Re-designing the Patient Experience to Improve Safety and Outcomes (and Patient Room 2020)

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Patient Room 2020 at Dupont Corian Design Studio
 
Healthcare has undergone a number of changes in the last several years and will continue to undergo changes as paradigms within the industry change, and as technology becomes further integrated into its core. What will the patient experience of the future look like? What changes can we bring about to ensure that the future is the best it can possibly be?
 
The NYC Health and Business Leaders (http://www.nychbl.com/), an organization that seeks to connect leaders from every aspect of the health economy together to learn, network, and foster business and innovation in NY, recently held an event at the Dupont Corian Design Studio in Chelsea, to help answer these questions. The event, called “Re-designing the Patient Experience to Improve Safety and Outcomes”, featured the following esteemed panelists:

 

  • Ilene Corina - President, PULSE of New York and nationally recognized patient safety advocate
  • Dr. Yves Duroseau- Chairman, Emergency Medicine at Lenox Hill Hospital
  • Dr. Shalom Kalnicki – Chair of the Department of Radiation Oncology at Montefiore
  • Dr. Rainu Kaushal - Chair of the Department of Healthcare Policy and Research at Weill Cornell Medical College and Physician-in-Chief of Healthcare Policy and Research at NewYork-Presbyterian/Weill Cornell Medical Center
  • Moderator: Joyce Lagnese, Esq.- Chief Legal Officer, Medical Risk Management, LLC
 
While at the space, attendees at the event were able to explore Patient Room 2020, a full-scale prototype of what a future patient hospital room could look like. Salley Whitman, Executive Director of NXTHEALTH (http://nxthealth.org/), an organization that seeks to impact healthcare via research and design, gave guided tours of the space. Highlights of the Patient Room of the Future included its sleek design, hidden storage spaces for supplies, sharps containers, and tablet technology, overhead lighting that could project clouds or rainbows (for serenity, to entertain kids), blue tooth and wifi capabilities so patients could access apps and education tools, a patient lap desk with a tablet screen embedded in it as well as side controls during meal times, and a convenient charger pad to wirelessly charge mobile phones. The bathroom was especially impressive, with features like moveable walls to make room for caretakers (or equipment like wheelchairs), hand rails and shower tools designed for stability and ease of use by caretakers and patients, a toilet with deluxe comfort features and the potential for bio-sensor technology, and a side table for personal items or use as a diaper changing station.
 
The lively panel discussion brought to light many pearls of thought when it comes to patient engagement, experience, and safety.
 
On communicating with patients:
 
The panel spoke about the importance of language, communication, and understanding. Dr. Kaushal, “We as the doctors need to try to understand the patient and and we as patients have to try to explain who we are to doctors”. Ms. Corina emphasized that it’s not about intelligence or acronyms (that both doctors and patients probably don’t know anyway), it’s not even just about health literacy, but communication and meeting people where they are. Dr. Duroseau echoed these sentiments, “The provider needs to make a connection with the patient in a language he/she can understand. It has to be language specific and age specific. Not one size fits all. You really need to understand who that patient is”. He punctuated this by telling the story of two patients, Patient A and Patient B, getting sutured in the ER. Patient A, who is told that some of the sutures may come out during the healing process (and no need to worry), will have a different experience and perception of care received than say Patient B, who isn’t given any advice or instructions.
 
Dr. Kaushal told the story of a patient who was hospitalized for newly diagnosed diabetes. Every day a nurse came in to show the patient how to inject insulin. She would draw up a syringe and inject “insulin” into an orange. The patient was discharged but came back several days later, with extremely high sugar levels. It turns out that the patient would inject insulin into an orange and then eat the orange.
 
Communication is a 2-way street. It’s about talking and listening, and more importantly it’s about understanding, regardless of literacy or education level.
 
On patient engagement:
 
For quality healthcare, the patient has to be at the center. Patients have to be integral partners. Dr. Kalnicki made the point that non-patient-centered care doesn’t exist. Patient engagment is important because a more engaged patient helps us prioritize what is important to them.
 
 
On the patient experience in NY:
 
Ms. Lagnese presented some information on healthcare in NY. When it comes to disease metrics, NY leads other states, but when it comes to patient satisfaction measures which includes communication with care providers, ability to ask questions and getting them answered, NY lags behind. NY does very well when it comes to metrics and technical aspects but there is work to be done in non-technical measures. Again, communication is key. It must also be noted that there is a direct correlation between patient satisfaction and liability.
 
 
On what healthcare can learn from other industries:
 
A lot can be learned from other industries, the hospitality industry is a great example. Dr. Kalnicki mentioned that the root of the word hospital is “shelter for the needy”. It’s about bringing back humanism to medicine and focusing on the patient experience and the healthcare experience.
 
 
On the role of technology in healthcare:
 
Technology is a tool and we’ve seen it used in the form of patient portals, social media support groups, and electronic hospital records. However, it’s not a panacea and cannot stand alone. Dr. Kalnicki said that we need “both the technical and the non-technical… alone, it’s like a great painting without a frame”.
 
Dr. Kaushal spoke about data vs. knowledge. What electronic medical records sometimes lose is clinical context, the “A” for assessment that is part of the clinical SOAP note. There is a richness in the thought process and the assessment. Access is not enough, you have to understand the value and clinical context of data.
 
Dr. Duroseau spoke about the need for leadership that understands both worlds (both tech and non-technical).
 
 
On pilot programs in place to enrich the patient experience and improve safety and outcomes:
 
The panelists spoke about different programs that are helping to improve the patient experience. One is the use of simulation labs to help teams work on decisionmaking and team processes inclusive of multi-disciplinary rounds. A second program was based on the fact that a majority of patients who are discharged from the hospital cannot identify who their primary doctor was, as they are often seen by residents, specialists, and allied health, so an online list was created, where care team members and patients could see a list with the names and photos of all caregivers. A third program was a formal caregiver support center where training was provided by volunteers who would adopt a caregiver, teach them tasks and provide resources that would be helpful post-discharge, inclusive of going over medications, cooking classes, guiding shopping lists etc.
 
It is clear that design, patient-provider input, communication skills,technology, and innovative ideas and programs will play a major role in improving the patient experience in NY. There is a lot of work to be done, but the future looks bright.

 

Center4 (Social Innovation) in NYC

Technology has the ability to touch our lives because of its ubiquitous nature and its unique role as an enabling platform. I had the pleasure of attending the grand opening of the Center4 (205 West 39th Street, 16th floor) in NYC. The mission of Center4 is to help benefit social good by transforming the nonprofit health and human services sector by accelerating technological innovation. Its sponsorship includes the Blue Ridge Foundation, FEGS, and the Booth Ferriss Foundation.

Center4 focuses on the 4th sector of social innovation, which is the combination of 3 other sectors -government, private, and the nonprofit sector to solve social and healthcare issues including homelessness, mental health, workforce and employment needs, aging and youth development. There are currently ~35,000 nonprofits in the city and the center is a way of matching the tech space with nonprofits, as well as providing resources and mentorship for better efficiency and sustainability.

Brian Cohen, Chairman of NY Angels, spoke at the grand opening and talked about the need for people words and human words when it comes to technology. At the event, he announced the establishment of “Angels for Good”, which would educate angel investors on investing for social good, he also presented the Center with a check for $10,000.

14 different companies were showcased at the grand opening and I had the opportunity to talk to 2 of them in depth. The first company was Apploi (http://apploicorp.com/), which seeks to connect job seekers and employers, particularly in the service and hospitality industries via mobile technology. Employers pay to list jobs, and the app is free for job seekers who fill out a one time application, as opposed to filling out the same form and details over and over again for multiple jobs. It is device agnostic and is available as a free-standing kiosk or can be accessed from any mobile device. This is especially helpful, as job seekers who do not have land lines can easily access jobs through their mobile phones. Another key feature of the app is that it lets employers record questions and potential employees record responses. For example, a restaurant owner could ask a potential bartender hire to record him/herself making a martini. A second key feature of the app is the ability to show users jobs that are nearby, so a job seeker could potentially walk down a street and be notified that job openings are available.

The second company that I spoke to was CauseVox, an online fundraising platform for individuals, causes and nonprofits. Clients have the ability to design and customize their fundraising sites and have access to fundraising and social media enabling tools. The Causevox site (http://www.causevox.com) also offers tools, tips and resources to help clients in their fundraising efforts.

Center4 is yet another example of what is happening in NYC’s ever growing tech and entrepreneurial ecosystem. Moreover, it brings the work of social good and social innovation to the forefront and celebrates it.

To find out more about Center4 please visit their web site at: http://www.center4nyc.org/

Being “P/C” About Healthcare -It’s Not What You Think

There are many words that are often used when it comes to talking about technology, healthcare and entrepreneurship. Call them what you like, jargon, buzz words, professional language -they help us frame how we think about the problems that exist, and are often a signal that a person has been initiated into this world. There are also the acronyms, the alphabet soup that consists of ACA’s, AMA’s, UX/UI, and to a certain extent, because of their quantity, OMG’s, the resultant WT*’s, and hopefully a certain DIY attitude that helps define the spirit of entrepreneurship and the entrepreneur.
For me, it’s less about acronyms and more about the meaning behind the words that we use. It’s less about disruption, and more about being “P/C” about healthcare and digital health. Whenever I think about what’s happening now and what will happen, the same words always float in my mind.
The P’s
-PEOPLE. To me, people are at the core of everything. People are a part of the why and how of everything. It’s people who run companies, it’s people who are affected by the system, it’s people who inspire us to do what we do. In healthcare, it’s the patients and the providers (doctors, nurses, allied health etc) who are at the center of the ecoystem, even though it seems like sometimes they are lost in the fold. This leads me to another “P” word, and that is participation. I believe that a system works most effectively when the people who are most affected by it are able to fully participate in the processes and design of that system.
-PURPOSE. I believe that having a clear purpose is incredibly powerful; it guides your actions. Put yourself in the places of greatest need, where your skills and talents can make a difference. For many, a purpose that is connected to service is often connected to joy -the kind that cannot be bought, but multiplies and is inherent to who we  are and strive to be as human beings.
-PASSION. Passion is the fire that lights our days and warms us during the cold twilight of our endeavors. Passion is what drives us to go farther than we ever could without it. Passion is the match that sets the rest of the world aflame.
-PLATFORMS. Technology is a platform that enables us to do things that we could only dream about before. With every new groundbreaking technological advance, new technologies and methodologies are built upon that. Platforms are also important because they give people a place to stand and be heard.
-PILOT. Pilots are important because they let us test out if an idea works and how we can improve upon it in a real world setting -the only setting that really, truly, matters.
-PIONEER. In a way, being an entrepreneur is about being a pioneer. It’s about embarking into often unknown territory with only your mind, your dreams, and the tools that you have and then making your way. It’s about being able to change the landscape of the places that you touch.
-PROGRESS. Sometimes bold, drastic change is needed. Other times, it’s about those incremental improvements that add up to something in the long-term. Imagine an ocean of change being built up by adding one droplet of water at a time. When it comes to progress, I also think about changing the ratio in healthcare, business and technology. Women are often the primary consumers and decision-makers in a household, especially when it comes to healthcare, so why aren’t they more equally represented when it comes decision-making at the broader, executive and national levels? This needs to change and it will. Personally, I’m committed to making that happen.
-POSSIBILITIES. The world is full of possibilities and they are limitless. If none are seen, then make your impossibility an I’M POSSIBLE-ility.
The C’s
-CHANGE. It’s about having an open mind, change cannot happen without that first step. It’s about being open to the idea that change is needed and being open to solutions that can come from anywhere.
-CARE. HealthCARE. We need to take care of ourselves in order to be healthy. We need to put care into what we do and how we do it when it comes to what happens to the people who are affected by what we do.
-COMMUNICATION. It’s a cornerstone of healthcare. It’s often the breakdown in communication that leads to a snowball effect of issues down the road. How do we work towards not just hearing each other but listening as well? Words are important, but their meaning even more so; people hear your heart language before they hear your words.
-COLLABORATION. Working together and building teams is a way of celebrating our differences and sharing our individual strengths to support the changes we are trying to achieve in a synergistic way.
-CONNECTION. We live in a connected world and it will become ever more so with the Internet of Things. However, connection isn’t just about the physical connections, it’s also about getting through to the heart of the problem and more importantly to the hearts of the people. It’s about being able to see the whites of people’s eyes, about being able to understand our commonalities, our needs, our wants, our collective dreams.
-COMMUNITY. Building an ecosystem is incredibly important. It takes a village, in fact it will take many villages. A sense of community is important because it is the broader unit to which we are all apart of. Communities are built, they aren’t just made, and their strength lies in their members.
-CODE OF ETHICS. CODE OF HONOR. CONSCIOUS CAPITALISM.  As a doctor, as a student of medicine, we take the Hippocratic oath, and it’s about being in service to others and “first do no harm”.  We are also human, and making mistakes is a part of our humanity. It’s not about being perfect, it’s about acting with a conscience. Everyone at one time or another has been privy to the ugly side of business -broken promises, expectations that were not met, outright lying and backstabbing. It’s just business, people say, that’s how it is. I disagree and reject that.  Business isn’t a war, it’s more like the Olympics, where people work hard to be the best and compete so that the combined efforts lead to a societal win. I believe that you can do good by doing well and you can do well by doing good. I believe that you can prosper without being a jerk and I believe that we can change the notion of how business can be by refusing to drag ourselves to that level. Your word should be as good and as binding as the paper with which you endorse and sign your name. Integrity, trust, honor, these are the words that matter in business, and in life.

Merck l Heritage Provider Network Innovation Challenge Demo Day: 5 Solutions for Improving Patient Health

January 23, 2013 was demo day for the 5 semi-finalists of the Merck l Heritage Provider Network Innovation Challenge. The goal of the challenge was to create products or services that would help patients with chronic disease, in particular, diabetes and/or heart disease patients, adhere to their care plans. According to challenge guidelines, submitted concepts would focus on “human-centric opportunities to achieve health and wellness”.
The event was sponsored by Merck, which has been active in the digital health space, and invests in digital health, via the Merck Global Health Innovation Fund (http://www.merck.com/ghi/); The Heritage Provider Network, a California-based network of providers, urgent care clinics and affiliated health care plans that provide health and preventative services to its clients (http://www.heritageprovidernetwork.com/); and the Health Data Consortium, which runs Health Data Challenges and is a collaboration of government, private and non-profit organizations and individuals that work together on measures that use health data for improved health and health outcomes (http://www.healthdataconsortium.org).
The demo day judges were: America Bracho, CEO of Latino Health Access; Allan Chochinov, chair and co-founder of the School of Visual Arts MFA Products of Design Program; Josh Rosenthal, co-founder and CSO of RowdMap; Michelle Snyder, EIR of InterWest Partners; and Mark Wagar, President of Heritage Medical Systems.
Prizes for the challenge included $20,000 for the 5 semi-finalists for the development of a product proto-type, mentorship and a 3 day boot camp in San Francisco. Two finalists would receive an additional $20,000 to conduct mini-pilots and the overall winner of the challenge would receive $100,000 to advance the prototype to a real world solution for people living with diabetes and/or heart disease.
The 5 semi-finalists presented at the AOL building in New York and included:
1. Sense Health (http://www.sensehealth.com)
A company that helps to create and monitor care plans for patients in between appointments with providers using an SMS-based system. The company is currently running a randomized control trial at Montefiore Medical Center. (It was also a participant in NYC’s PILOT Health day 2013, you can read more about that here: http://charlenengamwajasat.wordpress.com/2013/06/28/my-review-of-nyc-pilot-health-day-2013-10-interesting-companies/).
2. Frame Health (http://www.framehealth.com)
A company that uses the Hogan Assessment Health Personality Profile to produce adherence profiles for patients. In 6 minutes, the platform is able to determine which psychological triggers will be most effective for patients to maintain medical care adherence.
3. Fit4D (http://fit4d.com)
A company that uses a platform that integrates data, workflow and device integration and the input of healthcare providers to develop a personalized program for patients.
A company that uses dynamic technology that generates personalized, multimedia daily to-do-lists on mobile devices.
A company that has created “a new vital sign for primary care”, a number that takes into behaviors like smoking, alcohol use, and activity level/weight to make personalized behavior referrals.
The two challenge finalists, announced January 27, 2014 were SenseHealth and Wellframe. Notably, both were alums of health accelerator/incubator programs, StartupHealth, and RockHealth, respectively.
Two-sense:
Overall, in looking at the companies, they represent the intersection of mobile, health, social media, data, human behavior and intend to capture and target health-affecting behaviors that occur in between  office and hospital visits -time frames that are generally longer than time spent in facilities. This human + tech approach, which targets in-between-times and represents point of care moments is incredibly valuable because it’s real world behaviors, actions, attitudes, and knowledge, as well as knowledge gaps, that affect care and ultimately, health outcomes. The use of SMS is compelling because it is one of the easiest, cost-effective and most ubiquitious technologies out there and it is already integrated into many people’s lives.  Having a new vital sign of behavior in primary care is provocative because of its simplicity as a concept and it’s ability to potentially condense a lot of information into one indicator. Having to-do lists in piece-wise forms for patients can be interactive and motivating and may very well lead to to improved outcomes, as those steps can lead to additive positive effects.
I was glad to to see the importance that was placed on design, as evidenced by having a judge with a design background, as well as how companies leveraged existing technologies and information distribution channels so as to not burden patients with high service costs. Additionally, was glad to see a female CEO, as well as docpreneurs as  semi-finalists in a major health technology challenge.

7 Reasons Why Your Doctor is Still Using Dinosaur Tech

Did you ever walk into a doctor’s office & then have to fill out a long paper intake form with the same information you’ve filled out multiple times before (name, date of birth, insurance etc)? Or notice that your doctor is writing notes on pieces of paper that remind you of your days in school? Did you ever see someone carry a pager around? Was that person wearing a white coat?

You can bank and pay for your Etsy/Amazon/Target/Apple “gotta have that now” stuff online. You can Skype with your family who lives thousands of miles away. You can order a pizza & know the exact moment it comes out of the oven. You can interact with @Oreo, @TacoBell @Grumpycat online.

So why can’t you easily see your health charges online? Why can’t you get a quick text or email that you’ll be seen by your doctor in 10 minutes? Why can’t you Skype with your doctor?

1. Until recently, your doctor has probably had little to no training or exposure to the world of digital health.

If you do a quick and dirty poll and ask the MD’s in your life what it is, you’ll likely get a ?-mark look or an answer related to apps, electronic medical records, or meaningful use. How can that be? Don’t most doctors have smartphones & tablets? Yes, a lot do but their use in a professional capacity isn’t 100% yet.

Until recently, there were no courses in med school or noon lectures in residency related to health information technology, wearables, personalized medicine, medical apps etc

It’s hard to use something or integrate it into your daily life if you’ve never heard of or really used it before.

2. Time is an issue.

Doctors focus on taking care of patients. I’m thinking more about your symptoms and how you feel than the medium I’m using to document your visit.

Then for docs that are tech-inclined, there are literally thousands of apps & products out there & it’s time consuming to mine all of them. Plus, patients are individuals and some things are not one size fits all.

3. Inertia (Thankfully this doesn’t apply to everyone)

It exists. Healthcare is a complex system with many layers and many players. I once read that it takes 15-20 years to make big changes happen.

My two-sense: We are rooted in tradition, yes, but the main tradition we uphold is caring for patients. This entails providing the best care possible & embracing new technologies, thought frameworks, workflows that will give the people (we swore an oath to care for) the best possible care experience.

4. Cost.

Do you remember when video game consoles first came out? They weren’t in color & there were very simple & basic things you could do, and not much else? Fast forward to the consoles & games of today which provide an Imax or in some cases a virtual reality experience. Big difference, right? Medicine is slowly making its way from version 1.0 to version 2.0.

Remember how pricey version 1.0 of any tech is? Then 5 years later version 5.0 is as pricey but 20x better. That’s kinda how it is too. Thing is though, version 1.0 is deeply entrenched & is usually pricey to remove and you have to train people to use the new product & there will definitely be speed bumps along the way.

5. So-so to bad first time experiences

Have you ever tried on a dress or a suit that clearly was made for someone else but you tried to make it work anyway? Well…certain kinds of tech weren’t originally made for doctors (actually made for billers) & so the initial experience wasn’t so great.

Or another way of putting things is, if you took a bite out of something & it was not what you expected, bitter even, would you be more or less likely to take a second bite?

6. Your individual doctor may not be the main decision maker when it comes to choosing & using tech.

Doctors use the tech tools that are available to them. As a student, doctor-in-training, or even as a supervising physician, you tend to use the technology that is already in your clinic, hospital, center & don’t really play an active role in choosing the tech.

7. Classic battle of innovation vs. regulation

The actions of doctors, healthcare providers, which include nurses, physician assistants, medical assistants etc, (only wrote doctors cuz I am one & for the alliteration) affect lives. We tend to favor things that have been tested & researched & that don’t do gross harm. Thing is, innovation pretty much implies the unknown.

Ok…so these are the issues. Now for some good news.

Times are changing. I’ve seen initiatives in regards to digital education, collaborative innovation, and health policy changes (government push to go digital). In addition, chips are getting smaller and faster and technology is becoming evermore accessible cost-wise. Organizations & startups are taking a hard look at what hasn’t worked & where a lot of the friction/pain points are, in order to come up with solutions that make the healthcare experience better. Last, there has been a push by patients, by the general public, for change to happen & trust me, it will. It’s just a matter of time.

Let’s Talk Square event in Harlem

Harlem is a place that I know very well. I spent 5 years there as a young medical student at the Sophie Davis School of Biomedical Education at City College. It’s like a second home to me, and I go there all the time, to meet with academics, friends, for great events, and to eat at my favorite neighborhood spots.

I love going to neighborhood spots like Flor de Broadway for jamon con queso on pressed cubano bread and great conversation, Santiago’s Deli for the Santiago Spicy -the sandwich that got me through 3 am anatomy dissections- and some old school Goya malta, to La Tropesienne on the East Side for the baguettes and croissants. Newer places like Vinateria, Marcus Samuelsson’s (formerly of Aquavit and author of Yes, Chef!) Harlem restaurant Red Rooster, Minton’s Supper Club and the Lido are putting out great food with great ambience (and jazz!-so bring your dancing shoes). And then there are the classics, like chicken and waffles at Amy Ruth’s or collard greens, fried chicken and mac and cheese at Sylvia’s.

Harlem has a rich history of food, culture, art, music, and dance. It is the place that captured the hearts and minds of people like Zora Neale Hurston, Countee Cullen and Langston Hughes. Today it’s capturing the hearts of a new generation, but what always seems to resonate with me as I walk around the neighborhood is the electrical energy of a vivacious, yet earthly and indomitable spirit, and above all, a real sense of community, acceptance and belonging, regardless of where you come from.

Harlem has always been a place that hustles and bustles with the comings and goings of makers and creators, and now it has broad-based wifi! Harlem is now home to the Harlem Business Alliance which supports small businesses with classes and information, Harlem Seeds and Aquaponics, which teaches young people about sustainable farming, the Harlem Garage, a new co-working space for entrepreneurs, the Harlem Biospace, a life science incubator and wet lab space on the West Side that seeks to broaden New York’s scope in the field and to instill a love of science in the next generation of thinkers and creators, Kiiln NYC will be the first all female founder incubator in NYC and act as a step-out life science incubator on the East side, the Zahn Center at CUNY, which focuses on hardware startups, and of course, Columbia University, home to a Health Tech Assembly (which I am a member of), a community of mentors and students working to change healthcare via innovation and entrepreneurship.

I had the privilege of attending Let’s Talk Harlem, hosted by Square (at the legendary Apollo Theatre, a place where Stevie Wonder, Michael Jackson and Lauryn Hill have all performed), for a town “square” on local businesses. I’ve been a fan of Square for a long time, because I believe that it democratizes commerce the way Twitter democratizes communication, and it does so in a simple, elegant, and intuitively designed way. I think that there is something incredibly powerful about an individual being able to achieve his/her dreams and tools and knowledge play a key role in making that happen.

The panel discussion, which was moderated by Square CEO (and Twitter Chairman) Jack Dorsey, featured Marva Allen of online bookseller Hue-Man Bookstore, Erika Dilday, executive director of the Maysles Documentary Center, Seven Brown, founder of Harlem Skin Clinic, and Emmanuel Pena, co-owner of Astor Row Cafe. Congressman Rangel (who had a few cameos) was also in attendance.

Mr. Dorsey asked the panel about business plans, hiring, how to grow a team & customer acquisition. In regards to business plans, the panel talked about having a vision & a roadmap, but noted that the plan can change all the time (or even 17,000 times). In hiring & growing a team, Marva Allen said, “Lead from a position of passion…and meet the staff where they are.” When it comes to customers, the panelists talked about customer service, authenticity and creating unique experiences. “They buy you”- Seven Brown. “We are the product” -Emmanuel Pena.

Mr. Dorsey also asked the panel about challenges, regulation & ambitions. The inefficiencies of government interactions came up as well as the need for accountability. Taxes as well as rising infrastructure costs & rent also came up. Ms. Brown talked about the importance of analytics for your business and deciphering your wants vs those of your customers.

In regards to ambitions & what needs to happen for small businesses & Harlem, Ms. Dilday talked about organizing a Harlem film festival & Mr. Pena talked about creating checklists for each type of small business, in terms of forms, agencies to contact, and protocols that could help a small business owner better navigate the complex government system. I think that this is a great idea, & sorely needed; it would streamline complex processes & help small businesses save time, money and energy -all of which they could put back into their businesses.

Mr. Dorsey mentioned that one of the things that Silicon Valley has is a culture of support & mentorship. Ms. Allen said that in Harlem there is a lot of collaboration, but what’s needed is more formal training. I agree, formal training in a milieu of community & passion would definitely take things to the next level.

During the Q+A portion of the talk, the topic of gentrification came up. Harlem has definitely attracted a lot of big box stores in recent years, but how do we keep it from becoming just another run of the mill place with stores, how do we preserve that sense of culture & community that exists? How do we nurture entrepreneurs, small (and large) businesses? I don’t have all the answers, but I think that talking about what’s happening is a start. Getting people together to share ideas & experiences is a start.

Square has had town squares in other cities, including Detroit, St. Louis and New Orleans, places where people are staying to really dig in, cultivate their gardens & revitalize communities. There’s a grit to that, and a love of place, people and community that I respect and admire.

Technology is definitely helping to foster the growth of cities. I always think about how we can we use technology to help us do things we already do, but in a seamless way, or a way that enhances our experiences. However, tech, although fast becoming ubiquitous, is only a tool, it is the people who are the heart and soul of companies, and the heart and soul of our communities.

I think that there is something to the local experience of knowing your neighbor. Knowing where your food comes from and who makes it. Going back to our roots and re-discovering old recipes & small batch techniques. Having respect for a craft (and for the crafters) -be it a cup of coffee, a wooden chair, or a woven rug, you can tell when something is made with love and passion.

During the talk, Mr. Pena talked about being an entrepreneur, and “if you can’t find the answer to something, you make it.” Square’s birth comes out of that same vein, and so does that of a lot of small businesses. It’s about having an enterprising spirit, a dream, and working towards bringing what you want to see in the world to fruition, despite obstacles that may stand in your way.

Christopher Reeve once said, “At first, dreams seem impossible, then improbable, and eventually inevitable”. Congressman Rangel touched on immigration & how it is people with hopes & dreams who leave a country, & that “small business is what people coming to.this country think they can succeed in”. This is evident if you walk down almost any street in NY, people not only bring their dreams with them, they bring who they are, and who they want to become. Additionally, their children get a front row seat to entrepreneurship & what it means to make an honest living and to work towards your goals.

At the event, attendees were given Square kits (which were in the shape of what else? SQUARES!) We were also treated to small Squares that held the thinner version 2.0 dongles. I really liked the little squares because they fit easily into your purse or the pocket of your jacket/shirt or jeans. Pull it out, plug it in & boom, get started in 5 minutes. The packaging was very well designed, it tells you exactly how to use it in easy to follow instructions & tells you the cost up front. I also noticed how well they economized the space, every word, picture, seems to have been placed with care. The larger Square kit had little pamphlets about Square Register & also financial analytics (very helpful in terms of keeping track of bestsellers). Opening the kit was reminiscent of opening a new tech toy or opening up packaging for a new phone rather than opening up something just for work.

I think that the simplicity of Square, its affordability, its design in regards to form & function (i.e. quick cash deposits so a business’ working capital isn’t tied up) and the fact that it is device agnostic are all boons. Anyone can start a business with a tool that may actually be more platform than just a singular tool. I’ve seen artists use it, bakeries, kids selling lemonade, and from the buy side, I’ve used it before to buy face cream, soap, artisan food, and even used it to buy John Mayer’s “Born and Raised” CD at his CD signing at the Reed Space on the LES.

Square has also launched Square Market, where vendors can offer their goods to a wider market, and most recently, Square Cash, a service where you can send & receive money via e-mail.

Now in talking about Square, I would be remiss if I didn’t mention @grannyny, who recently appeared with her grandson on the Today Show. As an avid tweeter, giver of hugs (both in-person & virtual), cheerleader & tech startup advisor, she’s proof that it’s hip to be Square at any age and that it’s the people in our lives & the people who help run our businesses that make them what they are.

Harlem will always have a special place in my heart. In terms of what it will become in the future, collaboration, communication & the preservation of a sense of community will be key, and as Mr. Dorsey (aka @jack) says, let’s talk, and let’s keep talking.

My goals for digital health (in NY)

“What would you do if you weren’t afraid?” – Spencer Johnson
I know that it is bold to put your goals and dreams out there, but hey I’m a New Yorker, and we are bold people with big dreams, and we have the drive to make things happen. (+/- coffee ;)
Every day, I wake up and ask myself 3 questions:
1. What are the things, and who are the people, that make you want to dream with your eyes wide open?
2. How can I make an impact in the world?
3. How can I make reality better than my dreams?
About me:
I’m a proud native New Yorker. New York isn’t just the place I was born and the place that I live and work. It is the place that continues to give me an education and a life full of beauty and vibrance. The electrical energy of the city runs through my veins and I am inspired by it.
I am a NYS-licensed physician who trained at SUNY Downstate in Brooklyn and at Lenox Hill Hospital in Manhattan. I  became a doctor because I wanted to help people stay healthy and be able to fully take part in their lives. I went to the Sophie Davis School of Biomedical Education at City College because in particular, I wanted to serve the underserved. I worked on the upcoming NYS Patient Portal for New Yorkers (http://patientportalfornewyorkers.org/) because I believe that information is powerful and that health information should be accessible. I also believe in building something that gives people more than they ever expected. (Linkedin here: http://www.linkedin.com/pub/charlene-ngamwajasat-md/61/bb0/b23)
My goals are:
1. To make NY a digital health and life science capital
2. To create a NY digital health fellowship that would be the first of its kind anywhere
3. To create something like an MIT Media and Innovation Lab but for healthcare
NY as a digital health and life science capital
After the Valley, New York is the country’s second leading tech hub and amazing things are happening here. I’ve been to numerous lectures, meetups, and demos inclusive of NY tech week, data week, Maker Faire at the NY science hall, Open Data meetups, digital health conferences, NY3DP, New York Tech Connect life science events and have met makers, designers, developers scientists, small business owners, students, who are all contributing to the ecosystem. In terms of life science, there have been multiple IPO’s on the NYSE in the last year and there are multiple incubators focusing on the field in Long Island, Buffalo, in Harlem (Harlem Biospace, and Kiiln- which will be New York’s first step-out life science incubator and has all female founders), as well as the opening of the New York Genome Center. In terms of digital health, there are several incubators and dozens of companies that are working hard to address issues in healthcare from insurance exchanges to pricing transparencies to medication adherence to the management of chronic disease.
Private public partnerships and a very supportive government have also added to the ecosystem and have drawn people from other places in the country and from across the oceans to New York, because they realize what a special place is it is for innovation, the sciences, design, and digital health. New York has always been a place where thought leaders come to and are born, it was the birthplace of women’s suffrage, and in the late Mayor Koch’s words, New York “is the place where the future comes to audition”.
I believe that New York will become a digital health and life science capital because of all that is here, but most of all because of the people who are here. It is their spirit, their ideas, their talents that wil make this happen. It is also their willingness to take a risk and say yes to the future that will further drives us there.
Digital health fellowship for technologists, healthcare providers and patient advocates
I believe in the power of technology as a tool to connect us, a means of communication and access to information and a broader world, as something that could potentially lead to cost savings in a healthcare system beleagured in complexity and high costs. However, I think that the power of people trumps even the power of technology. It is only as good as the people who create it. In the past, a lot of technologies seem to have been created in isolation of those who were ultimately going to be using them, they were bulky, ran counter to workflow, and would crash all the time. They didn’t reflect a deep and nuanced understanding of what and how people who used such tools went about their day. I’m a doctor by training, so it would be like me building a house. I can guess what a person would want at a basic level (bedrooms, bathrooms), but maybe I wouldn’t know how the house would be used (by a single person or a large family and there is a difference). I believe in the concept of participatory design, the idea that the people who will be using the technology should be involved in its development because the end product would be a better fit and because in the process, those involved, would be able to learn from the process of creation and testing, as well as learn from each other.
What I see fellows doing:
  • use open data to design research projects and outreach initiatives (let’s collect data and really find out what we need to address, what resources we have so we can have better resource allocation, and let’s see if our initiatives are actually working)
  • learn from each other by working on such projects
  • be ambassadors of digital health (a lot of people don’t know what it is and how it could help them, let’s get out there and show people from patients to healthcare providers)
  • act as innovation leaders and scouts (there is a world out there, and I believe in the bi-directional transfer of information. we can learn from each other, developing world-> developed world and vice versa)
  • act as bridges to people who want to get into the field, learn more about the ecosystem in New York (so many bright and talented people that I’ve met want to get into the space, but they aren’t sure how) or as sounding boards for entrepreneurs
  • engage in hands-on work (testing technologies out, talking to parents, seniors, hospital systems about needs/feedback, or what about take your developer to work day at the hospital? Or Computer Science 101 for doctors?)
  • teach in academic settings
  • act as idea agents and agents of change (what if we used facial recognition technology or fingerprint technology now available on smartphones to login to accounts/secure data? what if we changed how we do things, how we talk about and what we expect when it comes to healthcare?)
Healthcare innovation lab
I am really inspired by programs and initiaves by Cleveland Clinic, UCSF, TED and TEDMED, Futuremed, Singularity University, The X prize, and MIT Media Lab. I would love for there to be a place in New York where the future is being created every single day. Where what if’s turn into how. Where the word can’t doesn’t exist. I would love to see a place where academics, healthcare providers, designers, artists, data scientists, geneticists, nutritionists, chefs even, could work together to develop new ideas and new technologies. What if we finally could find a cure for the common cold? What if we found a way to develop 3D hologram medical avatars a la Star Trek? What if we crowdsourced ideas from people all over the world to come up with solutions? (I bet there would be some really good ideas). What if we invited people doing interesting things to test some of our work or for them to teach us what they do (nanomedicine, architectural design with health in mind, bioinformatics using computer algorithms)?
I believe in the talent that exists here in New York. I believe in the will of the people who are burning the midnight oil and who make this town run. I believe in a present and a future that holds community, collaboration, communication, and health in high regard.
Join me, and share your ideas.
Let’s make this happen. Let’s change the world.