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The real future of healthcare is cultural change, not just AI and other technology



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“It actually is quite easy to be a futurist with regards to where are we going with health,” says Dr Ron Grenfell, director of health and biosecurity at CSIRO.

“It takes 15+ years to get evidence into practice,” he told the Commonwealth Bank’s Future of Health conference in Sydney last week. The “inertia of the system” will hold back the adoption of a lot of technology that’s being pitched as the future of health.

That, in your writer’s view, is one of the two big conceptual challenges at the heart of so many discussions of the digital transformation of healthcare. Vendors are pitching technologies like AI and chatbots to reduce the workload of humans, yet the healthcare sector is way behind the pace.

Dr Kevin Cheng is founder of Australian healthcare provider Osana. They use cloud communications provider 8×8 for their own needs, and use cloud-based medical records, but they run into the usual problems when communicating with other providers.

“I tried really hard not to buy a fax machine for our startup, but we failed,” Cheng said during a roundtable in Sydney last week, to much knowing laughter.

“When I talk to allied health and specialists, we’re often crossing IT barriers. It’s hard to get people on the phone to talk, so we’re very transactional … the other clinician could be sitting in a room next door, but we’re literally writing letters to each other and not talking,” he said.

Cheng believes Australia is lagging behind other high-tech nations. GPs in the US are now doing many of their consultations virtually, he said, whereas in Australian that generally only happens in remote locations.

“We’re having to create our own scorecards and dashboards in our own datasets, because there’s no reporting analytics that is on the market that fits our workflows,” Cheng said.

Phil Kernick, co-founder and chief technology officer of information security firm CQR Consulting, confirmed that belief.

“Nowadays doctors use computers for everything, and it doesn’t matter which industry you’re in, these are run badly. They’re run inefficiently. They’re run insecurely,” he said.

When it was “just” data, that didn’t matter so much. But software is now integrated into diagnostic and therapeutic devices, and if vendors are to be believed, AI will soon be taking control.

See: AI and the NHS: How artificial intelligence will change everything for patients and doctors

“I have a real concern that as everything moves to technology, and when we get into AI and machine learning something, we stop understanding how the technology works,” Kernick said.

We’re building systems that have a “very shaky foundation, and there are no regulations around this,” he said.

“If you look at the Therapeutic Goods Act, you look at how we regulate medical equipment, there are no software security standards. The information page actually says we take a risk-based approach, and use the same risk-based and safety-first approach to all systems, whether they include software or not. I mean, that’s just waffle. It doesn’t mean anything.”

Making patients the actual focus of healthcare

Cheng says that Orana’s strategy is to put the patient’s health at the centre of their business, focusing on prevention and outcomes, rather than the transactional fee-for-service treatment model.

“Patients are going to be consumers, so they’re our customers, and that means that we need to practice in a different way. We want to be partners with patients in their health and well-being,” he said, and data and apps will be part of that.

Dr Bertalan Mesko, director of The Medical Futurist Institute, says that the healthcare sector could and should go much further.

“By 2050 the most important change will be that patients will become the point of care,” he told the CommBank conference from Budapest. Not just becoming more engaged, or “empowered”, but the actual point of care and service delivery, using their own apps and devices to gather data, rather than travelling to medical facilities for diagnostic tests.

This isn’t so much a technological revolution, according to Mesko, but a cultural revolution. In your writer’s view, that’s the second big conceptual challenge.

“Since Hippocrates, for 2000 years, medicine has been quite straightforward. Medical professionals know everything, and they let patients come to them for help, they tell them what to do, and patients go home, and either they comply with what they were told or not. Usually half of them do, and half them don’t. That’s quite a bad success rate,” Mesko said.

Medical knowledge, and even the patient’s own data, were held in the medical professionals’ “ivory tower,” he said. But that’s changing.

See: VR, AR and the NHS: How virtual and augmented reality will change healthcare

“With crowdsourcing and crowdfunding, with Amazon and social media, with open access to medical papers, and all of these online communities out there, now patients can get access to the same resources,” Mesko said.

“The hierarchy of the doctor-patient relationship is transforming into an equal partnership.”

And sometimes patients race way ahead of their doctors. Diabetes patients, for example, have combined a continuous glucose monitor, an insulin pump, and a small computer such as a Raspberry Pi, to create what is in effect a do-it-yourself pancreas.

“Many of us have no medical or engineering training and we work on improvements in the evening or at the weekend, for free,” Dana Lewis, founder of the Open Artificial Pancreas System project, told the The Guardian in July.

“Commercial devices similar to ours are now being trialled and gradually coming on to the market: we’re happy to be helping companies to speed up development. The most important thing is that people don’t have to wait,” she said.

Governments and regulators “seem to be pretty terrified about these developments and technologies”, Mesko said.

“When patients find out that there’s a solution technologically for their health problem, they will not wait for regulators to come up with a solution. They will make those solutions themselves,” he said.

“It’s possible for a government to come up with a digital health policy — not just a healthcare policy or a health IT policy, those are different things — a digital health policy that focuses on the cultural aspects of the changes technologies initiate.”

It’s the Terminator scenario forever

This is not to say that the technology isn’t important. AI-powered chatbots can take care of routing patient interactions, for example, leaving the clinicians more time for managing and patient’s health.

According to Murray Brozinsky, chief strategy officer of Conversa Health, the company’s chatbots have saved Northwell Health some $3,400 per patient when they’ve been used to help manage patients after a hip or knee replacement surgery.

Rather than having a clinician call a patient every week to see how they’re doing, a chatbot can check in daily, or whenever the patient has a question. Using what Brozinsky prefers to call “augmented intelligence” any problems can be escalated more quickly.

Mesko, like many other medtech boosters, thinks AI will be the key technological change between now and 2050, but he says it’s important to be clear about what than means.

Artificial narrow intelligence is what we have now, in everything from a car’s braking system or Amazon’s recommendation engine.

Read: IoT and the NHS: Why the Internet of Things will create a healthcare revolution

Artificial general intelligence would mean having one algorithm with the cognitive ability of one human.

“We are far away from that,” Mesko said.

“And then we would have artificial superintelligence, meaning one algorithm would have the cognitive power of humanity, basically meaning that we are doomed. It’s the ‘Terminator’ scenario forever.”

“So I think we have to draw a line under which point it would be great to develop AI. It will be just before reaching artificial general intelligence.”

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Five Top Tips for Radar Briefings



Inspired by Harley Manning’s excellent advice on vendor briefings for evaluations, I thought I would document some of my recent experiences. Let’s be realistic: GigaOm is not the gorilla in the analyst market. Plus, we have some curious differences from other analyst firms — not least that we major in practitioner-led evaluation, bringing in an expert rather than (as Chris Mellor points out) “a team of consultants”. Nothing wrong with either approach, as I have said before, they’re just different. 

So, what would be my top tips for vendors looking to brief us for a Radar report? 

1. Make it technical

At GigaOm we care less about market share or ‘positioning’, and more about what the product or solution actually does. Our process involves considerable up-front effort pulling together, and peer reviewing a research proposal, following which (every time) we produce a Key Criteria report — for subscribers, this offers a how-to guide for writing an RFP.

By the time we’re onto the Radar, we’re mainly thinking, “Does it do the thing, and how well?” If we can get our technical experts in a virtual room with your technical experts, we can all get out of the way. See also: provide a demo. 

2. Understand the scoring

Behind GigaOm’s model is a principle that technology commoditizes over time: this year’s differentiating product feature may be next year’s baseline. For this reason, we score against a general level, with two plusses given if a vendor delivers on a feature or quality. A vendor doing better than the rest will gain points (and we say why), and the converse is true. If we’re saying something, we need to be able to defend it — in this case, in the strengths and weaknesses in the report. 

3. Make it defensible

Speaking of which, a vendor can make our lives simpler by telling us why a particular feature is better than everyone else’s. Sorry, we’re not looking for an easy ride, but to say what makes something special gives us something to talk about (as opposed to “but everyone thinks so,” etc). Note that customer proof points carry much more weight than general statements — if a customer says it to us directly, we’re far more likely to take it on board. 

4. Tell us scenarios

At GigaOm, we’re scenario-led — which means we’re looking at how technology categories address particular problems. Many vendors solve specific problems particularly well (note, I don’t believe there’s such a thing as a top-right shortlist of vendors to suit all needs). Often in briefings, I ask ‘magic’ questions like, “Why do your customers love you?” which cut through generalist website hype and focus on where the solution is particularly strong. 

5. Focus on the goal 

A Radar briefing shouldn’t be perceived as a massive overhead — we want to know what your product does, not how well your media-trained speakers can present. Once done, our experts will be able to complete their work, then run the resulting one-pager back past you for a fact check. For sure, we’d love as much information as you can provide, and we have an extensive set of questionnaires for that purpose.

I’ve just flicked back through Harley’s ten points, and there’s a lot in there about being respectful, aiming to hit dates, not arguing over every judgment, and so on. Wise words, which we get just as often, I wager. I also recognize that even as we have published schedules, methodologies, planned improvements, and so on, you also have your own challenges and priorities. 

All of which means that together, our primary goals should be effectiveness, such that we are presenting you, the vendor, correctly with respect to the category, and efficiency, in that a small amount of effort in the right places can benefit all of us. Which probably means, let’s talk. 

The post Five Top Tips for Radar Briefings appeared first on GigaOm.

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Achieve more with GigaOm



As we have grown substantially over the past two years. We are often asked who (even) is GigaOm, what the company does, how it differentiates, and so on. These are fair questions—many people still remember what we can call GigaOm 1.0, that fine media company born of the blogging wave.

We’ve been through the GigaOm 2.0 “boutique analyst firm” phase, before deciding we wanted to achieve more. That decision put us on a journey to where we are today, ten times the size in terms of headcount and still growing, and covering as many technology categories as the biggest analyst firms. 

Fuelling our growth has been a series of interconnected decisions. First, we asked technology decision-makers —CIOs, CTOs, VPs of Engineering and Operations, and so on—what they needed, and what was missing: unanimously, they said they needed strategic technical information based on practical experience, that is, not just theory. Industry analysts, it has been said, can be like music critics who have never played in an orchestra. Sure, there’s a place for that, but it leaves a gap for practitioner-led insights. 

Second, and building on this, we went through a test-and-learn phase to try various report models. Enrico Signoretti, now our VP of Product, spearheaded the creation of the Key Criteria and Radar document pair, based on his experience in evaluating solutions for enterprise clients. As we developed this product set in collaboration with end-user strategists, we doubled down on the Key Criteria report as a how-to guide for writing a Request For Proposals. 

Doing this led to the third strand, expanding this thinking to the enterprise decision-making cycle. Technology decision-makers don’t wake up one morning and say, “I think I need some Object Storage.”

Rather, they will be faced with a challenge, a situation, or some other scenario – perhaps existing storage products are not scaling sufficiently, applications are being rationalized, or a solution has reached the end of life. These scenarios dictate a n often, the decision maker will not only need to define a response but will also then have to justify the spending. 

This reality dictates the first product in the GigaOm portfolio, the GigaBrief, which is (essentially) a how-to guide for writing a business case. Once the decision maker has confirmed the budget, they can get on with writing an RFP (cf the Key Criteria and Radar), and then consider running a proof of concept (PoC).

We have a how-to guide for these as well, based on our Benchmarks, field tests, and Business Technology Impact (BTI) reports. We know that, alongside thought leadership, decision-makers need hard numbers for costs and benefits, so we double down on these. 

For end-user organizations, our primary audience, we have therefore created a set of tools to make decisions and unblock deployments: our subscribers come to us for clarity and practitioner-led advice, which helps them work both faster and smarter and achieve their goals more effectively. Our research is high-impact by design, which is why we have an expanding set of partner organizations using it to enable their clients. 

Specifically, learning companies such as Pluralsight and A Cloud Guru use GigaOm reports helping subscribers set direction and lock down the solutions they need to deliver. By its nature, our how-to approach to report writing has created a set of strategic training tools, which directly feed more specific technical training. 

Meanwhile, channel companies such as Ingram Micro and Transformation Continuum use our research to help their clients lock down the solutions they need, together with a practitioner-led starting point for supporting frameworks, architectures, and structures. And we work together with media partners like The Register and The Channel Company to support their audiences with research and insights. 

Technology vendors, too, benefit from end-user decision makers that are better equipped to make decisions. Rather than generic market making or long-listing potential vendors, our scenario-led materials directly impact buying decisions, taking procurement from a shortlist to a conclusion. Sales teams at systems, service, and software companies tell us how they use our reports when discussing options with prospects, not to evangelize but to explore practicalities and help reach a conclusion.

All these reasons and more enable us to say with confidence how end-user businesses, learning, channel and media companies, and indeed technology vendors are achieving more with GigaOm research. In a complex and constantly evolving landscape, our practitioner- and scenario-led approach brings specificity and clarity, helping organizations reach further, work faster and deliver more. 

Our driving force is the value we bring; at the same time, we maintain a connection with our media heritage, which enables us to scale beyond traditional analyst models. We also continue to learn, reflect, and change — our open and transparent model welcomes feedback from all stakeholders so that we can drive improvements in our products, our approach, and our outreach.

This is to say, if you have any thoughts, questions, raves, or rants, don’t hesitate to get in touch with me directly. My virtual door, and my calendar, are always open. 

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Pragmatic view of Zero Trust



Traditionally we have taken the approach that we trust everything in the network, everything in the enterprise, and put our security at the edge of that boundary. Pass all of our checks and you are in the “trusted” group. That worked well when the opposition was not sophisticated, most end user workstations were desktops, the number of remote users was very small, and we had all our servers in a series of data centers that we controlled completely, or in part. We were comfortable with our place in the world, and the things we built. Of course, we were also asked to do more with less and this security posture was simple and less costly than the alternative.

Starting around the time of Stuxnet this started to change. Security went from a poorly understood, accepted cost, and back room discussion to one being discussed with interest in board rooms and at shareholder meetings. Overnight the executive level went from being able to be ignorant of cybersecurity to having to be knowledgable of the company’s disposition on cyber. Attacks increased, and the major news organizations started reporting on cyber incidents. Legislation changed to reflect this new world, and more is coming. How do we handle this new world and all of its requirements?

Zero Trust is that change in security. Zero Trust is a fundamental change in cybersecurity strategy. Whereas before we focused on boundary control and built all our security around the idea of inside and outside, now we need to focus on every component and every person potentially being a Trojan Horse. It may look legitimate enough to get through the boundary, but in reality it could be hosting a threat actor waiting to attack. Even better, your applications and infrastructure could be a time bomb waiting to blow, where the code used in those tools is exploited in a “Supply Chain” attack. Where through no fault of the organization they are vulnerable to attack. Zero Trust says – “You are trusted only to take one action, one time, in one place, and the moment that changes you are no longer trusted and must be validated again, regardless of your location, application, userID, etc”. Zero Trust is exactly what it says, “I do not trust anything, so I validate all the things”.

That is a neat theory, but what does that mean in practice? We need to restrict users to the absolute minimum required access to networks that have a tight series of ACL’s, to applications that can only communicate to those things they must communicate with, to devices segmented to the point they think they are alone on private networks, while being dynamic enough to have their sphere of trust changed as the organization evolves, and still enable management of those devices. The overall goal is to reduce the “blast radius” any compromise would allow in the organization, since it is not a question of “if” but “when” for a cyber attack.

So if my philosophy changes from “I know that and trust it” to “I cannot believe that is what it says it is” then what can I do? Especially when I consider I did not get 5x budget to deal with 5x more complexity. I look to the market. Good news! Every single security vendor is now telling me how they solve Zero Trust with their tool, platform, service, new shiny thing. So I ask questions. It seems to me they only really solve it according to marketing. Why? Because Zero Trust is hard. It is very hard. Complex, it requires change across the organization, not just tools, but the full trifecta of people, process, and technology, and not restricted to my technology team, but the entire organization, not one region, but globally. It is a lot.

All is not lost though, because Zero Trust isn’t a fixed outcome, it is a philosophy. It is not a tool, or an audit, or a process. I cannot buy it, nor can I certify it (no matter what people selling things will say). So that shows hope. Additionally, I always remember the truism; “Perfection is the enemy of Progress”, and I realize I can move the needle.

So I take a pragmatic view of security, through the lens of Zero Trust. I don’t aim to do everything all at once. Instead I look at what I am able to do and where I have existing skills. How is my organization designed, am I a hub and spoke where I have a core organization with shared services and largely independent business units? Maybe I have a mesh where the BU’s are distributed to where we organically integrated and staffed as we went through years of M&A, maybe we are fully integrated as an organization with one standard for everything. Maybe it is none of those.

I start by considering my capabilities and mapping my current state. Where is my organization on the NIST security framework model? Where do I think I could get with my current staff? Who do I have in my partner organization that can help me? Once I know where I am I then fork my focus.

One fork is on low hanging fruit that can be resolved in the short term.  Can I add some firewall rules to better restrict VLAN’s that do not need to communicate? Can I audit user accounts and make sure we are following best practices for organization and permission assignment? Does MFA exist, and can I expand it’s use, or implement it for some critical systems?

My second fork is to develop an ecosystem of talent, organized around a security focused operating model, otherwise known as my long term plan. DevOps becomes SecDevOps, where security is integrated and first. My partners become more integrated and I look for, and acquire relationships with, new partners that fill my gaps. My teams are reorganized to support security by design AND practice. And I develop a training plan that includes the same focus on what we can do today (partner lunch and learns) with long term strategy (which may be up skilling my people with certifications).

This is the phase where we begin looking at a tools rationalization project. What do my existing tools not perform as needed in the new Zero Trust world, these will likely need to be replaced in the near term. What tools do I have that work well enough, but will need to be replaced at termination of the contract. What tools do I have that we will retain.

Finally where do we see the big, hard rocks being placed in our way?  It is a given that our networks will need some redesign, and will need to be designed with automation in mind, because the rules, ACL’s, and VLAN’s will be far more complex than before, and changes will happen at a far faster pace than before. Automation is the only way this will work. The best part is modern automation is self documenting.

The wonderful thing about being pragmatic is we get to make positive change, have a long term goal in mind that we can all align on, focus on what we can change, while developing for the future. All wrapped in a communications layer for executive leadership, and an evolving strategy for the board. Eating the elephant one bite at a time.

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