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Introducing � DATA!

May 28, 2010, 10:27 AM, Posted by Steve Downs

Next Wednesday at the IOM, HHS will do a big unveiling of its Community Health Data Initiative.  It will be a pretty big deal – HHS Secretary Kathleen Sebelius, White House CTO Aneesh Chopra and HHS CTO Todd Park will all be on hand and the expectation is that major tech companies will unveil prototype apps built off of some of the data sets that HHS will be making public.

The HHS/IOM event will be web cast, so check it out.  Either of these links should work:


It’s an interesting headline when you step back and think about it.  HHS is making a major announcement – not about a new research breakthrough, a new vaccine, a new Medicare benefit or even a new grant opportunity.  It’s about **drumroll** … **drumroll** ... data!  Seriously.  The bet here is that the thousands (and I do mean thousands) of data sets that HHS maintains could actually support some useful applications – applications we can’t even imagine yet – in the same vein that the weather data produced by the National Weather Service generates so many services and businesses.  To some extent, these data have been available before, but they’ve been hard to get to.  The difference here is that HHS is planning to make access to the data easy and beyond that, make them available in ways that most lend themselves to application development.  It’s a conscious strategy to enable others to add value to these government data.

At RWJF, we’ve had a hand in one of the first major apps – the County Heath Rankings – which plots community health characteristics – for every county in America.  Go to the site and you can find both health outcome data, like premature death, and the social, behavioral and environmental factors that lead to those outcomes, like obesity, unemployment and air pollution.  And you can see how each county ranks on any of those factors compared to other counties in your state.  And the County Health Rankings data has even spawned an irreverent take on the data – the County Sin Rankings – winner of the Sunlight Labs Design for America contest for visualizing health data.  Check out the other contestants, who all offered imaginative ways to present health data to the public.  The point is that the government is not best suited to come up with creative ways to help people understand the health of their communities or the quality of the medical care they receive.  But creative designers, developers and activists, when given access to the data, can do it much better.  Once there’s a good platform, we always get happily surprised by the apps.

I’d love to hear what people think are the most exciting apps that get announced on Wednesday.  And while you’re at it, can you think of a more exciting name than “Community Heath Data Initiative?”

What is the Role of the Physician in a Data Rich World?

Apr 1, 2010, 1:52 AM, Posted by Steve Downs

Last week’s Project HealthDesign workshop, held at the Vanderbilt Center for Better Health in Nashville, focused on how clinicians could use “observations of daily living,” or ODLs – data associated everyday experiences such as diet, exercise, sleep and pain – to provide better care to people with chronic diseases.  The five Project HealthDesign teams are refining their plans to integrate ODLS into the treatment of premature infants and their parents, obese teens at risk for depression, adults with Crohn’s disease and its complications, adults with asthma and depression or anxiety disorder, and elders with mild cognitive impairment.

A presentation by Kevin Johnson, vice chair of the Vanderbilt University Medical Center Department of Biomedical informatics and the project director of a previous Project HealthDesign grant, raised interesting questions about how to present information captured through ODLs and who should interpret the information.  Johnson showed this graph, which represented a self-report of medication usage over a month’s period as compared with a schedule. 


Clearly, any of us can tell at a glance that the patient adheres to this medication schedule extremely well. The presentation conveys this information quite clearly and, frankly, it doesn’t take a great deal of clinical training to interpret the information. But consider two other cases.  First, if this chart showed a much poorer rate of adherence, the challenge would be to look for patterns in the missed, late and on-time doses to see if there were behavioral triggers or environmental factors that explained the results (e.g. a change in work schedule means the noontime dose is problematic, a Thursday evening softball game makes it unlikely to remember). In the second case, one could overlay on the medication chart other data, such as pain level, mood or even clinical signs like blood pressure and look for patterns that might lead to inferences about correlations and interrelationships.

In each of these three cases, one could ask what skills and training are needed to review, interpret and act upon the information (one can even take it a step further and ask which of the cases requires human vs. algorithmic interpretation). Of course, at some level, the answer is “it depends,” but thinking about the question gives some insight into the broader question we’ve been asking of late in the Pioneer Portfolio:  “What is the role of the physician in a data rich world?” I’m not a clinician, so I’m on shaky ground here, but it seems to me that only the third case requires clinical training – because it’s a case that requires integrating clinical knowledge into a pattern sensing activity. It’s a form of clinical problem solving. The second case doesn’t seem to require clinical knowledge so much as an understanding of some concepts from consumer behavior, design or even behavioral economics and an ability to motivate – to work with the patient to find a solution.  And the first case seems to lend itself to automated processing to determine if the behavior is within some predefined range.

The question gets even more interesting when one factors in the patient’s own engagement in these cases. One would hope that the patient is looking at the same data and developing her own questions and hypotheses. With whom should she discuss them?

What do these scenarios and questions imply for the way we currently primary care and the health professions that make up that enterprise? How will those professions need to evolve?  Will we need new professions? And are the right skills being taught to the right students today?

The Government Wants You to Play with Your Food

Mar 11, 2010, 8:02 AM, Posted by Paul Tarini

In a move that underscores the potential for digital games to improve health and healthcare, the US Department of Agriculture together with Michelle Obama’s Let’s Move initiative announced yesterday a competition for apps and games “that encourage children directly or through their parents to make more nutritious food choices and be more physically active.”

The Apps for Healthy Kids competition will award $40,000 in prizes in two categories: Tools and Games.  All entries will be judged on their

  • Potential impact on target audience;

  • Quality, accuracy, and content of message;

  • Creativity and originality;

  • Potential for further development and use; and

  • Potential to engage and motivate target audience. 

Judges include Aneesh Chopra, U.S. Chief Technology Officer, White House Office of Science & Technology Policy; Eric Johnston, Senior Software Engineer, LucasArts; and Steve Wozniak, Co-founder, Apple Computer, Inc.

When USDA was thinking about this contest, they pulled together a group of folks for advice, including Debra Lieberman, National Program Director for our Health Games Research Program; and, Ben Sawyer, who runs the Games for Health Conference, which we support. 

Kudos to the USDA for seeing the value of games and to Debra and Ben for their contributions.

Simplifying the Legal System: Philip K. Howard at TED 2010

Feb 25, 2010, 9:44 AM, Posted by RWJF Blog Team

Philip K. Howard, Founder & Chair of Common Good – a Pioneer Grantee – gave an engaging talk at TED 2010 on four ways to simplify the legal system. We encourage you to listen to the talk and then pop back over here and let us know what you think about his ideas.

You can also read more from Howard on RWJF’s Health Reform Galaxy Blog.

'Tis a Gift to be Simple

Feb 22, 2010, 9:50 AM, Posted by Paul Tarini

George Whitesides, a chemist and the Flowers University Professor at Harvard, gave an elegant talk on simplicity at TED.  Whitesides asserted that simple things have four qualities:

  • They are predictable and reliable;

  • They are cheap;

  • They have a high value-to-cost ratio; and

  • They are stackable, that is you can combine them to build more complicated things.

The lowly transistor is a simple thing.  It’s also the building block of modern electronic devices.  Transistors enabled computers which enabled the internet which enabled, well, you get the picture. The point here is that simple things have emergent properties, that is, they enable complex systems to arise out of simple interactions. The next point is that you can never predict what results or complex systems will emerge when you stack a bunch of simple things together, snowflakes included.

What he’s talking about, clearly, are simple physical things.  But it led me to two thought experiments I’d like some help with…the first: identify two or three simple things that could be combined to create some novel product, service, or experience that would significantly improve health and health care. 

The second: can you deconstruct a complex aspect of our health care system and identify its most simple parts as a first step in re-thinking how things get done?