Depending on what term you Google, there are dozens of health-related apps listed as the best ones for patients and consumers. Things like Tummy Trends, iCookbook, MyFitness Pal, and so on. The list of health-related wearable devices is equally lengthy.

Millions of dollars are being spent to develop these apps and devices. And billions have been spent and will be spent by individuals—consumers—who are interested in either getting better or in staying healthy.

So I thought maybe the time had come for someone to add a voice of reason to this discussion. I kept waiting for someone to do that, and when nobody did I thought perhaps I should take a stab at it.

There are enough apps and devices available to pretty much record data about every body part and every conceivable health condition. I can purchase an iWatch, a Samsung smart belt, an Under Armour shirt, and smart shoes. Sensors can be strapped to every part of me.

So that must be a good thing. Right? Not so fast Charlie.

If you bought and wore every device, and used every app, would you be healthier? Or, would you just have a lot of data?

1. Each of the apps and wearables are stand-alone recording devices. Data from one app or device knows nothing about the data from any of the other apps or devices.
2. Data from some apps lacks information. Eating 2,000 calories of Twizzlers records the same number of calories as eating 2,000 calories of salmon.
3. The fitness trackers look nice, but they are not designed to tell you, “Stop running NOW! Dial 911.”
4. The user of the apps and the wearer of the devices must be qualified to play doctor. They must be able to understand the data and draw correct conclusions from each app. And they must be able to correlate their data from one app or device and interpret its meaning in light of the data collected from all of the other apps and devices.

Reams of data, very little information. Nothing seems to be able to answer the question, “So what?” So in my small mind, I do not see how an individual is supposed to manage their health using any of there data because they are missing one important piece of information—what is all of this data telling me I should do?

The missing app, the missing device, and the piece of the puzzle that is not available to a consumer is the one that collects all of my data, analyzes all of it, and tells me what I should do tomorrow. Everyone’s current wellness plan for tomorrow and the next day is to collect more data.

One solution would be to allow consumers to download a physician or strap one to their wrist. Any why is that important? Because without being able to do that the consumer is forced to play doctor. They guess, and guessing is not the healthiest choice for maintaining your health.

But what if there were a way for consumers to collect data and allow the doctors to pay doctor? There is. It’s just not being done.

Let’s come up with a solution by simply looking at one person’s app and device data; yours or mine. Suppose the Hospital of the University of Pennsylvania (HUP)—my provider, or Anthem, or CVS decided, “We want to know as much as we can as often as we can about our patients’ and customers’ health. And—this part is a big deal if you happen to be a healthcare executive—what if we wanted to know the same information about people who are not our patients and customers?

(Sidebar. This is a big deal because non-patients and non-customers are the exact group of people your marketing departments are targeting. Suppose that every day for the last two years Sally, who is not a patient at HUP, has been allowing HUP to collect, manage, and assess all of her health app and wearable data.

If Sally gets sick, she is going to go to HUP because they know everything about her. Perhaps HUP, having analyzed Sally’s health data, recognizes Sally, notifies Sally, and treats her? Sally went from being a consumer with no provider to being HUP’s patient.

And Sally will be no more interested in changing providers than she would be to change the bank with which she has stored all of her financial information. Payers—Anthem and retail pharmacies—CVS can develop the same consumer friendly way to proactively manage the health and wellness of their stakeholders.)

This health data aggregator, this Super-App has to be interactive. It can reside on a PC. It ought to reside on a mobile device. And ideally, it should reside in the cloud. And instead of having clinicians reviewing all of this data, it should be cognitive.

Today’s post is pretty lengthy, so you may want to grab a snack.

If you are male, this piece will make perfect sense. If you are female, it will make even more sense.

I did a project in one of my prior homes. It involved the simple task of rearranging bedroom furniture, a 15 minute project, total cost—nothing. After all, how difficult can that be? The actual moving of furniture involved nothing more than I’d planned. Only when I thought I was done did I notice that the television set was now located a good 20 feet away from the cable television outlet.

The obvious solution would have been to simply move the furniture back to its original position. Can’t do that. To move the furniture back is either admitting defeat, or that I wasn’t bright enough to realize that the cable outlet and the television would be on opposite ends of the planet by the time I finished. Besides, my wife had already seen the new arrangement and if I moved it back to its original position I would have to explain why.

So when she enters the room and asks why—she will ask, that’s her job—there is a 25 foot piece of black coaxial cable snaking its way diagonally across her bedroom carpeting I had better be prepared to answer.

If you’re quick, really quick, you can try and bluff your way around the problem with a technical answer. You can try and explain that all of the static electricity that was created by sliding furniture across the carpet has caused the sonic membrane surrounding the fiber optical transponders in the coax to be 6 ohms off the medium allowable temperature variation for the building codes in your neighborhood. What you’re really doing is stalling, allowing for a brief period of self-correction.

That truth, having failed me, the only other option left was to try something close to the truth. I’m forced to say that I knew the cable would be at opposite ends of the room before I moved the furniture. My plan all along was to call the cable company and ask them to come to the house to install another outlet on the correct wall.

It’s my wife’s job to inquire how much that will cost. This is a clear case of me answering her question without bothering to think. It’s important to have a clear understanding of the underlying issues before trying to solve the problem. I replied that it should cost $40, and that we will only need to leave the cable strewn across the floor for a few days.

It’s then her job to say that if we put the furniture back where it was we could solve both problems in 20 minutes. Besides, the cable technician left a mess the last time they did some work, and she wasn’t going to spend more money for poor service. Stay with me here, this is how it becomes her fault, and how it relates to healthcare.

Once her issues were out in the open was a simple matter to devise a solution to address them. The solution needed to be implemented quickly and it needed to be free. My answer came quickly—too quickly. Eighty percent of the problem could be handled by simply running the cable along the floorboard, and then under the bed. That only left 5 feet of cable between a happy marriage and me. Unfortunately, the 5 feet in question is from the foot of the bed to the television and ran across the major walkway of the room.

Undaunted, I asked her to help me move the bed. This accomplished, I headed for the garage to find exactly the proper tools for the proper job. I returned five minutes later, tools in hand. I was surprised to see the look of dismay on her face. Her look of dismay may have resulted because of the razor blade knife I was holding. After 20 minutes of the best Boolean logic I could muster, I convinced her, or at least myself, that it would be a simple matter to cut a small hole in the carpet and force the cable underneath. After all, the bed would hide the hole.

The only other tool I thought I required was a roll of duct tape and a 4’11” broom handle. Women know we are confused about how to proceed the moment they see the duct tape. Most men, when cornered believe that enough duct tape, properly applied, can serve as a panacea for anything up to and including world hunger.

You’ll note that I specified the exact length of the broom handle. It’s only after having attempted the project that I’m able to relate the relevance of the length of the broom handle. Men on most projects, especially those being watched by their wife, wouldn’t bother to measure a length any more than they would ask directions while driving across Borneo with half a tank of gas.

Hindsight dictates that I should have measured both the distance the cable had to travel under the carpet and the length of the broom handle prior to taping the cable to the handle and shoving a 4’11” broom handle under a 5 foot expanse of wall-to-wall carpet.

The fact that the carpeting was wall-to-wall is key to understanding what lay ahead. Let’s make certain that the situation is spelled out clearly; the new carpet in our new home had a hole in it, a broom handle was now stuck under the carpet. And my wife, my east and my west, God love her, was perched on top of the bed’s footboard, with her talons firmly grasping the solid walnut. She stared at me with a look that would give carrion eaters a bad name.

Walking to the wall and grasping an edge of the carpet firmly, I pulled up a good 10 feet of it from the tacking, acting all the while like I would have to have done that even had the handle not been an inch too short. Leaning with my one arm on the newly exposed carpet tacks, I asked her to help me remove the handle from beneath the rug. Once that was accomplished, and while bleeding profusely, I looked for another proper tool to complete the task. Walking through the kitchen I wondered if the tool I needed was there. Naturally, it was; one half of a pair of chopsticks; also known by its new technical name, a broom handle extender.

Five minutes later, the broom handle extender and cable was firmly duct taped to the broom handle and once again shoved under the carpet. They both went in, but no cable came out the other side. So, I retrieved the handle and surveyed the situation. The situation, as it turns out, was that in my hand were a perfectly good broom handle, a piece of coaxial cable, and no broom handle extender. The extender was now smack dab in the middle of the five foot expanse that I was trying to cross. The problem was that it was now on the wrong side of the carpet—the underneath side. It was positioned perfectly. It was too far under to be reached from either end. In other words, the chop stick had just become a permanent fixture in the bedroom.

Certainly, one small chopstick hidden beneath 400 square feet of carpeting was not a big problem to me. It was not a problem unless you happened to be walking barefoot across the carpet and you happened not to be the one who put it there. In that case, it became not unlike the fable, The Princess and the Pea.

My princess found it immediately.  In that fable, it was the princess could not sleep. In my case, I knew that the non-sleeper in the story would be me for as long as the chopstick remained under the carpet. Keeping my eyes focused firmly on the task at hand, I foolishly believed that if I could resolve the problem of the cable, the matter of the chopstick would resolve itself.

One final trip to the garage led me to return with a second broom handle. The carrion-eater looked on in disbelief at my inability to finish what I had started without us having to sell the house at a loss before I was through.

My project had become a quest. A mile of duct tape later, both broom handles were taped together end-to-end. Even if I destroyed every square foot of carpeting in the house, I would not lose this broom handle under the carpet. A minute later the cable emerged exactly where it should have, on the other side of the room. I pulled the out broom handle, attached the cable, and turned on the television. Everything worked, just as I had known it would.

I took a bow.

Standing in front of the television, admiring my work, I noticed that I was now a good foot taller than when I began the project. Was this an illusion brought about by my success? As was quickly pointed out by the ice princess, my new stature was more attributable to the fact that all of the carpet padding that used to lie between the end of the bed and the wall was now compacted into a large lumpy ball. The ball of padding was located in the same twilight zone the chopstick found, right in the middle of the walkway. Trying to correct the problem only made it worse. Each time I prodded the ball of padding with the broom handle it grew larger underfoot. Within minutes it looked as though I had managed to suck up every inch of padding from every room in the house, and I had placed it between my wife and my getting a good night’s sleep. Resorting to logic once again, I quickly pointed out that she should walk on it because she would no longer be able to feel the chopstick.

The next day I was on the phone scheduling an appointment with the carpet installation service. The carpet installer had to pull up most of the carpeting in the bedroom to be able to reach what she had affectionately labeled Chopstick Hill.

I watched him work and I learned all about carpet padding and the installation of hardwood floors. He explained that it was lucky for me that he came over because our padding was not good quality padding and we would not have known that had he not pulled up the carpet. I asked him why I would want to spend $300 for new padding. Without responding, he just kept slamming his knee into the carpet installer, charging $100 for his efforts and my education.

I was so impressed with his discussion of hardwood floors that I almost bought one on the spot to surprise my wife. By now, you and I know she wouldn’t have appreciated the surprise. Anybody who did not want to spend $40 on the cable repairman would probably have a little more trouble accepting spending $5,000 for a floor she didn’t need. However, I was able to walk around with a silent smirk on my face for days knowing that had we done it my way from the start, called the cable man, we could’ve saved the $100 and never put a hole in the carpet.

Now that I think about it, I should have waited until she was out shopping.

Did I mention healthcare?

This is what happens when you try to fix a problem with which you have no experience.

The largest business system in your organization, whether you work for a provider or a payer, is the system that interacts with your patients and your potential patients. It must interface well and easily with all of your other business and clinical systems.

Those people—patients, caregivers, family members, and referring physicians—need to talk to doctors and nurses. They need to solve problems and resolve disputes. They need to schedule appointments, set up payments plans, file claims, make a payment, order refills, ask questions about their health data, order their health records, and dozens of other things.

A non-trivial exercise. Like moving cable.

Sometimes it pays to get help.  Or, you may be able to wait until everybody is out shopping.

Pascals’s Wager posits that humans all bet with their lives either that God exists, or that he does not. Based on the assumption that the stakes are infinite if God exists and that there is at least a small probability that God in fact exists. He argues that a rational person should live as though God exists and seek to believe in God. If God does not actually exist, such a person will have only finite losses whereas they stand to receive infinite gains or infinite peril if God exists.

Paul’s Wager posits that members of the healthcare triumvirate—providers, payers, and retail pharma—are betting the future of their firms either that consumerism will be the most dramatic change in healthcare in fifty years, or that it will not. Based on the assumption that the stakes are infinite if consumerism exists and that there is at least a small probability that consumerism in fact exists. I argue that a rational healthcare executive should live as though consumerism will create a dramatic change, and seek to act upon it. If consumerism does not prove to create a dramatic change, those leaders will have only finite losses whereas they stand to receive infinite gains or infinite peril if consumerism proves to be what I think it will be.

Anyway, the argument made sense to the voices in my head. There is a football adage that says when you throw a pass three things can happen, and two of them are bad.

So how does consumerism apply to retail pharmacies? When you write a prescription, five things can happen and four of them are bad.

• People fail to fill their prescription (20%)
• People fail to pick up their prescriptions (abandonment 14%)
• People fail to take their medication as prescribed (50%)
• People fail to renew their prescription (+25%)

Of those who take their medications, fifty percent do not take them as prescribed. In addition, over time, many people stop taking their medication.

These failures are so prevalent that we even have a term to describe them—nonadherence. What we don’t have is a term or a plan to correct the failures.

Clearly, some percentage of these failures cannot be fixed. Nonadherence is made up of several factors; cost, co-pays, convenience, side effects. However, user and consumerism friendly tools could make a world of difference.

Technology exists to let physicians know that what they prescribed was not filled. They could be notified that the medication was filled but not picked up, and the pharmacy already knows the medication was not picked up. And physicians and pharmacies can determine whether a medication was refilled.

Physicians and payers and pharmacies could create incentives for adherence. They could provide digital follow up reminders and track the response. They could automatically refill the prescriptions.

All of those things would work to improve the failure rate. But what if there was a personal health concierge available in patients’ homes. It could reside on a PC. It could operate from a smart app, or be tied to a wearable. Heck, it could even function with Siri-like functionality on an Amazon Echo-like device. And if you can deliver the functionality on Echo, you can deliver it through a smart watch, a smart phone, and a tablet.

• “Did you take your Toprol today?”
• “Today is the final dosage of your antibiotic.”
• “Your Niaspan runs out next week. Do you want me to refill it now?”
• “If you refill your Niaspan now, we will reduce your co-pay by fifty percent.”
• “Are you having any side effects from your statin? Please reply, ‘yes’ or ‘no.’ If yes, would you like to speak with a pharmacist?”

All of these things can be done.

They simply aren’t being done.

Every day patients are betting with their lives that they do or do not need to take their medications.  And yes, they are responsible for their choices.  But anyone who does not believe that an Easy Button would improve the process is just being naive.

Consumerism for retail pharmacies.

New College, in Oxford, England, was founded in 1379, hundreds of years prior to the invention of the I-Beam. Enormous oak beams support the roof of the college’s main dining hall. Each beam is two feet square and forty-five feet long.

Wood has a number of characteristics.  The characteristic most relevant to this discussion is that it rots.

About 100 years ago, entomologists were studying the beams that supported the dining hall’s roof and they noted that the beams were infested with beetles. Apparently the students were not the only diners in the room. The beams could not be repaired, and the integrity of the five hundred year-old roof was in jeopardy.

Unfortunately for the college, it was widely assumed that all of the large trees from the old-growth forests had long since been felled. It appeared that the only way to preserve the dining hall was to use modern materials.

New College owned a great deal of land and actually employed its own forester—someone who could see the forest and the trees. When the college asked their forester about whether he knew of any large trees, the Forester replied, “I was wondering when you’d come asking.” The administrators discovered that when the college was built, a grove of oaks had been planted for just such an emergency.

The information about the grove of oaks was passed down from forester to forester for more than 500 years.

Long term planning: Planning that provided the perfect solution, not a series of ad-hoc fixes year-in and year-out.

When I built my home I did some long term planning as well.  I had telephone jacks and Ethernet wired to every room in the home so I could make a call from any room in the home and have an Internet connection in every room.  About a week after we moved in to the house I learned about something called a wireless router.  So much for my astute planning.

So, how does planning come in to play with healthcare providers?  Or does it?  Has anyone in your organization ever used the terms long-term planning and consumerism in the same sentence? In the U.S., and among U.S. healthcare institutions, long-term usually refers to those events that happen just beyond the threshold of the current year’s budget. Has anyone ever said, “I want to ensure that when I retire, that this is in place for the next CEO?”

When a single grain of sand enters an oyster’s home, the oyster gets irritated—if oysters had children, they would learn to get along with many grains of sand in their homes and cars—at least those oysters who drove. So, we have an irritated oyster. And when irritated, oysters get busy. And when oysters get busy, they build things. Pearls.

Let’s see if we can compare that to healthcare. When someone calls a health system, the health system gets irritated. And when irritated, health systems get busy. And when health systems get busy, they build things. Call centers.

Most health system call centers are nothing more than a big room with a lot of phones in them.  And that is exactly how they function.  There is no ability to both support care coordination and back office functions. There is no ability to support both patients and consumers. There is no first contact resolution.  There are, however plenty of opportunities to call and call and call.

And now the callers are irritated. The callers wish they new how to make pearls.

So, how would things differ if instead of the call center being just a big room with a lot of phones, someone had actually planned for and designed it to support both patients and consumers?

Your call center is probably the largest and the most complex business process in your organization. It is the only business process that will be used by everyone; patients, prospective patients, care givers, family members, and clinicians. It is the only business process whose effectiveness will sooner or later will disappoint every single user.

Yet it is never treated as a strategic asset. Here is a hint. Do not develop a plan to create the most remarkable call center in the country.

Design a plan that allows the big room with phones in it to deliver the most remarkable consumer experience in the country.

But until someone actually creates that plan and designs it to provide a remarkable experience by using the most complex business system in your organization, your call center will continue to be just a big room with a lot of phones.

Here’s one last hint. By the time you have build that call center that delivers the most remarkable customer experience in the country, you should already have started planning for a business model that does not need a call center in order to be great at consumerism.

Now, call Amazon or Netflix.

You can’t. Great consumerism; their big rooms with phones in them were turned into oyster bars. That is where you need to set your sites.

To be transparent, when I enter a hospital as a patient I should probably hang a sign around my neck, “You may be in my next blog.”

Did you know that if you shuffle a pack of cards properly, chances are that the exact order of the cards after shuffling has probably never been seen before in the history of the universe? Another fun fact is that 10! (factorial) seconds is exactly six weeks–twice as long as the average time required to schedule an appointment.

Patient access blog fodder. Sometimes the simplicity of what is dysfunctional is so obvious as to make me wonder why we cannot just set aside five minutes a fix it.

“Be here at 8 A.M.,” I was told.  8 A.M. had come and gone several minutes ago.  I was thinking about stepping out for a haircut and a massage when my number was called.  The entire process about waiting to be served reminded me of being at the Department of Motor Vehicles.

The admissions clerk at the hospital told me the charge for my ultrasound would be $871. 871 is not a prime number, but since the admissions process had run beyond fifteen minutes, I thought I would add a little something to the discussion just to entertain myself during the doldrums. “Take the number 871,” I told her, “And reverse the digits to create a new number; 178. Subtract 178 from 871. Add the resulting number, 693, to the result of its inverse, 396, and you get 1089.” This actually works with any three-digit number whose digits are decreasing, but I did not tell her that.

Eight hundred and seventy one dollars. Not $870; not $900. It struck me as a bit odd to be able to pinpoint the cost to a specific dollar, especially since health systems do not know what any procedure costs. I asked a supervisor about the price.  “We do not know what something costs, we only know what we charge.”

“Does anyone know what it costs?” I asked. She told me I was wasting her time and mine with my silly questions.

Anyway, the outpatient admissions process, at a hospital where I was already in their computer, took seventeen minutes. I gave her my phone number 4 times, my address twice, and the name of my first girlfriend once.

I asked if I could have pre-admitted myself online. She said she did not know, but she told me that the pre-admit process should have been done on the phone to save me all of this time. I asked if the process would have been shorter had I done it on the phone and she said it would not have been. “How then would that have saved me any time?” I asked.

By then, her eyes looked like she was in a death spiral. My eyes looked the same.

She escorted me to the waiting area. The television show, “What’s My Price” was playing loudly through the television speakers. A collection of Vietnam-era magazines was scattered among the waiting room’s Formica side tables. I turned on the ceramic, avocado-colored lamp and waited.  I started to calculate each of the periods of waiting just to see how much of my time I was investing in doing nothing.

The rest of the ultrasound went smoothly, more or less. “Hold your breath….” A new radiology technician was undergoing training. Apparently the person doing her training had glossed over the part of the training relating to the bit where she was supposed to reply, “Okay, breath.”

Note to health system executives: Try and schedule an appointment—mine required three phone calls and several minutes on hold. After that, go through the admissions process and see what that teaches you about the issues of consumerism facing your patients.

The scheduling and admissions processes haven’t changed since Betty White was a baby.

They should.

A remarkable experience for every person at any time on any device.

Or not.

None of this is rocket surgery.

I received a text message from my manager asking me to call her back in five minutes–she was doing her laundry.  Her text caught me off guard  enough to make me believe there had to be a pony hidden somewhere within her statement.

Why does your boss do laundry?

For the same reason your boss makes school lunches, changes the oil in the car, unloads the dishwasher, buys the groceries, pays the bills, picks the children up after soccer, and does the hundreds of other things each week that require adult supervision.

Who not if not us? If not you. Things need to get done. Also on everyone’s list are schedule the kids’ physicals. Pick Sally up from school and take her to the doctor because she sprained her ankle during gym. Walk the dog. Order refills for your father-in-law. Take Sally from the doctor to an urgent care clinic for an X-Ray. Walk the dog. Dispute an insurance claim.

Stuff happens.

And here is why that matters. Everyone you meet is either your patient or a potential patient. You have stuff, and they have stuff. The last thing anyone needs is to have to spend more time than is needed to do things they do not want to do.

People do not want to spend fifteen minutes on the phone with Verizon. And they do not want to spend fifteen minutes on the phone scheduling a physical with Our Lady of We Have All The Time In The World.

But guess what? For the most part, you no longer have to spend 15 minutes on the phone with Verizon. Most of the things that you need to accomplish with Verizon can be accomplished online. Not true with healthcare.

Is Verizon a mobile-first company, one that reengineered all of its processes so that the things you need to do could be completed virtually? No. It is just a company that lets customers do some things online.

A true mobile-first company is one that is at its best without a call center, one that says to its customers, ‘You can’t call us.’ Those companies, companies like Amazon, Netflix, and eBay, designed their businesses so that people never need to call them.

And how has that affected them? These companies function better than all of the other companies. And they tripled their customer service hours. Instead of only helping their customers between 8-5, Monday through Friday, they offer 24 x 7 customer service 365 days a year.  Online.  Without ever having to talk to anyone.

Their customer satisfaction is higher than any healthcare firm. Their marginal cost of providing exceptional customer service to their next customer is zero.

Your boss does laundry. People are busy. Nobody in their right mind wants to talk to anyone in your firm with the exception of speaking with a clinician. And for some reason, most health systems and payers do not provide that service.

People call your organization because they have no other choice. Before spending a fortune improving your call center, rethink the business problem. And then rethink the solution.

The orthopedist sanitizing my hand did not look old enough to legally use the alcohol swabs. “How long have you had this problem?” She asked me.   “About a month,” I told her. “And why did you wait a month to have someone look at it?”

“Because, I’m a guy.” That is what guys do.

“This is not uncommon for someone your age.” And exactly what age might that be? I wanted to ask her. I reinserted my hearing aid and dentures, swallowed a few Metamucil pills, grabbed my cane and waddled to the lobby.

The reason the best-laid plans of mice and men often go astray is not the plan; it’s the mice and men, and the women—see, even I can be politically correct when it suits me.

It wasn’t too long ago that the biggest healthcare consumerism issue was ensuring that your organization had a website. Next, it had to have a mobile presence, one that had some semblance of the desktop’s website’s functionality. A mobile presence qualified your system for bonus points; it merely allowed you to check the box. The website of a highly respected Pennsylvania health system has a ‘Mobile Health’ link on its homepage. When clicked, the link’s only display is a phone number—check-the-box. Thankfully for healthcare, having a mobile presence is no longer an important issue.

The reason having a mobile presence is no longer an important issue is that the issue of mobile-first has bypassed it. Mobile-first is a slick way of saying that the first place most consumers go to conduct their business with an organization is to a mobile device. It means designing an online experience for mobile before designing it for the desktop. It also means people expect to have a good user experience, and they expect to be able to complete certain tasks when they visit your mobile site

The term ‘responsive design’ comes from the strategy of design called design-thinking, also referred to as user-centered-design-—see how that word ‘design’ keeps cropping up? The opposite of employing design-thinking is designing without thinking; without thinking about what users want and the type of experience they want.

Responsive design used to mean making sure that when a user went from your website to your mobile link that the information fit well and functioned well on the smaller display screen. Now responsive design means doing just the opposite—going from a small display, the display with which users are most familiar, and making it work just as well on the desktop. (Two examples of organizations that have not done a good job of managing this consideration are FoxNews and USA Today. Everything flows nicely on a phone. It works less well on a tablet, and the desktop user experience is hideous.

So, after years and years of hard work, a very, very small handful of healthcare providers and payers have demonstrated some skill at making their Internet presence a corporate asset. All have a website—check the box. Many of those websites can be viewed on a smart device—check the box. Some smart devices actually take users to an app instead of a website—check the box.

But the number of healthcare companies whose online and mobile offerings actually lets users complete tasks would fit comfortably in a Hyundai—do not check the box.

The reason this is so important is because there are few if any reasons for people—patients, customers, and consumers—to ever visit your company via the internet more than once.

Don’t believe me? Read the stats about how many people visit you online. You will see that when compared to the number of people who call your company each day, the number of online visitors for that same day will be relatively small. More people visit you online during the weekend and after 6 P.M. on weekdays because your call centers are closed.

And half of the people who visited you online will wind up calling you because they could not accomplish anything online.

The ROI of your existing online investment is probably zero.

Ask yourself this the next time you think about why your organization has an online presence. Does the functionality of your presence answer the question, “What do we want people to know about us?” If it does, you are halfway to understanding why you have a problem.

The only reason to even have a website or an app is to be able to answer the question, “What do people want to do when they visit us online?”

And the reason your organization cannot answer that question is that the organization never asked the question.

Here is the secret sauce to being online. Nobody wants to know anything about your organization. Nobody. They want to do something, or they want your organization to do something they cannot do for themselves.

The only value most people get from visiting your healthcare organization online is when they find its telephone number. After navigating all over the site and realizing that they cannot actually schedule an appointment, or obtain a refill, or set up a payment plan, they realize they have no choice but to call. Had they wanted to call your firm they would have done so instead of going online. Or, they would have said, “Hello Google. Call Kindred,” and bypassed your firm entirely.

Is the entirety of your online functionality nothing more that a Where’s-Waldo, digital version of the Yellow Pages?

The online functionality of the best healthcare systems is probably worse than that of the mom-and-pop consignment store down the block. The consignment store’s website displays their new inventory, it lets customers buy products online, and it even sends customers alerts tailored to their stored preferences—how cool is that—2-way interaction. Cognitive 101.

Healthcare’s idea of 2-way interaction is limited to telling patients your bill is past due. Cognitive 001.

Friday I spoke with the president of a highly respected health system in Texas. We were sharing ideas about what is about to happen, about the art-of-the-possible. I said, “I ought to be able to tell a Siri-like device, ‘Schedule the next available MRI for me.’”

To which she replied, “And it should be able to reply with, ‘If you select the 6 P.M. opening Monday, we will discount the cost by ten percent. And if you pay for it now, we will discount the cost by another ten percent.” Turbo Cognitive.

If she and I had been playing poker, she had just raised my bet, and beat my three jacks with a full house. Well done.

A regular reader of this blog wrote asking me about how I write, inquiring about how much time I invest in developing an outline for each piece, how I decide on a topic for the piece, and how long it takes to write.

I am afraid my answers disappointed her. I replied I am the kind of person who likes the beach because it is so close to the ocean. I never use an outline, I rarely have a topic in mind until I am well into the piece, and each piece usually takes twenty to thirty minutes to write. Maybe I’d be a better writer if I did those things, but patience has never been a strength of mine.

January 11, 2016 USA Today. Ford is making a big push to get intimately involved with the daily mobility needs of all motorists, regardless of whether they own a Ford automobile.

Why is that statement so important to healthcare? I’ll write, you read, and we will come back to that question in a bit.

I spent a few hours trying to buy something over the weekend. My perspective on shopping is simple—if it can be bought, it can be found on Google and purchased online.

My efforts this weekend changed my perspective. What I wanted to buy, what I had looked high and low for, does not exist online. While that may not seem to be a big deal, it should be if you are interested in healthcare, the Affordable Care Act, population health, or your own health.

I wanted to see how easy it was to purchase services, or a program related to health. My health. My wellness.

I Googled ‘buy’ and ‘purchase,’ and ‘health’ and ‘wellness.’ Other than a multitude of hits about whether I want to purchase insurance and nutrition products, and a recommendation to add the term ‘care’ to my search, I did not find anything.

So every healthcare executive in American, both private and public, believes we must recast healthcare to a model focused on prevention on wellness and on health management. Do that and everyone wins.

The downside with that model, and it is a big one, is that nobody has figured out how to package, market and sell those services, and in turn, nobody can buy those services. It is a little like selling tourist travel to Mars. Nobody is selling it because they cannot deliver it, and in turn, nobody can buy it.

Once you have their minds, their wallets will follow. Suppose the average consumer spends ten hours on the phone dealing with your health system. That same person currently spends between 900-1,000 hours a year interacting with their mobile devices. What if your system could be part of those hours? What if you could make the user experience very good and very effective? Wouldn’t that help your brand? Wouldn’t that help make your patients feel more valued?

A handy health assistant living right in your pocket or on your wrist. It could even be tied to reward-based programs with partner companies.

We want to manage the health of the population, and we want to pitch wellness. And it sounds like many people would line up to buy that service. Like going to Mars, it is a great idea. Unfortunately, nobody is building the health and wellness rocket ship.

Back to the article in USA Today about Ford and their app. To me, the most important feature about what Ford is launching is that people do not have to be a Ford customer to benefit from the app.

People do not have to be a Ford customer to benefit from their personal assistant app.

What if the statement read, “People do not have to be a patient of the Cleveland Clinic (or a customer of Anthem or Walmart) to benefit from our personal healthcare assistant app?”

And what do we call those people? Consumers. Prospective patients. The same people your marketing group is spending millions of dollars to turn them into patients.

Might a healthcare personal assistant that benefited patients and consumers be of more value than just another billboard showing a group photo of your urology group?

The best way to drive value is to offer value, to give people something to make their lives better. Give them a solution to a problem they did not know they had.

The way to offer preventive care, to help people habitually manage their health and wellness, is to design and package a solution. Executives are looking at a whole new way to approach healthcare. They cannot manage care with tools and processes designed to provide care.

Start over. Simplify. Perfect. If you were serious about offering proactive care and wellness, wouldn’t it make sense to design an offering?

For those who read this far and are wondering why healthcare needs to use an app from FORD, I may not be able to give you the help you need.

A weed is a plant out of place. Put one in the middle of a putting green and you will spot it immediately. The best place is to hide a weed is with all of the other weeds; if it is there, you will never notice it.

Consumers are a lot like weeds. Put one in a hospital, and they stick out like a sore thumb among the patients. The best place to hide a consumer is with all of the other consumers. If they hide online, or on the phone, they become invisible.

And when you think of consumers, you think of customers. And when you think of customers, you think of customer experience. And when you think of customer experience, you think of your own experience as a customer. And how good is that experience? It is awful. Even your best experience is average, and you had to elevate an average experience in your own mind just to keep yourself from jumping off of a bridge.

Here is the headline. Quit worrying about customer experience; it no longer matters. It does not matter to the people who run businesses. It no longer matters to customers.

Have you lost your mind, Paul?   No, I have simply come to my senses.

None of us can name a single firm that as evolved from delivering a mediocre experience to delivering a remarkable one. It does not matter why that is true, it just is.

The interesting part of this discussion to me is the statement, “It no longer maters to customers.” That almost sounds antithetical—I can’t believe I spelled that correctly in one attempt. Of course customer experience matters to customers; why wouldn’t it?

It no longer matters because customers, you and I, created a workaround. We changed the conversation by eliminating the conversation. According to a Harvard Business Review article, the only reason 50% of us ever call a company is because there is no alternative to calling the company.

Not only are customers choosing to shop online, they are shopping online at places designed specifically to meet the unique desires of people who want to shop online. While no man is an island, we prefer to interact with companies as though we all lived on an island.

Case in point. Nordstrom’s. Their trademark has always been to provide the best customer experience. And that worked great for them as long as customers based their decision about where to shop based on customer experience. But now, Nordstrom’s is closing stores. Not only have Nordstrom shoppers moved away from buying in Nordstrom’s stores, they have moved away from buying from Nordstrom.

Then are the large numbers of customers who decided where to shop based solely on price. Those customers were willing to put up with terrible experiences to save a dollar. Then they asked, is there a way to get lowest price and eliminate the customer experience?

If we list all of the components that create a bad customer experience, the number one item on everybody’s list would be people. Of course there are the hassles with parking and travel time and lines and inconvenient hours. But what if a customer could eliminate all of those hassles?

They would. And they have. For goods and services. I cannot remember the last time I was in a mall, or went to the bank or to a post office.

The only things I have to show up in person to buy are gas and groceries. Ninety percent of those purchases do not require me to interact with anyone, and they do not require me to make those purchases during a fixed time period.

I work hard to ensure I do not have to work hard to do business with anyone. I do not buy stamps. I do not make a bank deposit. I buy what I want, from whom I want, when I want, and by using whatever device I want to use.

There is only one remaining industry that still requires me to conduct my business when they want me to do it and to do it on the device they want me to use. Healthcare. 8 A.M. to 6 P.M.; Monday through Friday; using a phone.

Entire industries have been taken apart and reinvented by customers who demand an easier way to do business with them. Want to buy anything in the world without getting out of your pajamas? Amazon. Want to watch any television show or movie without every having to rewind or drop of the tape? Netflix.

What Netflix did that is really cool is that it reinvented two industries. First, it reinvented DVD rentals and allowed people to rent movies by mail. And what did Netflix reinvent next? Netflix reinvented Netflix by eliminating the need to mail DVDs. Any how did they do that? They eliminated DVDs.

Amazon is not in the retail business. Netflix is not in the movie rental business. They designed their entire business model to be in the connected with people business.

Entire industry verticals are about to be eliminated, at least with regard to how people interact with those verticals. A sector like home decorating could collapse into a single company like Houzz. All of the products and services all under one roof. But without the roof.

And Bitcoin. ‘Nuf said.

Where are twenty percent of all online articles accessed and read? From Facebook. Facebook is now the world’s largest content distribution channel.

The differences between a social-media savvy Nordstrom business model, and Amazon’s “We don’t give a darn about social media strategy” are night and day. In my opinion, having customers like your organization on Facebook, or having someone Tweet about your organization is nothing more than a waste of good 1’s and 0’s.

Boston Children’s Hospital has more than 500,000 likes on their Facebook page. That is good news only if you are the employee whose compensation is based on having a really high number of likes.

People would have you believe that the most important current business initiative is the Internet of Things, the IoT. The big deal about the IoT is that it connects physical devices. So does duct tape. The big deal is not connecting devices to devices. It is connecting people to organizations in a meaningful way. In a way that lets people do what they want when they want. The People of Things (POT)—though not the same POT creating millionaires in Colorado. The Connected with People Business. Amazon. Netflix.

Today the expression, “I’ve got a guy for that,” has been replaced by, “I’ve got an app for that.”

Except for healthcare.

For those who have not read the business book “Who Moved My Cheese”, my take on the premise of the book as it relates to healthcare is that it could come down to one of two things.  Either nobody moved it, and you have not found it because you have not bothered looking for it.  Or two, you have been looking for it in the wrong place, in the maze.

Whether you have made zero attempts, or numerous attempts to find the cheese, I moved it.  And I am putting it right out in the open.  The cheese–the prize–in healthcare is consumerism through contextual, cognitive health.

Call me healthcare’s fromager.

What if instead of looking for the cheese you made the decision to make the cheese?

According to LinkedIn, I am connected to 1,117 healthcare CEOs. If this is not the year one of them decides to recast healthcare into a consumerism and cognitive model, which year is?

Let us begin 2016 by looking at the end of 2016. Let us begin by asking of those 1,117 executives, “What did you do to find the cheese in healthcare in 2016?”

I think those of us reading the answers to that question 361 days from now will be really disappointed with the answers. I suspect many of the 1,117, upon proper reflection, would be equally disappointed with their own answers. “I cut costs by 9%. We implemented valet parking. Customer surveys showed a 15% improvement in the food we served in the cafeteria. We added a Starbucks cart to our lobby. Our HCAHPS number improved by 3.14159…percent. (π. An irrational number—so is the value of improving your HCAHPS score; irrational, that is. (Sorry, I digressed.))

Mark Zuckerberg, Facebook’s CEO, stated he is going to make cheese.  He is creating an artificial intelligence concierge in 2016. Now, that is a goal. It is a big goal. It is a measurable, binary goal—he will do it, or he will not.

Dear 1,117; What is/are your goals?

Could the answer to that question come down to one degree of separation? There is something incredibly different between the numbers 211 and 212. One unit. One of the numbers represents nothing. It represents being close. It represents doing nothing. It represents the ability to do nothing. The number 211 is one degree away from being able to change the world; one degree of having changed the world.

Water, at 211 degrees, is hot. Pretty hot. Really hot. But that is it; it is not hot enough. There is nothing else you can say about 211-degree water.

However. Heat water to 212 degrees and you recast the entire world. Water boils at 212 degrees. Boiling water creates steam. Everyone knows about steam. Steam redefined the world. Not a big deal except for the person who realized that a one-degree change in temperature can cause a twenty-ton locomotive to move. Twenty tons of steel sitting motionless. Twenty tons of steel, not only set in motion, but also set in motion at your direction.

It would be so much easier to be able to report that all of the healthcare CEOs were sitting there at 211 degrees. Clearly, that is not the case. Like pin-the-tail-on-the-donkey, many of them are cold. Some are dealing with issues that are lukewarm. How many are at the cusp of changing the world, of deciding to make cheese?

CEO. Chief Executive Officer? Chief Execution Officer? Cheese Maker.  The word ‘executive’ is a noun. It does not imply action or accomplishment. On the other hand, Chief Execution Officer implies someone with a charter to do something. But, to do what? Cut costs? Grow the endowment? What, why, and what was the benefit are the questions that matter.

All of these people have their hearts and minds dedicated to improving healthcare. And that is good. What I am looking for, what seems to be missing are the handful of individuals who are tasked with rethinking, with reinventing, the business of healthcare; cheese makers; fromagers.

Not the business of how do we make more money. The business of how do we improve everyone’s and anyone’s health. Who is in your organization, be it provider, payer, or pharmacy is in charge of that? Who is the person in charge not of fixing what is broken, but of making sure that everyone under your care, patient and consumer is better served by the end of the year?

Better served means better access to your organization. It means access when and how people want it. That leads to consumerism. People do not want to have to work hard to interact with your organization; they do not want to be limited to doing it between 8 A.M. and 5 P.M. Monday through Friday. They do not want to have to pick up the phone to interact with it. Today, access is poor. And because access is poor, healthcare consumerism—unless someone is on their way to CVS—does not exist.

Once your organization, be it a provider or payer, improves access and opens the door to consumerism, the next step of the continuum to recast healthcare is context. What is the context for the interaction? And context requires a great tool set. If you know the context but do not have the tools to fully meet the context, you will have failed your consumers and patients.

Access. Consumerism. Context. Drum role…..Cognitive Health.

Population health. Population health management. I may be naive, but seems that it is impossible to manage the health of the population without knowing the health, the real-time health—how is Sally today—of any of the people who comprise the population whose health you are to be managing…and improving And who knows the health of anyone?

To those of you charged with coming up with the answer to that question, might I offer a suggestion? Just suppose all of the people within your radius of service had the ability to communicate their health information to you on a daily basis. People means those whose health data resides in your EMR, and those whose data does not—let’s call those people consumers.

What if, instead of people who have no understanding of the health data they record on their smart apps, those who have no ability to draw inference on the data they record on those same apps, could provide data to those who could provide that inference?

That would be a good thing. But when measured against the qualifier of being both necessary and sufficient that is only a necessary thing. So is a two-hundred million dollar EMR. If the most recent bit of health data we know about all of the Sallies is that they had their gallbladder removed three years, we know nothing about how healthy they are today.

What is missing? What is missing is having someone state that their goal for 2106 is to create a Zuckerberg-like solution regarding an artificial intelligence (AI) for healthcare. Alexa-like (Amazon) capability for healthcare. AI for healthcare.

The moonshot for healthcare is an AI capability for someone, for anyone, to interact with an AI healthcare ‘concierge’ and manage their health, and manage their wellness. That does not exist today.

There are a gazillion ways to record and track someone’s health data via smart apps and wearable devices. There is no way to answer the question ‘so what’, regarding any of that data.

The elephant in the room is that the only person who knows anything about the data stored on those apps or on those wearable devices is the least qualified person to know what to do about that data. The consumer.

The problem is that smart apps are nothing more than dumb apps. They are not able to tell you what you should be doing; they simply record what you did.

So, back to my 1,117 CEOs. Wouldn’t it be helpful to be able to tell people, patients and consumers, on a habitual, knowledge-based and interactive basis what they should be doing to take care of themselves, to manage their health?

None of the smart apps, none of the wearables can walk and chew gum at the same time. They cannot answer the question  ‘so what,’ and they cannot relate the data collected from one app with that of another app.

Let’s make cheese.