Meaningful Use – The Math behind Health I.T.

The healthcare industry is in a mad rush to get up to digital speeds and to become relevant in the new world of ObamaCare.  The impetuousness came with ARRA (American Recovery and Reinvestment Act of 2009), when the federal government offered to pay medical practices and hospitals the money to upgrade their Health information technology (health IT) if they qualify under Meaningful Use (MU).  It is an investment our government is making that should also provide a healthy return.

The United States spent more on health care per capita ($7,146), and more on health care as percentage of its GDP (15.2%), than any other nation in 2008 and in December 2011, the outgoing Administrator of the Centers for Medicare & Medicaid Services, Dr. Donald Berwick, asserted that 20% to 30% of health care spending is waste.  This waste comes in the form of over-treatment, failure to coordinate care, administrative complexity, burdensome rules and fraud.  So with the government making such an admission, it means they are desperate to see a more efficient system, where tax dollars are no longer lost in the shuffle.

The waste they hope to dispel comes in the form of proactive efficiencies that will help providers reap benefits beyond getting money for an upgrade; reducing errors, increasing the availability of records and data, providing reminders and alerts (making healthcare more proactive), providing clinical decision support, and by automating the process for prescription medication. As redundancies are reduced, costly errors decrease.

What is great about this is that while the Federal government is bankrolling this process, they are not micro managing.  This allows the free market inventors to solve the problems in a way that streamlines the process and really works for medical professionals who will be shopping around for the best solution.

To give you some idea of the math involved: ARRA authorizes a net $27 billion in spending to support EHR (electronic health records) adoption through 2017.  In perspective, it’s a shadow of what is spent annually on healthcare by the US Government.  Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) – together accounted for 21 percent of the budget in 2011, or $769 billion. Nearly two-thirds of this amount, or $486 billion, went to Medicare, which provides health coverage to around 48 million people who are over the age of 65 or have disabilities. The remainder of this category funds Medicaid and CHIP, which in a typical month in 2011 provided health care or long-term care to about 60 million low-income children, parents, elderly people, and people with disabilities. Both Medicaid and CHIP require matching payments from the states that will also benefit from the stimulus.

If the $27 billion spent on EHR eliminates only 5% of the waste, a conservative amount for the sake of argument, the US Government will save $38.45 billion annually.

Is there a downside?  As this data becomes more digitized, privacy advocates are rightly paying attention.  But MU requires that the facility “conduct or review a security risk analysis per 45 CFR 164.308(a)(1) and implement updates as necessary and correct identified security deficiencies as part of this analysis.”  In other words – they must be compliant with HIPPAA, a topic for another future post

There are always risks with such an overhaul – but the math involved makes an extremely compelling argument in favor of Meaningful Use dollars.

Whiteboard-IT creates custom software for many industries, including the healthcare industry.

One Tool That May Keep You Relevant

Last week I wrote about PhoneGap in the context of how I believe it could make mobile development more available to small business.  This week I am writing of another equalizer which can work cooperatively with PhoneGap, and allows mobile friendly sites to be developed without the need for a native mobile application. This provides developers with a write less – do more environment and can buy time for small businesses, hesitant to take the plunge.

Though we are seeing small businesses loosening their development dollars, the mindset of austerity from a down economy is still ever-present.  So as the number of electronic touch-points increases exponentially, the money allocated to keep pace is still being doled thoughtfully and efficiently.

I give you JQuery Mobile(JQM); a turbo boost for your development dollars that gets you to the mobile environment while developing for the web.  Because mobile is quickly becoming the first-screen customers see, businesses can no longer ignore applying effort in this area.

Also notable is the fact that mobile and small screen size are no longer one and the same.  With giant phones like the Galaxy S3 and small tablets like the ipad Mini, net tops, desktop replacement laptops etc, it’s really important to utilize screen real estate, or lack thereof properly, and custom targeting will never get it right.

What happens when you custom target a desktop, then minimize the screen and drag it into the corner? Unless your site is reactive then it will not produce a good experience. Prioritizing columns and replacing icons can provide a great experience without having to custom target screen resolutions.

Still, it’s one thing to develop a mobile app and another to be mindful of the mobile environment. While many business owners are deciding if an app is the way to go, they can now buy time to ponder the question. One way to do this is to bring your website to its lowest common and most efficient denominator, something JQM is helpful to do.

JQuery is the brainchild of John Resig, and is the most popular Javascript library used today.  Its mobile version works with all popular smartphone, tablet, and desktop platforms, and is very easy for a developer to use.

The world now thinks of a website as more than a virtual directory.  And with Google’s emphasis on recency and relevancy of content, websites have much more information from which to cull, which is not always practical for smaller screens.  To help solve this, JQM provides responsive tables that allows developers to prioritize columns  and use abbreviated headers on the page so that only crucial information is displayed.   This releases the pressure on the decision to go mobile and allows you to concentrate on when to go full throttle with a mobile app.

When do you do this?  When you are ready.  It takes a plan that weighs cost vs. profit, and has a good marketing strategy, a good design, good content, and a desire to invest your brainpower – your most important asset.




The Mobile Savior of Small Business

Among the radical changes in the recent world is the impact of mobile devices on modern society.  Quickly becoming the first screen of information for everyone, mobile apps are even being used by the electronically resistant senior population who has found convenient use of large-print apps and the ability to maintain closer contact with grandchildren.  We have seen such a great shift in the past five years so that even the shortest elevator ride has people pulling out their phones to manage their lives.  This poses opportunity, as well as, challenges for businesses trying to stay ahead of the pack.

Big business has been the first mover with custom mobile apps that segment services to their simplest form.  With a few clicks on an iPhone, anyone can re-order medication, purchase movie tickets, or find their way using GPS technology.  To the small businessman, mobile apps are still something to put-off developing because it adds to the development budget, and they resort to mobile friendly sites that only require one build.  This means developing web apps with a width of less than 960 px and reducing the number of pages that display on mobile devices.  A true mobile app requires additional development dollars, but is native to the mobile device, even using geo location sensors and maps.

There are also more challenges involved with mobile apps because, just as web applications must function in multiple browsers, mobile apps must also function in multiple mobile frameworks (iPhone, Android, etc.), adding to the burden and cost of development.  For all the trouble, most small businesses throw in the towel applying their efforts in things they understand.

A new friend has come into the development community, and it has the potential to narrow the gulf between small and large business.  PhoneGap is a free and open source framework that allows you to create mobile apps using standardized web APIs for the platforms you are most likely already using.  That means, without needing to write code in a new language, developers can continue in their native environments, like HTML, CSS, or JavaScript.  PhoneGap will then recompile the code, turning your web app into a mobile app that runs on IOS, IPhone, IPAD, Android, Blackberry, Windows 7, Web.O.S, and Simbian.

Adobe saw the potential and invested heavily in PhoneGap as part of their plan to compensate for FLASH Players fading relevance.  They have put this service into a pretty package and are adding services such as compiling your code in the cloud, which ultimately improves consistency and offers convenience to the developer. They sell it simply:

Build great apps powered by open web standards. Cut down on development time by re-using your existing web dev skills, frameworks and tools. Get all the benefits of cross-platform development while building apps just the way you like.

Developers should be paying attention because they can use their existing development team without the need to find or create mobile specialists.  It also allows the ability to incorporate sensors, like geo location and cameras, which are native to the mobile environment.

Small business will love this because it simplifies their development strategy and gives them wider access to their customers.  It makes mobile development affordable for everyone and could very well equalize the playing field between big and small business.   For this reason, we are paying close attention to PhoneGap and hope to add it to our list of services very soon.

Understanding the lifetime value of a project

When calculating the value of a project, consider the lifetime value of a client

Early in my career as a freelancer, I would look back on projects that went way over budget on time, and when eating a large portion of my time I would tell myself  “I’m never doing that again”.  However, on the very next project I would fall back into my old habits of trying to make sure that the customer got what they wanted for their budget.

Many times looking back, I considered this a business error.  After all, how can I make any money if I flush it down the drain by going over budget and eating a large amount of my time on every startup project?  Time and time again on new projects, I would add unnecessary features early in the project, and then late in the project regret it because of the non-billed time I spent in order to close the project out to the client’s satisfaction.

Lately however, I’ve looked back upon my career and a successful application lives on, grows and needs to be nurtured and enhanced.  Some of my biggest failures on the initial project have virtually made my business.  Without giving any numbers in particular, I’ve had several projects that, over the lifetime of the project, have provided revenues of over 70 times the initial project costs.  Now with this comes a great deal of service, but after all, that’s what we sell right?  And unlike the initial project, where there is usually some risk with the client, add-ons after the project is a success are typically a no-brainer.  Adding a report here or a time-saving action there provides immediate quantifiable value, and is usually an easy target for us to stay on budget.

It’s so important to make sure you get to the finish line with relationships intact, even though at the end of it you may be so tired of the project that you want to rip all of your hair out and go be a greeter at Wal-Mart.  I think this is where a lot of freelancers and businesses fail.  At the end, they are so frustrated with the project and client relationship that they are ready to move on to something and someone else, where they swear they will not make the same mistakes.

With a focus on the life of the relationship, it has taken the pressure to avoid eating the cost of some overtime on the initial project off of our chest, and allowed us to focus on the long term goals of the client as if they are our own.  After all, their success is our success and embracing that has made all the difference.