Friday, August 5, 2016

Uncertain Health in an Insecure World – 90

“Lake Daze”

I’m on vacation. Not for the entire month of August, like some fortunate Europeans friends. A mere week away from The City will have to suffice. And even that is half over!

Just what have I learned on vacation?

First55% of American workers don’t take all of their paid vacation.

According to GfK Public Affairs and the U.S. Travel Association, in 2015 we left a cumulative 658 million vacation days unused and $61.4B in forfeited benefits. Why not?? – 28% say that they fear falling behind while sitting on a beach, while 19% think it will help them get a promotion, and 17% fear that they’ll lose their job. When was the last time one of your co-workers was fired on vacation?

Second - you can’t swim in a data lake, no matter how big the data.

Gartner IT defines a data lake as a set of disparate data assets collected in addition to the originating data source. These data assets are stored in a near-identical format to the native source format, for use by experts who can explore data refinement & analytic techniques independent of the system-of-record compromises that are implicit to traditional data repositories like data marts or data warehouses. In the hands of Hadoop wizards, data lakes can eliminate data migrations and data silos, reduce the cost of data transformation, and help to leverage big data analytics.  Given that only 20% of data are structured (orange), the need to direct the flow of the other 80% – big data (blue) – remains critical. Hadoop can mix and manage orange and blue box data together (below).

Without Hadoop, big data lakes are “all water and no substance.”
Thirdvacations can wreak havoc on our personal routines.

On Day 1, I received a Garmin Forerunner 235 fitness tracker as a gift; I’ve been anxiously tracking my pulse rate 24/7 since. Wearable technologies are great motivators. My device lets me program daily fitness goals… hitting a pulse of 165 on the run near my VO2max is a rush! And it prompts me to “Move!” after a brief period of inactivity. Digital health LinkedIn leader Paul Sonnier did burst my bubble by sharing a PCWorld report that hackers love to break into mobile health (mHealth) apps! In recent testimony to the U.S. Congress Energy and Commerce subcommittee, mHealth apps often lack good privacy or security safeguards, creating portals into electronic health records (EHR) where secure information is harder to edit out. With mHealth apps installed in one-quarter of U.S. mobile devices, only a few vendors seek permission before sharing your data. Third parties aren’t yet bound by U.S. federal HIPAA privacy rules, so the potential for exploitation is great, especially when start-ups are lacking the cash to invest in such controls.

So for now, unless I give Garmin permission to save my little data on The Cloud, I’m still in control.

Fourthwe never really leave the job behind.

This week, my patients are being covered by colleagues within my medical group.  The patient portal in our EHR is activated, but like most large health systems, we do not require its routine use. Theoretically, the portal should connect my patients to me (or my office) by email using a convenient, safe and secure on-line connection. This digital health business sector is undergoing massive growth, in an effort to virtually connect patients to providers, or to their own personal health information (PHI). Such capabilities are part of the Obamacare “meaningful use” (Stage 3, Objective 5) requirements, that will soon virtually manage healthcare benefits & payments, provide prescriptions and add appointments. hopes that such enhanced patient access can improve patient outcomes. Unfortunately, a Commonwealth Fund study of a cohort of 7,609 seniors from 2011 to 2014 (JAMA August 2, 2016, Vol. 316m No. 5) shows that these digital health tools do not reach the very population that needs them the most (below). Altarum Institute and Robert Wood Johnson Foundation research indicates that low income and non-English speaking vulnerable populations have unique cultural needs and are less likely to access healthcare information.

Just because you have access to technology doesn’t mean you’re fluent in using a program that’s based in technology.”

Last The best things in life take time.

For example, Quincy Jones’ Thriller baby back ribs recipe recommends eight hours of cooking time. They’re Oprah Winfrey’s fav ( ) and well worth the wait. So I dedicated a whole day to making them, and so should you! On my non-culinary days off, I learned that daytime social media is just like daytime television… lots of POP… and little sizzle. Influencers relay redundant quick-hitting infomercials about political extremes, biological drug benefits, financial planning and healthier life habits. Despite all this powerful new knowledge, I feel pretty much the same – digitally un-transformed.

So when floating away from the Square, there is still some peace to be found, if one is selective and disciplined.

Fortunately, the lake is long and my data network is spotty. 

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