Brexit, more than anything else is the result of a crisis in confidence that has been brewing among the electorate if not since the EU was formed, then perhaps since the global financial crisis of 2008.  This crisis stems from a feeling of helplessness towards fixing socio-economic and political problems that are often times experienced.  Those in favor of Brexit voted that way because they felt betrayed by government policies which they believe prioritize global interests over their own.  
No doubt, globalization has brought advances in transportation, communication, and healthcare in even the most remote and poorest part of the world.  How can one ignore the value of social media in connecting people across continents, allowing them to share interests and build long lasting relationships?  Nonetheless, globalization is seen as the culprit for feelings of envy towards those that are not from the UK.  The UK has close to 3 million residents from other EU countries while it struggles with refugees that have not assimilated into its population.    
Political and economic elites have for so long now advocated the notion that the world is one village.  What happens in Manila is equally as important as what happens in Piccadilly Circus.  There is no intended maleficence in this thought process, but, in America politicians have always understood that in order to win an election, a candidate has to be in tune with the thinking of his/her local constituents and more than anything else, meet with them and listen to them.  In other words, “politics is local”.  It is that way because citizens of democratic societies want to feel empowered in shaping their own destinies.
However, even in America, the rise of Donald Trump is a result of that same feeling that supporters of Brexit have, and that their elected representatives abandon them as soon as they are elected. 
How must one deal with the current state of affairs?  To begin with, every citizen must understand that political office is not only civic service, but also, a privilege that only a few have.  Political office holders at every level must not stray from their mission of representing their own people all the time.  When running for office, allegiance must not be made to any political party or lobbyist, but rather to one’s own constituents.  The reason why incumbents are more likely to be elected is because the deck is stacked against new comers through gerrymandering and the power of lobbyists.  I would hope to see the day where the cynicism of “power above all else” and apathy is no longer a common notion among voters.  I do not know how elections are run in the UK, but I can certainly claim that election laws in the US should be reformed.  The money spent on presidential elections is obscene, especially if a voter understood that their local representative is far more likely to influence their wellbeing than the President.
Equally important, is an educated society that is not completely influenced by their political leanings.  A free society where citizens can exercise their own power to shape their destiny requires that those citizens understand their own laws and know their politicians.  Effort must go into knowing candidates and bills that are being voted on.  With so much information pro or con to every candidate and every issue readily available in the papers, the internet, the news sites and ones contacts, it is easy to ingest the information, reflect on it and then make an educated decision on who to support or what to vote on.  If you do not believe that you have the power to change an outcome, just imagine, for better or for worst, how Brexit succeeded even though the UK Prime Minister had put his job on the line to defeat the measure.    

I have been reading about and practicing data analytics for several years now and I still don't get the hype that exists about the real value that it brings to its users.    Granted that cloud, remote virtualization, Big Data,  and advanced global networks  have made it easier and cheaper to store and analyze petabytes of data that if tapped on effectively can produce facts that would help any cause.  It is true also that analytics can bring the power of prediction and Business Intelligence can put information at one's fingertip in a format one can easily understand.  No doubt that cloud can help any enterprise get the necessary resources it needs virtually in real time. I for one have seen the value of Customer Service Analytics to help drive customer retention and loyalty.   With mountains of data, data quality and governance solutions, master data management  and data integration is allowing organizations manage their information assets many times quite effectively.  

There are a number of business domain areas where analytics has made a notable mark for consumers.  Data analytics on online flight reservation systems for example has helped Southwest Airlines provide numerous popular flight paths to travelers at very affordable prices.  On defense intelligence and terrorism, analytics has helped the intelligence community thwart attacks to a number of critical economic lifelines of the national infrastructure.  In life sciences, analytics is marking advances in the human genome project and the cure for many diseases of an aging population.

So great...Data Analytics certainly does give us a plausible value.  But, here is where I see it failing.  The current state of analytics and Big Data is such that it is helping somewhat in commerce.  However, how is it helping in the daily personal decision making of individuals as a whole?  Think about it.  How many spam ads and unwanted emails do you delete from your box every day?  In Q2 2013, the number of spam emails grew 4.2% from Q1 2013 to a average total of 70.7%of email.  When you purchase a product online, how much help do you get from vendors in comparing their products to the competition?  There are consumer guide sites such as CNET that do provide some information on purchasing electronics, but can you say the same thing about selecting a good primary care physician?  Can you honestly say that the data that the NSA gathered on you or other citizens will never fall in the wrong hands and do you trust the government that it never will?  Can you think of a web site you can go to that gives you real measures on information leaks? Do retailers who have millions of credit card records on file give you any statistics on number of security/privacy incidents and does that data show how they compare with other retailers? Think about any of the recent customer support calls that you made for a product that you purchased.  How does it compare to a similar experience say 5 or 10 years ago? If we took a survey that could measure weather a retailer is genuinely concerned about your issues, how would you think that retailer compares to say 10 or 15 years ago? 

It seems to me that bottom line, the value of analytics is in providing quality valuable service or product and that in itself builds the trust between the provider and the consumer.  So despite all the technology and gadgets in use today, we are still a long way from building that trust, and trust is the currency that we should be measuring success of analytics in any enterprise.      

Xerox invented Laser printing and copying less than 50 years ago and as a result revolutionized the publishing industry.  This innovation was so significant during its time that the outcome was that almost every Japanese electronics product manufacturer, the likes of Canon, Konica, Ricoh and Minolta invested billions to market office printing and copying products.  Xerox’s invention triggered the modern publishing paradigm that we live in today.  Of course, as we all know, when publishing spilled over to the internet and digital content became the biggest innovation of early 21st century, it led to a worldwide shift in knowledge and cultural norms spurred by a new invention, the social media.   

The millennia generation may take mobile content sharing and social interaction for granted, but those innovators of the 70’s know well that each new generation of innovation piggybacked on the previous one.   In the 1980’s Adobe developed PageMaker that marked a standard for printing digital content on paper.  Online digital content borrowed from that same innovation to mark new standards and methods of rendering images and text onto the rich content you now find on the iPAD.  Careers in content management and social media marketing were an outcome of these inventions.

During the 70’s when Xerox opened Palo Alto Research Center and invested billions in printing and publishing systems, it had a sizable impact printing and publishing business to tap on for its Research & Development costs.  Tax incentives for R&D also helped win those innovations.  Nevertheless, those billions that were invested were fraught with early failures.  Remember the likes of General Foods, Compaq and EF Hutton.  These were successful companies which invested billions in their products and eventually failed.  But, many have picked up their pieces and created more successful businesses.   To make an analogy for Xerox in today’s terms, one can site biotech innovations and the average lead time of 10 years that it takes to bring a drug into the market.  Kudos to those entrepreneurs who are willing to stick to their guns while waiting for their drugs to make their mark.     

Such is the current fate of the Health Exchange Marketplace that was a key element of the Affordable Care Act.   The state of Oregon got one of the largest per capita federal grants, if not the largest one to implement the state online Health Exchange Marketplace.  Both the Center of Medicare and Medicaid as well as state officials would acknowledge at the time that the federal grant was intended to be a stepping stone for innovation and to be used as a model nation-wide.   Expectations were set high by a democratically elected legislature and governor who were fighting tooth and nail against an onslaught of skeptics in media, partisan legislature and other partisan groups.  In 2011, the state’s vision was to build an online marketplace that required no more than 50-100 staff members to administer the entire Exchange bureaucracy.  For the Obama administration, that vision was supposed to be carried through to other states.  Of course, what happened next was a mistake in execution which can be blamed not only on the federal and state bureaucracies, and the contractor who was helping in building of the Exchange, but also on the insurance carriers who dragged their feet as a result of the skepticism that existed.  The Oregon exchange would have provided a seamless interface to insurance carriers, the state Medicaid enrollment system and the federal CMS hub making it easy to register, shop for, enroll and administer the individual and employer plans.  Other state Exchanges such as those of the State of Kentucky, Washington and California were dealing with much larger citizenry and tax base where they could afford 10 to 20 times more staff members to administer the Exchange.  In those cases, focus was not on innovation or seamless integration, but more so on getting the online enrollment applications submitted.  So, those states were able to get the web interface up and running by the open enrollment deadline of Oct. 1, 2013.

A lot can be said for the mistakes that were made.  But, it can certainly also be said that the vision that existed in early 2011 was later clouded by the cynicism of partisan politics.  The state that now had to rely on additional federal grants to complete the project was faced with a federal HHS bureaucracy who no longer had the clout to provide additional grants.  One can site numerous examples of failures of a similar kind in the private sector which were followed by successes only because the leaders of such initiatives were able to convince their constituents that staying the course or some course corrections would yield a positive outcome.  We may never know whether this will be true of the Oregon State Exchange as the governor and the state bureaucracy has decided to use the Federally Facilitated Exchange (FFE) for next year’s open enrollment period.

Two things we do know however.  First, that it is possible to get the State Exchange right if leadership is willing to stay the course and reinvigorate the vision that existed in 2011.  Secondly that despite all that you hear about the failures, that IT expenditures in like situations are much larger in other business sectors.  In banking, for example, Gartner data shows that the average IT spending is 6.3% of revenues.   In global banking institutions that number could be as high as 15% of revenue.  In the Healthcare sector the expenditures are at an average of 4.2% of Revenues.   We can probably all agree that health insurance carriers and providers leave lot to be desired on their online services.  One can argue of course that each sector has its own nuances and business models that do not make it possible to spend more on IT.  However, other data also shows that private sector institutions that have robust governance and who exhibit a lot of agility in their business operations also tend to spend more on IT as a percentage of their revenues.  In government where comprehensive data is lacking, the DOD and Homeland Security agencies spend about 6.5% of revenues.  Other agencies spend a lot less.  In State government, the best numbers that exist point to an average of 3.5% of revenue comparable to rates found in Pharmaceutical, Telecommunications and the Insurance sectors.

The Affordable Care Act signed into law in 2010 provided $35 billion in grants to states and the healthcare industry for improving citizenry access to healthcare information and for electronic health records.  Part of this appropriation was for federal grants for state exchanges and Medicaid modernization.  This investment is only a down payment and in many cases an incentive for the private sector to understand that the mission of the federal government is reducing the cost of healthcare by streamlining healthcare administration.  One can argue that private sector innovation, fraud prevention and certainly streamlining regulations can contribute significantly to cost reduction.  One thing is certain however and that our economy cannot afford a situation where healthcare services are provided to the citizenry in a haphazard way.  Therefore, it is imperative that healthcare payers, providers and all forms of government find ways of collaborating in order to find significant ways to reduce the cost of healthcare.  We can start by going back to the age where politicians and citizenry alike can lay down their arms and find ways of working together.   

Conventional wisdom would indicate that the cost of health and medical care will go down as a result of the push by government to implement electronic health and medical records (EHR / EMR).  One can certainly understand that as a result of tremendous gains in the use of emerging standards for sharing health and medical records.  The Clinical Document Architecture and HL7 has helped entrepreneurs ride the band wagon to invest in cost effective platforms for hospitals and their provider members making it easy to share information between providers and to efficiently administer medical care.  In addition, the use of portable devices at many care facilities has brought significant gains in the flow of clinical information between physicians and healthcare technicians.  How is it then that a recent study shows that the United States still ranks 22nd out of 27 high-income nations (US Ranks...) when analyzed for its efficiency of turning dollars spent into extending lives?  Some politicians would argue that the high cost of care is due to the far superior R&D and resulting healthcare services provided in the United States as compared to elsewhere in the world.  That is certainly evident in the leading edge medications and minimally evasive surgery tools and techniques which are no doubt second to none.  However, there can be no excuse for such gains when the healthcare economy of the country has been moving towards a growing dichotomy of haves and have not's.  It is certainly counter-intuitive that over the last 30 years access to health care for the elderly has improved so drastically while  fees for services by practitioners has been reduced.  Many practitioners have countered the drop in their disbursements of Medicare and insurance carriers by administering more and more unnecessary procedures. Some have even dropped their membership with carriers and are charging cash fees to patients that can afford to pay for the services.  Carriers are now countering with limitations on the administering of certain health services.  In addition malpractice insurers have increased their fees to counter that trend.  So, in essence we could be riding a death spiral that result only in havoc in the largest industrial country in the world.

The solution can only lie in a conscious effort to review all the policies surrounding the administration of healthcare and to built efficiency into it.    Why for example should a hospital pass on the cost of compliance with the Health Information Portability and Accountability Act (HIPAA) to the patient when such cost is unrelated to the care needed by the patient (Hospitals Waste...). Improving the standards and procedures by which providers handle personal health information should result in a net reduction in the cost of that healthcare and not an increase.  That is where messaging and document standards can certainly make a difference.  Securing and providing the means for auditing records should be something that is known to those building the Healthcare portals and government agencies performing the audit should have adequate tools for doing those audits before the healthcare portal goes live.

Another area were some gains have been made in many states is to cap the cost of malpractice so that the fees that practitioners are paying for their insurance does not unexpectedly rise as a result of a single incident.  Over the last 10 years, we have witnessed a considerable reduction in the rise of insurance premium rates for automobiles in California simply as a result of those caps.  Obviously, a small percentage of malpractice can cause irreversible damage to patients and their families.  In those cases, one cannot argue against large monetary judgments.  Seizing the practitioners license from practicing is punishment enough to remove the risk of further malpractice.  Instead of penalizing insurance carrier for mistakes of a few practitioners, what if states provide public/private partnerships that would pay for such damages to patients.   

From time to time, one needs to look at the list of thousands and thousands of medical conditions which are now being standardized by Health & Human Services at the federal and state levels and the correct prescription for those conditions and ailments.  These standards are being deployed under the new ICD-10 nomenclature.  The motive for it at the federal Center for Medicare and Medicaid is to reduce fraud.  But, there is a tremendous cost in overhead by state agencies and healthcare payers alike in ensuring that patients are getting the correct prescription for the conditions they have and the cost of administering that overhead should not add to the burden of administering the overall healthcare cost.  The jury is out on this one, but one can certainly create economies of scale by grouping and simplifying low risk conditions and procedures while paying more attention to  more complicated conditions such as cancer or type 1 diabetes.  Payers should build triggers into their automated systems that would allow more complex conditions to be under further review or better yet to reduce the number of services which require pre-authorization by driving the cost of basic medical care down to negligible rates.  That way, one can even expect to see basic medical care be covered by single-payer (there I said it), while physicians and practitioners focus on complicated medical conditions.

Finally, and this is were something has definitely gone wrong in is the lack of competition that federal and state regulations have created for payers and providers alike.  Insurance agencies and  providers should be able to market their services beyond their regions to gain some economies of scale.  With the advent of tele-medicine and real time communications between patient and practitioners, government must remove the burden to the practitioner who wants to practice across regional boundaries.  If you want a small clinic that provides excellent cardiac diagnosis capabilities in Chicago to build its own EHR / EMR capability, in addition to the incentives that have been provided by the Center for Medicare and Medicaid for funding those endeavors, why not make it even more appealing by allowing that clinic to practice its medicine in rural Iowa or Arkansas.    


Yes, EHR / EMR can definitely reduce the cost of healthcare, but that is not a foregone conclusion.  What is needed also is policymakers that can augment technology gains with changes in programs and changes in regulations that would make those gains more possible.  

A good article by Nitin Mehta on motivation for content migration. My experience has been the same. A few lessons learned:

1. Make sure you have a motivation for a migration. It is not enough to say I want to standardize on a specific platform if you have not committed a strategy and resources to it.

2. Make sure you are gaining value. Standardizing is not enough. Value can be in terms of better content control, easier content creation, better content search and analytics, and what have you. Whatever it is, estimate ROI gains.

3. Make sure the scope is understood or you could end up spending a lot of content that is no longer useful. Keep the users involved.

4. Don’t just pick a solution vendor. Have your incumbent vendor involved in the project. I bet you that you can find better Sharepoint or Oracle expertise from an incumbent resource than you would from Microsoft or Oracle. The incumbent knows your content and processes and they may be able to do a better job.


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A great article given to us by IBM and written by Alan Earls, ebizQ contributor on Strategies for Building a Case Management Architecture, advise for all those in the law enforcement, health and human services and legal professions.  At TS Analytec Inc. we have certainly experienced the need for common frameworks for building viable solutions for delivering low cost service excellence in federal, state & local government  health and human services.  Business Process Management has a promise, but, building bridges, as Earl presents is a major factor.

Strategies for Building Building the Best Case management Architecture

imagine how frustrating it would be if you brought your car into a dealership for service and 
the car wasn’t ready until three hours after they told you to pick it up. assume that this is a 
very busy place that offers a broad array of services. in fact, they frequently expand their 
services with new options, such as a free car wash, shuttle service while your car is being 
serviced, and car detailing. But as they deliver these new services, they often don’t have the 
right processes and systems in place to support them. The shuttle driver’s schedule isn’t 
integrated with the shop’s delivery schedule, so the driver picked you up far too soon. They 
offer detailing but don’t have the car wash on site. Cars have to go to another car wash down 
the street, which adds to the wait time. get the picture? adding new services without integrating 
processes is chaotic — and it can have a real negative impact on customer satisfaction.

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