Can the Compassion of “The Crowd” Reduce Suicide?

HodlerDespondency1887WinterthurA web

Hodler, Despondency, 1887, Winterthur

Something we think a lot about here at Body1 is how to “Connect People with the Health Information that Matters Most to Them”.   In fact, we’ve made that our Mission.   We seek to apply it in our work, and in the ideas which we share.

Here’s one idea.  There’s a huge social opportunity to leverage digital for suicide prevention. Especially so, since suicide is a huge mental health issue that is largely unresolved.   It is a top 10 cause of death in America, 3rd behind only cancer and heart disease in years of life lost.   In the most recent full reporting year (2012), the US Centers for Disease Control and Prevention (CDC) report 40,600 suicides, equivalent to someone dying every 13 minutes.

Given the immediacy of the need and the ubiquitous of smartphones, digital could offer a solution.  A 24 hour/day, 7 day/week, 365 day/year (24×7, 365) app that video links to a trained peer counselor is one possible approach.

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There are some big questions to be answered first, including (but not limited to):

1. How to staff with appropriately trained personnel?
(one approach- could be drawn from a pool of *trained* volunteers with a round robin telephone routing),

2. How to market & distribute
(possibly via health plans, Apple, Google, telco’s, etc);

3. Who funds?
(options include CDC, state Health depts, crowdfunded?)

This seems to us like a wonderful way for digital to contribute to the social good.  Thoughts? Comments?

7 Deadly Mistakes which Kill Templated Medical Websites

Templated sites from WordPress (WP), Magento, and others have become popular.   We at Body1 even deploy these for small healthcare clients launching their first sites.   They are cheap.  They are convenient.  And they can be dangerous.

Here are seven common mistakes that we’ve seen.  We’re often brought in to fixed “shattered” software projects, where a project starts and then cannot finish because of added complexity due to poor planning and unexpected scope creep.

1. Modifying a template without planning. Template-driven systems like WP or Magento are fine but customization adds considerable complexity.  Adding or deleting features changes the overall code base.  Separate parts of the site will break, suddenly incorporate random pieces of code, or reformat the page, among other unexpected issues.  To address this, Body1 systematically scans the entire site in a staging environment after every major code push, with the ability to selectively roll back and adjust potentially problematic changes.

2. Ignoring QC and testing.  The activities of quality control (QC) and testing actually are as important as coding.  Coding is only 50% of successful website or marketing software deployment.   Once a site is coded it has to be thoroughly checked and the code updated to fix issues.  This step is often skipped on templated sites- and then the owner is surprised when the site breaks.  Automated link checkers, load simulators, and browser emulators are useful tools.  On sites Body1 builds we use such tools to check issues prior to launching but inevitably there are still issues which can only be caught by a smart pair of human eyes.

3. Not deploying a separate “stage” site.  It’s easy to develop in a folder on the planned live site.   It’s harder to set up a separate, password-protected “staging” site with a process to cleanly copy the files over to the planned live site.  But that is best practice.   Completely separating the development from the live code ensures that:

  • all the functionality can be confirmed as working before deployment,
  • code in the development & live folders does not conflict, and
  • issues in deployment can be quickly and easily fixed.

4. Ignoring the hosting environment details.  Understanding and control of the hosting environment is critical to successful programming.  Issues in hosting often cause problems with the site performance that masquerade as software problems. This is why Body1 controls its hosting environment.  We were called by a panicked customer with a Magento site (eCommerce web template from eBay) whose log-on was failing and their “Magento programmer” couldn’t figure it out.  It turned out it was caused by the host running out of disc space (see below).  Without disc space the programs will fail.  This was especially acute for this eCommerce site where there was a 4gb catalog and multiple development folders.

5. Hiring a low cost developer to start with a quality development team on stand-by.   This is the classic “penny-wise, pound-foolish” trap.   Coming in to clean-up in a crisis situation is not ideal for anyone.   Starting with a low cost developer (often one with heavily discounted rates who works out of state or overseas but is “always available via Skype”) is a sure way to slow or break your website.  Such a process also ensures that a high quality development team will have to be brought in at the last minute, on a rush basis, to decipher code and re-architect a site under intense deadlines.  Since it is always more complex and takes longer to unravel someone else’s code, problems are invariably missed.  This results in the development process being more time consuming and expensive.

6. Retaining the cheap talent to work on perceived “easy parts” of the website while the top talent fixes the problems.  This is the classic “Too many cooks in the kitchen spoil the broth” situation.  We’ve seen firms do this to try to reduce costs on shattered projects.   However it inevitably ends up not being cost-effective as the coordination needs increase significantly and the coding efforts end up conflicting.  If the project is “shattered”, the cheap outsourced programmer costs, rather than saves, money.  Using a top development firm on a templated site facilitates control of the hosting environment, properly staged projects, and leverage of automated testing tools and QC.

7. Eschewing site monitoring and maintenance after launch.   A templated site is not a high-availability site, nor is it fool-proof site.  Automated monitoring and planned on-going maintenance of websites is valuable.  This is especially so for healthcare sites.  Automated monitors can detect problems before they before obvious to the end user.  Monitors even can be set up that follow every order through the purchase funnel for sites selling health products or services.  Besides real-time QC, those monitors then provide a tool to analyze consumer buying behavior.

Maintenance plans allow these problems to be fixed proactively without impacting the their live environment.  Because web browsers (such as Explorer, Chrome, Safari, and Firefox) and operating systems (such as Windows, OS, and Android) evolve, it is inevitable that the unmaintained templated website will break.  A good rule of thumb is to allocate 20-25% of an initial web budget to ongoing maintenance.

Avoiding the 7 deadly mistakes of templated medical websites is not hard.  A little forethought, a dash of prudence, and the willingness to invest initially is the best way. Besides on time and on budget website launches, there is an added benefit- maintaining one’s own emotional equilibrium.

Chris Messina

Gene Tests, Delivery Drones, & Avoiding Regulatory Meltdowns on the Web

There are some interesting parallels in the FDA’s recent action telling the firm 23andMe to “cease & desist” all marketing of its personal genomics test with the recent news about Jeff Bezos and the Amazon “delivery drones”.  Both are new technologies which will require regulatory understanding and adaptation.

However, by contrast, Amazon has floated (figuratively & maybe literally…) the drone idea, launching public discussion and regulatory contemplation.  By contrast, 23andMe blazed ahead.  Brave? Hubristic? Both?

The FDA’s approach is almost always to prioritize the prevention of harm.  Is there potential harm (like unnecessary prophylactic organ removal) from misinterpretation? Probably.  Can it be mitigated?  Surely, but the FDA will want to be part of crafting the solution if it’s potentially accountable for the potential harm.

My experience running an orthopedic device firm taught me that firms consult with the FDA retroactively at their peril. Even now it is surprising how few medical & wellness firms have a regulatory control process in place for public-facing web content and mobile apps.

What are the practical lessons here?

  1. Both are new technologies, which will require regulatory understanding and adaptation.
  2. Both are best served by proactive vs. reactive regulatory engagement
  3. Amazon has approached the regulatory environment more cleverly by “floating” its idea early.
  4. It’s possible to re-engage after facing regulatory problems, but more difficult.
  5. Inadequate or missing systems for regulatory content management is another area where many firms fail.

I hope 23andMe works things out with the FDA. It would have been far better to fully engage them earlier, but there is still hope.

Chris Messina

Deciphering “Cyber Monday”: 5 Lessons for HealthCare CEO’s

There are five valuable lessons from the phenomena-turned trend “Cyber Monday” for healthcare executives. First, Cyber Monday shows that anything can be marketed online, including healthcare. Second, demographics say that your audience will be online that day. Third, an effective web presence is critical in determining your success. There’s more; let’s get started with a story…

Like most, my e-mail box was flooded with “Cyber Monday” deals and offers. There were the usual “Get away to the Sunshine” travel and “Stock up NOW for Christmas” gift offers. However, more interestingly, strewn among the “Beethoven’s 7th Symphony (42% off) and Leather Custom Photo Books (72% off) was a whole new class of sellers.

For the first time healthcare information and service offers were prominent. Harvard Medical School promoted its Health Reports at 20% off for the remaining 8 hours of Cyber Monday. There were local yoga, massage, and kick boxing class specials. More esoteric was the offer from Advamed, the trade association of large device manufacturers, offering a one-time Cyber Monday special of 20% off of courses ranging from “The PMA Process”  to Molecular Diagnostics and the Changing Landscape: Considerations and Implications”. In short, there were a lot of healthcare offers and they ranged widely.

Cyber Monday is the little brother to “Black Friday”, the deal-filled day after Thanksgiving. However as often happens with little brothers, it is on the way to dwarf its big sister. In-person live transactions are shrinking; the National Retail Federation (NRF) reported that Black Friday in-person retail shopping fell for the 1st time ever in 2013- by 4.1%. By contrast, online transactions are growing. What are the big five “take home” lessons?

Lesson 1-Whether it is a good, a service, or information, Cyber Monday shows it can be sold online. Some of the fastest online sales growth rates are in service and information segments. That means that virtually anything can be promoted on Cyber Monday. However, chose your audience well. A deal on birth readiness classes in Seattle will not do well if promoted to seniors in Miami.

Lesson 2- Your specific audience, even if highly targeted or very local, is online on Cyber Monday. It’s not a fad anymore; 131 million Americans are estimated to go online shopping this Cyber Monday (52% of the US adult population), a 2% annual increase. Morever, they are projected to purchase 36% more goods, information and services this year than last Cyber Monday, according to analytics firm comScore.

Lesson 3- Beyond selling products and services, Cyber Monday can be leveraged to drive awareness for your mission. Even politicians have discovered this; this year the Republican National Committee (RNC) promoted Ronald Reagan lithographs at a Cyber Monday special 15% off, while a Democratic Campaign Committee touted a Cyber Monday promo of Elizabeth Warren wearables. In the healthcare world, promoting mission awareness is critical. For example, Advamed’s mission goes far beyond selling technical healthcare courses; they are promoting courses on Cyber Monday to raise the profile and impact of the medical device industry writ large.

Lesson 4- Your website needs to be prepared for Cyber Monday. A Healthcare.gov-type failure would not only hurt sales, it would impair credibility. Has your web presence been strategically planned, and is it regulatory-compliant? Demand to honest responses to the question, “Can our site(s) handle ten times its normal load?” Have your sites been “stress-tested across multiple platforms by a credible third party and have you seen the results? Is the user-experience friendly and consistent across varied browsers? Is there an accountable leader for each site?

Lesson 5- Your web presence must be mobile-friendly, on both Cyber Monday and beyond. Somewhere between 1 in 5 (comScore) and 1 in 3 (IBM) of all users will access sites this Cyber Monday from mobile platforms- smart phones & tablets. Deploying “responsive sites” or sites which auto-detect mobile access and reconfigure accordingly is critical. Body1 has a Mobilized™ web process that it uses to analyze and deploy health sites which anticipate, detect, and respond dynamically to mobile traffic. Some similar technical audit process should be required by every senior healthcare executive for all of their websites.

Savvy healthcare executives learn from multiple industries. Cyber Monday is a great lesson originating in retail proving that anything can be marketed online, including healthcare. The demographics show that most educated adults are online that day and many are prepared to act. However capturing those actions whether via a sale, a recommendation, or an introduction requires an effective, managed web presence.

“Cyber shopping” may not be for you. However, it is not a fad, it is a trend. As a result, “Cyber marketing” and “Cyber sales” should be top of mind for health and life science leaders—and not just on “Cyber Monday”.

Ground-breaking Doctor Leaves an Extraordinary Legacy Behind

John Ludden, M.D. was an extraordinary man. He was a physician, a business executive, and a teacher who radiated both intelligence and humility, despite holding three degrees from Harvard. He was generous with his insights, only requesting that the recipient in turn share theirs. He was a “pay it forward” guy.

John was immensely interested in how the health care system itself could be improved. He realized early that people and processes were both vital. Many of the best parts of ongoing health reform came out of ideas that John helped pioneer, first as Medical Director at Harvard Community Health Plan, then as Director of the MD/MBA program at Tufts Medical School. He was busy there and as a director at NCQA, the American College of Physician Executives, and elsewhere, but still found time to help an emerging eHealth start-up, (Body1).

John was not only a director of Body1, he was an active contributing creative force. He was intrigued by the Internet’s promise as a means to improve patient care. As just one example, John’s psychiatry experience and insights were the intellectual basis behind Body1’s online depression self-assessment tool. This tool was so robust when it first launched that we had to reduce some of the functionality, as we did not want to “practice medicine online”. But that was classic John Ludden–give what you needed, and then also give some extra.

John died last month but his legacy lives on. I am grateful to have known and worked with him. Everyone at Body1 is. We remember his keen intelligence, his unique grin when a particularly good insight hit him, and his kind sense of humor. In a world where gentlemen are often hard to find, Dr. John Ludden was a consummate gentleman and we are all better people because of him.

Chris Messina, CEO, Body1

Note: John’s family has chosen to support The Great Books Foundation in his memory.

Will the Next Wave in Global Health Care reform be Mobile…and Come from Africa?

Recently I participating in a roundtable discussion with the Harvard Business School Health Care Special Interest Group. Our speaker for the evening was explaining (& pitching) his company, which had developed a tracking approach for identifying which brands of drugs were counterfeit. Apparently that’s a huge problem. That wasn’t the most interesting part.

The most interesting was:

a. how ubiquitous mobile phones are in Africa and

b. how people there are using them to manage their medical care (it’s true consumer-directed healthcare at work)

Seems like we in the US could learn a lot from this simple model. It connects the medical buyer directly with the medical provider. Costs are transparent.   Payment is swift and simple.In Kenya, for example, a pre-paid care for medical services can be purchased and continuously filled. Family members can add to the stored value as a gift and many do. Physicians accept these cards as payment for medical services, debiting the charges as provided. There is acute awareness of which clinical provider offers the “best value for money”. Patients vote accordingly, with their money and their feet.

Professor Clay Christiansen at Harvard has introduced the world to the concept of “Disintermediation”, the idea that over time, simple innovations starting from the low end of the market, end up completely changing and disrupting the market. Given that seminal insight, maybe we in the US healthcare industry should be looking hard over our shoulder at the innovations underway in Africa.

Photo: Erik Hersman