Again there has been just a heap of stuff arrive this week.
First we have:
Tuesday, May 26, 2009
Reinventing Health Reform: Innovators Take on the Bureaucrats
by David J. Brailer
There have been few times in the past when new ideas and innovation in health care were needed more than they are today. This is a time when patients, clinicians, policymakers and health leaders face many challenges and are in need of new ideas. Many hope that this time of change and disruption is also a time for our aspirations and dreams to soar.
That we need innovation in health care may surprise some people. After all, we are an industry that is proud of our creativity and discovery. Look at the progress we have made in the life sciences -- in biotherapeutics, implanted devices, imaging modalities, genomics and diagnostics. In each of these areas, we have seen near-complete knowledge turnover in the past decade, and many of these ideas have already made it to the commercial marketplace.
But life sciences is only 15% of health care spending. In the other 85% -- the way care is delivered, organized or financed -- we have seen little change across many years.
It is not that we don't know what we want from a better health care system. In my opinion there are five things we should do much better tomorrow than we do today:
- First, when someone seeks treatment, do not kill or maim them;
- Second, get more for our money tomorrow than we do today;
- Third, give consumers a real stake in their health care;
- Fourth, protect society from an inevitable biological or other public health disaster, whether natural, accidental or intentional; and
- Fifth, bring into common use new tests and treatments that add real years to our lifespan within a short period of their discovery.
We have an urgent need to make these aspirations reality -- to bring them to commercial viability and to show the world that they work on the scale needed to matter in health care.
Much more here with links :
This is an excellent piece of commentary in my view. The five things to be working on are spot on!
Second we have:
NHS patients given right to delete electronic record
- Owen Bowcott
- The Guardian, Tuesday 26 May 2009
NHS patients will be allowed to delete electronic summaries of their treatment records from a new national medical database, the Guardian has learned.
The decision represents a significant concession in data protection policy following talks between health service officials and the Information Commissioners' Office (ICO).
Until recently the Department of Health had resisted pressure from sceptical patients and doctors critical of the security risks generated by confidential records being transmitted across the NHS broadband computer network known as the Spine.
Last month, officials described the cost of deleting individual summary care records (SCRs) from the system as prohibitive. The Department of Health had offered instead to "mask" or "suppress" unwanted files, making them difficult to access – a process that would nonetheless leave personal details on the database.
SCRs are being introduced as part of an NHS-wide initiative being rolled out across the country to provide clinical staff with information on those they treat.
Much more here:
http://www.guardian.co.uk/society/2009/may/26/nhs-patient-medical-database-spine
This certainly shows just how hard the privacy issues are with shared records. NEHTA take note. A mix of secure communications, PHRs and provider controlled systems look like a better option to me for a host of reasons.
More coverage here:
http://www.ehiprimarycare.com/news/4872/patients_will_be_able_to_delete_their_scr
Patients will be able to delete their SCR
26 May 2009
Third we have:
May 25, 2009
NHS 'loses' thousands of medical records
By Michael Savage, Political Correspondent
Exclusive: Information watchdog orders overhaul after 140 security breaches in just four months
The personal medical records of tens of thousands of people have been lost by the NHS in a series of grave data security leaks. Between January and April this year, 140 security breaches were reported within the NHS – more than the total number from inside central Government and all local authorities combined.
The sacred principle of doctor-patient confidentiality is being compromised, Richard Thomas, the Information Commissioner, has warned. Britain's information watchdog has ordered an urgent overhaul of data security in the health service.
Some computers containing medical records have been left by skips and stolen. Others were left on encrypted discs – but the passwords allowing access were taped to the side.
In an interview with The Independent, the Information Commissioner's chief enforcer blamed the growth of a "cavalier attitude" among NHS workers across Britain for the exposure of the sensitive records.
-----
Examples cited include:
Privacy emergencies: NHS security breaches
*Computers containing the names, addresses and medical notes of 2,500 Camden Primary Care Trust patients were left beside a skip at St Pancras hospital, London. The computers, which were not encrypted, were stolen and never recovered.
*Medical details of 6,360 inmates and former inmates at Preston prison were lost after a memory stick was taken outside the grounds and went missing. The date was encrypted, but the password had been helpfully written on a note taped to the device.
*Cambridge University Hospital lost an unencrypted memory stick carrying treatment details of 741 patients was taken away in a staff member's car. The stick was found by a car wash worker who worked out who the device belonged to after accessing it.
*The unencrypted medical histories of 2,300 cancer patients were compromised by Hull & East Yorkshire Hospitals NHS Trust after the theft of a desktop computer and a laptop.
*Two laptops were stolen from Central Middlesex hospital, and a desktop computer from nearby Northwick Park hospital, after the card security system was disabled for maintenance. Test results of 361 patients were lost. The details were encrypted.
Full reporting continues here:
http://www.independent.co.uk/news/uk/politics/nhs-loses-thousands-of-medical-records-1690398.html
This is a salutary warning regarding the level of care that is needed to look after data properly. It is not easy.
Fourth we have:
Providers turn to IT for efficiency, but is it working?
By Jean DerGurahian / HITS staff writer
Posted: May 26, 2009 - 5:59 am EDT
Part one of a two-part series:
With speed and accuracy the name of the game for laboratory results, Great Basin Scientific hopes its new diagnostic tool will help providers find infections quickly and efficiently so that care delivery can be improved.
The tool is a silicon chip-based technology that allows staff to test multiple samples on one platform. The Salt Lake City-based company expects that its automated molecular diagnostic system will give results in less than one hour. The tool is still in the development stage; Great Basin has conducted a preclinical study with a full clinical trial in four to six participating labs scheduled to begin in August.
It is the productivity cycle of the hospital lab—the number of tests that can be processed during a shift—that is central to Great Basin’s work. Test-to-result time is critical for effective work, said Great Basin CEO Ryan Ashton. Providers need to know what’s wrong with a patient. “They want to run those tests 24-7.”
Technology plays a role in boosting the laboratory’s ability to conduct more tests, Ashton said. Moving diagnostics to the point of care is something hospitals are exploring because they recognize it would reduce the time it takes to get a sample, test it and return the results to the care provider, he added. “Anything that’s going to make their jobs easier is going to be something they’ll really like.”
Indeed, technology plays a role in productivity across the board, and the healthcare industry is no exception. From faster laboratory results to real-time electronic information in emergency departments to online “dashboards” that monitor performance metrics—providers have begun to embrace automated processes to improve their operations.
More here:
http://www.modernhealthcare.com/article/20090526/REG/305269964
The second part is found here:
http://www.modernhealthcare.com/article/20090527/REG/305279991
For both registration is required (Cut and paste URL if you have access issues and have registered)
There are some useful research findings on cash benefits presented in this article as well as discussions as to good ways to use performance information.
Fifth we have:
Cyber Secure Institute Issues Analysis of Virginia Health Database Hack and UC-Berkeley Hack; Demonstrate Inherent Risks in e-Health That Must Be Addressed
WASHINGTON--(BUSINESS WIRE)--Today, Rob Housman, the Executive Director of the Cyber Secure Institute, released this statement concerning the recent hacks showing the vulnerability of the healthcare of Americans:
Have you ever told your doctor something private that you wouldn’t want your friends and neighbors or a tabloid paper to know?
Have you ever received a medical test result that you wouldn’t want shared with your employer?
Recent attacks demonstrate that your most private healthcare information is seriously at risk. And, absent major changes, the risks will grow exponentially.
Last month, hackers attempted to extort $10 million after breaking into a Virginia State web site used by pharmacists to track prescription drug abuse. The records of more than 8 million patients were deleted and a ransom note was put on the Virginia Prescription Monitoring Program’s homepage, demanding $10 million dollars in exchange for the return of the records.
At almost the same time, The University of California at Berkeley disclosed that hackers had broken into their health-services database. The University began sending out notification letters to current and former students. The hackers had access to, and may have taken, health insurance information and medical information. The breach in the server took place from October 9, 2008 until April 9 this year, when administrators discovered messages left behind by foreign hackers.
These are not the first instances where cybercriminals have stolen the private healthcare information of Americans. Last December, Lawanda Jackson pleaded guilty to violating federal privacy laws by selling private medical data from celebrities, including Britney Spears, Farah Fawcett and Maria Shriver (wife of California Governor Arnold Schwarzenegger), to the National Enquirer tabloid. Last October, cybercriminals attacked Express Scripts, one of America’s largest processors of pharmacy prescriptions, threatening to release personal information of millions of Americans unless their demands were met. There is an ongoing investigation into the Express Scripts incident.
More here:
This press release states the obvious – but it is important such issues are kept in mind as systems are developed and implemented.
Sixth we have:
DDI Health Selects Vital Images as Its Preferred Advanced Visualization Solution
MINNEAPOLIS, May 26, 2009 (GLOBE NEWSWIRE) -- Vital Images, Inc. (Nasdaq:VTAL), a leading provider of advanced visualization and analysis software, has been selected by DDI Health, a leading provider of diagnostic eHealth (EMR) software solutions in Australia (including a Web-based PACS), to be its integrated advanced visualization partner. DDI Health will be one of the first eHealth providers to offer advanced visualization to its customers in the Australian market.
"We are excited to expand into the Australian market with a partner like DDI," said Michael H. Carrel, president and chief executive officer at Vital Images. "We believe that there is tremendous value and potential in the close integration of EMR systems, PACS, and advanced visualization capabilities. We look forward to working closely with DDI to deliver that value to the Australian market."
More here:
http://www.globenewswire.com/newsroom/news.html?d=166050
It is good to see collaboration between US and Australian companies like this, especially in the e-Health space.
The DDI web site is worth a look. Some of the stuff looks pretty cool!
http://ddihealth.com/Home/tabid/57/Default.aspx
This space is pretty active with ProMedicus having bought what seems to be a similar company a few months back.
http://www.promedicus.com.au/release/ProMedicus_Release_090128.pdf
Seventh we have:
Thursday, Apr. 16, 2009
In Denmark's Electronic Health Records Program, a Lesson for the U.S.
By Eben Harrell / Copenhagen
The Frederiksberg University Hospital in Copenhagen looks like any other hospital in the developed world, except for one notable absence: there are no clipboards. Instead, doctors and nurses carry wireless handheld computers to call up the medical records of each patient, including their prescription history and drug allergies. If a doctor prescribes a medication that may cause complications, the computer's alarm goes off. In the hospital's department of acute medicine — where patients often arrive unconscious or disorientated — department head Klaus Phanareth's PDA prevents him from prescribing dangerous medications "on a weekly basis," he says. "There's no doubt that it saves lives."
In the effort to reform American healthcare, electronic health records (EHR) are a double victory: they both save money (by reducing the duplication of tests and labor associated with manual filing systems) and improve outcomes (by reducing medical errors). President Obama recently pledged $19 billion to computerize America's medical records by 2014. But while health economists and campaigners in America debate what such a brave new paperless world will look like, the small Scandinavian country of Denmark has already made the transition, and is happy to tell the world about it. (Read "The Year in Medicine 2008: From A to Z.")
Denmark has a centralized computer database to which 98% of primary care physicians, all hospital physicians and all pharmacists now have access. Danish residents can gain access to their own records through a secure website. The website alerts the patient by email if a doctor, pharmacist or nurse views their records, and allows patients to make appointments, set end-of-life wishes, and even email their doctor for advice on illnesses that do not require an office visit. While basic records go back to 1977, a detailed history is available of all "patient contacts" since 2000.
Much more here:
http://www.time.com/time/health/article/0,8599,1891209,00.html
I would add there are a few lessons for somewhere closer as well!
Eighth we have:
Patient Safety Missing from Health Reform Discussion
Janice Simmons, for HealthLeaders Media, May 26, 2009
Nearly 10 years ago, the Institute of Medicine released its report To Err Is Human: Building a Safer Health System, which put a spotlight on problems surrounding patient safety. Last week, a panel of providers and policymakers who initially experienced firsthand the impact of that report—which estimated that upward of 98,000 people died each year in hospitals due to medical errors—had a chance to reflect how the report exceeded or fell short of expectations during the intervening years at a meeting of the National Patient Safety Foundation Annual Congress outside of Washington.
Lucian Leape, MD, one of the authors of the report and an adjunct professor of health policy at the Harvard School of Public Health, said the early publicity over the report "really took us very much by surprise."
Overall, there were three messages to the report:
- This is a serious problem
- It's not bad people but bad systems
- This needs to be a national priority
"Unfortunately number three never happened, and that's the big disappointment," he said.
In the healthcare reform area, patient safety should be an important issue in the debate, but federal attention has not been there, said James Guest, who is president of Consumers Union. "I think it's critically important that in addition to access, in addition to cost savings, and in addition to other factors, patient safety really ought to be front and center in health reform."
Full article here:
This is certainly the truth – and the message seems to have made even less progress here in Australia, despite the efforts of many. I suspect the population have really not been given a clear enough message of the scale of the problem.
Ninth we have:
Should Virtual Colonoscopies Be Covered by CMS?
Carrie Vaughan, for HealthLeaders Media, May 26, 2009
Earlier this month, the Centers for Medicare & Medicaid Services announced that it would not cover computed tomographic colonography or virtual colonoscopy. CMS said in a memo that while the "technology was promising," there was insufficient evidence on the performance of CT colonography in Medicare aged individuals to "conclude that screening CT colonography improves health benefits for asymptomatic, average risk Medicare beneficiaries."
Advocates of CT colonography blasted CMS' decision saying that wider use of screening could save 20,000 lives annually.
Colorectal cancer is the third most common cancer among both men and women in the United States and accounted for nearly 50,000 deaths in 2008, according to the American Cancer Society. The majority of these deaths could be prevented by the early detection of colorectal cancer through screening, but only half of people age 50 or older, for whom the test is recommended, have received the screening. The reasons vary. Some people lack education about the importance of screening, others don't have health insurance coverage, and some just procrastinate or avoid taking the test because it is an invasive procedure and requires the unpleasant task of cleansing the colon.
Much more here:
This is an interesting discussion and shows how somehow the decisions around technology adoption can be less than simple.
Tenth we have:
Feds propose Web site to educate public on PHRs
- By Mary Mosquera
- May 22, 2009
The Office of the National Coordinator for Health Information Technology (ONC) has proposed developing a Web site containing facts about personal health record (PHR) systems and the privacy policies related their use to help consumers make informed decisions.
In a notice in the Federal Register today, the national coordinator’s office described a project to develop an online model or template in which PHR providers would present the facts and key information about privacy, security and information management policies.
More here:
http://govhealthit.com/articles/2009/05/22/feds-propose-phr-website.aspx?s=GHIT_260509
Maybe something that NEHTA / the NHHRC should emulate?
Eleventh for the week we have:
Blumenthal: Stimulus a 'sweetener, not determinant' of health IT adoption
- By Mary Mosquera
- May 21, 2009
Health information technology leaders made the case for linking the economic stimulus plan to the broader goals of health reform, including improved heath care services and population health, at a conference in Washington, D.C., yesterday.
The health IT provisions of the stimulus were designed to correct the failure of the market to spur the adoption of health IT and to demonstrate its value. In doing so, it will also be a tool to meet the aims of health reform, said Dr. David Blumenthal, the nation’s health IT coordinator, at a May 20 conference sponsored by the Brookings Institution.
Under the American Recovery and Reinvestment Act, physicians and hospitals will be entitled to increased Medicare and Medicaid payments starting in 2011 if they can demonstrate “meaningful use” of electronic health records. ONC has said they would define the term by early summer.
Much more here:
http://govhealthit.com/articles/2009/05/21/blumenthal-on-health-it-adoption.aspx?s=GHIT_260509
This provides useful insight into how Dr Blumenthal is thinking about his new role.
Twelfth we have:
CCHIT to adapt programs to federal health IT agenda
- By John Moore
- May 19, 2009
Certification organization to adjust schedule, policy handbook to reflect mandates
The Certification Commission for Healthcare Information Technology will put its 2009-2010 programs on hold and update its certification policies in light of guidance contained in the American Recovery and Reinvestment Act.
CCHIT said today it will defer the launch of its latest certification programs until it has reviewed the Office of the National Coordinator for Health IT’s forthcoming standards and certification criteria. ONC will deliver a draft rule containing those items to the Health and Human Services Department by Aug. 26, according to ONC’s plan for complying with ARRA. CCHIT’s certification cycle was set to begin July 1.
More here:
http://govhealthit.com/articles/2009/05/19/cchit-health-it-agenda.aspx?s=GHIT_260509
This is pragmatic and sensible. I do hope all the good work that has been done is not lost in the Administration transition.
Vastly more here:
http://www.modernhealthcare.com/article/20090528/REG/305289991
Leavitt talks CCHIT, stimulus and new administration
By Joseph Conn / HITS staff writer
Posted: May 28, 2009 - 11:00 am EDT
Part one of a two-part series
Thirteenth we have:
http://www.ehiprimarycare.com/news/4871/google_says_user_data_aids_flu_detection
Google says user data aids flu detection
25 May 2009
Google’s co-founder Larry Page has said that the European Commission’s demand for user data to be deleted after six months would prevent the site from being able to plot and predict potential pandemics.
According to a BBC report, Page said the less data internet companies like Google are able to hold about user searches “the more likely we all are to die.”
Speaking at Google’s annual European Zeitgeist conference in Hertfordshire, UK, he said that deleting search data after six months would be “in direct conflict” with the ability to map pandemics.
Much more here:
A classic example of the unexpected consequences of a policy position. Clearly the longer the search data is held the easier it will be to tell the severity and rate of spread of pandemics.
Fourteenth we have:
Employing proven technologies can positively impact nurse satisfaction, hospital operations and patient care.
Breakthroughs in informatics improve nurses' daily routines.
By Amy Lillard
Today's nurses are at the center of care delivery. But nurses on average spend only about 31 percent of their time on direct patient care. The rest? Paperwork. Resource allocation. Information management. Workflow and communications issues. All the necessary work that can and must be done, but which puts extraordinary pressure on a nurse's capabilities and time.
But the use of proven technology solutions can have a major impact on individual satisfaction, hospital operations and patient care. A new report for the California HealthCare Foundation, Equipped for Efficiency: Improving Nursing Care Through Technology, says emerging technologies like wireless communications, real-time location systems and even delivery robots can dramatically increase a nurse's time with patients.
When nurses and their facilities take on their everyday challenges, and apply powerful tools to tackle them, a better work environment and better healthcare result, say the report authors.
Examples Abound
The nurses consulted for the report mentioned numerous projects completed with the help of technology, said Fran Turisco, MBA, research principal at CSC, a consulting and systems integration company, and co-author of the report with Jared Rhoads, MS, senior research analyst at CSC.
"Nurses are asking, 'Here's a problem, now how can we use technology to redesign the care process and help us everyday?'" Turisco said. "These technologies are working in real hospitals and for real nurses, people who rolled up their sleeves, dug into a problem and put technology to use to make a big difference."
The report details how hospitals across the country are using technology for practical solutions to persistent problems. This perspective is spreading to nurse administrators and nurses on the unit floor, as they are faced with shortages and increased patient demands.
"Nurses are constantly multitasking at the highest level," said Linda Talley, RN, director of nursing systems at Children's National Medical Center in Washington, DC. Talley and her team used a patient monitor alarm system to enhance communications.
"We need to continue to push toward finding smart solutions that bring decision support to what we have. It's tremendously challenging to triage and prioritize all the multiple tasks nurses are confronted with every day. Why not use the tools at hand to make nursing work more efficient, intuitive and user-friendly?"
Lots more here:
http://nursing.advanceweb.com/editorial/content/editorial.aspx?cc=200146
Good to see the nurses getting some profile in the area.
Fourth last we have:
Electronic health records: potholes on the road to eHealth
Last Updated: Wednesday, May 27, 2009 | 3:53 PM ET
Canadians are heavy users of the health-care system. Every year, there are 322 million office-based visits to the doctor. The vast majority of them — 94 per cent — result in handwritten paper records.
Those records — your health history — normally stay in a file folder in your doctor's office, inaccessible to a medical professional who might appreciate the information they contain when you're facing a medical emergency and are unable to communicate.
Making those records available in an electronic format has been on the federal government's to-do list for nearly 20 years. But it took until Sept. 11, 2000, for Ottawa to commit substantial cash to get the ball rolling.
The federal government announced that it would set aside $500 million for "an independent corporation mandated to accelerate the development and adoption of modern systems of information technology, such as electronic patient records, so as to provide better health care."
The following March the money went to Canada Health Infoway Inc., a not-for-profit organization set up to bring Canada's health-care system into the 21st century.
Canada Health Infoway says better access to information will enable clinicians to:
- Devote more time to patients.
- Improve patient safety by reducing the risk of errors that could be prevented by access to a patient's complete health record.
- Deliver more efficient care, leading to lower costs and shorter wait times.
Canada Health Infoway has received $2 billion towards the revolutionizing of the nation's health records. While the agency's goal is electronic health records for all Canadians by 2016, so far, only five per cent of records are electronic. But the agency expects half of health records to be electronic by the end of 2010.
Canada Health Infoway says fully electronic health records will save the health-care system $6 billion a year.
Much more here:
http://www.cbc.ca/health/story/2009/05/27/f-electronic-health-records.html
This is a very useful external view on how things are going in Canada in e-Health. Seems major progress but a few big issues yet to be sorted would be the summary.
Much more reporting here:
http://www.cbc.ca/canada/ottawa/story/2009/05/28/ehealth-mcguinty-review028.html
Opposition wants minister's resignation over eHealth spending
Of course there is also some positive news!
Telehomecare project to improve delivery of services in Yukon
May 27, 2009 (Whitehorse, YK) – Health and Social Services Minister Glenn Hart today announced a telehomecare project to improve the delivery of services to homecare clients.
Departmental homecare staff will now be using a mobile data system, that they can bring into their clients’ homes and access up-to-date electronic homecare records.
Third last we have:
AT&T, other firms test devices to help monitor patients from afar
08:24 PM CDT on Monday, May 25, 2009
Long-term treatments for diabetes, high blood pressure and other chronic killers work only if patients care for themselves properly.
That's why doctors, hospitals, and high-tech companies such as Dallas-based AT&T Inc. are so excited about a new generation of devices that let medical professionals track patient progress.
These wireless devices automatically send doctors stats that people already measure – weight, blood pressure, etc. – so doctors can intervene at the first sign of trouble rather than waiting till patients feel bad enough to seek help.
The Department of Veterans Affairs already uses such "telehealth" technology on 35,000 patients.
Now, private health groups – working with insurers, universities and technology makers – have begun tests that could lead to widespread deployment over the next couple of years.
"A lot of this is old technology," said Bob Miller, executive director of AT&T's communications-technology research department. "But we're putting it together in ways that will help millions of people live dramatically better lives."
Much more here:
http://www.dallasnews.com/sharedcontent/dws/bus/stories/052609dnbusattmed.3b68acd.html
This is an increasingly important area that is attracting more attention in the mainstream press.
Second last for the week we have:
Summary Care Record use jumps in Bolton
26 May 2009
Use of the Summary Care Record by the out-of-hours service in Bolton has risen from 200 accesses a month to 200 accesses a week following the introduction of an integrated ‘SCR’ system from Adastra.
Adastra’s integrated SCR enables fast ‘two click’ access to the national Summary Care Record than was previously available, enabling summary care record access to become routine to check whether a patient has an SCR record.
The increase in uptake has been mirrored in other urgent care settings in Bolton where the Adastra SCR integrated solution is available, according to Dr Darren Mansfield, NHS Bolton’s clinical lead for urgent care.
More here:
http://www.ehiprimarycare.com/news/4870/summary_care_record_use_jumps_in_bolton
This is good news, but one really wonders why access was not properly integrated in the first place!
Last, and very usefully, we have:
The Myth of Macroinnovation
An idea is making the rounds and appearing in articles like this New York Times piece, and it goes roughly thus: the age of the small inventor is over because to work on stuff that matters requires the largescale coordination of people and materiel that only governments and large corporations can provide. This notion that we're entering a Golden Age of Macroinnovation is bunkum, I'm happy to report.
Scale matters, scale has always mattered, but scaling is not innovating. It's true that there are many opportunities for businesses and governments to do big things. That's always true—all my friends who worked at Yahoo! and Microsoft said one of the attractions was the ability to write code that would be used by hundreds of millions of people. However, the article basically says, "large institutions are tackling large problems." That's wonderful news, much better than large institutions ignoring large problems, but has nothing to do with innovation.
Perhaps I'm wrong, perhaps scaling is a form of innovation. Innovation is characterised by disruption and the unknown. Think of those governments and large corporations and ask yourself: are these the birthplaces of radical thinking, new ways of getting things done, and risk-taking leaps into the unknown? Of course not. Governments are the most risk-averse institutions in the world, more so than medicine where lives hang in the balance—doctors at least listen to evidence, whereas the definition of bureaucracy is "we follow the rules regardless of reality". Governments exist to preserve the status quo that elected them, not disrupt it.
.....
I love that governments, NGOs, businesses, and citizens are going to be tackling large and meaningful problems with the aid of the tools and techniques developed by researchers, entrepreneurs, and hackers around the world. But to mistake using those techniques for inventing them is to ignore that great lesson of Margaret Mead: "Never doubt that a small group of thoughtful committed people can change the world; indeed, it is the only thing that ever has."
Much more here:
http://radar.oreilly.com/2009/05/the-myth-of-macroinnovation.html
It is the end of the last paragraph I wanted to highlight. I think it is remarkably true and certainly so in the e-Health domain.
There is an amazing amount happening. Enjoy!
David.
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