Fast Healthcare Interoperability Resources (FHIR, pronounced “Fire”) set of Resources and removing complexity and simplifying the approach the is a recurring theme for Incremental Improvements.

Don’t let perfection stand in the way of progress

You can read more about the project in the FHIR Wiki he mentioned here. Listen in to hear Mark talk about the new project and how he is turning the oxymoron of Explanation of Benefits (EOB) which fails to provide insights to the people it is directed at and how the DaVinci project. The move from the old model of Fee for Service (FFS) to paying for outcomes is also driving a whole shift in data accessibility and utility and willingness to share which is exciting for our the consumer rights driven access movement.

Their Incremental steps to improvement include the huddle but listen in to hear what other incremental steps you may be missing that has added significantly to their team-based approach, coordination and success

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.

Listen along on HealthcareNowRadio or on SoundCloud

Consumer Rights Driven Data Access was originally published on Dr Nick – The Incrementalist

Digging in to Your Social Media Feed

Social Security
Digging into your Social Media Data

It was with interest I read a recent Viewpoint article in the Journal of American Medical Associations (JAMA) titled: Social Determinants of Health (SDoH) in the Digital Age, Determining the Source Code for Nurture authored by Dr. Freddy Abnousi, the head of healthcare research at Facebook, along with a couple of other authors, Dr. John Rumsfeld, Chief Innovation Officer at the American College of Cardiology (@DrJRums) and Dr. Harlan Krumholz, Professor of Medicine at Yale (@hmkyale)

They rightly point out the major contribution of social determinants of health – a fact highlighted as far back as to 1946 and the World Health Organization (WHO), but the research has been hampered by the inability to capture accurate granular data which is mostly self-reported (with the associated unreliability). We do need better approaches and the social networks offer a tantalizing look into data of this nature with a peek into online behavior, data that is posted by the millions of users who engage daily online.

They offer an intriguing potential to pre-identify suicidal ideation, “with enough advance warning and accuracy to stage a peer-driven intervention“. The opportunity to identify high risk for opioid addiction or finding those at highest risk of cardiovascular mortality and engaging with the users corresponding social network who would be “tasked with responsibilities”.

There is much to applaud in the concept but it raises some serious and challenging issues in my mind

1) Informed Consent is a major challenge and history and recent revelations do not engender any confidence that this data or insights would not be used against the patients or their families

2) De-Identification of data is already problematic – when you consider Intensity Analytics ability to identify individuals and behavior simply from their interaction with a keyboard

3) Trust is broken across so many areas and the current system is working as designed – a business. It is highly unlikely that users would ever *knowingly* give their consent

4) Healthcare consumers in the United States are struggling while the business of healthcare continues its march towards profit. Intuitively any insights from an SDoH program would have to focus on the best economic solutions which are mostly non-healthcare solutions (food, housing, income, education)

We need insights and data to provide the data to support and effect change and this idea has merit – but without some real changes to the business of healthcare, it will struggle to take off or deliver value to our population. I’d suggest a better incremental step would be to look at this data to show the underlying struggles of the users and creating a catalyst for change


Digging in to Your Social Media Feed was originally published on Dr Nick – The Incrementalist