Wednesday, October 4, 2017

Hiding Behind the Label of a ‘Patient’ vs. a ‘Consumer’

An Anecdotal Story Every Day!

Tonight, I had a rather 'clouded exchange' on Twitter, with a person who shall remain nameless, about the difference between a healthcare patient and a healthcare consumer.

Is there really any difference? Yes. There is.

After more than a few tweets, I had enough. I signed off and took the garbage and recycling cans to the street. It's pickup day tomorrow. Then as I poured the can from my office into the 'black container' I got a second wind. I rebooted and here's my take on the exchange I had.

I challenge any reader to comment below and educate me about the difference between a healthcare patient and a healthcare consumer. And how the feel-good phrase of "healthcare is a right" applies to the 'consumers' in the story below.

There's Most Certainly a Difference

Then I recalled a conversation I had earlier today with a very close 'family friend/associate'  that, in my opinion, is a perfect example of the point I was trying to make: that most people are healthcare consumers – not patients - that people often make personal choices that often negate their status as a ‘patient.’  That there's a difference between true patients and healthcare consumers.

That people who 'consume' a lot of healthcare services often lean on the label of ‘patient’ as some way out of not being labeled a ‘consumer.’ "I can't help myself. I NEED these expensive services! I have not choice! I'm a patient!"

Here's a Story About Being a Healthcare Patient vs. a Healthcare Consumer

This post is for that person I just had a long interaction with on Twitter. 

(To be sure, this story is certainly not unique, I’ve witnessed it before many times. I’m sure you have too. Unfortunately, I’m sure it’s repeated by 100’s of 1000’s of people every day.)

A Healthcare Consumer Walks into a Bank:

“A lady I work with is a teller at the bank.”

“She’s about 60 years old and she weighs about 250 lbs. She's about 5 foot tall”

“She’s a self-described diabetic.”

"Every week she calls out at least one day because she has a doctor's appointment. She said she once spent 30 days in the hospital"

Suck up the Sugar!

“Every day she walks in to work with a ‘Big Q Drink’”

(I think the Big Q from QT is a 64oz drink. That’s 64 ounces – a HALF GALLON! With 700+ calories and 6+ ounces of sugar. SIX OUNCES of SUGAR… For breakfast! Read on…apparently just the wake up drink BEFORE THE REAL BREAKFAST!)

“Every day she brings an 8-pack of muffins, a box of cookies or some other ‘dessert. She sits down in the break room an washes down 3 or 4 muffins with her Big Q drink.’”

(How much more sugar is contained in these muffins? Does she share any of those or eat all of them. I didn't ask.)

Don't Kid Yourself, Your Choices Impact Others!

“In the last two months, she has ‘called out’ of work over 20 times. At first, it created a lot of hassle for the rest of us. We had to fill in, we had to cover for her.

(I assume that ’20 times’ over two months means 20 work days? Apparently 50% of her work schedule?)

"And after a while we began to expect it. And the managers wouldn’t do anything. They told us "We have to accommodate her. One manager said she'd love to fire her but would get in trouble. This lady got away with things none of us younger people would get slack on”

(Remember how healthcare issues impact productivity? Our collective well-being? Well this true story should be a wake up call.)

Healthcare Consumption Patterns Run in the Family!

"Her husband has had bypass surgery three times."

“Her husband often brings a bag of lunch from McDonalds for her."

"He's often wheeled into the bank in a chair."

"One time he got out of his chair and fell. It was huge deal because we had to call an ambulance and basically put the bank on lockdown while we all waited for the ambulance to come and take him away."

"Of course she also left work that day so the rest of us had to cover for her”

Taxpayers Support this Lunacy!

“This lady told us that her husband is retired from a career with the city of <Not Saying.> That he was a 'public servant and has 'excellent healthcare' - and that "I'm so glad that we don't have to pay ANYTHING  for our healthcare!'

(Right! Excellent healthcare. Paid for by the taxpayers of <Not Saying!>

To the Caffeniated Mommy I bantered with earlier tonight on Twitter:  I ask you: Is this lady a healthcare patient? Or a consumer?

Healthcare is NOT A RIGHT!

It's time we all woke up about the very limited Healthcare Resources available. And how much certain people consume. And how their actions have direct and indirect impact to the rest of us. And who are NOT acting like a 'patient.' 

Who still thinks healthcare is a right? Unfettered. Without any personal responsibility? I don't!

Tuesday, September 26, 2017

Why I Won't Play with Old-Fashioned, Rude Healthcare IT Recruiters

Like many experienced people in healthcare IT, software product management, and advisory consulting services, I get more than a few inquiries - cold and warm - from recruiters about opportunities that “are a perfect fit for you based on my assessment of your LinkedIn profile. You're a great candidate for this high-paying position just a few blocks from your home and we have great benefits! And you can bring your dog to work in your underwear!” 

Historically I've ignored most of these. To be sure, I do like working in my underwear. (Sorry for that image) But I do ignore these silly offers, especially nowadays, because I’m not looking for full-time employment. I do the work I want to do and I’ve been happy with what I'm doing; all on my own, free from corporate BS. I'm paying my bills. I go on vacations every few months.

Always Be Open to Serendipitous Opportunities

So, a couple of weeks ago I got an email from a corporate recruiter with a specialty Electronic Health Records (EHR) company here in Phoenix. The email stood out. It was a non-traditional pitch for a product manager opportunity that seemed like a good fit; short and to the point. Its wording implied whoever wrote it had a unique way to reach this passive candidate. To be sure, it wasn’t the usual solicitation we all get:
  • Templated response with mail merge errors 
  • A request for salary history and three references
  • An offer for an entry level project manager position in the construction industry in Qatar - with commission opportunities!

So, I thought: Why not? I’ll give it a shot. At least I’ll likely meet some local healthcare IT people. At best I may hook up with a company where I can really add major value. What can I lose? I succumbed to the recruiter’s pithy email come-on and the out of the box “job description.”

But a Sucker is Resurrected Every Minute

Boy was I ever fooled! Here’s How:

After some back and forth, a 'quick call' was scheduled. It lasted 45 minutes. The recruiter shared insight into what people like me want to know:
  • What the key skills and qualities for the opportunity demand
  • Who the position would be interacting with and take direction from
  • What most important business expertise and technical skills are required
  • And more that I won't go into here
She Hooked Me!

I got a good feeling about the opportunity. I started to think: "How am I going to unravel the contracts I have with current clients?" I was told this fast rising specialty EHR company was on a fast-track! They needed to fill this position quickly. They've been looking for a while and not finding anyone qualified! I received an emphatic “you seem like a perfect fit.” Yes!  

So I sent over a hastily updated resume. (Who actually has a resume these days? Another subject for another day)

Wait, Wait & Wait Some More

Fast forward one week: no response. I thought "No big deal. They reached out to me.
I wait another week: Nada!
Now two weeks+ and I wait some more. Nada!

So, after two+ weeks, this creative, out of the box, wear sandals and bring your dog to work cool software place, Dot-Com Wannabee EHR company can't even bear send an email to say: "Bear with us as we continue our review." 

Not even a "Can you tell us more about XYZ?" 
Not even a “Thanks but no thanks!” 
Not even a clever, witty response like “Beat it raw fuzz nuts!” 

Why Isn't Closure Provided to 'Candidates?'

So, I inquired. I got a vague response to the effect of “We have a new person involved and need more time.”

Really? Two plus weeks for a senior position that YOU reached out to me about? After I clearly stated before we even spoke that I wasn't currently looking for a job? And this ‘seasoned recruiter’ doesn’t have the common sense, basic courtesy and integrity to take 30 seconds to send an email informing someone THEY reached out to as to the status of the opportunity? 

Any company that treats strangers like this, that THEY reach out to so poorly, is a company that EVERYONE should be wary of working for.

And this company splashes the word “Integrity” all over their job descriptions!

Nope. No integrity at all

Now I know. If anyone is ever looking to work for an EHR vendor here in Phoenix – and there aren’t many – shoot me an email and I’ll let you know more about this company.

Thursday, August 31, 2017

Rock Health’s Survey on Streamlining Enterprise Sales in Digital Health - Part 1

Anyone who’s been involved with ideating, defining, creating, selling or implementing software products and services for any length of time knows that selling to health plans, health systems and other healthcare enterprises is a ‘tough game across the board.” The sales cycle is long, you have to deal with the oft times quasi-governmental structure of a large, corporate enterprise and you have to be able to think on your feet and pivot quickly.

Digital Health Entrepreneurs and Healthcare Enterprise Executives

Early last week, Rock Health – an organization that exists to fund and support entrepreneurs working at the intersection of healthcare and technology – released a summary of results from a survey they conducted titled Streamlining Enterprise Sales in Digital Health. 80+ digital health founders and enterprise healthcare leaders responded to the survey, providing their perspective on three key questions aimed at better understanding successful B2B business practices in digital health:
  1. What type of relationship do enterprise customers want with startups—and how should startups approach potential customers?
  2. What are pilots for—and are they being used correctly?
  3. Healthcare sales cycles are long. How can startups get their pitches to the right enterprise buyers quickly?
This blog post is the first part of a two-part curated summary of responses to the three questions posed by the survey. 

Much of the content in this post is taken from this post on the Rock Health website. I'm merely presenting it in a format and order in which I believe may help many readers absorb the material.

Relationship Between Enterprise Customers and Entrepreneurs

Enterprise buyers noted that startups who pitch them often fail to realize that digital health startups exist in a potentially crowded space.

Enterprise buyers want—and expect—startups to demonstrate differentiated offerings from the customer’s perspective; to craft their pitch and “tune out the noise of what’s not relevant [to their unique value proposition] and align [the enterprise customer to] what your priorities are.”

Experience with Pilots

The survey reports that almost 70% of enterprise pilots converted to paying customers. Key considerations noted include:

69% of pilots had an active user within six months of the “handshake.” i.e. the time period from closing the deal to their first active user in the pilot.

Another 20% of pilots took between seven months and one year to engage their first user after the deal was made.

After a first, essential pilot that’s often needed to get an offering off the ground, startups must be sure to strategically time-box the pilot pitch process for subsequent pilots; or risk wasting a lot of time and lost opportunity.

Pilots Can Be Distracting

The pursuit of pilots can dilute a startups efforts. If you’re going to do pilots, don’t do more than one or two and make sure they convert into cash. Otherwise, pitching a pilot versus a sale is just diluting your efforts.

Startups should consider pricing pilots higher than the cost of a standard customer license. This can help to create aligned incentives.

Better to focus on deeper engagements with potential partners than spreading yourself thin.

It Won’t Go as Fast as You Think

It takes at least 18 months to contract with a health plan:
  • 6 months generating interest or a pilot
  • couple months to find an executive sponsor/business owner to push it through
  • 6 to 8 months for a technical security assessment
  • 4 to 6 months for contracting.
Even when a startup launches and has a contract with an enterprise customer, it doesn’t mean their enterprise pilot customer will be ready to implement—it could just mean the startup is a queue.

Build it Before They Come?

Avoid being tempted to oversell your product before it’s fully ready to go. Or maybe not?

39% of CEOs in the Rock Health survey approached customers for a pilot before their minimum viable product (MVP) was ready.

Enterprise customers want something that solves their pain points and scales fast. A lot of startups aren’t ready for rapid growth even if the pilot goes well.

How Startups Can Pitch to the Right Enterprise Buyers Quickly

Know that sales cycles are long, requiring patience and a knack for relationship building. Finding the right buyer in a big organization can be disorienting.

Crafting the pitch is tricky when talking to a complex, multi-faceted enterprise customer.

Knowing your competition is important but knowing “who your competitors are targeting” is not generally a factor in closing deals. Startups should assume enterprise customers know the competitive landscape (even if they don’t let on!).

Know your customer is more important: Several enterprise buyers felt that startups approach them with insufficient knowledge about their priorities, challenges, or knowledge of their organization’s role.

Make It Personal and All About the Enterprise

Every customer wants to feel unique; no one wants a “one size fits all” pitch. Differentiating your offering among competitors will strengthen the credibility of your product and sales pitch.

Entrepreneurs need to make their customer feel special by personalizing their pitch. The key to personalizing an approach is learning about the customer. An easy way to understand the basics of your customer include:
  1. Prioritize well-researched quality interactions over quantity.
  2. Read the most recent SEC filings – annual reports - and familiarize themselves with the customer’s product portfolio.
  3. Carefully review the LinkedIn profile for every customer on the sales call.
  4. Consider involving the enterprise customer as a co-developer so long as they have the right approach—and are the right partner.

More Coming Soon

The 2nd blog post will summarize the remaining information resulted from the Rock Health survey. Again, you can read the entire survey here. I'm merely presenting the results of the Rock Health survey in an alternate format that may or may not help you appreciate its value.

For more information on developing a relationship with healthcare enterprises, see this post I wrote “Developing Relationships with Corporate Enterprises: Questions, Considerations & Approaches for Entrepreneurs”

For more on digital healthcare, check out my blog at and consider following me on Twitter where I share as @ShimCode.

Friday, August 18, 2017

Basic Technical Skills Needed to Become Health Literate

Hardly a day goes by when I don't see, hear or read something about the need to increase health literacy of patients and healthcare consumers. There's almost always some mention of basic technical skills required to even begin to gain a level of healthcare literacy. Practically speaking, increasing literacy about any subject – whether it's health, literacy, healthcare literacy, literacy about personal finance or anything for that matter – demands a basic level of technical skills.

Moreover, as print media and traditional approaches to education and training give way to new technology-based methods, it's more important than ever to obtain a basic level of proficiency using personal computers, tablets and smartphones to further the opportunity to improve health literacy.

What Basic Technical Skills Are Needed?

Here are some of the basic technical skills I believe are needed to become literate on any topic in today’s world.


1. Understand basic input methods including traditional keyboarding, “swype-ing,” touch screens and voice to text

2. Navigate file folders, create new folders and storage location's

3. Download files to specific folders

Here's some lesson modules covering basic computer skills. And one other set of online courses that I recommend.

Accessing, Reading and Creating Documents

Create, read, edit (when appropriate) and save documents in popular formats including:

1. Word processing (doc/docx file types. i.e. Microsoft Wor\

2. Spreadsheets (xls/xlsx file types. i.e. Microsoft Excel)

People largely need the ability to navigate around a spreadsheet and perhaps add data to a spreadsheet (or online form), not necessarily have the ability to create and format a spreadsheet

3. Presentations (ppt/pptx files types. i.e. Powerpoint)

The ability to view presentations is essential

4. Finished documents (PDF. i.e. Adobe PDF)

People will primarily need the capacity to read and save PDFs

Navigate Online (i.e. The Internet)

Navigating online and being able to access information is critical. 

1. Recognize, understand and use hyperlinks (aka URLs)

2. Recognize and use email addresses and various social media handles – like @ShimCode

3. Use a search engine (e.g., Google, Bing, or Yahoo)

4. Bookmarking information

Here are some online courses on navigating the internet that I recommend.

Communicate & Share Online

Besides being able to navigate the internet, locate and access information, it's important to be able to share information with others. Here are some basic skills in this area:

1. Via email

2. Via instant messaging or chat

3. Via web uploads

4. Commenting on blog posts and articles

5. Via social media accounts

Participate in Online Activities

More and more information is becoming available online in various, “rich formats” - often presented in an interactive way customized to specific end user needs. Nowadays, becoming more literate means being able to attend or participate in:

1. Webinars

2. Video conferences – live streamed and pre-recorded

3. Tweet Chats

Here's some information on How to Participate in a Tweetchat

What Else?

Health literacy and healthcare literacy are important. What other other skills, technical or otherwise - are needed to become health literate? 

Check out this collection of articles, blog posts, tips and ideas about Health Literacy. Consider subscribing to this blog (See 'Subscribe via email" on right side of this page) and following me on Twitter where I share as @ShimCode.

Thursday, July 20, 2017

More on the Value of a Worthwhile #HIT100 Nominee

Today’s HIStalk newsletter included a short piece from one of their often anonymous contributors -‘Expanding Paunch’ - who called into question the ‘worthiness’ of those who’ll be ranked among the #HIT100

[For those not familiar with what #HIT100 is all about, here's some info on this year's event.]

Scoring a #HIT100 Nominee - The Expanding Paunch Scale

From Expanding Paunch: 

“Re: HIT100. I’d like to see the winners scored on real-life experience and accomplishments instead of chronic Twitterhea.” I spent way too much time thinking about this idea, coming up with a scoring methodology that reflects what I look for in assessing someone’s accomplishments in deciding whether they are therefore qualified to render healthcare-related opinions. Here’s my first pass – score yourself and your peers and tell me which criteria you would change. I’ll grade the HIT100 once they are named, using the self-reported information (often inflated) from their LinkedIn profiles since everything should be right there. The scores I tested tracked pretty closely to my assessments of some of our industry’s more prolific pundits, ranging from 0.5 points to over 70. I was kind in deleting an additional metric that deducted points for using self-styled, questionably accurate labels such as thought leader, visionary, thinker, innovator, and entrepreneur.

Education & Work Experience - Analytical Approach
Expanding Paunch shared an interesting commentary about being worthy of the #HIT100 ranking and his/her accompanying ‘spreadsheet rating’ chart offered some good metrics for supporting for her/his position. Education and work experience are key requirements for being a good source of "HIT" information, ideas and opinions.

What does #HIT100 stand for?
To be clear, “HIT” means “Health Information Technology.” I think most people who’ve been active in health IT and social media for any length of time understand that the #HIT100 event was borne based on the idea of acknowledging one’s healthcare IT knowledge, skills, experience AND social abilities relative to the creation, curation AND dissemination of insight, ideas, opinions and occasional facts regarding healthcare information technology products, services, challenges, opportunities and issues - via social channels.

What Makes a ‘Good’ #HIT100 Nominee?
For some reason, ‘Expanding Paunch’ doesn’t appreciate the value that a solid background in information technology, a 'non-clinical' background, experience with content creation and curation, and the ability to share content across a range of social channels can have. 

I've shared my take on What Makes a Good #HIT100 Nominee and 11 Qualities of a Good #HIT100 Nominee.

Non-IT, Clinical Management Expertise Only?
‘Expanding Paunch’ apparently believes that a worthwhile health information technology social media “persona” can only be attributed to someone possessing an advanced clinical background in “management.”

Two major omissions in this ranking methodology are:

1. Penalizes those who aren't a "provider of clinical care" and/or not having a direct patient clinical care focus. 

I get the fact that ultimately it's all about the patient and providing clinical services. But the reality is that administrative, financial, communication and other 'non-clinical services' provided by people other than physicians are important parts of healthcare.

2. Doesn't include any acknowledgement of a person's social footprint.

What's an Ideal #HIT100 Nominee?
I guess a practicing physician who’s a CMIO at a vendor with some sort of 'informatics only' role is considered the ideal #HIT100 prospect? Regardless as to whether they actively share their knowledge via social channels, conferences, podcasts, etc.

How Do You Rank on the Expanding Paunch Scale?

I did a one minute calculation of my ‘#HIT100 worthiness’ based on the ‘Expanding Paunch' algorithm and I garnered about 20 points - apparently I’m not worthy. 

I'm looking forward to ‘Expanding Paunch’s’ rating of the HIT100 ‘winners.’  And I’d like to know more about how ‘Expanding Paunch’ ranks himself too.

Steve S - ShimCode

P.S. In the past, I spent a lot of time tabulating and sharing #HIT100 info and commentary when others wouldn’t or weren’t able to tabulate and/or share. This post is my contribution to this year's #HIT100 event.

Previous Blog Posts on the #HIT100