Category Archives: Health care

The other 2/3: Health, education and IQ

Rozelle, Scott, & Hell, Natalie. (2020). Invisible China: How the Urban-Rural Divide Threatens China’s Rise: University of Chicago Press.

I have been to China once or twice every year since 2004, teaching at the BI-Fudan MBA program. As everyone else, I have observed and been impressed with the incredible development that has happened since then. When I first visited Beijing in 1995, there was a dirt road from the airport to the city. Now, of course, it is a highway with at least four lanes in each direction. I have taken the high-speed train between Shanghai and Beijing several times, and have been impressed by the sheer energy of Shenzhen, China’s Silicon Valley.

But there is another China that you seldom see. With the exception of a trip to Lijiang and an unplanned taxi trip to a small village outside Shanghai, I have never really seen rural China – the roughly 2/3 of China subject to hukou, a policy that disallows migration from rural to urban areas.

As Rozelle and Hell writes in this book, China has grown into an economic superpower in record time, but its public health and education system has not kept up. Children in rural areas are subject to malnutrition (chiefly iron anemia), intestinal parasites, and uncorrected myopia. Couple that with lack of intellectual stimulation at a very early age, and you get a large portion of the population that will be largely unemployable as China’s manufacturing jobs are automated or move to other countries, and construction jobs disappear because, well, everything has been built. This puts China in danger or ending up in the middle-income trap, along with countries such as Mexico and Brasil.

I remember visiting Ireland – a country that has become rich from a rather poor starting point – with students at the end of the nineties, in the midst of the Irish economic miracle. The country attracted investments because it had very little bureaucracy, low taxes for foreign corporations, but most of all because it had a highly educated, English-speaking work force. As one IBM manager put it: The country was “so poor that the only thing we could afford was education.” In an economy built on knowledge and innovation, you need a large portion of the workforce with skills at least at a high school level. Given the health and cognitive challenges in rural China (not to mention as many as 40 million lone males as a result of selective abortion) China simply is not geared for that, outside the urban areas.

This can, and must, be fixed. Some of the remedies – multivitamins, glasses, and deworming tablets – are relatively cheap and easy to implement. Training a child, especially one from an environment with little intellectual stimulation (a consequence of many children being reared by grandparents with a background in subsistence farming) up to high school levels takes 12 years, and presupposes that the child is capable of learning how to learn.

Rozelle and Hell stress that the central government is moving in the right direction, making basic education free and repurposing the “one-child” control bureaucracy towards ensuring better child care. China is a rather well organized country, and central campaigns for change tend to work. But does China have the time needed? It worries me that Xi Jinping apparently has outlawed the term “middle-income trap” (along with images of Winnie the Pooh), afraid of the apparently necessary transition to more democracy that inevitably will come from a better educated population. Possible disasters (civil war, outward aggression to deflect attention from internal problems, mass criminality a la Mexico) are many. China’s leadership and communist party has to a large extent been based on meritocracy, but as Adrian Wooldridge writes in another highly readable book, the signs of cronyism are already there.

This could end ugly.

SmartHelp: Locating employees in a crisis

If there is a crisis – do you know where your people are?

Imagine the situation: An event (terrorist attack, industrial accident, public transportation accident) of some proportion happens. Many people are hurt, lots of rumors abound, emergency services are responding. Almost immediately, the question arises: Are any of my employees affected by this – and do they need help?

At present, most organizations locate their employees by calling them or sending emails. This is slow and ineffective – when Norway was hit by a terrorist bomb in the Oslo city centre in 2011 during the summer holiday, it took one of the large newspapers more than two days of frantic telephoning to find all their employees. Most of the employees were, of course, just fine, but the company still had to locate them all. In such a situation, knowing who is not in danger quickly is very important, because it lets you concentrate resources on those who need help.

Smarthelp Decision Support, the emergency service communication platform, allows an organization to quickly – within minutes – determine where its employees are and whether they need help. Smarthelp does this while maintaining privacy of the individual employee.

Most large organizations have a system where employees register where they travel on business. For this service to work, the employee has to remember to update it, though for some companies, this happens automatically if they purchase their tickets through a specific travel agency. While this may help, people travel for pleasure, deviate from their itineraries, forget to register their travels, and purchase their tickets from the cheapest, rather than the official source. Consequently, nobody knows where they really are.

SmartHelp Decision Support (see picture) allows the company to set up a geographical area surrounding the event, and contact all their employees (based on lists of telephone numbers) to determine whether they are inside this area or not.

terroreksempel

Here is another example: You are responsible for security in a large company facility – say, an office building. The company receives a bomb threat which necessitates evacuating the building with thousands of employees. If the employees have SmartHelp on their phones, you can communicate with them all, and determine whether they (or at least their smartphones have left the building (limited by GPS accuracy). You can define a rallying point or area and get an automatic message as soon as someone enters the area, allowing you to quickly determine who is not accounted for. (At this point, GPS location – which we use – does not allow precise location inside a building, but that could change as WiFi locationing services get better.)

rumorsparisAnother advantage is information: In the November 2015 terrorist attack in Paris happened, there where (as is usual) lots of rumors circulating in the hundreds of thousands of Twitter messages and other social channels. With SmartHelp, the authorities would have been able to send targeted messages to specific areas, conveying a precise and autorative message across a cacophony of noise and misinformation.

SmartHelp works anywhere in the world where there is mobile reception (I have used it to signal my position to my host in Shanghai, for instance.) Privacy is handled through an ingenious cryptographic architecture that is secure and fast – the platform is certified for the medical information under the Norwegian data privacy laws, among the strictest in the world.

If you want more information, please contact me or Fredrik Øvergård, CEO of SmartHelp.

(I am on the board of Råd AS, a company that has developed the platform SmartHelp for Norwegian emergency services, allowing shared situational awareness, communication and privacy. The company is now seeking customers and collaborators outside this market.)

Smarthelp is a platform technology consisting of, at present, three elements: Smarthelp Rescue, an app for iPhone and Android that allows users to transmit their position to an emergency service; Smarthelp Decision Support, a decision support system which allows an operator to locate and communicate with users (both with the app and without), and Smarthelp Secure Infrastructure, a granularly encrypted communications platform for secure, private communication. If you want to see how the system works in a 911 central situation, see this video:

Hans Rosling in memoriam

Hans Rosling died from cancer this morning.

Not much to say, really. Or, maybe, so much to say. I met him in Oslo once, I had seen his video and suggested him for the annual “big” conference for movers and shakers in Oslo. He came and wowed everyone. Simple as that.

Here is another one (this one in Swedish) where he just shuts down a rather snooty and ill prepared newsshow host by saying, essentially, “this is not a matter of opinion, this is a matter of statistics and facts. I am right and you are wrong.”

What a man.

Accenture and connected health

(Notes from an Executive Short Program called Digitalization for Growth and Innovation, hosted by Ragnvald Sannes and yours truly, in Sophia Antipolis right now.Disclaimer: These are my notes, I am writing fast and might get something wrong, so nothing official by Accenture or anyone else.)

Andy Greenberg is relatively new to Accenture, having a background in various technology companies involved in health and fitness monitoring.

The Internet of Things is the next era in computing, we are moving to the second half of the chessboard, Moore’s law is still active. Everything gets faster all the time, sensors cheaper, more and more connections and kinds of connections becoming available. A lot of the data growth has been driven by sensors. Smartphones everywhere, but can’t be assumed in the health space.

We need to capture the data, and we can’t send it all away – so we have to do data analytics on the edge, i.e. do analysis right away. You have to think about some things, such as engineers designing for engineers is not a good thing, and that if you can do something – such as connecting a device – it does not necessarily mean that you should do it. However, there will be 25 to 50b connected devices in the next few years – and it can deliver value. Tesla, for instance, can update its cars  instead of recalling them, improving customer satisfaction and saving money. An Airbus can send messages about needed parts, in the future they will be 3D printed at the airport before they land. There is a large gap between how many CEOs think IoT is important and how many have any kind of capability to do it.

IoT has enormous potential in health care. We have an aging population – and that is true of the health providers as well. Patients have different expectations: “health consumers are becoming consumers, comparing their experience not to the last doctor’s visit, but the last time they bought something on Amazon”. Spending on healthcare is increasing, as is the number of connected and connectable devices.

IoT enables connected health services, including merging the experience at home and at hospital, feeding data from home and feeding treatment from hospital to home after a hospital stay. The key is to understand the complexity of where people are at different times and manage accordingly, as opposed to thinking that they are either one kind of patient and another – we are all different types of patients at one time or another. Key is to focus on preventing readmission to hospital, but there might be more value in managing the healthy population – focusing only on the high risk patients may not be the right strategy. (Dee Edington – Zero Trends). It is not just about getting the ill well, but keeping the well well.

Moore’s law works both for fitness devices and medical devices. For fitness devices, wireless offloading of data makes a real difference, the holy grail is when the data offload disappear completely, if something monitors you all the time and alerts you to do something then you are more likely to use it. Medical devices have been more about diagnosis, now moving into monitoring and adherence. Proteus Digital Health, for instance, has a smart pill that monitors that it is being taken, for instance. Problem is that you need to wear a patch, and the first drug it is being applied to is one for schizophrenia – in other words, the patients that are most likely to be paranoid… There is also work done with smart devices, such as asthma inhalers, which can track how much it is used, geolocate, match to other people using inhalers same day, track pollen count etc. Find covariation from individual and communal data.

Healthcare players need to understand consumer expectations – Disney spent more than one million on wristbands to make the interaction with their parks much more frictionless. Healthcare providers should do the same thing – help their patients navigate through their services – including hospitals – to make the experience more seamless. This is happening in the pharmaceutical space: About half of all presecriptions are either not filled or taken incorrectly. Some names: Gecko Health, Propeller Health, Adherium, Inspiro medical.

When you add connectivity to the mix, it changes everything. One challenge is that even though the value is clear, the person receiving it may not be the one paying for it. This means that many device innovations are seen by their creators as a way to be unique, that will change over time because the value is much bigger of things being standardized and more widely distributed. You also need to standardize to the lowest common denominator from a connectivity perspective. Security is obviously an important issue as well.

Q: How do you make a secure app, how do you handle security?

Andy: Only a minority has a code on their phone, so you need a separate login. Security has be be part of the design from the very beginning. The biggest piece of guidance is to understand that.

Q: Can you see health care become completely digitalized?

Andy: Health care will always have a large human element, and there are huge hurdles in interoperability, but in between 5 and 10 years we will see significant action. The technology is not the problem any more, it is all about adoption.

Francis: We are stuck in a fee for service model that is, in my opinion, broken. Should move to a value model, and digitization can help with that.

Q: Where will we see the first real use of it?

Andy: Already seeing that, pockets of it. Maybe the most interesting and recent adaptation is the use of telemedicine about mental health. The VA hospitals are doing that to allow face-to-face conversations with clients with mental health issues. The key here is having payers pay for this as legitimate treatment. Remote monitoring is coming along. Change in payment models and health plans that change prices if you carry a device also drives this.

Q: The nordics are a bit of digital laggards – what will happen here?

Andy: The nordics tend to be ahead in technology and behind in business models. The aging population is a driver and Asia is a big area for that. Regulatory constraints are going to be a big hurdle, some countries are so high on privacy that they make it almost impossible to even try. Payment is important – if governments say they are willing to pay for making the elderly stay home longer, then it will come.