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Healthcare's digital divide: consumers vs providers

Last week, I wrote about embracing niche use cases, or what is known as the long tail. I referenced a William Gibson quote: The future is here…it’s just not evenly distributed.  If we are defining the future as processess, ideas, or technologies which sound far fetched to most, but in actuality exist in niche areas, then there is another way to consider their distribution. These processess, ideas or technologies can be widely accepted by some groups but still dismissed as "the future" by others. Consider mobile health technology.

According to the Pew American Life Project, nearly half of US adults have smart phones. Float Mobile Learning suggests there are 186 phones for every hospital bed in the US. They also suggest health apps is the 3rd fastest growing area on Apple's App Store. In 2011, South by South West, the popular interactive and music festival in Austin added a healthcare track. This year, the Health Track drew thousands, including big brand names like Qualcom, Cisco, and more.

But wait, there's more.

I created my own infographic... actually, it's part of a slide deck I use internally from which I've stripped the branding and strategy parts. Still, it shows how online and mobile health have tipped, and for consumers, are no longer niche areas.

See the trend here? If 80% of US Adults (including 56% of seniors) are going online for health information, can we really say the distribution is uneven?

The Digital Divide

There is a term, the digital divide which speaks to the rift between those with internet access and/or tech skills, and those without. Examples include the elderly and underserved communities, though there are certainly exceptions in those demographics.

There is another digital divide. When we consider the relatively wide adoption of online and mobile health ideas, processess and technologies, there is still a group for whom this is the's out of reach, or not part of the plan: provider organizations.

Here, the future is evenly distributed among the general population, but very sporadically adopted by providers.

I'm not pointing fingers. This isn't easy stuff. 80% of doctors may have smart phones, according to Float, but how many are also advanced programers and IT gurus? And should we expect them to be? Nor should we expect them to expend their precious margins - believe me, they aren't as high as pop culture would suggest - on developing a state-of-the-art application.

Nevertheless, I suggest there are ways for providers and health systems to start embracing the future:

  • Use what is already available - if you have an EMR with a patient portal, then encourage patients to upload data from health apps. Likely, it will start as CSV attachments which will not immediately be discrete data. Nevertheless, it is engaging for patients, helpful to providers and forward thinking.
  • Share your expertise online - 80% of US adults want health information online, be part of filling the vacuum. When I give talks to clinical folks this is the point I stress the most. There is a powerful difference between hearing your local doctor's reaction to a new study and reading a national, disembodied by line on a national news site. Be the local expert!
  • Partner - if the idea of building your own app, accepting patient data, or starting a youtube channel is daunting, find someone who can help. This is part of a consumer's decision making process, how savvy, available and with it is my doc or health system? Would you fly an airline that didn't let you book online or bank with a bank that didn't have online banking?
  • Embrace cost reduction - If you are a primary care provider, do you really want to ask people to wait in your waiting room for 40 minutes to see you for 10 to get a refill on allergy meds? Building a process for reimbursable eVisits isn't nearly as hard as it sounds. Patients want them. We can FaceTime or Skype around the world, but not our doctors? How's that for uneven distribution?
  • Self-scheduling - finally, in the no-brainer category, nearly all airline tickets are booked online. OpenTable dominates dinner reservations via the web and mobile app. Why does it take a 10 minute call to get a doctor's appointment at a horrible time on a day that doesn't work for me?
One thing is clear, if we consider the uneven distribution of mHealth in terms of consumer vs provider, the idea is already mainstream for a huge segment of the market. With prospects like that, it doesn't take much to find gold. Embracing online tools and mHealth is going to be a major differentiator for providers and health systems who get on the band wagon early.

Mobile Medicine & Mobile Health Care: Float Mobile Learning.


Vail's EpicMix, an innovative model for healthcare data

I'm not a huge fan of what I call blatant marketing. You know it when you see it, particularly with interactive campaigns online. You want me to do what? Like this page, give you my home address, and retweet your link for a chance to win an iPad? No thanks. I avoid frequent shopper cards at the grocery store for the same reason. When Vail Resorts launched Epic Mix last year, I was skeptical. Vail wants to track every move you make, literally, on their mountains. Vail installed RF chip readers in every lift line and started putting RFID chips in their lift tickets. You go through a line, and they know it. They also know your age, gender, address, family members and travel dates. With the tracking and demographic data, they have a pretty good idea about your habits at their resorts. You can even tie your credit card to your ticket for on-mountain purchases. I imagine the database thinking something like this (you know, if databases could think):

The Jones family starts skiing at 10am most days. Not surprising since they are from the East coast and have the time change. The kids are both in ski school today ... cha-ching! Oh look, mom and dad just stopped for lunch at the high end restaurant and the kids are eating pizza at the casual on-mountain restaurant. Mom skis black diamonds mostly and is logging 2x as much vertical as dad. They seem to come out every year around the same two weeks. Judging from their address, I bet they make about $110,000 a year and take two major vacations. We should email them a month before, I'll make a note of it. I wonder if they'd want a time share....

Pretty spooky huh?

So what did Vail do to change the value proposition of their data capturing? They launched EpicMix, a customer facing portal into the data. You sign up and register the ID number from your lift ticket. From there, things get social very fast. There is a FourSquare like game component where you earn pins - just like the real pins you see on people's hats or jackets - for accomplishments. Ski 26,400 feet and you get the 5 Miler pin. Head into the Northwoods area and you get the Gone Wild pin. The service also tracks your runs and vertical feet per day and season and lets you compete against friends and family. There's even iPhone and Android apps to track your stats in real time. And, of course, it all connects to Facebook and Twitter.

This year, Vail gave professional third party photographers the boot. Now, Vail's own photogs hang out near huge EpicMix Photo placards around the mountain. Ski up, and they scan the RFID tag on your ticket and snap a few pics. That evening, the pictures are uploaded to your EpicMix account and can be shared on Facebook or Twitter for free.

Vail took customer tracking and turned it into a value added service. It's a draw, something Vail's resorts have which other ski areas don't have.

It will come as no surprise I see a healthcare analogue in all of this. Rather than capture data about customers and keep it to themselves, Vail turned it into a customer-facing service. Does your doctor treat your medical records the same way? Can you go online and look at them? Do you get rewarded, even virtually, for losing those 10 pounds or controlling your asthma? Can you chose to share parts of your record with family or friends?  Can you chart your A1C scores over time?

Even with the rise of patient access into electronic medical records,  we've still got a ways to go before we reach the same level of understanding about personal data. I continue to see consumer devices and services leading the trend, which tells me two things: 1) people do want to own, collect, monitor and selectively share aspects of their health and 2) the consumer oriented companies can do it for cheaper. The later is likely owed to less red tape, regulations, research, etc. To be fair, there are iPhone apps which will graph your weight. And there are iPhone apps which will track your skied vertical feet. But the value of that data changes when it's shared with your provider (not that it has to originate with them, mind you).

Any thoughts? Are you aware of any provider organizations who are going beyond MyChart (an example of a patient EMR portal) and offering value added analysis and services on top of YOUR health data? What kinds of things would you want to see, beyond direct, unfettered access to the record?

By the way, according to my EpicMix dashboard, in the last 12 months, I've skied 121,453 vertical feet at Vail resorts... not too shabby for busted knees!

Since I've basically given Vail a free ad, I might as well embed their EpicMix video, it explains the service pretty well:

Healthcare Marketing Insights discusses reimbursement

subtitled: and takes a few well deserved jabs a comment I made on a healthcare marketing site. Chris and the gang at Interval Marketing produced a great podcast this week.

Of the topics discussed, one that really resonates with me are some of the complications surrounding the reimbursement challenges of our third party payor system. For those of us who work in that part of the industry it can be easy to be lulled into forgetting how complicated the system is. Ask any patient who has been denied after seeing a doctor and they can remind you about the challenges.

The Interval crew also delved into a question posted on Health Leaders Media: "If You Could Tell the CEO One Thing About Marketing, What Would it Be?" My comment on that post was, "marketing is dead". As ambiguous and inflammatory as that comment sounds, the Interval team did a great job of interpreting my meaning. One of my favorite concepts is the idea of the "experience economy". The term comes right from the title of a book by Pine and  Glilmore. The essence is that we live in a time when ubiquitous connectivity and real time communication (IE social media) enable consumer to discuss products and experiences in real time. To put that in context, I do not need to see a billboard about a hospital in town, I can see what people are saying about that hospital right now online. Those experiences will have a much greater impact that marketing.

Chris makes an eloquent counter point about marketing. When applied as the "art and science  of [retaining and growing a customer base]" it is not far afield from the experience economy. I would argue that under that definition the onus (and effort) moves off of traditional marketing and is placed on operations, customer service and clinical outcomes. In that sense, the need for billboards and print ads becomes superfluous - marketing, at least in that sense, is dead.

I have had the recent pleasure of some deep conversations with a friend who knows a lot more about these concepts than I do. Without a doubt those who "get it" understand that the future of healthcare marketing is not about a bigger watermelon truck. Business development has to be strategic and tied to the proverbial bottom line. When service and the patient experience are approached with the same attention, the results are surprisingly affirmative in advancing that bottom line number.

Enough of my drivel, have a listen to Chris and the Interval team here on their site, or subscribe via iTunes

crowd source healthcare marketing

sanctification guaranteed or your trash back I will admit to some bias about true cost centers, particularly in healthcare organizations.  My “day job” is all about maximizing revenues. To many of my colleagues it would be anathema have a personal interest in what is traditionally called marketing and communications. “Do you have any idea what they spend on phone book ads?”. And its true, some of their spends are costs that may be well intentioned but have probably outlived their usefulness. So why not crowd source it? Why not let your patients and staff create the marketing materials - or at least some of them? It is a way to reward your most loyal fans, it has much lower costs and is about as interactive as it gets.

The typical experience goes like this:

Service line leader: “We need to brand this joint replacement program, we need a catch phrase...oh and pamphlets...and what about a website?”
Marketing leader: “Ok, we’ll use GraphixArts for the design, and BrandFirst for the wording, we probably need InWebX for the site... Lets budget about $10,000 to get started”

Maybe its a little different. Maybe its all done in house, or with one firm. Regardless, there is a lot of effort and expense involved. As I have written previously, most hospitals would be happy to have a 2% operating margin. 2%! So before you scoff at $10,000 being so low compared to hospital bills, think about what happens when each service line needs to incur $10,000 or more of expense. Its hard to eschew those kind of figures and how they effect the bottom line.

The solution is simple. Ask for help. Just asking your constituents to be your friend. Arn’t we supposed to be able to ask friends for help? Start simple. Lee Aase, the guru behind Mayo Clinic’s social media program, has turned to crowd sourcing to help pick a logo for his SMUG site. Lee maintained some editorial control by offering readers a limited number of choices on which to vote. The same model could be applied to branding a service line. Ask your read/write web friends to submit some rough samples of logos. Post them to a site like Flickr and then setup a Tweetpoll. Let your patients and staff and physicians vote on which sketches they like best. Once you have a direction, engage the artist to complete the job. I do not pretend to know the world of graphic arts, but my guess is that many of submissions  will come from part-timers or artists who are simply interested getting their name out there. In other words, they will be a lot less expensive than a big firm.

The same plan of attack can be used for all manor of creative work. Run a contest for the best web design. Let users submit designs, express some editorial control and narrow the list to the top 3-5 and let your constituents vote. Billboards, despite my feelings about their relevance, may be an even greater gold mine. What photographer would not jump at the chance to get a shot on a billboard? Start a Flickr pool for your healthcare organization and accept submissions for a billboard shot. Pair the best photo, with the best tag line from twitter submissions and presto, instant ad campaign. Just make sure to include credit to the artists too. As an amateur photographer, I would gladly give a shot away in exchange for seeing it in a large format in my town. I’m probably not alone.

Now, before the marketing and communications folks feel like crowd sourcing puts them out of a job remember this: someone has to make sure the messages are on track. Someone has to pitch the idea to your friends and fans. Someone has to then sell the crowd-sourced project back to organization. You have your work cut out for you. What you have in your back pocket is an army of friends via the read/write web on whom you can lean for favors. As long as you return the favor (crediting, using their work in a public forum, etc) then the cycle is endless.

What do you have to lose? Try it on a simple project - an internal flier. Give employees the chance to create some materials showcasing a wellness program. Let other employees vote on what you feel are the top three options. Flip video cameras are cheap. Windows Movie Maker is free (yep, I’d rather see everyone get an iMac on their desk, but the reality is what it is). Ask teams to create 30 second spots for their department. Gwinnett Medical Center in GA did just that. Share the best ones on your intranet and facebook and youtube and flickr and...well you get the point. These folks are already on your side and will forgive any imperfections in the process. Put that good will to use and you will be paid back in droves.

What can hospitals learn from Mr Rogers?

Won't you be my neighbor?  (Part 1) Mr. Rogers got it. Here was a man that kicked off every show by asking the audience to be his neighbor. He was literally genuflect when asking us all to be his friends (he was also clearly a fan of comfortable footwear). Fred Rogers may have understood social media and the importance of relationships in brand building long before any of us. And he also clearly understood that being humble and earning the friendship he asked for paid much greater dividends than telling his audience what to think. So why are healthcare organizations and physicians not doing the same thing?

In Social Pulse, I suggested that healthcare organizations might actually ask their patients, staff and physicians to be their friend. It sounds easy and perhaps even a tad juvenile (medicine is far too serious work for such pedestrian language). But without that invitation healthcare organizations will never gain the traction with social media that thought leaders are touting today.

Jumping into the world of social media is often a splash of cold water to the corporate face. Just because you build it does not mean they will come. As Steven Barley, head of internet services for Riverside Health System in Norfolk Virginia, states frankly: The reality is not everyone in your market is on FaceBook and even fewer still are on Twitter. So how can healthcare organizations encourage the conversation to take place online when only a fraction of their markets are online? Borrow a page from Mr. Rogers - and ask very simply "will you be our friend?"

Imagine a campaign that asks that very question, "Will you be our friend?" on billboards around town, on flyers in staff break rooms and in an email to physicians. Maybe its nebulas, "join the discussion at" which directs your new amis to the CEO's blog and the hospital's twitter account. It could also be more overt - "Generic Hospital is on FaceBook, look us up and tell us how we are doing". Does it mean taking off the jacket in favor of the cardigan (proverbially speaking)? Yeah, it does, it also means speaking to people they way conversations occur, not in the vernacular of a press release. It requires healthcare organizations to humble themselves; indeed the first step is admitting that you may not be as important in your constituents' lives as you think. But if your organization believes that you truly serve your community (including employees and physicians) then why not ask on bended knee - "will you be our friend?"

Fortunately it may not take getting your entire market online to be a success. A critical mass may be as little as 2-5% of a market (1,600-4,000 patients for an average 80,000 vist/year hospital). Malcom Gladwell, the author with a genius for making commonsense sound extraordinary, has written about the power of influencers in The Tipping Point. Gladwell tells us what marketers have known since the dawn of time: nothing beats word of mouth.  Most social media early adopters fit the mold for what Gladwell calls "connectors" and "mavens". The former are people who have a natural ability and pride in facilitating relationships. We all know them. They are the ones who answer anything with "oh, you should talk to my friend So-and-so about that, I'll arrange a lunch." The later, mavens, are our friends who always seem to know about the best meal in town, or which computer has the best bang for the buck. If you have spent any time 'crowd sourcing' on Twitter, then you have seen both personalities in action. If a healthcare organization reaches 2-5% of its market through social media, and that 2-5% are mostly connectors and mavens, then imagine the conversations they may have on your behalf. All of the sudden you have an army of powerful influencers in your community who are ready to help you own the perception.

Healthcare organizations (and I'm counting physician practices in that group), starting thinking "What would Mr. Rogers do?". Invite your communities and constituents to join you in a conversation. As patients, and we are all potential patients, see out ways to engage with your care providers. If your provider is not interested in a two way dialogue consider what that says about them as an organization. A neighborhood is, by definition, a community and a community cares about one another.

I hope you will be my neighbor -

The Cluetrain - time for Healthcare to get onboard

Over the weekend I read an inspiring book: The Cluetrain Manifestoby Rick Levine, Christopher Locke, Doc Searls, and David Weinberger.

The Manifesto consists of four discussions surrounding 95 theses; the crux of which is that "markets are conversations". In a world were the internet gives everyone a voice, its time for organizations to listen to and participate in those conversations or be left behind. The authors argue that the internet has tipped the scales in favor of the consumer. Connectivity has given a everyone a chance to shout as loudly as they can how wonderful, or how poor a product is. They challenge institutions to learn the parlance of the new market place and become an active, and most importantly, genuine participant. The penalty for non-compliance is simple, they get left behind and become afterthoughts or lessons of failure.

The book was written in 1999.

1999, that is 4 years before MySpace, 5 years before FaceBook and 6 years before Twitter. The Cluetrain authors already knew what most businesses are still coming to grips with. "Markets are conversations."

A few weeks ago I posted my own white paper on the use of social media in healthcare. The terms and tools are newer, but the ideas are rooted in the work of Levine, Locke, Searls, and Weinberger (though I did not know about the Manifesto when I drafted Social Pulse).

Here in Richmond, VA we have a stretch of interstate that I have dubbed "Healthcare Highway". There are five hospital billboards in less than one mile. "We are the best carido program on the East coast...", "We treat you faster in our ER...", or "Best place to have a baby..." there is nothing wrong with that type of marketing. A friend describes it as being a good neighbor, reminding the community that you are there. But it serves little purpose past that.

This is the time to stop littering the skyline with superlatives and start having conversations. As healthcare providers we need to ask our employees, patients and physicians how we can best help them. What do you want out of a relationship with your local hospital? How can we serve you better, and when we don't live up to your expectations, how can we make it right?

The good news is that its not too late. Unlike what we are seeing with the automotive and credit industries, the unique nature of healthcare has afforded us a chance to slip under the radar. But it will not last long. Look at the scrutiny and criticisms leveled at the for-profit insurance industry. Sure there will always be services where we have a captive audience: OB, the ER, etc. But as modern medicine makes traveling with an health issue easier and recovery time faster will we start seeing people leave our markets and travel for their care? And when that happens, patients will not beat down your door because of your billboard on 64-W, they will come because you cultivated a real and meaningful relationship.

The Cluetrain Manifesto can be found on Amazon, the authors has also made the entire book available online for free here.