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What it Takes to be a Successful Healthcare Entrepreneur

On Wednesday, April 29th, StartupGrind Buffalo and Health 2.0 Buffalo teamed up to bring you a “fireside chat” with Niall Wallace of Infonaut.

Introduction: Health 2.0 Buffalo

The event was kicked off with a quick pitch from Health 2.0 Buffalo.  First, we laid out the goals for our group:

  1. Get entrepreneurs looking at healthcare
  2. Support those that take the leap
  3. Foster collaboration in our Healthcare Community

We also gave an overview of our multi-step approach:

  1. Get the creative juices flowing with peer-to-peer demos from front-line healthcare workers that are already getting tangible value from their technology.
  2. Extract ideas from the healthcare community through panel discussions and “problem pitches”.
  3. Validate those ideas against existing community solutions
  4. Reverse pitch validated ideas to the startup community.

Next Steps: We’re planning a meeting in the coming weeks to review our plan in more detail and get some ideas simmering. Then we’ll come out swinging in the fall.

Main Event: StartupGrind Fireside Chat w/ Niall Wallace

Infonaut is a healthcare startup born out of the Toronto SARS crisis. After spending almost 6 years doing disease surveillance for public health, they’ve developed a unique approach to tracking and controlling the spread of infections in hospitals.  Today, Infonaut is commercializing their product for the U.S market and they’re doing it right here in downtown Buffalo. Niall Wallace, Infonaut co-founder and Chief Innovation Officer, gave a thoughtful and entertaining account of how they got here.

NOTE: 1.7 million people contract infections in U.S. Hospitals each year resulting in 99K deaths and costs of $20 Billion (CDC)

The Canadian Healthcare Startup

Wallace started off by saying that “being a Canadian entrepreneur is great… and it sucks.”  It’s great because there’s a lot of opportunities to execute paid pilots within the healthcare system.  This gives you capital to work with and an opportunity to validate your ideas in real world scenarios.  It sucks because Canada is a single payor system that buys through RFPs and as Wallace put it “You don’t see too many RFPs for things that don’t really exist yet”.  That’s a huge road block for the innovative startup.
Buffalo’s Opportunity

Given that single-payor road block in Canada, Wallace and his team decided to look south.  They hooked up with Dr. L. Nelson Hopkins at the Jacobs Institute and asked him to help them enter the US market.  This led to Infonaut taking up residence in the Jacobs Institute at BNMC, hiring a new CEO in Thomas Quinn and most importantly, acquiring paying customers. Wallace described his current situation as a “sweet nirvana spot for a co-founder”.

Wallace pointed out that Buffalo has an amazing opportunity to bring in more companies like his from Canada.  Buffalo should collaborate as a community to lure these companies who’ve refined their business through a series of paid pilots in Canada, but who are currently struggling with commercialization in that single-payor system.  Let’s bring these companies in via BNMC, VCAMP, 43North, StartupNY, etc.  Wallace said, “the hard work has already been paid for”. The ideas are validated and refined… we can help take them to market.

Wallace is working with Buffalo leaders to create momentum on this front by introducing Canadian entrepreneurs to resources available to them here in Buffalo.  Last year a Buffalo contingent went to MaRS Discovery District in Toronto to talk about our growing medical sector. More recently, BNMC welcomed entrepreneurs from MaRS to tour their campus and will be hosting a similar group from Hamilton later this month.

What it takes to be a successful healthcare entrepreneur

Wallace sites his team’s non-healthcare background as a huge advantage in coming up with new ideas in the space. The existing players may be good at “grabbing budget”, but they’re stuck in an old mindset and “aren’t close to cracking the nut”.  Wallace recommends that startups assemble diverse teams with experience in many industries.  Reminiscent of the Medici Effect, this type of team will have perspectives that healthcare alone just won’t.  He adds “healthcare is operating 10-12 years behind the technology curve”.  Simply put, a team with only healthcare experience may not be aware of all the possibilities available to them.

With your team in place, Wallace advises that you “never give up” or “give up early”.  There was a bit of humor here for sure, but it’s a powerful message.  Work your idea, but be open to the possibility that it’s the wrong one, or maybe just the wrong time.  This won’t be your only idea… if you’ve got entrepreneurship in your blood, then you’ll always have the “next thing” to work on.  Don’t be afraid to get to the fast no and let this one go.  That said, if you get past the early validation and you decide to make a run at it, then plan on at least 18-24 months of grinding it out before you can hope to get a paying customer (maybe more).  This is the nature of selling in healthcare and it’s especially true if you’re selling something that didn’t previously exist.  This isn’t a bad thing, but it’s certainly something you need to plan for both in your execution and in the management of your energy and emotions.

“Innovation is commercialization… it happens when you start selling what you’ve got”.

Finally, it’s important to know that “R&D is not innovation”.  R&D is experimenting, learning and validating your ideas. It’s paid pilots. It’s the grind.  According to Wallace, “Innovation is commercialization… it happens when you start selling what you’ve got”.

That’s perspective.


Join our communities: Health 2.0 Buffalo and StartupGrind Buffalo.

Consumer Engagement in Healthcare

I had the good fortune of attending Digital Rochester’s event where IT leaders gathered to discuss Consumer Engagement in Healthcare.  The event was co-sponsored by HIMSS NYS Chapter and brought together 3 great speakers to address the topic:

Michael B. Jackson, GM, Consumer Health Care, Intel Corporation

Rajesh Kutty, Founder and CEO at iVEDiX

Michael Gurowski, President & Managing Partner of U.S. Employee Benefits Services Group

How long will consumer health be a thing?

Michael Jackson of Intel led off with this intriguing question.  He said that color TV was a

Michael Jackson, GM, Consumer Healthcare at Intel Corporation.

Michael Jackson, GM, Consumer Healthcare at Intel Corporation.

thing…. and then it was just TV.  I’ve heard this question around terms like mHealth and Digital Health as well.  I agree with Jackson that while these things seem new today, it won’t be long before they’re just… health.  When we get sick, we’ll grab the iPad for a quick telemedicine session, get our prescription sent to the pharmacy and be alerted when its ready via a mobile app notification on our phone.  All of these systems will be connected and the physician’s EMR will know when we’ve picked up the prescription.  This won’t be a thing to us… it’ll just be the normal and expected way to get care.

So how will we get there?  Jackson pointed out that Digital Health is much like Digital Marketing only with higher stakes.  The 5 steps to loyalty ring true here:

  1. Learn – We must become educated consumers. What’s available? What’s the best approach to get care in this situation? Etc.
  2. Validation: We’ll decide which care to consume just like we pick NetFlix videos… we’ll check the online rating. How many stars did this physician get from patients like me?
  3. Conversion: This is where we decide to become a customer (or patient).
  4. Use the service: This is the actual delivery of healthcare
  5. Commit: Loyalty to a brand.  You won’t shop around (as much) for your next episode of care. You won’t hit the exchanges in the next open enrollment. They’ve earned your trust and your loyalty.

The need has always been there, but according to Jackson “it’s the empowerment that’s changed”.  This empowerment is being driven by major shifts in the healthcare landscape:

  1.  The Affordable Care Act (ACA or “Obamacare”) put 10 Million newly insured patients into the system.
  2. 10,000 baby boomers turn 65 every day in the U.S..
  3. Steadily rising healthcare costs
  4. Not enough new providers are being trained to meet the increased demand for services (Assoc. of American Medical Colleges suggest a shortage of up to 45,000 PCPs by 2020).

These pressures have paved the way for major payment reform.  Healthcare is rapidly moving away from a Fee for Service model (buying services) to a value-based model (buying outcomes).  To support this, providers must be able to quantify the value of the services they provide.

Turning to Technology

This isn’t just slapping EMRs in place, but rather a thoughtful approach that engages patients up-front, implements efficiencies on the back-end and constantly measures our effectiveness on actual patient outcomes and costs.

Jackson walked us through the evolution from eHealth (EMRs and digitization) to Open Health (data is shared) to Smart Health (personalized).  Our success depends on how we handle the data. It can’t be a deluge of mostly irrelevant information, but rather a mapping of the data to content that is relevant to the audience.  A patient needs to see things that are meaningful and actionable TO THEM, while a PCP needs another set of content and an Oncologist another set altogether.

Marry data to relevant and personalized content to get the response you want.

Data you can feel!

Rajesh Kutty of iVEDiX picked up where Jackson left off and focused on the final delivery of that personalized content. Kutty cited estimates that there will be 13 billion mobile devices in the world-wide market by 2020.  Increasingly, mobile is THE platform you’ll reach your consumers.  These devices provide a small form factor to work with which really emphasizes the need to make your point quickly and with little noise.  Kutty made another point about these devices that I’d never considered… “touch invokes a subtle connection with our data that we’ve never felt before”.  Your consumers will literally touch your content as they view it on a phone or tablet… it’d better “feel” good.

This concepts of touch and personalization may be more relevant to healthcare than any other field.  There are more customer touches to the healthcare system than most other businesses. The services provided are often the most important we’ll ever receive and the emotions we bring to the table both as patients and providers can’t be ignored.  We can’t design interfaces that users hate (and as Kutty pointed out… most doctors hate their EMR).  The content and the interface  need to push redundant, irrelevant or otherwise in-actionable data out of sight and focus  on the exceptions.  What matters right here and right now from MY perspective in THIS situation? Deliver it to me in 3-5 data points with just a handful of variables. And for God’s sake… make it feel good.

Health Insurance is Consumer Facing Too…

Michael Gurowski of U.S. Employee Benefits Services Group rounded out the discussion with a presentation on consumer options in Health Insurance.  It was immediately clear that this was the topic that hit closest to home with the audience as the questions, which were somewhat sparse for the first two speakers, came rolling in to Gurowski.  Health Insurance is, in a lot of ways, the most relevant topic in a talk on consumer health.  That’s because its the piece we’re closest to understanding today. We know how much comes out of our pay checks and with the ubiquity of High Deductible plans, we know that most of our care will still come out of pocket.  Generally speaking, we don’t like this.  That said, its not really the insurance we don’t like, but rather the sky-rocketing costs of healthcare combined with little transparency to help us understand what’s going on.

Gurowski did a great job of explaining some of the products that payers are putting in place to help consumers make the best of our bad situation.  While the High-deductible plans do put more out-of-pocket burden on us, they do so in order to keep our premiums down in a ridiculously expensive healthcare system.  It’s now our choice how we want to spend the “savings” and Health Savings Accounts (HSA) give us a tax free way to sock it away for a rainy healthcare day.  Gurowski also cited the growing trend of tools to compare costs and give patients transparency ahead of picking a provider or procedure.  Telemedicine options are popping up as well and providing us with a way to save money and time for the most common services and we can do it from anywhere, 24x7x365.  Further, wellness programs are coming online that incentivize healthy behavior and try to keep us from needing services in the first place.

Where do we go from here?

Massive change is happening in healthcare today and it’s creating a tremendous amount of strain on providers, payers and patients alike.  As consumers, we most directly feel the pain in our pocket books and that’s driving us to ask more questions and expect more from the system that handles the most important purchases we’ll ever make.  This, as we are seeing now, will lead to innovation in the products offered by the payers. But as I stated above, this is just making the best of a really bad situation and won’t solve the underlying problem. We need “Smart Health” and we will only get there by engaging patients and providers alike in a meaningful and actionable way.


The event was organized by Travis Masonis – CIO and VP of IT at Jewish Senior Life and Leader of Digital Rochester IT Leaders Special Interest Group

The panel was moderated by John Schrenker – Program Director, Roberts Wesleyan College – WNY Liaison for HIMSS New York State Chapter

And one fun note about iVEDiX… they’re a silo-busting, mobile device data delivering company who’s offices are in a silo… literally. Fantastic!


WordCamp Buffalo Slides: Selfish Accessibility

This post originally appeared on my blog.

Photo of Buffalo WordCamp t-shirt.
The Buffalo WordCamp shirt was again printed by You and Who (whose logo is visible where the tag would be), which means that 1,600 meals were donated (one for each shirt) to those in need. I think every WordCamp should do this. (related tweet)

Buffalo WordCamp has just wrapped up and folks are hopefully going to take new ideas back to their own projects. There were many great talks and even panel discussions that turned into more of a WordPress support group for the audience and panelists alike. A first for Buffalo WordCamp that I hope they repeat. Also a plus, 48% of the attendees and 35% of the speakers were female, better ratios than I’ve seen at many other conferences.

My Slides

If you just come for my slides, then you are at the right spot. I’ve embedded them here, or you can go see them at SlideShare. In addition to questions and feedback from the audience, I’ve already gotten some feedback from the Twitterverse. In particular my use of the word “continuum” on slide 77. I am open to suggestions for a better word, so feel free to share.


I grabbed some photos from the event as well, captioned below (originally posted on my Tumblr, where they are larger).

Panoramic view of Canisius College Science Hall
This year the event was held in the new Science Hall at Canisius College. This is the atrium where lunch was served and announcements were announced (shot taken shortly after the lunch crush).
The crowd at the start of the event.
Some of the announcements being announced by announcers and co-organizers Ben Dunkle and Andy Staple.
The breakfast table.
A nice spread of pastries to get the day going. I am amazed I only ate one.
Attendees for my talk.
Accessibility talks never net a huge crowd, but at least those who did show up wanted to learn more, had good questions, and challenged me.
My shirt.
After a quick Twitter poll, I broke from my normal pattern of wearing more professional attire and went with the Montgomery Ward mechanic’s shirt with the fur collar.
My badge and the schedule
The badge had the day’s schedule printed on the back (handy), and they also provided a printed schedule (also handy).
View of the cemetery from one of the talks.
Buffalo skyline.
A view from the after-party at Western New York Book Arts Center.
Type bits.
Some sample type at Western New York Book Arts Center. If you’ve never been and you are at all interested in type, you should visit.

The Future of Health Lies in Great Systems of Care

The world of siloed healthcare is coming to an end. Government and private payers continue to roll out new programs that emphasize tight clinical integration and transparency with an emphasis on quality. This sentiment was echoed in Buffalo on October 15th at The Future of Healthcare Forum presented by Jaeckle Fleischmann & Mugel, Lumsden McCormick and the Medical Society of Erie County. Titled “New Models of Collaboration in Healthcare”, the forum featured a keynote speaker from the high-performing Wisconsin based Gundersen Health System, along with a panel including some of Western New York’s top healthcare leaders:

Key note:
• Dr. Michael Dolan – Medical Vice President – Gundersen Health System

• Ronald Mornelli – SVP/Chief Network Officer – BlueCross BlueShield of WNY
• Dr. Michael Edbauer – CMO – Catholic Medical Partners; CCO – Catholic Health
• Dr. Michael Cropp – President and CEO – Independent Health
• Daniel Porreca – Executive Director – HEALTHeLINK
• Dr. L. Nelson Hopkins – CEO – The Jacobs Institute

What’s going on in Wisconsin?

La Crosse, Wisconsin boasts the lowest per capita Medicare spending in the U.S. and was ranked #7 in Overall Health System Performance (BTW… Buffalo was #54, which is in the top quartile). Dr. Michael Dolan gave us some insight into how that city and its surrounding region performed so well by describing the operations at the Gundersen Health System. Dolan cited several key areas for his Gundersen’s success:

  • A solid EMR implementation – Everyone uses the same EMR and can easily search across the entire system (in some cases they can even search across the other large hospital systems in the region). He called it a “Data Goldmine”. Notably, physicians led the implementation team and they put a lot of emphasis on training. The staff was ready to go when the solution launched and can participate in CME courses to refresh they’re skills and learn new ones over time.
  • Advance Care Planning – Thanks in a large part to Gundersen’s Respecting Choices program, 92% of people that died in a Gundersen hospital in 2008 had an Advanced Care Plan (ACP) in place. What’s more, the doctors typically knew about this ahead of time. Dolan said they start discussing ACP with patients as soon as they reach 50 years of age.  Side Note: This topic was discussed at length at the recent P2 Collaborative of WNY  2014 Creating a Healthier Community Conference which I summarized here.
  • Care Coordination – Dolan described the program as “patient centered; not insurance driven” and noted that it was so effective that providers began referring non-Gundersen Health Plan patients. Now it’s a system-wide program that boasts 40% decreased costs per patient after 2 years and saves $8 for every $1 they invest. He noted that it’s not great for hospital revenues, but “it’s the right thing to do”.
  • System Accountability – The Wisconsin Collaborative for Healthcare Quality (WCHQ), is a voluntary consortium of Wisconsin’s healthcare providers. They have agreed to share their quality data and best practices to help drive improvements state-wide. The data is public, cannot be used for marketing and is never broken down lower than the system-level. This lets the systems handle their own internal quality improvement. The results have been striking. For example, the Controlling High Blood Pressure measure improved from (an already pretty good) 62% to nearly 77% in less than 8 years.
  • Management – There are physician leaders at every level of the organization and Gundersen goes to great lengths to develop those leaders. Their senior managers do “rounds” EVRERY DAY – basically they spend an hour walking around and talking to staff to ensure they have the pulse of the organization. They share their successes on Activity Boards and in regular Recognition Events that are led by a senior manager. They organize a physician book club (usually leadership topics).
  • Access – Gundersen’s providers and specialists are regularly on the road. They travel to most of their 48 regional sites providing access to needed care even in the most remote regions. When they can’t send a doctor in person, they send them over the wire. Gundersen’s telemedicine program is growing rapidly (19 of their sites use it) and according to Dolan the patients and the doctors both love it.
    Dr. Dolan closed his key note with the title of this post: “The future of healthcare lies in great systems of care”. The Gundersen model provides us all with a glimpse of what’s possible.

What do the Western New York healthcare leaders think?

The panel discussion was moderated by Larry Zielinski, Adjunct Professor at the UB School of Management. Zielinksi covered a lot of ground:

  • On Collaboration vs. Competition in WNY – The panel was unanimous on this topic. They suggested that we should collaborate on high-level procedures and compete as a community against Rochester, Cleveland and Pittsburgh. Rather than fighting over the pie, we should focus on creating a pie that’s big enough for everyone. They added that “The elephant in the room is UPMC and Cleveland Clinic; not Catholic Health and Kaleida”. They admitted that we don’t have a formal vessel for collaboration amongst the big systems in WNY and that’s something we need to think about.  Dr. Dolan added that the overall success in Wisconsin has happened in a “very competitive” landscape that includes a behemoth in the Mayo Clinic. They’re collective approach is to “collaborate when we can and compete when we have to”.
  • On Narrow Network Insurance Plans – A recent study suggested that narrow networks are more efficient (panel was not specific, but I found this relevant post and a recent Georgetown study). Amongst members in the study, primary care was up and hospitalizations were down. That said, the panel felt that it’s not necessary to eliminate choice in the plans, but rather to influence choice with the benefits structure. That way all provider options remain on the table… some simply cost more than others.
  • Is the ACO Model Scalable? – Short answer… yes. However, the panel stressed that we should not underestimate the time and effort required to develop the infrastructure, change the culture and achieve greater collaboration with the many sources of data in the community. Catholic Medical Partners has been attacking this issue for almost 9 years. The time they’ve had to mature in the model has been a huge factor in their continued success (they are the #3 MSSP ACO in terms of savings).
  • What about Specialists? – The panel seemed to feel that the best way to integrate specialists is to have them become “employed”. By getting them on “the same team” and ideally working in the same space we’ll begin to see some real benefits of collaboration. The Gates Vascular Institute building was actually designed to create “collisions” (what the Silicon Valley crowd refers to as “Serendipitous Encounters”). They gave an example where several procedures were accomplished at the same time at Gates that otherwise would have required multiple surgeries spread out over several weeks in different facilities. This type of collaboration saves time and money and is better for patients. They did however note that reimbursement models will need to catch up with these “collaborative” surgeries.
  • On Quality and Price Transparency – It was clear to the panel that the availability of quality and price data is already affecting behaviors. An important point was that this data has not just been hidden from patients, but in many cases from their providers as well. This data should be curated and put in the hands of the physicians so that they can use it to better serve their patients. They can use it to determine which specialist is going to provide the best quality and value for the patient.  This will provide a vital service to patients with high-deductible plans.
  • Is the local HIE funding model viable? – As long as the HIE continues to perform then the state and local leaders will continue to see value in funding it. Right now, it’s working. HEALTHeLINK is on target to process nearly 1 million patient queries this year and studies have shown that they have an impact in reducing duplicate MRIs and CT Scans and preventing hospital admissions. With adoption, consent and usage already on the rise, the advent of the State Health Information Network of NY (SHIN-NY)  is sure to further expand HIEs role throughout New York state.
  • Have we seen a decrease in “human” care due to EHR use? – The technology shouldn’t replace doctors or make them less relevant. Rather, it should complement them. It’s important to ask “what do we want to use the tech for?” The panel advised that we shouldn’t try to codify things that are best handled by a conversation between patient and provider. Taking this approach will reduce the “hassle factor” of EHRs and allow the doctors to engage more with their patients. The panel added that we’re actually faced with a great opportunity to INCREASE the “human-ness” as we embrace the team care model. Non-physician team members can bring a skill-set to the care continuum that the PCP does not possess. That means the patient will have more face-to-face time with a team member whose skills closely match their needs.  Dr. Dolin chimed in and added that telemedicine is probably the most technology dependent form of care there is and patients love it. He’s found that weak communication skills are amplified by the technology, but providers with strong communication skills are unaffected by it. It’s important to attack the problem at its root and work with providers to develop these critical skills.
  • What will we see in WNY over the next 10 years? – The panel pointed to examples locally where collaboration and integration have already proven effective.  As far back as 1986, Health Care Plan put all disciplines in a single location and it was a success. They’re confident we’re on the right path. They believe that the healthcare delivery system will get broader and more integrated as we begin to address the social determinants of health. Patients will become more engaged and take on a new influential role as they embrace healthcare “consumerism”.  The panel noted that we already have “pockets of excellence” here in Buffalo, but we need to work together to spread that across the entire delivery system. How do we work together to pool resources and attract “rock star” leaders to the region? Dr. Dolan chimed in that “events like these show the desire” and suggested that local leaders need to “be open to look at best in class and bring it here”.

The forum sent a clear message that the future of healthcare lies in “great systems of care”. Not specifically hospital systems or Accountable Care Organizations or any other construct that exists today. Rather, it will be “systems” in the general sense where healthcare providers are tightly integrated with one another, but also with the communities that they serve. Information flows smoothly from patient to provider to specialist and the entire community collaborates to manage our health… not just our healthcare.

Speaking more regionally, the panel called for a change in the way that we look at the competitive landscape in Western New York. Rather than compete against one another, we should collaborate and compete as a community with Rochester, Cleveland and Pittsburgh. It’s a noble goal and one that’s attainable in time. While we’ve got our work cut out for us, events like this lay the foundation for building that community.

The entire community collaborates to manage our health… not just our healthcare.

Forum logos 4

Anna-Lesa Calvert at TEDxBuffalo 2014

Anna-Lesa Calvert at TEDxBuffalo 2014

Anna-Lesa Calvert at TEDxBuffalo 2014

Anna-Lesa Calvert gave her first TED talk at TEDxBuffalo 2014 to a packed house on Tuesday, October 14. Since 2012, Buffalo Soccer Club (BSC) has developed and grown their Soccer for Success program in partnership with the US Soccer Foundation, United Way, and Independent Health Foundation. I just learned they’re now serving 700 kids (and their families) with a 24-week program at 20 sites around the lower-east and -west sides of the City of Buffalo. 84% of their players show real improvements or maintenance, season over season, on aerobic capacity, BMI percentile, and waist circumference. That’s exciting!

How does BSC encourage healthy lifestyles? Not by stopping play to hear lectures or watch film strips. They actually work healthy thinking into the game. Remember “sharks vs. minnows?” Try playing “Good snacks vs. junk!” Anna-Lesa bets that your kids can surprise you when they get tagged by a “good snack”, naming healthy foods like kiwi to get out of the junk team. You’d be surprised at how good kids are at coming up with fresh ideas.

Even more exciting, BSC recruits 50-60 coaches per season, and keeps the player/coach ratio low. Coaches show up before practice and games, and stay after too. While picking up cones, every player has the chance to talk to a real adult outside their everyday circle of teachers and parents. Players open up about problems, and coaches embrace them. In fact, coaches even get training on how to be better mentors. Who would you open up to when times get tough? BSC coaches care!

Buffalo Healthcare Conference Promotes Communication and Patient Engagement

P2Collab LogoThe P2 Collaborative of Western New York held their 2014 Creating a Healthier Community Conference on October 9th in Buffalo, NY.  As a technologist who usually works from the outside-in, I really enjoyed the opportunity to get some front-line perspective from the community.  Here’s a breakdown of the presentations:

Ellen Goodman – Have you had the conversation?

Ellen Goodman, Co-Founder and Director of The Conversation Project gave a powerful keynote on the importance of clearly identifying our end of life wishes.  This is a topic that can be difficult to talk about, but it’s often the deciding factor in whether the death experience is a good one or a difficult one.  The idea is much broader than the “pull the plug” stories we tend to hear about. In fact, Goodman points out that there’s “rarely a plug to pull”.  The conversation is more about making decisions around risky and/or aggressive treatments that offer marginal benefits while posing a significant risk to our quality of life near the end. Everyone is different. Do you want to exhaust all options regardless of the risk, or do you want to make sure you’re comfortable and with family when your time comes? Either way, its important that you make your preferences known.

Goodman proposed that the “Longevity Revolution” is the next big social change.  She felt that if we “fixed healthcare and aging, but did nothing to fix the way people die; then we’ve failed”.  The solution? Talk about it!  Social change happens when people share their stories.

Goodman also noted that the topic is too often discussed from the standpoint of cost, and unsurprisingly, that turns people off.  I agree that talking about it from the cost perspective will be ineffective, but as a society we cannot ignore that aspect. We spend incredible amounts of money on end of life care and the results are not always good.  In fact, Forbes Contributor Michael Bell wrote a post on end of life medical spending and found evidence that the less money spent in the final year, the better the death experience is for the patient.

So we’re spending a ton of money, negatively impacting quality of life and placing tremendous stress on patients, their families and care-givers.  The evidence certainly suggests we should all consider having the conversation.

Lastly, I wanted to share this video.  Goodman presented it as an example of how we can do better. It’s only 4 1/2 minutes and it shows how a provider made a meaningful impact on a terminal patient with one simple question: “What would be a good day for you?

If you need help getting started, download the Conversation Starter Kit.

Neighborhoods to Nursing Homes | The Conversation Project at ECMC

The Conversation Project team from ECMC followed up Goodman’s keynote with a very personal take on how they facilitate this in practice everyday. They’re often helping families have this conversation in times of great crisis when emotions and stress-levels are high.  They shared touching stories from their personal and private lives that showed how important it is to approach the situation with compassion and a clear sense of purpose.  To me, the main point was that we need to change the dialogue and tone from one that tries to “get the forms filled out”, to one that tries to find out what’s important to the patient. We need to know what they truly want.  During the Q&A session, a commenter added that when dealing with proxies, the question should not be “what do you want us to do for your loved one”, but rather “what would your loved one want us to do for them”?

The team shared some important statistics too:

  • 90% of us believe its important to discuss end of life issues with our loved ones. Only 30% of us actually do.
  • 60% of us say that it’s extremely important that our family is not burdened by tough decisions about our care.
  • 70% of us wish to die at home yet 70% of us die in a Nursing Home or hospital.

The most often cited reason for not having the conversation was that we thought it was “too soon”.  The ECMC team counters that :”It’s never to soon, but often too late”.

Thomas Workman, Ph.D. | Toward Shared Decision Making as the Norm: What We All Can Do

Workman defined the goals of Shared Decision Making (SDM) as follows:

  • A patient fully understands the potential benefits and harms of each option.
  • A patient applies their personal preferences, life circumstances, and values when making a choice.
  • Both patient and provider reach a mutually satisfying decision in which both have confidence.

The entire healthcare industry is moving towards a more patient-centered model and practices like SDM will help solidify the patient as the owner of their care.  Its THEIR decision and its THEIR life.  Workman notes that SDM lowers anxiety and lower anxiety has a proven effect on outcomes.  This transition will require the same type of deep and personal connection between patients and their caregivers that were discussed in the earlier sessions.

Mindy Thompson Fullilove, M.D. & Lourdes Rodriguez, Ph.D. | Introduction to Urban Alchemy

This was by far my favorite presentation.  Fullilove and Rodriguez’s style fit the event perfectly, because this felt much more like a conversation than a presentation.  Maybe without even realizing it, they gave us a live example of how to do what we’ve been talking about all day: Make a connection and communicate clearly.

It didn’t hurt that the topic itself was so interesting.  The speakers believe that “A strong city will power a large region” and that “neighbors that help each other are the foundation for making us well”.  With those ideas as the basis, they showed us how the concepts of urban alchemy can be applied to reverse the collapse of our communities and put us on a path to restoration.  They walked us through the steps taken to create Giraffe Path – an urban trail that connects the Cloisters to Central Park through the escarpment parks of northern Manhattan. The project connected disparate communities and gave them a sense of oneness. It also gave people a reason to get outside and move. A good one-two punch for community restoration and health.

This talk definitely put Fullilove’s book on my reading list: Urban Alchemy: Restoring Joy in America’s Sorted-Out Cities.

Franchelle Hart | Open Buffalo: Building Community

The day wrapped up with Open Buffalo – an organization focused on strengthening community ties and giving the entire population a voice.  Some keys programs from their website:

  • Mobile Democracy Center – will engage at least 1,000 residents per year with voter registration, information about equity issues, and advocacy tools to increase individual engagement and action while overcoming geographic and cultural divides.
  • Emerging Leaders – will train over 100 residents per year to mobilize their communities around equity issues and to take on leadership roles in community, nonprofit, and government sectors.
  • Innovation Lab – will build Buffalo’s capacity to generate new ideas, do original research, draw more effectively on local and national best practices, share information more broadly, and draft new laws and policies.
  • Open Buffalo Arts Network – will mobilize arts groups to aid in mobile democracy and emerging leaders projects, to contribute creativity to issue-based work, and to change the stories Buffalo tells itself and the world.

In Summary

I’m glad to have attended the conference and I plan to be an annual attendee from this point on.  The speaker/topic line up was great.  It gave me things to think about as a professional, but more importantly as a father, husband and citizen.  The conference made it clear that communication is key to our success and gave us some tools to begin improving our methods today.  I come away knowing that while it is important to examine and understand the entire population, healthcare needs to be delivered to the individual.


Buffalo Contingent Heading to Toronto to Talk Healthcare Innovation

TorontoOn October 14th representatives from The Jacobs Institute, Kaleida Health and dig Buffalo are heading to Toronto to explain how we’re building a Health Innovation Ecosystem right here in Buffalo, NY.  The announcement and RSVP info can be found here.

For those of you who don’t know what’s happening in Buffalo, we’re on the comeback trail. A couple of highlights:

  • Hundreds of millions of dollars in private investment rebuilding downtown
  • The Buffalo Billion – a pledge from Gov. Andrew Cuomo to invest $1 Billion to expand the Buffalo Niagara economy
  • Buffalo Niagara Medical Campus – a consortium of the region’s premier health care, life sciences research, and medical education institutions, all located on 120 acres downtown.
  • Thriving Startup and Tech Scene – Checkout digBuffalo, Z80 Labs and VCAMP for startups and NextPlex or Meetup for countless professional groups.

Given everything that’s happening here in Buffalo, I’m really excited to see the beginnings of a collaborative relationship with our neighbors to the north.  In a recent post, healthcare entrepreneur Geoff Clapp suggests that Toronto might be the next great hub for Digital Health.  He cites three key factors for this:

  1. The MaRS Innovation Centre – an “Innovation Hub” with an interest in healthcare and startups. Notably, this is the site of the Buffalo panel discussion on October 14th.
  2. Education System – University of Toronto Medical School and Waterloo head up a solid education system.
  3. People – From MaRS to the local Health 2.0 chapter, Toronto has some top notch people leading the way.

Clapp also points out that many of the healthcare startups in Toronto are targeting the US Healthcare market.  Given our proximity, entrepreneurial culture and bustling healthcare market, Buffalo can serve as an ideal jumping off point for entry into the US market.  If you’re curious how that might work, attend the panel and talk to Niall Wallace of Infonaut – an Ontario-born health entrepreneur who’s company is embedded within the Buffalo ecosystem.

Given the similarity in our ongoing efforts, it makes a lot of sense for Buffalo and Toronto startups/entrepreneurs/innovators to come together.   I’m thrilled to see that happening.



SIDE NOTE: If you’re in the startup scene and not looking at healthcare, read Healthcare’s Trillion-Dollar Disruption by Dave Chase.  The  idea that “new patient-centered population health models will cause more than $1 trillion of value to rotate from the old models to the new and create more than a dozen new $10 billion high growth markets” demonstrates the opportunity. This fact is also evident when you look at the growth in venture funding for digital health startups over the past 3 years (see chart).  Finally, and most importantly, work in this market can substantially improve people’s lives. Get in there entrepreneurs…

01_Rock Health Q3 2014 Funding Figures

Adrian Roselli’s Upcoming Speaking Gigs

One of the things I enjoy about my job is having the opportunity to share my knowledge and experience (and get corrected). This year already started out well with my talk at HTML5 Developer Conference back in May. Happily I have five more speaking engagements coming up in the next couple months.

WordCamp Buffalo

On Saturday, September 13, I will have the pleasure of speaking at WordCamp Buffalo for its (and my) third year. Based on the speaker line-up there will be plenty of great topics, so I look forward to being an attendee as well. My talk this year will be about accessibility.

If you are new to WordCamp Buffalo, a quick overview:

WordCamp Buffalo is a one day conference held in Buffalo, NY focusing on WordPress. Our goal is to increase knowledge about WordPress for people who already are working with it, and show some benefits of using it for anyone who may be interested, but aren’t currently working with WordPress.

Tickets are available now, so you have plenty of time to prepare for heckling me. This year the event is being held at the new Science Hall on the Canisius College campus. A map is embedded below, and information on metro stops, hotels, and parking is available on the WordCamp Buffalo site.

Accessibility Camp Toronto

I am excited to say that I will be speaking at Accessibility Camp Toronto in late September. It probably goes without saying that I’ll be speaking on accessibility. Given Toronto’s proximity to my home town of Buffalo, and the fact that I used to wander up to Toronto about once a month, it will be nice to visit a city I’ve neglected for a couple years now.

Instead of re-stating what Accessibility Camp Toronto is all about, I am going to cheat and quote the site directly:

Focusing on users with different disabilities, sessions can cover digital accessibility topics from the web (technical to tactical), desktop software, mobile apps, eLearning, online gaming, open source innovations, and everything in between. Watch this brief video from the first Accessibility Camp Toronto to get a feel for what to expect during the day. Also, video recordings from the 2013 camp are available.

Regardless of your level of knowledge, this event is for you. It will be a great opportunity for members of the design/development, usability, accessibility, other IT and end-users with disabilities communities to interact and learn from each other. We recommend you browse the Frequently Asked Questions, especially if you have never attended a participant-driven BarCamp/unconference before.

Please support the event with a $5 suggested donation at the door. Your donation will help cover the costs for miscellaneous expenses – event materials, food, etc.

Please follow event updates on Twitter via @a11yto.

Make sure you register as it is my understanding that the event is three quarters full. If you don’t follow @a11yto for updates, at least check in on the #a11yto hashtag.

The nitty gritty: the event is held from 9:00am until 4:00pm on Saturday, September 27, 2014. It is being held at OCAD University, 100 McCaul Street, Toronto, ON M5T 1W1.

UX Singapore

By far the farthest-from-home of my speaking engagements to date, I’m thrilled to be speaking at UXSG (User Experience Singapore). Having attended its sister event, UX Hong Kong (UXHK), last year I can say that I am excited not just to speak but to hear from all the other great speakers who will be imparting wisdom, knowledge, and perhaps a few local dining suggestions.

For those not familiar with it, UXSG is a three day event intended to onnect UX professionals across disciplines and cultures. As one of the founders of (way back in 1998), this statement from the conference organizers resonates with me: It is a platform made for and by UX professionals to foster stronger professional collaborations and personal friendships. Given that I made some great connections as an attendee at UXHK, I don’t doubt I’ll have a similar experience here.

I will be giving a lightning talk on the third day of the conference, Friday, October 3, at 11:00am Singapore time. I’ll be updating my “Selfish Accessiblity” talk for the UX audience. The abstract of my talk is posted at the UXSG site.

I’ve been to Singapore once before, but only for a day. This time I am looking forward to spending a little more time there and, in particular, experiencing the venue for the event, the relatively new Star Performing Arts Centre.

National Association of Government Web Professionals

Much as I would like to say that I will be speaking at the National Association of Government Web Professionals (NAGW, I don’t know where the “P” went, perhaps it was originally “Webmasters?”) conference in September, I won’t be. I was, however, asked to do a separate webinar for members for one of the conference topics I submitted — an intro to responsive web design.

As far as I know you need to be a member of NAGW to be able to attend the webinar, so I can’t share a URL, let alone a Google Map. I can, however, point you to the slides from a similar talk I gave last September: Slides: Responsive Web Design Primer

While the federal government may have its own crack web team now (or so the reports claim), state and local governments don’t have that same team and can’t as easily share their expertise. It seems NAGW fills a gap by providing a forum for these web professionals to share and help one another, as noted in its own description:

NAGW is the National Association of Government Web Professionals, an organization of local and state government web professionals working together to share knowledge, best practices, innovative ideas, and other resources. We collaborate on technologies, and network with other web professionals to improve our capacity to provide value across the web to our communities.

If you are a member, the webinar is Tuesday, October 21 at 11am mountain time. I hope I am able to provide some value to its membership, and if not, maybe they can be amused by how deftly I don’t do webinars.

Learning Choices Network

In a break from the last speaking engagements listed above, which have all been about web technologies and best practices, I get to list an event that isn’t about the web at all. Sorta.

Learning Choices Network (LCN) is a local (to Buffalo) organization focusing on alternative education such as self-directed learning and life-long learning. To let the organization speak for itself, this is from its Facebook page:

LCN exists to create, facilitate, and promote alternative opportunities for authentic learning in the local community while connecting educators, community advocates, parents, and business people who are seeking workable solutions for educational choice.

As someone who has built a career around the web, but for whom the web had barely sprung into existence when I started, being self-taught was the only option I had. For a sense of timing, Mosaic was released while I was in college (with Netscape Navigator soon to follow), so there weren’t classes to take, let along many with experience to help me get started. As I developed skills and started to rely on mailing lists to refine them, I co-founded and started writing, trying to become the kind of teaching and training resource I never had. I have been following that approach ever since (I believe evidenced by this very blog).

I’ve followed the same learn-as-you-go model for when I co-founded my business, Algonquin Studios, 17 years ago as well as other companies we’ve spun off since then. Just as I formed to help provide a resource like I didn’t have when I started, we’ve been spinning up VCAMP, our own local incubator/accelerator to help provide a platform for other business that we didn’t have when we started.

At the LCN event I will speak about how I started down my self-directed learning path, identified (and sometimes discarded) mentors, and somehow managed to be a (so far) successful entrepreneur when both the technology and economy have flolloped up and down like a mattress from Sqornshellous Zeta (sorry, it really is the best word to use). If you’re lucky, I’ll even (probably incorrectly) speculate on the future of education and learning, something for which I am woefully unqualified.

The event will be held from November 8 through November 10, 2014. Tickets are available online. The event will be held at Buffalo History Museum.

Eliminating 500,000 Avoidable Hospitalizations: Let the Data be your Guide

In my last post, we discussed the importance of regional and state-wide collaboration within the NYS DSRIP initiative.  This time we’ll take a look at the overall goal of the project, give it some context and look at some ways we can use open data sets to focus our efforts as we begin this 5+ year journey.

The goal: NY and CMS aim to reduce avoidable hospital use by 25% state-wide over 5 years. According to the DSRIP FAQ:

“Avoidable hospital use encompasses not only avoidable hospital readmissions, but also inpatient admissions that could have been avoided if the patient had received proper preventative care services.”

The following 4 measures will be used to measure DSRIP’s success:

If you combine the state-wide aggregates from each of these data sets, we’re looking at about 2.2 million instances of potentially avoidable hospital use. Those are our targets.  To reduce that by 25%, we must eliminate over 550K admissions!   To put that in perspective, if you think of each admission as an individual person, that’s enough people to fill Ralph Wilson Stadium more than 7 times!

Ralph Wilson Stadium - 7

This is a monumental task.  I suggest that DSRIP teams utilize the open data sets made available by NY DOH and others to “short-circuit” their planning and quickly focus in on the most advantageous targets.

If we take another look at the source data sets, we can see that they’re not equally represented across the state. In fact, Potentially Preventable ER Visits make up 95% of the pool with over 2.1M of the 2.2M potential targets!

Potentially preventable hospital use across NYS in 2012.

Potentially preventable hospital use across NYS in 2012.

In other words, we can eliminate ALL of the PPR, PQI and PDI state-wide and still fail miserably unless also we take a huge bite out of those ER visits.

So let’s start with the 95%. Are there any areas that stand out? Any low hanging fruit?

Lets identify the region with the most PPV Events.  In 2012, that distinction went to Kings County with around 350K events.  On the flip side, they were “expected” to have about 87K more.  Even though they had the most events, they performed better than all but 5 counties on a per capita basis.  Kings county is doing pretty well… probably not the place to start.

Who’s performing the worst relative to their NYS expected rate?  Comparing the number of actual PPV events to the expected number, we can identify the “Excess PPV” events. Since these counties are performing worse than the NYS expectation, they represent good places to start digging for answers and potential savings. The 10 worst performers by rate represent a pool of more than 65K events to target for elimination:

Actual PPV Events - Expected PPV Events = Excess PPV Events

Missed expectations: Worst PPV performers based on difference in observed vs. expected rate in 2012. Excess PPV Events = Actual PPV Events – Expected PPV Events

We could also target counties performing worse than expected, but prioritize those generating the largest volume of Excess events regardless of their per capita rate  – this group yields nearly 125K viable targets.  It also bumps 2 of the NYC region counties to the top of the list, reminding us that downstate might represent the biggest opportunity to move the DSRIP needle.

Worst PPV Counties by volume

Opportunities for change: Worst PPV performers by volume. Excess PPV Events = Actual PPV Events – Expected PPV Events

The data helps us to quickly identify some targets for further evaluation. Now we can  start doing the real work: Why is the ER so heavily utilized in St. Lawrence, Albany and Schenectady?  What’s being done differently in Kings and how can it be applied in these trouble areas?  Why is Kings doing so much better than nearby New York and Bronx counties? What innovations can we bring in from outside of NY? Here’s a few ideas that sound interesting:

We won’t find all the answers in open data sets, but they can really help us to focus our efforts. Let’s identify the low-hanging fruit, common problems and best practices and focus our energy on the areas that are likely to give the best results.  $8 Billion sounds like a lot of cash, but its going to go quickly in a state-wide effort incorporating 6-8 Million patients. We need to work smart. The data can help us do that.

CSS Summit 2014 Slides: Making Your Site Printable

This post originally appeared on my blog on July 15.

CSS Summit

This afternoon I awkwardly stumbled through my talk for CSS Summit, Making Your Site Printable. I can tell you that speaking to a screen instead of to a room full of people is a whole different experience than I was expecting. Fortunately for you I do not have an audio/video recording. I do however, have all the slides.


Making Your Site Printable: CSS Summit 2014 from Adrian Roselli


Links to resources referenced in the slides (in the order they appear):

Ticket Giveaway

I’d like to note that thanks to the generosity of CSS Summit, I was provided with two tickets to today’s talks that I could give away as I saw fit. I opted to offer them to two deserving young women from the Buffalo chapter of Girl Develop It (neither heckled me):

The Twitters

Finally, one of the novel things about an online conference is that attendees seem to be more active on Twitter. I got feedback and questions, and even fielded a few sub-tweets (I happen to know the print styles aren’t glamorous, but most of the fundamentals aren’t). I’ve collected the tweets in a Storify, which I have embedded here:

Update: July 21, 2014

Based on the activity from these two tweets alone, I am really hopeful that web developers are starting to see that print styles have value and belong in a responsive workflow. Only time will tell. The tweets: