Awesome Blab About #HCLDR Tweetchat Last Night! Great Insights For The Future

There was a wonderful discussion on blab last night after the HCLDR tweetchat (here’s Colin’s tee-up blog post about the HCLDR community and giving thanks) about how Blab and tweetchats can work together for the benefit of both. I was present at the beginning, but excused myself when my wife arrived from business trip. Much of the discussion is consistent with my pre-#HCLDR tweet chat blog post. I even drew a diagram of how Blab and a tweetchat might fit together, workflow-wise. :)

I listened to the blab twice. Once through and then a second time to transcribe and paraphrase those portions of the blab that were about how Blab and tweet chats might be combined. The following is NOT a word for word transcription (though bits and pieces occasionally may be). It’s a mashup of transcription, paraphrases, syntheses, and occasionally interjections (signified by brackets starting with CW as in [CW: ....]) I encourage you to watch the original. The material below reflects conversation starting about 12 minutes into the Blab.

By the way, I regard this as a seminal discussion. While I’ve seen about a half a dozen blabs so far in which these topics are explored, this is by far the most serious continuous exploration of how to combine Blab and tweet chats into single “thing”.

J: @Jimmie_Vanagon
P: @pfanderson
N: @Natrice
C: @Colin_Hung
CW: Me (@wareFLO, after the fact)

J (to C): Could Blab accentuate HCLDR tweetchats?

P: You’d need multiple moderators. Need best practices for viewers too. I like Twitter in foreground while listening to audio in background and then selectively respond. Others may prefer visual, but then they can’t tweet.

C: It is hard to blab and tweet at same time (when I participated in a previous Blab with Jim and Chuck during a previous HCLDR tweetchat)

N (to C): You did it with aplomb!

C: Dennis [over in the right hand audience activity stream] has interesting suggestion, how about adding T5 over a Blab? Kind of what we’ve been doing with Jimmie and Chuck, recapping the previous tweetchat. Blab allows for more reflection, exploration deeper into the topic. Certainly something we can investigate.

P: During Google Hangouts, tweets occur reactively to what is being discussed in the hangout. The Hangouts moderator is scanning the tweets and bringing them to the attention of the speakers. The guest speakers could then react to the posed Twitter chat questions. One can also ask viewers to live tweet some of the video. (I’m down to 3 percent: Bye!)

C: Blab could be a great way to organize a virtual conference

[CW: Thank Colin for mentioning The First Annual Blab & Periscope Healthcare Online Conference!].

The panel on screen could draw question and comments in from Twitter and other social platforms

[CW: interesting! Which other social platforms could work with Blab: Instagram? Pinterest? Co-host could hold tablet displaying image or video up the screen to get blabbers and tweetchat participant reactions]

[Blab and tweetchat together] might work. You’ve got live tweeting, tweeting snippets from the blab into the tweetchat, where the audience is larger. I could definitely see that work, especially when you have guests. You could have a more intimate discussion with them on the blab and that could generate a lot of tweets.

Patricia had a good idea about the host drawing questions in from the tweetchat.

J: Comparing blab to tweet chats, you may not have as many folks participate in the blab, but folks can watch the recorded video.

[CW: And I do! For example, I not only watched this Blab twice, I transcribed it and wrote this blog post. Frankly, I never read tweetchat transcripts after the fact.]

N: Recorded video can be shared afterward as well.

J: I realize you can storify a tweetchat, and create transcripts and so forth…

C: Blab and Twitter very different. Blab more like TV, like Meet the Press. I could become something. [cites example of Jim's recent blab (number one in live viewers on Blab during that time slot) on Direct Primary Care]. Plus Dr. Nick brought up possibility of patient panels on Blab… that would be incredible.

[CW: as long as privacy issues are handled well, which was discussed at length during the blab in which Colin and Dr. Nick participated]

N: It really is powerful to see the faces (on Blab). Another thing, it advertises the tweetchat you just had. It might bring folks on blab to the tweetchat. Lots of people don’t understand how great Twitter is. Blab could help.

Also, sometimes things can seem offensive on Twitter. But on Blab you see the people and you hear their voice and you think, “Oh, he/she is not so bad after all!”

J: Good point. Maybe we can get people together from different social media, and they could connect and find commonalities they don’t even realize until they meet on Blab.

C: I get to go to a lot of conferences and meet tweeps face-to-face, but most don’t get to do that, so Blab is the next best thing.

[CW: I go to quite a few conferences too, and I actually go farther. I find Blab superior to meeting at conferences face-to-face in some ways. Blab discussions are longer, more on point, and vetted (by viewers) in ways that IRL (In Real Life) scarcely approaches.]

So you’re right Natrice. When you meet face to face, when you see their tweets, you can hear their voice.

N: I’ve met so many wonderful people through social media and I admire Colin because he seems quiet and shy, but once he gets going he’s rocking the beat too.

C: I get asked what’s the difference between Blab and Google Hangouts. Blab is more intimate because limited to four people on the screen at one time. Blab is like a panel while Google Hangouts is like a conference call. Hangouts seem much more formal.

[CW: Personally, I find Blab to be like a cocktail party, you join a small group, topics pivot and then pivot again, and folks overhear and interject and join and then leave.]

C: Again, I get to go to a lot of conferences and meet tweeps face-to-face and here on blab I get that same feeling, for example, even though I’ve not met you Jim, I feel like I know you.

To me it’s a preference for medium. Some people like Instagram or Pinterest… just not me…

Blab feels like Twitter in its early days.

N: As a world, we need to draw together. The things that are happening in the world are really scary. The more we pull together…. its important, really important.

J: [Interesting discussion of how Jim was shooting a periscope of some Montana scenery. This was just after the recent Paris tragedy, and J. just wanted to put it out of his mind, but she wanted to talk about it. Which they did. And both benefited. From just a Periscope of some pretty scenery.]

I like Blab a bit more than Periscope because I can schedule Blab and tweet it out several times before hand.

However, tonight’s blab was completely spontaneous. We weren’t even going to do it, because Chuck’s wife would have been walking in his door when it started. But then Patricia expressed interest. In fact I think both Chuck and I started up blab at the same time!

[CW: LOL!]

J and N: Patricia seemed to like the blab by the end and she’d be great on blab.

C: Who will really like Blab are the podcasters. But unlike traditional podcasts, with blab you have the ability to have an open mike, so folks from the audience can participate.

N: Well, good night, it was a blast!

J: Thank you Natrice and Colin and everyone in the right for joining. And thank you for the tweetchat Colin, that was wonderful fun tonight.

[CW: Followed by more leave taking, funny thing about Blab, I've seen lots of Blabs that seemingly were about to end, multiple times, but then just keep going on and on! Cool!]

@wareFLO On Periscope!


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I Am Thankful For Innovation, Workflow, Blab, Periscope, and HCLDR: Happy Thanksgiving!

What a great set of questions, Colin!

I am reminded of a blog post I tweet every year on Thanksgiving Day. It starts with this paragraph.

I publish this on Thanksgiving Day and give thanks for our American tradition of innovation. It is a unique product of personality (forbearers and forerunners), platform (laws and traditions,) and opportunity (Thanksgiving’s Land of Plenty).

Now, on to your questions!

T1 From a healthcare perspective, what are you most thankful for this past year? (personal health or industry development)

While I’ve been involved in healthcare workflow and workflow technology for decades, it’s only been about five or six years that I’ve systematically blogged and tweeted about it. Five years ago I started searching the website of every HIMSS conference exhibitor, looking for workflow and workflow tech content. Initially I found very little (less than two percent of about 1200 websites). Every year the percent doubled. This was the first year that I found so much great content that I ran out of time. I was ecstatic! There is so much interesting conversation about workflow these days, from startups to thought leaders to even old-guard health IT companies.

I think workflow and, more important, workflow technologies, are beginning to explode on the health IT scene. Since I invested so much of myself trying to help make this happen, I am very thankful to see this groundswell.

T2 When you think about the #hcldr community, what are thankful for? What impact has #hcldr had on you personally/professionally?

Frankly, at the beginning of this year I wasn’t a member of the HCLDR tribe. Healthcare Leadership is about way more than health IT, so I focused on the HITSM community. But then something interesting happened. Substantive discussions of workflow began happening outside of the health IT community. In particular, the workflow topics I am so interesting in began intersecting with a wide variety of discussions about patient experience, from wellness to cancer care to home care, workflow ideas, sometimes called life-flows, sometimes customer journeys or experience maps. And so I began to see HCLDR as a potential natural home. That is what I am thankful for, an astute and collegial audience willing to talk about workflow, in all its manifestations and appellations.

T3 What other online formats or in-person events would you like to see from #hcldr?

Obviously, more use Blab and Periscope in and around HCLDR tweet chats. I think we got off to a rocky start, fellow Blitter and Pwitter addict @Jimmie_Vanagon. :) But I do believe that HCLDR can leverage these social video platforms in creative and useful ways.

In particular, I’d love HCLDR to take another (experimental) look at simulcasting the tweetchat and video. I’ve Blabbed and Periscoped both during and after HCLDR. But more important, I’m seeing more and more tweetchat folks on blabs and the topic invariably comes up: Wouldn’t it be cool if we could have the best of a tweetchat and the best of a Blab (or Periscope) and the same time! I really to think that (A) there are a small of best practices that could make this works, and (B) BOTH the tweetchat and Blab could benefit.

T4 In the next year what would you like to see #hcldr start doing/stop doing?

See T3! :)

@wareFLO On Periscope!


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My Free 12/3 Webinar: Wellbeing Through Workflow: How Structured Messaging Contributes to Better Patient Experience

At the very beginning of my three-decade love affair with healthcare workflow and workflow technology (hard to believe its been that long!) I studied “structured messaging” systems. They were academic research projects, not commercial healthcare products. In healthcare today, when someone hears “structured,” folks usually think of structured data, not structured workflow. Structured messaging is as much about structured workflow as it is structured data. And the usual word you hear before “messaging” is “secure,” for obvious reasons. However, recently, I’m hearing “structured messaging” more-and-more frequently.

So I was delighted when @TelmedIQ asked if I’d present a free online webinar about workflow, patient experience, and structured messaging, on Thursday, December 3rd, at 1PM EST. Here is the registration link and below are some of the details of what I will talk about.

By the way, right after the webinar, at 2PM EST, I’m hosting an informal Blab (kinda like Google Hangouts, but waay more fun! Here’s a bit of info about Blab, plus the related social video service Periscope). Please come to either or both. If you’ve not tried Blab yet, just go to this link to create an account automatically from your Twitter account, and then subscribe (so it will remind you when it starts).

Wellbeing Through Workflow:
How Structured Messaging Contributes to Better Patient Experience

Delivering an exceptional patient experience in modern healthcare environments is more critical than ever, and the number of opportunities to deliver it has increased exponentially. Modern patient experience extends far beyond traditional bedside manner, and now encompasses the sum of all interactions that influence patient perceptions across the continuum of care.

Specifically, I’ll cover:

  • The direct and indirect impact of healthcare workflow on patient experience
  • The systems, technology, and processes healthcare organizations can utilize to improve workflow
  • How structured messaging and healthcare communications platforms facilitate better patient care

One more thing! I’m so interested in workflow, I even make workflow art! This blog post begins with my artistic interpretation of workflow. Workflow is a series of steps, consuming resources, achieving a goal. The spheres are workflow tasks and activities, arranged as ascending steps, ascending toward a goal. The steps do not proceed in straight line, since real world workflows are sinewy and serpentine, figuratively speaking. The steps overlap, just as tasks and activities often do. Each step is supported by resources, namely the supporting columns.

After the webinar and blab, I will add the name or Twitter handle of whoever tweets most about the webinar or blab, and print and send them their prize. The hashtag? #POWHIT (click it, it’s really a hashtag!), which stands for People and Organizations fixing Workflow with Health Information Technology.

@wareFLO On Periscope!


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Blab’s Extraordinary Potential For Healthcare & Upcoming Blabs

At 2PM EST today, @jimmie_vanagon is blabbing with @PopHealthChick (and whoever else shows up) about Direct Primary Care. From 12PM Noon EST to 1PM EST is the weekly #HITsm tweetchat (about Personal Health Records). So I thought I’d schedule a Blab from 1PM to 2PM. Here is that link: After #HITsm: Blab’s Extraordinary Potential 4 Healthcare, Plus Upcoming Blabs! If you’ve not tried blab, just click it and you’ll use you Twitter account to register. Subscribe for reminders, or just show up! Showing up means following the link at 1PM (and 2PM) in a Blab compatible browser. Folks seem to have the best luck with Chrome. Safari does not. Supposedly Firefox does (but I’ve had no luck).

Jim (”Johnny”) Legan’s blab is about alternatives to traditional insurance in providing primary care. I’ll be there, sort of “Ed McMahon” to Jim’s “Johnny Carson.” My blab just before his is about anything anyone shows up wants it to be about. I do hope it has something to to with healthcare or information technology or, ideally, both. But hey, I’m flexible. In fact, the most frequent topic of conversation on Blab seems to be about Blab itself: its potential in healthcare, its idiosyncrasies and workarounds, and just sort of friendly joking around.

By the way, there are interesting workflow angles to direct primary care.

“The DPC model demands software that is very different from traditional EHRs…. practice patterns are continuing to evolve particularly as new technologies open up care models that weren’t possible before. Consequently, the ability to easily modify workflow, templates, etc is vital.” (Direct Primary Care: Technology Trends Supporting DPC and Requirements)

And there are also interesting connections among direct primary care, personal health records (subject of the HITsm tweetchat), and patient portals. PHRs and portals are not the same, but are often confused (). I think there are some interesting patient and physician workflow issues here as well.

Regarding “Blab’s Incredible Potential For Healthcare,” I’ve been party to several fascinating discussions. The first thing many first-time blabbers remark about is, wow, wouldn’t Blab be great for including patients in discussions of their care with other members of the care team. And then just as immediately, wow, what about privacy issues! We’ve even had expert health IT lawyers give us their opinions without charging us a dime!

The second topic is a favorite of mine. It’s a very selfish topic. How can I use Blab, Periscope, Twitter, and blogging together to maximize my enjoyment, education, and networking with intelligent and fascinating people? Yes, it’s a selfish topic, but I think other’s are interested too. There’s a lot of interesting ideas and trial balloons being floated about in this regard…

For examples of lots of other uses of Blab and Periscope in healthcare see several of my recent blog posts.

I’d like to mention several other scheduled blabs you may be interested in.

And of course my own “bridge” blab between the end of HITsm tweetchat and the beginning of @Jimmie_Vanagon’s blab about Direct Primary Care. If no one shows up, I’ll just let it run and get some work done. If you show up, we can hang out in the “Green Room” waiting for today’s Healthcare and Health IT (I’m sure it will come up!) main event at 2PM EST.

Maybe we’ll even talk about some of what I’ve written about in this blog post!

@wareFLO On Periscope!


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Patient Data Ownership Cannot Resolve Data Access Problems: But Workflow Technology Might

I had an interesting Twitter debate last week about whether patient ownership of patient data is the silver bullet so many seem to think. During that debate I Googled, “patient data ownership legal theory” (without the quotes). The top-ranked document was a law article in the Harvard Journal of Law & Technology titled Much Ado About Data Ownership (a reference to Shakespeare’s Much Ado About Nothing, so you can probably tell where this is going…).

The author has degrees in electrical engineering and law, plus a Ph.D. from Stanford, and directs the Center on Biotechnology & Law at University of Houston. The piece is interesting but heavy going (footnotes take up half the article!). I am not a lawyer (though I did take a three-credit undergraduate course in business law), so I’d love to get some comments from some lawyers in health IT on some of the following quotes.

“The urge to propertize health data needs to be weighed skeptically and with a clear understanding of how property rights actually work. If pursued, data ownership may disappoint many of its proponents”

“Statements such as “[w]hoever owns patient data will determine whether its benefits can be tapped” overstate the importance of controlling one raw material input to a complex, multistage production process.”

(BTW, “complex, multistage production process”? That’s workflow. Efficient, effective, flexible, and transparent management of complex, multistage production processes is exactly what workflow technology does.)

“Creating property rights in data would produce a new scheme of entitlements that is substantively similar to what already exists, thus perpetuating the same frustrations”

“Data propertization proposals fail because patients’ raw health information is not in itself a valuable data resource, in the sense of being able to support useful, new applications. Creating useful data resources requires significant inputs of human and infrastructure services, and owning data is fruitless unless there is a way to acquire the necessary services”

“Simply owning data will not ensure an adequate supply of data resources without access to the necessary services. Proposals that fail to address these realities cannot resolve the data access problem.”

“raw health data are just one of many inputs for creating useful data resources”

“Data holders do not have unlimited personnel and data processing resources to respond to queries”

“The fact that the necessary services are costly and in finite supply has ramifications for system design”

(Workflow exists in an economic context, which is why I like my definition of workflow: “Workflow is a series of tasks, consuming resources, achieving goals.” Consuming resources? That’s cost. Achieving goals? Those are benefits. Different stakeholders obtain different benefits from different workflows (see next quote). When economic context changes, workflow usually needs to change. This is one of the major problems with much current health IT technology. Without actual models of work and workflow, to be interpreted, executed, and systematically improved, ability of IT systems to change when their environmental context changes, is severely limited.)

“the optimal infrastructure to supply data resources for one use may not be optimal for supplying other uses”

“Data propertization proposals assume that if encounter-level patient data were simply assigned to the right owner, the market would be able to figure out the right price to pay for useful data resources such as [Longitudinal Health Record (LHR) and Longitudinal Population Health Data (LPHD)], and this price would cover the cost of necessary infrastructure and services to create those resources. This is not a safe assumption”

“Why Data Propertization Proposals Fail

To summarize, encounter-level patient data are an input that can be transformed into high-valued data resources — LHRs and LPHD — for use in clinical care, research, and public health activities. Making these data resources also requires inputs of human and infrastructure services — that is, data provisioning services. In theory, it is possible to produce LHRs for use in clinical care under a patient-controlled system. Such a system would subject all transfers of encounter-level patient data to consensual ordering, which would require permission of the patients whose data are involved. There are major limitations to such a system, however. Because of consent bias, the system cannot supply unbiased LPHD for use in research and public health projects. Research and public health users thus cannot be counted on to cross-subsidize the costs of developing patient-controlled LHRs. Unless the costs of developing patient-controlled LHRs are justified by the value they create in clinical care, a patient-controlled system may not be financially viable.”

“Access to raw patient data is necessary, but not sufficient, to ensure an adequate supply of useful data resources. Data provisioning services also are required. The prospective provision of services is inherently consensual in our system of law. The state’s police and eminent domain powers only allow non-consensual transfers of property; there is no similar mechanism to compel non-consensual provision of services”

“data holders have only limited capacity to supply services and need discretion to refuse. Nonconsensual access to data is possible whether under a property regime or under the regulatory regime provided by the Common Rule and HIPAA Privacy Rule. Nonconsensual access to services is not possible under either regime. Access to infrastructure services, rather than the unresolved status of data ownership, is thus the key impediment to data availability.”

Much Ado About Data Ownership covers so much more ground than what I have focussed on above, especially regarding privacy, research, and public health concerns. I encourage you to read the entire piece.

Regarding how workflow technology can help, I refer you to several of my recent blog posts. The Workflow Prescription: Patients Need Zapier, Workflow, and IFTTT-like Control Over Self-Care Workflow Automation At Home argues patients want workflow, not data. And Give BPM A Chance: Medical Informatics Should Add Business Process Management To Its Toolkit argues medical informatics research should focus more on workflow technology, not just workflow.

@wareFLO On Periscope!


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