Nanobots, Wearables, and Other IoT Innovations that Explode with Healthcare Data

Data has changed our world.. From our cars, homes, pets, and even our own bodies, data has opened our eyes to behavior patterns and allowed us to catch on to small issues before they become bigger problems. This phenomenon has made huge waves in the healthcare industry, including reducing operational costs, improving independent living, and increasing early detection of diseases. With the wildfire set by the Internet of Things, healthcare data from wearables and other mHealth devices are helping patients take a more informed and active role in their healthcare, and give doctors more insight into diagnosis and treatment plans.

According to Employee Benefit Research Institute, more than one-fourth of the US population use wearables, wireless medical devices, and apps to manage their health. How many steps did you take today? How many calories did you consume? How’s your heart rate today? Thanks to the Internet of Things, we get play-by-play data points enabling us to have more responsibility for and a stronger awareness of our lifestyle. More importantly, this access gives us a more accurate picture of own health—one that may help explain what’s going on when we are sick.

Everyone on WebMD.com: “Do I have a cold or is my leg going to fall off?

Many of us have experienced that moment when we are so sure that those cold symptoms are in fact a sign of something more serious… based on the twenty minutes we spent on WebMD.com. Most of the time, thankfully and hopefully, we are wrong. However there are times when you know something just isn’t right. In terms of diagnosis, no one is a better advocate for your health than you are, but wouldn’t it be great to have more precise answers? Data can provide just that. In fact, Google’s Nanobots are not only revolutionizing the way we get information, but also the speed at which we are able to obtain it. These nanobots allow physicians to get a better profile of the patient and detect dangerous diseases.. With the massive amounts of data obtained, doctors are not diagnosing on a symptom by symptom case, but by a more holistic view of the patient’s overall health. This, stronger diagnosis and a more effective treatment plan can be put in place. However, we’ll need a bulletproof analytics tool to make quick sense of all the data first.

Software is key to delivering enhanced patient experience

For healthcare businesses, it’s important to understand that software is central to turning collected data into health information, that can be utilized to enhance patient experience. Therefore it’s essential that applications used to analyze collected patient data operate without question – as the consequences can be as stark as life and death. On top of this, healthcare providers will need to understand how patients are utilizing associated health applications and how they are performing, in order to ensure necessary experience.  

AppDynamics helps with both of these areas. First, unified monitoring ensures that healthcare related software operates without issue. Second, application analytics can help innovative healthcare providers understand how their apps are used by patients plus how to enhance experience in order to maintain and gain loyalty.  

End-to-End Monitoring of Critical Applications: A Health Care Example

Thanks to an early season skiing accident, I found myself sitting in the Emergency Department of a small hospital in a Colorado ski town. The hospital had recently gone through a major renovation and was proud of its investment on HIT (Health care IT). Most patient workflows are now automated.

Screen Shot 2015-01-19 at 2.04.32 PMCheck-in and registration were a breeze. Within a few minutes, my patient record was updated, and my case was well documented. With an electronic signature of consent and a scan of my insurance card, all I needed to do was wait for my turn.  A large monitor displayed my name as well as the names of others waiting to be seen, as well as the likely waiting time.

Being a software person with a passion for HIT, I was beside myself. A small hospital in a mostly rural area embraced technology to facilitate patient care and expedite service. This is awesome!

I was eventually taken into an ED bay, where I became even more excited when I noticed the attending physician was carrying a tablet (as opposed to a clunky computer-on-wheels or a clipboard). She scans my wristband, and nothing comes up.

After a few more attempts and some not so pleasant comments about technology, the physician gives up on using the tablet as a very well intentioned IT person is running around telling everyone the “system” is down.

Screen Shot 2015-01-19 at 2.04.16 PMMy shoulder, assumed dislocated, is now really painful, and the drugs I was given to manage the pain are slowly taking effect. I am hard to understand on a good day; add the shoulder pain and the effects of medicine; the physician is now struggling to get her head around my case. Especially since all documentation about my accident and me as a patient are now lost!

More and more patients are coming in (mostly from Texas ☺), some with severe and life threatening conditions. Health care professionals and resources are backing up.  Quality of care and patient safety are now been affected. Lives are now on the line. And, in the middle of it all there is a very-sophisticated-yet–non-functional integrated EHR solution.

“Things have gone downhill quickly,” I think to myself. Chances are the problem is simple to fix. If only the poor IT person had the right tool, this whole mess would be quickly solved.

Eventually, with a great deal of professionalism and great bedside manners, my case is processed. As I am discharged from the emergency department with a separated shoulder, rather than pay my copay and receive discharge instructions, I am given a hand written prescription and a note saying the billing department will be in touch to collect the service fees.Patients In Doctors Waiting Room

Did I mention that the ER was now full of waiting patients?

In a highly integrated patient care environment, one simple failure can lead to an end-to-end collapse; hence the need for an end-to-end monitoring tool.

To put it in other words, when patient safety is involved and critical applications work in unity to support patient care, a robust, end-to-end monitoring solution is paramount!

It is likely that the otherwise very well done, mobile patient registration application had some level of monitoring. But this is not nearly enough.

Mobile Applications are about end user engagement. As such, only a portion of the application lives on the mobile device. While mobile applications are difficult to develop and maintain, they represent only the tip of the iceberg.

Behind the scenes, in the dark corners of a datacenter somewhere, live tens, if not hundreds, of backend system responsible for handling requests coming from the mobile devices as well as other crucial business processes.

With that in mind, a more robust monitoring pattern for a highly sensitive and complex application environment such as an Emergency Department, is to monitor not only the app as it executes on a customer’s (or patient’s) mobile device, but also the backend application infrastructure; arguably, a more complex tasks.

Needless to say, it is also fundamental to correlate the end user experience from the mobile device, across the network or internet and into such backend services.

This is the only way to understand the true end-to-end application performance and ensure a good end user experience. It also gives the administrators a full end-to-end picture of the application, allowing them to quickly and precisely identify and address faulty components. The end result is quick restoration of service.

There are many monitoring solutions in the market that only provide visibility on the mobile application (aka the tip of the iceberg). The 80-20 rule is applicable here, by monitoring only the mobile application only 20% (if that) of the entire application ecosystem is visible. Conversely, monitoring only the backend services excludes an all to important component of any business process – “the user”. Lastly, monitoring both sides separately with independent solutions misses the correlation and continuity between user, device, network and backend services.

AppDynamics is the only solution in the market who can monitor these business transactions beginning in the mobile device, into the services tier to the application, through message queues, into legacy systems, databases and eventually, into the termination point while maintaining the continuity of the business context of each transaction.

Anything else is purely superficial.

See how AppDynamics can help your HIT department, download a FREE trial today!

AppDynamics Offers to Monitor Healthcare.gov for Free

The Affordable Care Act and its many affiliated health exchanges have been online now for 11 days. To say this first week and a half has been challenging from an IT perspective is an understatement. Persistent “glitches” in these applications continue to prevent consumers from enrolling in health care programs in many states, especially those that rely on the federal site, healthcare.gov.

There are many reasons why these sites have had a rough start, as I outlined in my previous blog. It’s not surprising to anyone that these websites struggled to meet expectations, given the complexity of the applications underneath. And things are beginning to get better. But these glitches won’t go away for good until the engineers responsible for these applications get visibility into what’s going wrong.

Screen Shot 2013-10-10 at 10.55.30 PM

That’s why AppDynamics has decided to offer its software to the federal government for free for three months. I believe that our application performance management software can help the engineers working tirelessly to improve the sites by revealing to them where the bottlenecks in their applications are. Even more importantly, I believe that the insight provided by AppDynamics will help the government to dramatically improve the performance of these applications for end users and ultimately allow people to enroll in the programs more easily.

No matter what your politics are, I think we can all agree that no one likes a slow web application. So we’d like to make life a little better for everyone involved by helping those apps get up to speed.

Why is my state’s ACA healthcare exchange site slow?

Today marked the launch of the Affordable Care Act (Obamacare), which included the rollout of online health insurance exchanges in every US state and Washington, DC. Ahead of the launch, several states reported difficulties getting these new websites to function properly, and many experts and pundits anticipated slow performance as the whole system went live today. So why are these sites proving so problematic? Well, we can’t know for sure, but here are a few educated guesses (based on quite a bit of experience dealing with slow and troubled web applications):

  • Integrating with existing systems is difficult. Each state has their own healthcare systems already in place that rely on a whole host of different technologies ranging from Java to COBOL. Interfacing with these existing applications can be difficult, especially if they’re slow or unresponsive.

Health Insurance Marketplace - Please wait healthcare.gov

  • There wasn’t enough time to test. Testing an application really well requires a lot of time and resources to complete. With a hard deadline of October 1 these applications might not be completely ready for the big leagues.
  • They’re dealing with a lot of load… all at once. The uninsured as well as many curious Americans swarmed these exchanges en masse as soon as they became available this morning. If these applications receive more load than anticipated, the applications could simply crash.
  • There are thousands of corner cases to account for. Families’ health care eligibility scenarios could vary in literally thousands of ways, and the teams responsible for designing the application had to account for and test all of those different situations. When the permutations climb up into the hundreds of thousands it becomes extremely difficult not only to account for these situations in the application code but also to simulate these situations in a test environment.

Screen Shot 2013-10-10 at 10.25.38 PM

  • Federal and state governments don’t have experience launching web apps on this scale. Tech companies and eCommerce giants like Twitter, Facebook or Amazon have been building applications with massive scale for years, so when it comes time to build and deploy a new one they have experienced people to do it and tried and true processes to fall back on. Most state governments don’t have the same experience, which makes it more difficult for them to “get it right.” (And, we should mention, even the tech and eCommerce companies experience slowdowns and outages pretty regularly).
  • Checking for eligibility is a lot more complicated than buying an airplane ticket. Consumers may expect all websites to respond as quickly as their favorite travel site, but as Richard Onizuka, CEO of the Washington Health Benefit Exchange, commented, “Filling out an application for insurance is a much longer process than just buying a ticket to San Francisco on Orbitz.”

So if you’re experiencing poor web performance from your state’s health insurance exchange, take a deep breath and try again later. There are lot of reasons for the site to be slow, especially on their first day out of the gate. So be patient.