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People at a conferenceThe 19th Annual Genesys Partners Venture Dinner — Gen XIX– Tuesday night at the Union League Club in New York attracted nearly 100 venture capitalists, investors, journalists, entrepreneurs, and industry executives. As always, Jim Kollegger — CEO of Genesys Partners and one of the pioneers of the information industry — was an elegant master of ceremonies. He introduced the various sponsors, next day panelists for the SIIA Conference, several startup CEO’s, and a few of us who have been around the block a few times, each to make some comments. Following is a synopsis of what I had to say.
Like a broken record, I offered the normal upbeat view of the future of the Internet but prefaced my remarks by asserting that we are only 10% of the way there. In other words, of all the things that could be done on the Internet that would save us time and make our lives better, only 10% of them are there. It may sound low, but consider retail e-commerce. Although there has been continuous double-digit growth of retail e-commerce for seventeen years, it still represents just 5% of total retail (as of the end of October). I made a side reflection about the fact that while the total United States retail e-commerce for 2012 will come in at somewhere around $200 billion, one company — Amazon — amassed $57 billion in revenue for the year.  Why isn’t retail e-commerce 25% instead of 5%? Much is written about that here at patrickWeb but the short version is that there are still a lot of lame web sites. “Click here for the location of our nearest dealer where you can visit” or “call to buy the product you just found” or “Click here to download this form and fax it to us”.  How about healthcare? How is it fairing in terms of exploiting the Internet? Oh, if only it could be 5% of the way there!  Don’t you love the ubiquitous clipboards at doctor offices where we take a pen and provide a lot of information information that they already have.
I then offered my view of the status of the Internet and health care.  This is one man’s view of the evolution of the Internet including the seven characteristics I use every year.  The things going on under each characteristic continuously change and Jim asks me once a year to do a thumbnail sketch of my latest thinking.

Check markBroadband in the U.S. is not a pretty story compared to other parts of the world. We are second after China in number of broadband users, but 17th in the world in number of broadband users as a percentage of our population. The problem is that there are too many lobbyists and the FCC is a political organization. The new FCC head is a very smart guy with venture and business experience. He totally gets it. The only problem is that AT&T, Comcast, and Verizon have more lawyers than he does. Meanwhile France is offering 100 megabit access for $90 per month and WiFi throughout the country. Thanks to the telco lobby, many states have banned the offering of WiFi by municipal entities. Every citizen in Greenland has Internet access. We have 31,000 post offices.When it comes to healthcare, getting your laboratory results is anything but fast. Drawing your blood and getting it analyzed happens in hours, but getting the doctor to look at the results and communicated to you can take much longer. If you want the data about your blood, the doctor will tell you to call back the next day so a nurse can fax it to you. More streamlined methods are evolving. Microsoft’s Health Vault can be linked with Quest and as soon as the results are released by Qwest, you can have them on your iPhone immediately. E-prescribing is also advancing rapidly. Not only is it more accurate than the traditional scribble on a piece of paper, but the script is compared against other medications and known allergies thereby greatly reducing medication errors.
Check markWiFi is part of the fabric of the world. The big shift is streaming of data — not just tweets, but data from *things*. Bridges, toll booths, traffic lights, buildings, cars, and health monitoring devices attached to people. Hospital physicians may soon be adjusting the drip rate on infusion pumps in the hospital from their office based on real-time data from the patient. The WiFi infusion pumps enable hospital administrators to know where the pumps are (they never have enough of them) and which ones need maintenance. The creation of data is staggering. Of all the data in the world, 90% of it was created in the last two years. YouTube receives 60 hours of new video every hour. Wikipedia has 4 million articles and 8,000 editors. In healthcare, always on means better care for patients with chronic illness. Consumer electronics is showing the way with devices such as the Fitbit. I mentioned that my doctoral dissertation research is using technology from CardioNet that can monitor irregularities in the heartbeat and potentially provide an intervention by a cardiologist leading to reduced hospital readmissions. This is the tip of the iceberg – home healthcare telemonitoring may grow ten-fold over the next few years.
Check markThere are one billion computers (including tablets), one billion cars, 1.5 billion televisions, and 2 billion Internet users. Small numbers compared to cell phones — 5.2 billion paid subscribers. The Internet used to be where your PC is, now it is where you are.  Most of the cell phones are dumb but soon most of them will be smart and they will all have Internet access. The mobile web is unfolding and is taking part in creating data in addition to consuming it through streaming. When you take a picture on your iPhone, it goes into the photostream and from there to iCloud and from there to all of your other devices.   in healthcare, the inclusion of mobile devices for diagnosis is essential if we want to extend preventive preventive and diagnostic healthcare to the entire population on an affordable basis.  The iPad has been approved for use by radiologists. Many more mobile device apps will be approved for diagnostic purposes.
Check markSocial networking has become fundamental to all aspects of our economy and society. Integration of social networking with a full range of web applications will evolve to become the primary means of collaboration. The emerging issue is that many people are a bit liberal with sharing their every movement — what they are eating, listening to, where they are headed, their current latitude and longitude, and where they slept last night. They are not thinking that some day they may run for office or interview for a job. OpenSocial is an important new standard that will enable social media apps that work across all of the social media sites. The Europeans may legislate it, but regardless, a capability is needed to be able to remove things from the social media.  Facebook will have a role in healthcare, but more important sites may be  vertical and specific sites such as patientslikeme.com.  Further empowering consumers are sites like zocdoc.com that allow you to make doctor appointments in a simple and useful way.
Check markThe Semantic Web is the next big turn of the crank but the crank is moving slowly. Most web pages have links but do not have context. In other words the words on the page do not necessarily mean anything — but they could. If a web page said “Join us for a concert by The Eagles at Kimmel Center in Philadelphia next Tuesday” that set of words could have a lot of context. Clicking on it could add the concert to your calendar, knowing what “next Tuesday” means. It would also know exactly where the Kimmel Center is and that The Eagles is a performing group that performs a particular genre and your music player would receive a list of suggestions of music they have recorded or links to live concerts under way at the moment. This is the tip of the iceberg. The semantic web will lead us to a point where most of the interactions of web pages will be between computers not between computers and people. The biggest growth of intelligence is occurring in the field of analytics. Exabytes of data are being stored. Analytics will enable businesses to make sense of it, model their business and continuously adapt to what is going on. IBM’s Watson took on humans on the Jeopardy Show, but what is more interesting is the ability for a primary care physician to call and get a recommendation based on patient data they describe to Watson. Within a couple of seconds Watson will be able to review all medical information in the world and make a useful suggestion. Business Intelligence and analytics are poised to enable new insight into the mounds of big data that are being accumulated.
Check markTechnology isn’t the easiest thing at times. There are many dimensions to “easy” but one good example is the Nintendo Wii. At a local senior center, members find the Wii to be their exercise coach. It is not just for kids! The iPhone and iPad have shown how easy it can be to get applications on a handheld computer. Amazon has done the same with the Kindle. Most companies still don’t get the idea that the Internet is about power to the people. If you can’t make it simple, people won’t buy it. Cloud computing has become the mainstay for me and for millions. The convenience and reliability of the cloud is compelling. Add Dropbox and you have a completely replicated set of data, wherever you are and with whatever device you may be using. How about TV? Three remotes — BlueRay, Cable box, and TV — include 151 buttons. Even a savvy child could not possibly master this impossible user interface. Boxee TV has produced a good model of the future of TV, but I suspect that an upcoming Apple TV will be what finally provides the needed regime change. An Apple TV remote has three buttons.
Check markThis is the big one. Will we trust the Internet? Security technology is available to achieve much higher levels of security than presently deployed both at enterprise and consumer levels. It is a constant battle and requires significant budgets and a lot of talented people to maintain the needed security. The bigger issue will be privacy. (Stay tuned for the Firefox “do not track” feature). Banks have our personal information and they are using it. Healthcare insurers have more information about our health than our doctors do. Nevertheless, there is much to be optimistic about when it comes to electronic medical records. Perhaps 25% of doctors and hospitals use them but they are not easily interchangeable and accessible. This will change over the next few years as the government adds dollar incentives to make it happen. The result will be better quality of care, better outcomes, and fewer errors. And, fewer clipboards. We can trust the Internet and healthcare, but only if we get involved in our care and take an active role.  Mistakes get made, so everything so patients should question every step across the continuum of care.

The sound clip below is from a radio interview on WNZF in Palm Coast, Florida on January 11 with station general manager David Ayers. It was a prelude to a talk at the Community Open Forum educational series at Florida Hospital Flagler the following week. The event was hosted by Bill Tol, development officer for the hospital foundation. You will be able to tell from the twelve-minute interview that Mr. Ayers is quite healthcare-savvy with his comments and questions.

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John Patrick with David Ayers on WNZF talking about healthcare

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