New Report on Digital Health Technology for the Underserved

A new report from Jane Sarasohn-Kahn for the California Health Care Foundation (, Digitizing the Safety Net: Health Tech Opportunities for the Underserved, canvasses the digital health technology landscape through the lens of connecting healthcare to social determinants of health (SDOH). In Jane’s inimitable style, she combines reviews of some notable digital health solutions with analysis of the key drivers of this emerging area. (Note, in my last blog I named Brian Ahier and Lisa Suennen as two of the best analysts & writers in healthcare; Jane is the beacon who sets the standard so that others of us aim high!)

Three key trends shine through for me:

  • Encouraging signs of consumer marketing best practices are beginning to appear in healthcare marketing (e.g., understand your audience; segment the market & match the message to the segment; use technology that is appropriate for the segment)
  • Recognition by the medical community that social determinants of health (SDOH) play a significant role in health and health maintenance.
  • Change in payment models from fee-for-service to models that reward patient-centric care coordination is the ultimate driver of change in healthcare.

I highly recommend reading and bookmarking this report, which is available for download here:

Follow Jane on her blog,, on Twitter @healthythinker and as part of the Social Media Ambassador list for the upcoming HIMSS conference, #HIMSS16


HIMSS16 Planning

 I am extremely pleased to announce that I will once again be a Social Media Ambassador at the HIMSS Annual Conference, which takes place February 29 - March 4 in Las Vegas.

This year, the theme of my posts before, during and after HIMSS16 will be the effects of the maturing of the health IT segment on the start-ups, EHR/EMR vendors, other established IT vendors, and analytics companies of all types that populate the HIMSS exhibit hall. 

As you might expect, there will be both good and bad news for health IT companies, depending on one’s perspective. My first post will build on recent trends that were highlighted at the JP Morgan Healthcare Conference in San Francisco. Fortunately, other industry experts have already covered the details of trends and announcements made at the JPM conference & associated events. You can check out Lisa Suennen’s blog post that manages to weave a David Bowie theme into her account of the event: and Brian Ahier’s post: to get a well-rounded view of major developments at JPM from two of the industry’s most knowledgable insiders and best writers!

Speaking of the industry’s best, here is the official announcement of the HIMSS16 Social Media Ambassadors, a group that I’m very proud to call colleagues and friends:

I’ll be posting more information about the HIMSS16 conference in the run-up to the event, so please check back here or contact me at: if you want to schedule a meeting at HIMSS16.



An Economist’s End-of-Life Wishes: One-Hoss Shay Depreciation

Aging in place and end-of-life care were among the hot topics at the Partners Connected Health Symposium last week, which reminded me of comments I have made in the past regarding the ideal “one-hoss shay” method of living well for a full lifetime until a quick sudden death occurs.

Let me explain. Early in my career, I worked at the Urban Institute for an economist (Charles Hulten)  who specializes in depreciation theory and productivity analysis. We held a conference and published a book with the incredibly sexy title, “Depreciation, Inflation & the Taxation of Income from Capital”. Sounds like a pager-turner, right?

Well, one of the fun things I did to prepare for the conference was to go to the rare books section of the Library of Congress to find a copy of Oliver Wendell Holmes’ poem, The Deacon’s Masterpiece, or the Wonderful One-Hoss Shay: A Logical Story. I wanted to use graphics from the original book for the flyers we printed for the conference. (Note, shay is a anglicized word for  the French word ‘chaise’, which refers to a carriage; hoss is simply the way some of us in New England pronounce the word “horse”!).

The field of economics uses the term “one-hoss shay” depreciation to describe assets that retain their useful value until they rapidly fail (like a lightbulb).  

In the poem, the deacon constructs his one-hoss shay in such a balanced and logical way so that no part represents a point of weakness:

For the wheels were just as strong as the thills,
And the floor was just as strong as the sills,
And the panels just as strong as the floor,
And the whipple-tree neither less nor more,
And the back crossbar as strong as the fore,
And spring and axle and hub encore.

Nonetheless, exactly 100 years after it was built, the carriage succumbs to the decay of old life:

And yet, as a whole, it is past a doubt
In another hour it will be worn out!

First a shiver, and then a thrill,
Then something decidedly like a spill, —
And the parson was sitting upon a rock,
At half past nine by the meet’n-house clock, —
Just the hour of the Earthquake shock!
What do you think the parson found,
When he got up and stared around?
The poor old chaise in a heap or mound,
As if it had been to the mill and ground!
You see, of course, if you’re not a dunce,
How it went to pieces all at once, —
All at once, and nothing first, —
Just as bubbles do when they burst.

End of the wonderful one-hoss shay.
Logic is logic. That’s all I say.

As you might guess, my interpretation of the poem lends itself to anthropomorphizing the shay to the human body (remember Holmes was a physician and a medical reformer:,_Sr.#Medical_reformer.2C_marriage_and_family)[1]. In brief, in my view, the ideal scenario for end-of-life is a quick catastrophic end that punctuates a long healthy life. We can’t all avoid disease, but we can follow the deacon’s playbook and attempt to keep our bodies in balance and as healthy as possible as long as possible.

Would you say our current healthcare system is optimized for one-hoss shay depreciation, which requires an emphasis on preventive maintenance so that our bodies don’t “break down” but rather “wear out”? I know my answer to that question.  The more important question is: how do we change the current system that resembles a repair shop more than it does a health maintenance system?

Just the fact that we’re addressing end-of-life issues as major themes of healthcare conferences like the Connected Health Symposium and the fact that end-of-life issues are being raised in mainstream media indicate that we’re making progress.


I recommend this YouTube reading of The Deacon’s Masterpiece by Eddie Arnold (some of you may remember him as Oliver Wendell Douglas from Green Acres!):




[1] Reading this part of Holmes’ biography led to me check for references  to Holmes in Thomas Goetz’ new book, The Remedy, Robert Koch, Arthur Conan Doyle, and the Quest to Cure Tuberculosis, which I purchased at the Connected Health Summit. Indeed there are references to Holmes (not just Sherlock) in the book and there are obvious connections between the two Holmeses. 


Health Data Management Top 16 Health IT Experts List

Health Data Management Magazine is an obvious go-to source for me, given my focus on developments related to the sources and uses of health data.  

It’s gratifying to see that the feeling is mutual. HDM Magazine recently published a list of 16 Experts on Twitter Who are Leading the Discussion in Health IT and included me among some highly respected peers.

Any curated list is going to leave out some equally good candidates. Every time a list comes out, people who aren’t included tend to call out bias in the selection process. There’s always bias. But, as a publication that is well-versed in editorial curation, HDM Magazine does an excellent job of selecting a core group that is consistent in their focus on health IT and data-driven developments in healthcare and are known for providing a good deal of context around the issues. Better yet, the group includes a range of perspectives from within provider organizations, health IT vendors, patient advocates, government agencies, analysts, start-ups and research foundations. Despite the different perspectives, this group includes people who demonstrate a genuine interest in improving our current healthcare industry (I would say “healthcare system”, but that raises too many thoughts about lack of systems thinking in healthcare).

I don’t know if HDM Magazine made a conscious effort to include an equal number of women and men, but if they did, they exceeded that goal by naming nine women and seven men. In today’s world, that still merits a special mention and a “thank you” from the #HITChicks community!

Here’s the complete list of Twitter handles:

















The list includes some people who have been part of my Twitter community from the beginning (e.g., @ePatientDave @Cascadia and @SusannahFox) and some newer colleagues and friends and a couple of people I should obviously add to my list. 

Note, HDM Magazine created a similar list several years ago of top health IT social media people to follow and John Poikonen (@poikonen)  created a public Twitter list to make it easy for anyone to follow all the people on the list. That list remains one of my favorite lists to scan each morning. Note, John has added a few names to his list, as is his prerogative. In that same vein, I’ve just created a public list with all 16 of the health IT experts that HDM Magazine included on their list and have made two additions: @HDMMagazine and @poikonen! Here’s the link to the public list:


Mom-memorials from #IHeartHIT Session at HIMSS15

Lindy Stotsky, known to many of you by her Twitter name @EMRAnswers, gave a compelling and compassionate account at HIMSS15 of how the lack of access to patient records — by clinicians, patients, and especially family members/caregivers— failed her mother during her stay in a long-term care facility. Her story, appended below, resonated with the audience and led several other people to describe how experiences trying to navigate the healthcare system without full access to information from health records spurred them to become involved in health IT.

I followed Linda with a story of how my mother became interested in examining the data in her health record only after I prodded her primary care practice to provide access, once I realized that they had implemented a patient portal.

It was notable that most of the personal stories from the audience that followed Linda & my brief talks at the #IHeartHIT session related to caring for our Moms. I want to thank Linda for sharing her story here on the Health Content Advisors site.

I Was My Mother’s “Scrap of Paper”

I’ve worked in healthcare over 25 years:  In administration through hospital credentialing and procurement, as a practice administrator shuffling through paper charts, missing codes, and reimbursement in an era of managed care.  It was during this time that my Mother became ill with CLL (Chronic Lymphocytic Leukemia), and COPD (Chronic Obstructive Pulmonary Disorder). My Mother was a staunch believer in Health CARE. She grew up believing that physicians were healers- and that nursing facilities took care of the elderly. Her decision to reside in such a facility began our descent into a world I could not have imagined.

I looked, as most caregivers do, at the inside of the building, the floors, the paint and the aesthetics. We are preoccupied, vulnerable and first impressions are everything. I judged the worthiness of the facility by its locale, the staff and our welcome.  I took for granted that “Nurses” were RN’s, having an MD as Chief of Staff meant he was there every day, and daily living meant more than struggling to survive. I didn’t know about physician track records, medical malpractice and negligence. All blue skies and daisies, until my Mom became a resident. That started our fragile dance between long-term care (LTC), emergency departments (ED), hospital, provider, back to LTC.

Thus began my advocacy. Not just for MY Mom. I was vigilant about everyone’s Mom— policing halls, looking into rooms, and answering cries for help.  I watched my Mother change from a vibrant, confident superhero to a terrified, confused and helpless patient. I took her to providers who placed her on medication, only to bring her back to a facility where medications were routinely discontinued because of cost.

I was “on call” 24/7. My Mom became my mission. My 3 year old knew where all the toys were kept in the ED, as we were frequent fliers.  “AMA” meant no ambulance was ever called. I loaded her, her wheelchair, her O2 tank, and my son into the car, and as I was running out, I grabbed a piece of notebook paper with her medications scribbled on it. This was her medical record. And I was the keeper of the key information.

My Mother passed away after three years of suffering, much of which was preventable. Not only was there a lack of communication, a culture of caring had been replaced by one of cost. Human lives took a back seat to ROI. Instead of treating aging elders with the respect and dignity they deserved after years of giving, nursing homes were nothing more than “death beds” waiting to empty. I was so engrossed in the day to day challenges, that I didn’t have time to stop and think about the larger picture of what was wrong. 

15 years later I am sorry to say that things have not changed much. My daughter recently had Thyroid Cancer. She was eager to use the patient portal to coordinate her labs, multiple tests, from all providers.  It was not that easy.  Information gaps were everywhere; care coordination was still back in the year 2000.  We need patient access. But it’s more than that. We need actionable information. It’s been nearly five years since the enactment of the ACA and little has been done to promote shared decision making. The recent proposed rule change in the Meaningful Use Stage 2 measure related to patient access and downloading of their information[1] will reduce the  threshold for Measure 2 from 5% to “at least 1 patient”  for eligible providers (EP). This change HALTS progress. WE CAN DO BETTER. My daughter is working hard to be a partner in her care, yet she has a toddler, and she’s tired, and sometimes it’s easier to give up rather than continue asking.

 Linda, Regina Holliday and me at HIMSS15

 Please help us win this. Stand up and ask —-demand electronic access to your patient record.  We should not have to carry around a tattered scrap of paper with medical information on it. Join members of The Walking Gallery[2] of Healthcare as we tell HHS, CMS, Politicians and Advocates that PATIENT LIVES MATTER.

My name is Linda Stotsky, and I share my story as a patient, a caregiver, a Mom, a daughter and a Health IT Product Manager. I am currently the Director of Business Development at LogicNets.

 I can be reached at or on Twitter via @EMRAnswers


[2] For information on TheWalking Gallery, see