Tweets & Updates

Dear friends;

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Ramblings: Singapore health system hit by ‚Äėmost serious breach of personal data‚Äô in cyberattack

Most folks working in the healthcare industry, especially for those of us in Singapore would have heard by now, that SingHealth’s IT System was hacked where records of 1.5 million patients (including our Prime Minister, Mr Lee Hsien Loong’s) were stolen.

SinghealthHack

Before I continue, it is important for me to provide some context so one apply relevant perspectives when evaluating my thoughts below;

With the above, here are my two sense worth;

  1. Cyber Security in Health(care) is more complicated that you think
    • One cannot apply conventional IT security best-practices in the domain of healthcare because health(care) is different (if this statement baffles you, you are definitely not from our industry)
    • Some folks I’ve met argued that one can handle Cyber Security in Health(care) like the Military given both are consider “Critical Infrastructure”
      • My personal experiences with the military is limited to the actual service time (of 2.5 years full-time + reservist training till the age of 40) spent during my stint of compulsory National Service (mandated by law) in Singapore so I would not say that I am an expert but I think the nature, operational focus, priorities and budget between these two settings are drastically different (and yes, I have worked in clinical departments, in actual hospitals)
  2. The problem with Cyber Security in Health(care) has been around for a long long time
    • Case in point, I first wrote, publish and spoke on this topic back in 2004
    • Note:
      • It is important to take things into context: I authored the first paper back in 2003 where the eco-system (technology, threats, accessibility etc.) is very different from what we have today so take note when you read the whitepaper(s)
      • However, the underlying threat identified back then remains relevant even today. The method of entry described in the SingHealth incident – “An Internet-facing computer is first breached, and then used as a launchpad to gain deeper access into the network” is similar to what I described in my first paper
    • So don’t go around thinking that it happened out of the blue, the fact that SingHealth was able to detect and “reduce the damage” shows that they are somewhat prepared for such attacks as opposed to being caught totally off guard and losing more valuable data or worst, a total operational shutdown. So kudos to the unsung heroes
  3. The problem has been around for a long long time because it is a difficult one “to fix”
    • There have been several attempts over the years by both regulatory bodies (e.g. FDA) and Industry to try and address this “glaring” issue and to be honest, it’s not an easy one to resolve
    • If you truly wonder why, go take an actual technical course on Cyber Security and you will understand not only the complexity involved but also how it is IMPOSSIBLE not to be hacked – its just a matter of magnitude in terms of “depth of the breach
    • In this case, post incident investigation shows that “Method of attack showed high level of sophistication” and as mentioned in my previous point, it is IMPOSSIBLE to expect any internet facing” computer (including devices with embedded computing capabilities) not to be hacked, one can only limit the “depth of the breach” <- and from the reports, I think the folks at SingHealth did a pretty decent job

Now, I am not saying everything is fine and dandy and we should all have a good laugh at this saga then forget all about it after a nice cup of coffee. However, I think there are too many ‘experts’ out on the internet dishing out unwarranted (sometimes out of context) remarks that are totally unacceptable. (in other words, vent if you must but give the folks at SingHealth a break).

What is really important is to learn from this incident and figure out how to build in better mechanism so we are better equipped to handle such incidents in the future. To quote our Prime Minister, Mr Lee Hsien Loong “We cannot go back to paper records and files. We have to go forward, to build a secure and smart nation“.

Lastly, the above opinions are my own and if you strongly disagree – I wrote, publish, spoke on this topic since 2004, show me your published work specifically on this subject and we will have a conversation ūüôā

Nanyang Polytechnic – Starhub Centre for Connected Care

I tweeted about the official launch + MOU signing of the Nanyang Polytechnic (NYP) – Starhub Centre for Connected Care but thought I will also do a detailed blog post here.

nyp-starhub.jpg

First things first, for the interested, the news coverage of the centre is available at Straits Times¬†and I’ll be paraphrasing some of it’s contents (why reinvent the wheel) while sharing some of the ‘history’ and context of this centre.

My role with the NYP-Starhub Centre for Connected Care started back in June 2012 where I started serving as the Solution Architect for the NYP-HIMSS Centre of Excellence (Health IT), which was officially launched backed on 27 November 2013.

It is important to note at this point that my involvement is pro-bono, as part of the BinaryHealthCare Collaborative Outreach Programme (BCOP) so if you are an interested Institution of Higher Learning, drop us an email.

The NYP-HIMSS Centre of Excellence (Health IT) focused more on the acute-care settings (mainly ICU and in-patient wards), covering healthcare IT solutions such as electronic medical record systems, wireless vital signs monitoring and close loop medication management system that are used in many hospitals in Singapore (remember, this was 2012-2013) while the NYP-Starhub Centre for Connected Care focuses on the seniors (elder care) and those living with dementia.

fjimg_20180522_162052.jpg

In other words, this centre focuses on the¬†ageing population and long-term care sector, adopting¬†smart technologies to enable the “Smart Home” concept, including innovations such as mobile beds, elder-friendly cupboards as well as open-concept designs etc.

Now here is the million dollar question: why am I dedicating an entire blog post on this centre? The answer is workflow. “How fantastic is the workflow optimisation? Well, if you visit the centre (which I highly encourage), you will noticed that almost all the “high tech” stuff are blended in (to the extend of being invisible – like electricity!), that’s how awesome the implementation has been,

Workflow is not a synonym for Processes –¬†non¬†Health Informaticians usually confuses these two concepts as synonyms, if you are scratching your head right now, I suggest you read this whitepaper on workflow¬†or attend our signature course – Mini-HI : Mini Health Informatician

IMG-20180522-WA0007

So what my role with the¬†NYP-Starhub Centre for Connected Care? As mentioned earlier, my journey with this centre started back in June 2012 because I also serve it’s Solution Architect¬†(agin, pro-bono, as part of BCOP) as both centres serves to cover different segments across the Continuum Care!

The story of¬†NYP-Starhub Centre for Connected Care¬†have just started so stay tune for more exciting developments ūüôā

 

Just because you DON’T understand it doesn’t mean it’s “too academic”

Someone commented that I am “too academic” in my work approach and “lack” industry perspective.

My reaction was one of more surprised than annoyed because I’ve been told on most occasions that my approach was too pragmatic (taking situations contextually and using the most cost-effective way to fix the underlying causation) resulting in lack of “fudge” to publish anything “sexy” – this was the case even when I was working in a hospital, way before I venture into adjunct teaching and research.

As a practising consultant, feedback is very important to me but I have learned over the years, the importance of identifying genuine feedback versus people talking bad about me because they feel intimated by my work.

Taking a hard look at the context reveals that the person has no real experience working IN health(care), be it in hospitals (or any healthcare facility), HealthTech or MedTech companies, or even in a consulting firm offering services in a related area. This person also have no academic or professional qualification in health(care), technology, health informatics or anything remotely related.

Instead, this person work “loosely”¬†WITH us health(care) professionals (imagine a cashier working in a two star michelin restaurants, just because he works in an associated role doesn’t mean he knows how to run a restaurant nor make great food).

Of course, there is nothing wrong with working “loosely” with us, health(care) professionals can’t do everything by ourselves but what was puzzling was – why would this person feel intimated by my work? I’m a consultant and trainer, he is not (both in ability and reality) doing any of the stuff that I do and I don’t see myself doing anything of the stuff he is making a living on.

Nevertheless, I want to make it clear to the person, a very basic concept;

Just because you don’t understand the complexity and technical aspects of what I do / advocate / teach doesn’t mean I am “too academic”, it merely means you are not a real subject matter expert

(Don’t worry, it’s not your fault and I encourage you to attend the¬†Mini-HI (Mini Health Informatician) so you can start talking sense to us)

noob1

Behavioural Economics in Health(care)

beA “project colleague” mentioned recently (during a brainstorming discussion) that he encountered difficulties in gaining user adoption for a particular trial and was hoping that a tweak in technology (miniaturizing the device) would help solve the issue.

I went into “consulting mode” and posed a few questions, after which I suggested that he might want to adopt a few basic principles of¬† behavioural economics as part of the solution.

His first (and to be honest, very typical) reaction was “Is that even a real thing? I’ve never heard of it before”.¬†Because this is such a common response, I kicked into “auto mode’ and suggested that he “google it” and take some time to read up on that subject.

The gentleman came back 15 minutes time thanking me for the suggestion and exclaiming wonders on the subject Рbecause Prof. Richard Thaler recently won Nobel for his work in Behavioural Economics.

Prior to Prof. Richard Thaler winning the Nobel price, this positive reaction was not common at all. I’ve been teaching the basics of¬†Behavioural Economics for quite some time (it is also part of Mini-HI‘s curriculum) and I distinctively remembered my first attempt to deliver the topic in a public lecture (hoping to raise awareness to stakeholders on why their Digital Health projects keep failing and why blaming it on end-users and/or technical folks isn’t the solution).

That particular conference was the¬†mHealth Forum, part of the¬†HIMSS Digital Healthcare Week, Singapore, held back in October 2013. The topic of my presentation? “Behavioral Economics in Consumer Health Informatics ‚Äď Unleashing Patient Centric Workflow“.

While I did managed to deliver the lecture, getting it through “peer review” was nearly impossible – because the folks reviewing the topics are¬†not real¬†Health Informaticians. To these IT and business folks, I was trying to talk about something irrelevant and the speaking slot was better off given to someone blabbing on the latest buzzwords like Cloud etc. (I’d like to take this opportunity to thank Sarah Grant, the Education Manager at HIMSS Asia Pacific at that time for helping me push the presentation though).

So in a way I am really glad that Prof. Richard Thaler won the Nobel for his work in Behavioural Economics because it has become so easy to convince people to look into this subject.

Now the only “regret” I have in this context is not pushing through on my awareness efforts on cyber security threats in health(care). I published and talk about the subject back in 2004 (I actually have a IT Security qualification) but was repeatedly told by everyone that they are not interested. Ah well, I can’t help them all.

Context-Driven Innovation

InnovationInnovation has been a recurring topic of late (for me) and the subject came up again earlier today during a casual conversation.

While it is actually quite normal for me to touch on Innovation (I examine Innovation as a topic frequently in public conferences, private training sessions as well as teaching the basics as part of Mini-HI (Mini Health Informatician) what made the conversation special was that I was sharing the core principles on non health(care) related subjects (to be precise, I was applying it to Organisational Improvement and Product Development) and the people I was having the conversation with were very surprised at how the underlying principles are applicable to virtually any disciplines.

The reason(s) being? I was sharing on Context-Driven Innovation and as the name implies, is not only pragmatic but sustainable because it is innovation applied to the underlying needs (hence the contextual part).

To be clear, I didn’t invent the term “Context-Driven Innovation” (because it ready existed when I coined the term), what happened was (due to the nature of my work) I derived a set of “Innovation ideology” over time (through research and relentless practical iterations) and realised that the core principles derived are contextually relevant to the subject applied (hence deciding to call it Context-Driven Innovation).

I did made a determined push on this topic (in this region) back on 3rd August 2016 when I authored the theme (and general scope) for a local Health Innovation related contest / challenge that was aspiring to go regional, although I parted ways with the organising partners, they continued to use my theme of Context-Driven Innovation and some of my contents. To quote a portion of what I wrote back then;

XYZ Challenge 2017 brings together people and organizations across the entire ecosystem to develop new ideas for innovation that will improve the delivery of health and care services for the people (wellness) and patients (healthcare) across the entire continuum of care.

Jointly organized with the A and B the XYZ Challenge 2017 serves as a platform to germinate and empower professionals from the various disciplines to collaborate and leverage each other’s expertise & experience (e.g. Pairing clinicians with techies sharing similar innovation interest) to develop quality solutions that are context-driven as to ensure sustainable adoption, benefiting both the health(care) providers and consumer/patients.

As one can observe, the above paragraphs provides a guideline of sort on some parts of the prescribed Context-Driven Innovation but the context portion is missing. To properly explain the contextual portion, we need to first examine what Innovation is.

A popular definition obtainable off the Internet is the Merriam-Webster dictionary¬†version where¬†Innovation is defined as “a new idea, device, or method; the act or process of introducing new ideas, devices or methods“.

I respectfully disagree.

To truly illustrate the underlying reasons of my disagreement would take time, hence, it will be another topic for another day. What I will try to do here is briefly (and holistically) illustrate why, by giving an example using IoT – which is at the time of writing this article, touted as a great driver of innovation.

To ensure semantic understanding, the definition of IoT (according to Wikipedia) is;

The¬†Internet of Things¬†(IoT) is the inter-networking of physical devices, vehicles (also referred to as “connected devices” and “smart devices”), buildings, and other items embedded with electronics, software, sensors, actuators, and network connectivity which enable these objects to collect and exchange data.

Did you know that¬†first IoT device was a Coke machine at Carnegie Melon University in the early 1980s?¬†Let us re-examine¬†Merriam-Webster’s definition where¬†Innovation is defined as “a new idea, device, or method; the act or process of introducing new ideas, devices or methods“.

Simplistically put, IoT is not new but it is indeed a driving force for innovation.

At this point, I would like to introduce my definition of Innovation;

“Innovation is the use of tools (analogue and/or digital) to extend one’s reach (capabilities) or to bridge a gap as to meet an underlying need”.
Dr. Adam CHEE, 2017

So where does the contextual portion comes in? To explain this part, I would invite you to read an older article of mine – Use Case vs. Process vs. Workflow ‚Äď Which is the secret ingredient?, it briefly illustrates the concept of workflow (which is related but not the same as user-cases or processes).

With the understanding of what workflow truly is, I would like to finish this article by introducing my definition of Context-Driven Innovation;

Context-Driven Innovation is the optimisation¬†of Workflow and (could include) the utilisation of tools (analogue and/or digital) to extend one’s reach (capabilities) or to bridge a gap as to meet an underlying need”.
Dr. Adam CHEE, 2007

Till next time.

Ramblings: New Cartoon

It is not common knowledge but I would create simple cartoons to illustrate certain concepts, especially if I find myself repeating them often.

Most of these cartoons are not made known to public but I have decided to share with you folks, a new cartoon I’ve created today, on the topic of “How¬†NOT to leverage your Subject Matter Expert”.

(Inspiration source: Consulting clients in health(care)¬†projects as well as from companies I’m helping to venture into China.)

SME

Will technology replace physicians?

The question of “whether Technology will replace physicians in the near future” was posed to me last week during a commercial discussion and I thought I’ll share my perspective with you folks.

Truth be told, it was not the first time I was asked this question (or its multiple variants РClinical Decision Support, Artificial Intelligence, Big Data & Analytics, Machine Learning and of course, IBM Watson. For the uninitiated, the various concepts / technology mentioned are actually inter-related).

To illustrate my¬†perspective, I will quote a scene from the movie “Hidden Figures” (a 2016 American biographical drama film on African American female mathematicians who worked at NASA during the Space Race.)¬†

No worries if you have not watched the movie. Basically,¬†John Glenn, the first American astronaut to orbit the earth did not trust the¬†trajectory and entry points calculations provided by the newly-installed IBM 7090s and insisted that Katherine Johnson (the movie’s protagonist) check and confirm the numbers.¬†If Katherine had determined the calculations provided by the IBM 7090s to be inaccurate, then the¬†mission (to orbit the earth) would be aborted.

That was 1962. I would imagine that the scenario to be somewhat reversed in today’s context where we would insist that any calculations performed by humans be verified by computers.

So where is the part where I proclaim that “Technology replaced Humans”? I didn’t.

The main reason why people post the question of¬†“whether technology will replace physicians in the near future” (and its various variant) is because they;

So why won’t technology replace physicians?¬†To shred some insights, did you know that as late as 1942, a famous medical textbook considered bloodletting appropriate treatment for pneumonia?

What is my point exactly?

Well, the role of physician have been changing over the centuries, the constant introduction of better tools and knowledge only serves to help them do their job better (read: evolution of the medical discipline¬†) but advancement in the medical discipline will not be uniformed, that’s why bloodletting is still considered by some to be an appropriate treatment for pneumonia as late as 1942.

If you found the above illustration beneficial or enabled you to obtained further insights on the nature of health(care), I suggest you read my whitepaper on Sustainable Adoption in Health Informatics.

Note: Found this article useful? Then do a Good Deed today!

Updates: Optimising sharing of Updates

Hi everyone,

In order to optimise information flow (in this case Рupdates from BinaryHealthCare), we decided to tweak the workflow on how we will be disseminating updates through the use of Social Media.

  • Updates via Twitter and LinkedIn will be synchronised
    • The content distributed will be¬†mostly status update and sharing of external content (including events)
    • I understand that some social media experts will cringe at the idea of having the exact same content distributed at Twitter ¬†and LinkedIn (platforms designed for very different purposes), however, we are aiming to keep content shared at a professional level

So what does the above changes means? The idea is to make it easy for anyone interested in what BinaryHealthCare is up to.

  • If one wishes to be kept abreast of what we are doing and/or get new content as and when it is available, follow us via Twitter
  • If one wishes to communicate directly with us (for professional purposes), connect via¬†LinkedIn¬†or drop us an email

The changes are effective as of today so we really hope this help.

Cheers
Adam