Wearable Workflow, the Internet Of Things, and the Maker Movement: Free Full Text Download of My New Book Chapter

[Here’s a pdf of the chapter! Enjoy!]

Just in time for this year’s HIMSS15 conference in Chicago, I’ve published a chapter about an idea I call “Wearable Workflow.” The chapter appears in the new book “BPM Everywhere (Tagline: Internet of Things, Process of Everything). All attendees at my Friday, April 10, 1:00PM-1:30PM EST, Google Hangout about a new hashtag I’m promoting — #HIMSSmakers — will get a free copy of my chapter! Just tweet me after, at @wareFLO. I’ll send you the link.



Wearable technology and the Internet of Things have incredible potential for improving healthcare workflow. From the original calculator watch to today’s smart glasses and smart clothing accessories, wearable technology seeks to weave (sometimes literally!) information and communication technology into everyday life and work, making it pervasive, intimate, and, metaphorically, friction free. Especially promising are applications in healthcare. These, for example, include patient monitors for the well and unwell and wearable user interfaces to health information systems. However, wearable tech will not succeed unless we get the workflow right. Getting the workflow right means understanding the relationship of wearable tech to the Internet of Things, driving workflow at the point-of-care, and analyzing and optimizing this workflow. Inexpensive Maker-style prototyping of 3D-printed wearable and Internet of Things gadgetry is a great way to explore Wearable Workflow. This presentation is based on the Dr. Webster’s recent 2015 keynote at the Society for Health Systems, Institute of Industrial Engineering Healthcare Systems Process Improvement Conference.

Buy BPM Everywhere!



45-Minute Youtube Of My Wearable Workflow Keynote at SHS2015

Here it is! Slides and audio from my Society for Health Systems 2015 keynote! Hot off my hard drive! 45-minutes of wearables, Internet-Of-Things, workflow in healthcare goodness! There was quite a torrent of tweeting during the keynote, about the keynote (slides, quoted bullet points, etc.), so I’ve appended many of the best!


Seven Posts About Wearable Workflow And Healthcare Unbound

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I usually write a series of blog posts I tweet during health IT-related conferences (most recently HFMA, HBMA, MGMA, AMIA, RSNA…). So I really perked my ears when I found out about an important theme at this year’s Healthcare Unbound, the future of healthcare wearable devices and services. I strongly believe that success or failure of wearable technology in healthcare depends on getting “wearable workflow” right!

Below is a list of topics, each with a short description or teaser. I came at wearables in healthcare from a healthcare work improvement perspective. However, as patients more-and-more become members of the care team, the same workflow tech that facilitates care coordination increasingly includes the patient. (See: Patient Experience And Engagement, Workflow And Workflow Tech.)

The next blog post in this series is Batteries, Workflow, & Stigma Are Biggest Barriers To Wearable Tech.

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Google Glass Intel Inside®, The Internet Of Things, and The Maker Movement

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In this post I discuss the extraordinary Hype Cycle that Google generated, recent news the next version of Glass will use Intel chips, and the Maker Movement. I’ve argued staid health IT needs to become more like the Maker Movement. In order to more fully explain the “personality” of a Maker, I’ve described myself! 🙂 And my efforts to create a “peds-bot,” the 3D printed, microprocessor-animated, Robot-In-My-Pocket.

Are you familiar with Gartner’s Hype Cycle? It starts with a technology trigger. For example, miniaturization, cloud, and head mounted displays (plus other stuff) led to Google Glass.

Exciting potential captures collective imagination and buzz starts to build. The buzz begins to feed on itself. Folks project all kinds of fantastic wishful thinking without really understanding the technology. Of course, even the inventors sometimes don’t completely understand the tech, so this ignorance is a matter of degree. At some point, the hysteria of crowds can no longer sustain its stratospheric flight, and expectations crash. Many are so disappointed they actually think they were sort of hoodwinked. Subconsciously they “punish” the whole idea of the technology, consigning it to the dustbin of tech failures. However, some of the more clear-eyed realists soldier on: Learning, tweaking, improving. Success stores begin to emerge, though begin to be “re-acknowledged” might be the more accurate phrase. Eventually, the new tech is productively integrated into day-to-day workflows and taken for granted. If anyone pauses to reflect about the roller coaster of high hopes and dashed expectations, it’s usually to wonder what the fuss was about.

Glass could be the poster child for The Hype Cycle. It’s Peak of Inflated Expectations was so high, its Trough of Disillusionment so low, the Glass hype cycle is almost a parody of The Hype Cycle, which is already somewhat parody-ish caricature of what happens to new technologies.

I got Glass in June of 2013. At the point it was still climbing toward the Peak of Inflated Expectations. I used it all the time when out and about. No one, and I mean literally no one (unless I was at a tech meetup) knew what it was. Gradually the percent of people in the know increased. I gave personal, two-minute, demos to over 500 people. I never had a bad experience. Then editorializing began, in media and social media, about appearance (dorky), intrusiveness (privacy), and elitism ($1500, never mind it won’t be anywhere near that when it goes retail). While to this day, I’ve never had a bad experience while wearing Glass out and about, I did become increasingly selective about when I wore Glass. I’d never had a bad experience, but I was aware there was some, in my mind, unwarranted animus, and I don’t see any point in blundering into any unpleasant situations. Ah, those halcyon early days, when literally no one knew what Glass was and I felt comfortable wearing Glass without feeling self-conscious.

What’s my point? Well, when the new version of Glass is available next year, small enough to fit into my eyeglasses, I’ll be able to return to those halcyon days. I’ll be able wear Glass without worrying I may be offending someone’s fashion sensibilities. And, since some eyeglasses can cost hundreds of dollars, I don’t think there will be much different between eyeglasses with and eyeglasses without Glass technology.

That leaves privacy. It will remain a potential issue. Glass isn’t actually as privacy-invading, as people imagine. Simple rules of etiquette and good manners will likely suffice. I’ll carry old-fashioned eyeglasses as a backup, if it’s ever a problem. And, eventually, in the long run, social conventions will change, as they always have and aways will.

This blog post is the last in a series about “Wearable Workflow.” I had intended it to be about Google Glass and the Internet of Things. The wearable workflow would have been about workflows among Glass and an increasingly intelligent and proactive world. Coincidently I just received my Edison microprocessor from Intel. Doubly coincidently, the Wall Street Journal just reported that Intel is going to supply chips for future version of Glass.

In the above tweet you can see Glass, the Intel Edison microprocessor, and a corner of a “breakout” board. The breakout board is used for prototyping, because Edison itself is so small. Edison is small so it can be used in wearables. In the lower left corner of the breakout board is a small rectangle and a connector, on to which Edison is mounted in order to communicate with the board. What you can’t see on the Edison, due to the glare, is the tagline, “What Will You Make?” You see, Edison is aimed squarely at the Maker Movement, about which I’ve written previously.

Before I get to the real meat of this post, what I’d like to see happen regarding Glass and Intel, I need to supply some back story. When I got Glass in early 2013, I started looking around for ideas for Glass apps to build in order to better understand how Glass works from an software development point of view.

I wrote a so-called Glass Eye Chart app:

Co-developed a hospital environmental services app:

But what I was really fascinated by was the potential for Glass to interact, to sense and command, my near and distance environments. I’d seen the experience of two elderly bed-ridden relatives and wondered if Glass can be used to control house lights and temperature and such. It can. Here’s I’m talking about using the Glass customizable tilt angle for turning Glass on and off for someone whose head is on a pillow.

And so, above was my path from Glass to the Internet of Things. For example, below I learned how to turn an LED (Light Emitting Diode) on and off over Wi-Fi using Glass. There are gadgets that can accept the LED input and turn on an off an 120 volt appliance.

At that point (and I describe this in order to emphasize the importance of serendipity in the Maker Movement) I began in investigate Bluetooth as an alternative means of communication between Glass and Arduino-compatible microprocessors and modules. I bumped into to nurses from a local children’s hospital and that free wheeling conversion moved from home automation to wearable technology. What if grandma could tell Sparky her pet robot to turn on the lights. The grandkids would like that. Hey, pediatricians would like that. Can you fit Sparky into a shirt pocket? And that is how Mr. RIMP (Robot-In-My-Pocket) was (eventually) born.

Then, at the Wearable & Things conference, where I presented Mr. RIMP, I met Rex St John, Internet of Things Evangelist at Intel. I was aware I needed to make the next version of Mr. RIMP both smaller and more powerful. And that is where the Intel Edison microprocessor comes in. It’s more powerful than the Arduino Uno board version 2.0 of Mr. RIMP uses but also much smaller. And it has the onboard Wi-FI and Bluetooth I need to make Mr. RIMP interact with me and its environment.

While Mr. RIMP is essentially interactive, programmable, toy, it’s also a platform for my exploring my idea of “wearable workflow.” In fact, I have another character, besides Mr. RIMP, I call Mr. “Wearable Workflow,” (inspired by Reddy Kilowatt).

Building Mr. RIMP. Iterating through versions of him. Climbing multiple learning curves at multiple layers of design: software, hardware, 3D “carpentry”, and manufacturability (which I’ve barely begun to investigate). This has been my entree into a fascinating new world of making new things out of almost as new things.

Well those are my thoughts about Google Glass, Intel, and the Maker movement. I told is as a personal story, because I think it’s useful to understand a kind of playful engineering mindset. As Intel, itself, puts it I need “low-cost, product-ready, general purpose compute platforms that help lower the barriers to entry for entrepreneurs of all sizes—from pro makers [CW: that’s me] to consumer electronics and companies working in the Internet of Things (IoT).”

What I need, as an Internet of Things, wearable tech, “inventor,” are components (both hardware and software) that I can easily put together, Lego block-style, and means to control their interactive data and control workflows with each other, their environment, and me. I’m willing to create from scratch whatever I have to, within reason, but at some point either the path of least effort determines what I make, or, if too much effort, then I don’t make.

I need tools, tool chains, infrastructure, platforms, software development kits, example code, best practice documentation, technical support, communities to join (so I can get and give help), and then I need a path to manufacturability (if I want to Mr. RIMP that far).

Now, I know, I’m small potatoes. Basically an advanced hobbyist having fun. However, I think I’m representative of potentially perhaps millions of “Makers.” The confluence of 3D printing, inexpensive but multifunctional microprocessors such as the Intel Edison, wireless cloud, Bluetooth libraries, free resources, documentation, tutorials, and courses on the Web, are returning us, by analogy, to back when tinkerers in garages created entire new industries just having fun exploring the possibilities.

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Patient Engagement and Wearable Technology: From Around The Web

Today I’m attending the Consumer Health IT Summit AND working on my slides for a webinar tomorrow,Wearable Workflow Needs Health Systems Engineering (register here). (And following tweets from the HBMA conference and writing this blog post!) Tomorrow’s webinar is about wearables and classic concerns of industrial engineering in healthcare, namely work (and workflow) improvement. But patients, patient experience, and patient engagement are becoming so important to improving healthcare workflow. And wearables are becoming a key component of patient experience and engagement. So, I cross-indexed “wearables” and “patient engagement” and found the following articles and quotes. I’d be interested your take on them.

Blog: Healthcare Apps and Wearables – A Gateway to Patient Engagement?

“The information must flow without the patient having to facilitate it. Physicians must be part of the process of evaluating the engagement. With the world of wearables only in its infancy, interoperability of the network needs to define and drive how these independent silos will interact. When this networked transformation happens, the power of the system will far exceed that of the isolated patient or physician operating independently. Over time, this data will be combined with a complete health record to provide truly personalized medical updates and a comprehensive view of your health and habits, thus filling in all the gaps between medical checkups and doctor visits.”

…presenters and vendors to stress patient engagement through mobile health technology and workflow

“Wearable technologies … are taking connected health to the next level since some patients leave their mobile device at home or in the car. By having a device that is constantly worn on the body, patients can be empowered in a way that was not possible before. Some of these connected “wearables” are monitoring biometrics like heart rate and respiration. Others are simply detecting patient movement and sending reminders and alerts. We are seeing an evolution of wearables interacting with mobile devices and other ecosystems of connected health that already exist within the home. Bluetooth, Wi-Fi, 3G/4G and near field communication radios and sensors are all working together to keep patients connected like never before.”

The Future Of Healthcare And Wearables

“Healthcare in general is being impacted by an aging population, which means we need to devise new strategies and technology to help individuals better manage their own health (e.g. obesity), which will improve outcomes, increase longevity, and also help manage costs,” he said. “Behavior change is integral to achieving this goal; as Lord Kelvin stated: ‘To measure is to know. If you can not measure it, you can not improve it.’ Wearables are key to patient engagement….

the biggest challenge is integrating this data into the existing workflow and health IT systems. As a patient, Dr. Nick says that “there is no pathway for me to record, report, and include my data. Take a simple example of my blood pressure. My doctor has no way of including this in my electronic medical record (EMR) and is not included in his workflow. There are some exceptions, but this information needs to be captured consistently, flow to the doctor, and then the EMR for it to be part of the standard practice and care.”

Wearable Technology: The Coming Revolution in Healthcare

“the adoption of wearable healthcare-related devices could indeed be a significant step in patient engagement and improving population health — two critical success factors driving today’s increasingly complex healthcare environment. Specifically, wearable health technology brings three distinctly beneficial trends to the table — connected information, community, and gamification. By harnessing this trifecta, healthcare leaders have new ways to build engagement and create accurate, far-reaching views of both personal and population health….By bringing together people with a common interest such as weight loss, wearables serve as a mechanism to build engagement and at the same time compile information….Healthcare organizations can tap the power of that data to engage patients and develop more effective and more personalized approaches to care, thereby lowering the overall cost of care.”

Confusing Workflow Technology With Workflow Is Like Confusing Your Database With Your Data

You wouldn’t confuse your baseball card collection with the Microsoft Access database management system you use to manage it. Or confuse your patients with your EHR. But people, especially in healthcare, confuse workflows with workflow management systems all the time. I’ve discussed this important distinction before (EMR Workflow Systems vs. EHR Workflow Management Systems). But I think it is worth revisiting. Confusing workflow with workflow technology is what gives rise to the notion that introducing process-aware information systems into healthcare and health IT is mere “tweaking” of workflow.

Last week I moderated one of the weekly #HITsm tweet chats (Fridays, 12-1 EST Thank You To All Who Tweeted About Healthcare Workflow, Wearables, BPM, and Flowcharting!). It was well attended, 40 percent above average. In the introductory post I wrote for the HL7Standards blog I emphasized the distinction. Here is the shorter version of that.

Workflow is what actually happens when work is done. It is a series of steps, or tasks, that consume resources (money, time, effort, attention), and achieve one or more goals. Virtually all purposeful activity involves workflow.

Workflow technology, on the other hand, has some sort of model of workflow. This is model is executed or consulted, in conjunction with human users, when they do their jobs. These executable process models are at the heart of what distinguishes healthcare workflow technology from generic healthcare information technology. All information systems “affect” workflow (that is, influences workflow, for good or ill). But healthcare workflow technology “effects” workflows (that is, drives, makes it so, in the Captain Picard, Star Trek sense).

Why do I harp upon workflow technology all the time? Because it is the next generation of application architecture heading down the pike toward health IT, which is about a half a generation or more behind other industries. Sometimes folks say, “So what! Fix the incentives and the tech will fix itself.” I agree we need to fix healthcare incentives (whatever that means, I hear lots of strenuous debate about that particular topic). But even if we fix the incentives, billions of dollars have cemented frozen healthcare workflows into place. Similar to, by analogy, early human proclivities (such as eating until overfull in the presence of food) plaguing us this modern day, a decade of frozen health IT workflow will resist pressures to change for the better, if the better even presents itself.

Furthermore, regardless of which incentive regime we finally impose, it won’t work unless we have true workflow technology to make it work. It doesn’t matter, free market vs. socialized medicine, Meaningful Use-driven software development vs. Meaningful Use-Be-Gone-driven software development. We will have invested so much in workflow-oblivious, workflow-frozen healthcare information systems, that (A) they’ll be too expensive to change, and (B) we won’t have enough will or resources left to change them. We need to begin making our health IT systems more process-aware, now.

The sentiments of the previous paragraph are why I wrote Fixing Our Health IT Mess: Are Business Models or Technology Models to Blame?, one of my most popular (or at least most tweeted) blog posts.

Moving to executable models of work is not merely tweaking workflows. It is moving to a more flexible, effective, efficient, transparent and systematically improvable substrate in which to realize whatever systems of healthcare incentives we ultimately move to. And I can guarantee you one thing. We won’t get them right the first, second, or even third time. That’s why we need to create systems of health information management in which workflows can be more easily “tweaked.”

Related posts:

Trip Report: The WATCH Society’s Future of Wearable Technology In Healthcare Conference

I just got back from the fantastic Future of Wearable Technology In Healthcare Conference hosted by the International Society of Wearable Technology in Healthcare over July 24-25 in Indianapolis. Their Twitter account is @IntWATCHsociety. Before I get on with the trip report, a bit about myself and Glass.

There were many great presentations at the WATCH conference, on Glass and medical education, HIPAA and privacy issues, real-time video streaming, teaching the autistic, smart belts for pregnancy, managing tech in operating rooms, and so on and so on! However, as is usually the case, this trip report skews toward workflow and workflow-related theme, plus some personal adventures, and the attendees and presenters I actually got to meet. (Including two people who attended because of a post I wrote about the then upcoming WATCH Conference!)

Enough preface!

The day before the conference I drove to Indianapolis. The corn got taller and taller and taller!

In the morning of the conference I used Google Glass’ fantastic turn-by-turn navigation GPS to find the venue.

I, and (Google Glass controlled, via Bluetooth) Mr. RIMP, listened to a most excellent welcome from Paul Szotek MD. He’s behind that pair of LED “eyes” in the upper left. (See the next tweet for a better photo!) Here’s a great write up in the IndyStar about how he got Glass and used it during surgery.

The following is one of my favorite comments, from @PaulSzotekMD, from the entire conference: Glass is a phenomenal platform to force healthcare to choose which data is important! Absolutely spot on. Glass is a culmination of a trend starting with tablets and smartphones. As screen form factors have shrunk, more-and-more intelligence must go into selecting just the right data and options to a smaller-and-smaller screen. My guestimate is that the Glass micro-display, at 640×480, with the smallest recommended font size of 26px, at eight feet away from the viewer, can present less than one percent of the information of a 1600×1200 desktop or laptop computer monitor.

Rafael Grossmann, MD (@ZGJR on Twitter) gave the kickoff keynote, via Google Hangouts. Rafael is such an enthusiastic ambassador for Glass in surgery and healthcare! He really charged up the audience.

I first learned of Dr. Grossman last year, when he was the first person to stream video from Glass during live surgery. It even showed up on the Drudge Report!

Next year’s conference will be in Amsterdam.

The 2015 WATCH Conference chair is Marlies Schijven, MD, PhD (@MarliesSchijven on Twitter). I found the following among tweets from @MarliesSchijven. Most Glass owners have lots of these, photos taken and tweeted during demos. 🙂

I was delighted to many of my slides from my February slide deck highlighted in one of the presentations.

Certainly, medical education was a big theme at the conference.

One of my prototypes that I wrote last year was even featured!

It’s not really a Snellen Eye Chart. It’s for developers and folks trying Glass on of the first time. The 90px through 26px are standard font sizes for Glass. So the question becomes, when I handover Glass for a two-minute demo: What is the smallest font size you can see? With your glasses? Without? One or the other, about 95 percent can see everything down to the smallest 26px standard font.

A big topic at the conference was Glass integration with EHRs. This was my mockup of realtime patient location and task updating. I did it last summer, but was glad to see it presented here. It fits into the important theme of improving EHR workflow and usability.

You can find the rest of my slides, along with related speaker notes and links to resource materials here.

Back to the WATCH Conference!

Nicolas Terry, Health Law Professor (@nicolasterry on Twitter) made what he conceded many think is a boring subject — HIPAA — into a tolerably interesting subject. (For which I greatly admire his intelligence and good humor!) Here’s his best slide, what do to about Glass at your healthcare organization. Be sure to click on the image and zoom in to better see the individual bullet items.

Up there with @PaulSzotekMD statement (that Glass is a phenomenal platform to force healthcare to choose which data is important!) is this statement from a video shown of Steven Horng, MD speaking about using Glass to access information from his hospital’s EHR. Glass is ultimate unshackling of physician from workstation.

Between these two insights, figuring out what is important “here-and-now” when “here-and-now” keeps changing, and freeing physicians to get back to face-to-face, hands-on patient care, is the greatest potential for Glass to improve patient care.

In fact, the result of the right info and options at the right time in a complicate workflow, and freedom to move around, from problem to problem, solving on the run, will be, as REMEDY’s tagline reads: See More Patients. It’s a pun, of course. To see more is to perceive more. And free physicians from their workstations will allow them to serve more patients.

@PaulSzotekMD described a whole bunch of Glass prototypes he’d help develop with collaborators.

So I asked, what was the relation among the prototypes. Did he imagine using one after another in a workflow? He said absolutely. I hope you can see that I’m not unreasonably to suggest the phrase “wearable workflow” as it might apply to workflow among not just Glass apps, but among these apps and other wearable devices?

I liked the following quote, from @MarliesSchijven’s presentation, so much I tracked it down its complete context.

“Anthony (Tony) Jones, M.D., is the vice president and chief marketing officer for patient care and clinical informatics at Philips Healthcare. He explains, “The most exciting potential application of Google Glass in healthcare is the ability to allow providers to ‘virtually’ be in two places at once, which will have a significant impact on workflow and patient care.”

For instance, imagine a doctor or nurse is with a patient and he or she is doing a basic procedure that requires both hands. An alarm or alert is triggered in another room.

“Rather than interrupting the current procedure, the provider can use the verbal commands to call up the patient monitoring data that’s triggering the alert, Jones explains. “At that point, the provider can decide whether the alarm can wait or whether it needs immediate action.”

Similarly, bringing some of the basic vital signs info from the monitor directly into the field of vision via Google Glass allows the provider to do the procedure and view the feedback data without taking their eyes off of the patient.

“It sounds simple, but small workflow improvements like this can reduce errors and have a significant impact on patient care,” Jones says.”

The following slide describes a study examining how often and how long, on the average, a resident looked away from the patient to consult a bedside monitor. It doesn’t compare to Glass, but one hopes it could help increase the amount of time patients get the full attention of their care givers. I look forward to more such statistics comparing w/Glass and w/o Glass conditions.

On the morning of the second day of the WATCH Conference, before I even got out of bed, I reflected what I perceived to be the dominate themes of the first day of the conference. This is what I tweeted.

  • Google Glass
  • Medical education
  • Live streaming video
  • EHR integration
  • Workflow

One of the highlights of the WATCH Conference was the opportunity to finally meet Brian Norris, who I had only previous known through lots of interaction of Twitter (he’s @Geek_Nurse). He’s a triple threat — clinician, developer, activist — who really cares a lot about the Indianapolis health IT innovation and startup scene. I heard frequent comments of appreciation about Brian from other local Indianapolis-based attendees.

Brian provided particularly valuable insight to anyone hoping to get an app into the Google Glass online app store. Basically, follow instructions! Use Google’s checklists. Conduct a self test. Pay particular attention to branding. Google wants the attention on the app and its functionality, not an implied relationship or partnership with Google. Watch the size and location of your images!

By the way, I went through the Glass UI style guide and combined all their different example screens into a single 640×360 image you can use a the (temporary) background in any glassware you develop. Just turn it on once in a while to see if you’re coloring outside the line, so to speak. 🙂 You can access it directly from your GDK or Mirror API app at http://wareflo.com/glass-gutters-spacing.jpg.

One of the presenters didn’t show up, so I got to take his place! So, off-the-cuff (appropriate for a wearable tech conference) I presented Wearable Workflow, Google Glass, Wearlets and Mr. RIMP. I recorded it and I created a YouTube video from video of Mr. RIMP interacting with Glass, plus photos of his innards and from the conference. I got to talk about “wearable workflow” and “wearlets” (out of which wearable workflows are constructed). #

Many thanks to Brian Norris (@Geek_Nurse on Twitter) for tweeting the following photo of Mr. RIMP (and me).

Mr. RIMP attracted a lot of attention! Lot of folks wanted selfies with him.

I was particularly happy to get this group photo of Matt, a Google Glass Guide, Mr. RIMP trying on Glass, and myself.

John Springer give a great prevention about Glass in the operating room used manage supplies and devices.

By the way, I didn’t realize his Twitter account at the time, it’s @JohnSpriCST. Here’s his Twitter profile: “OR GLASS”!


Divya Dhar of Seratis Health gave an overview of her company, and how Glass could fit into their mobile care coordination platform. From the @SeratisHealth Twitter profile, “Seratis brings doctors and nurses out of the pager era by allowing #healthcare providers to coordinate, track and analyze care across the team.” In particular, I was intrigued by “Seralytics.” Once you support and capture care coordination workflow, the next obvious step it to data mine it, looking for patterns and insights to improve those workflows.

Finally we got to what was, in my mind, the best presentation at the WATCH Conference, Kyle Samani’s Achieving Scalable Commercial Success With Glass In Healthcare (slides). I interviewed Kyle a year ago for my blog about health IT workflow.

PristineIO is developing a sophisticated mobile and distributed workflow management system for Glass, combining video communication, checklists, and just-in-time user guides.

I saw the following point in several other demonstrations, a point with which I very much agree. Glass (and other wearables too, capable of delivering information to wearer and doing something in response to wearer intentions) requires considerable infrastructure and real-time management of information and workflow to be useful in healthcare. I made this very point in last year’s InformationWeek column Google Glass: Autocorrect For Your Life.

“For Glass to be the raging success I believe it will be, many Glassware apps — particularly in healthcare, the industry I call home — will require sophisticated self-adapting and user-customizable filters, priorities and workflows.”

Hub-and-spoke, central coordination and supervision, such as described in an earlier presentation, are all about what organizational psychologists call “span-of-control.” Information technology and machinery is, essentially, making it possible for less trained personnel to deal with more situations, but to subject to realtime quality assurance and immediately available specialized expertise. And it is this middleware layer, of contextually-aware computing combined with flexible workflow automation, which will make this increased span-of-control possible.

I didn’t tweet the slides, but one was a map with pins representing pilots and customers from coast to coast (accompanied by hint there are lots more in the pipeline). Kyle got there early (I think he was one of the first 1500 to receive Glass). Articulated a vision, executed aggressively, pivoted when necessary, all through while writing many blog posts about Glass and health IT along the way, to keep the rest of us up-to-date.


The WATCH Conference was well worth the trip, and bodes well for the future of the International WATCH Society. This “Conclusions” section as just a place for me to collect some thoughts that didn’t make it into the previous, more chronologically, thematically, presented slides, tweets, and interspersed commentary about them.

First of all, its interesting, the “WATCH Society” and “WATCH Conference”. WATCH stands for WeArable TeChnology in Healthcare. Glass is not the only wearable tech. And of course there are smart “watches” but 95-percent of the conference presentations were about Glass. There had been several large wearable conferences the weeks before, one on each coast, and in those conferences, Glass was not nearly as overwhelmingly represented. I think this is a testimonial to the grasp Glass has achieved on the collective imagination of healthcare clinicians and health IT visionaries.

Second of all, the two most impressive uses of Glass I saw, Glass to access EHR info at Beth Israel Deaconess Medical Center and PristineIO’s implementation of hub-and-spoke management of lesser skilled healthcare workers, both involve using Glass in ways Google did not foresee. In the case of Beth Israel, if you watch the video, the Glass app presents info in ways violating Google’s Glass guidelines. In the case of PristineIO, the native Glass Android operating system is being wiped away to make it literally impossible to violate HIPAA. One of the characteristics of transformation technology is that it ends up being used in a lots of ways unforeseen by the inventor of that technology. Twitter is a lot like that, for example, hashtags were invented by users. Now I don’t know if Glass is the Twitter of wearable tech in healthcare, but I think these unpredicted, even advised against, successful uses of Glass are the single best predictor something very interesting is going on.

Third, I don’t like to admit I am wrong. But I predicted last year that Glass would be an even bigger consumer phenomena than vertical phenomena (healthcare, energy, education, security, etc). While I program Glass with in eye toward uses in healthcare, I also love using it out and about. Its turn-by-turn navigation user experience is far superior to dashboard-based GPS. I love to be able to respond to a tweet or email (hands-free!) in almost sub-second response times. But I’ve changed my mind. Glass will be more successful in verticals such as healthcare, first.

Regardless, I am consistently and boundlessly effusive about Glass in person and online (2000+ tweets on the #GoogleGlass hashtag) was still surprised and impressed by the quantity, variety and subtlety of the Glass apps, projects, and envisionings I witnessed at the WATCH Conference. And, echoing what I heard from many people at the conference, WATCH was just the tip of an iceberg. There are many more stealth, under-the-radar, Glass in healthcare software development projects and startups than were presented publicly at the WATCH Conference.

Finally, many thanks and kudos to the doughty and visionary Indianapolitans who threw a great conference about wearable technology in healthcare! One more tweet!

P.S. By the way, I’m giving a keynote about Glass and wearable workflow at a healthcare conference this coming February. There will be a free webinar preview of that keynote September 16 I’ll tweet the registration link when it’s available. Here’s the title and abstract.

Wearable Workflow Needs Health Systems Engineering

“From the original calculator watch to today’s Google Glass and smart clothing accessories, wearable technology seeks to weave (sometimes literally!) information technology into everyday life and work, making it pervasive, intimate, and, metaphorically, friction free. Especially promising are applications in healthcare. These, for example, include patient monitors for the well and unwell and wearable user interfaces to health information systems. However, wearable tech will not succeed unless we get its workflows right. Getting the workflow right requires both means of driving workflow at the point-of-care and -health AND systems for analyzing, creating, and optimizing this workflow. In other words, successful wearable technology in healthcare requires health systems engineering. This presentation provides an overview of wearables and how health systems engineering can help make them a success in healthcare.”

In other words: Wearable Workflow!

P.S.S. Check out my own Google Glass in healthcare prototype!

Attending Upcoming Future of Wearable Technology In Healthcare Conference


A.S. (opposite of P.S.!)

I’m bringing my buddy Mr. RIMP. He’s a wearable robot controlled by Google Glass! Kids love him. And he even has a Twitter account!

July 25-26, in Indianapolis, The International Society of Wearable Technology in Healthcare is putting on what promises to be tremendous conference on wearables in medicine. Predictably, Google Glass is well represented, with at least eleven presentations out of a nineteen (some of which are TBA, so could be Glass as well).


I’ll be there, to add to my over 2000 #GoogleGlass tweets, a many blog posts and trade journal articles. This is a place to for me highlight speaker Twitter accounts and tweets. Below are just those I could find.

I also created the Twitter list Wearable Tech Conference.

  • @ZGJR Rafael Grossmann, MD, FACS Surgeon, Eastern Maine Medical Center in Bangor, Maine United States
  • John Scott, Founder and CEO, ContextSurgery by Context Aware Computing Corporation http://www.contextsurgery.com (not Twitter account, but interesting website)
  • @PaulSzotekMD Paul Szotek, MD Assistant Professor of Clinical Surgery Trauma&Acute Care Surgery / Abdominal Wall Reconstruction Indiana University Health, Indianapolis United States
  • @TGrantcharovMD Teodor Grantcharov MD PhD FACS Associate Professor of Surgery University of Toronto. Scientist Keenan Research Centre of the Li Ka Shing Knowledge Institute Canada
  • @ChrisVukin Christopher Vukin Team Evermed/Medright “How to use wearables with your EMR workflow”
  • @MarliesSchijven Marlies Schijven MD PhD MHSc Associate Professor of Surgery Academic Medical Center Amsterdam, The Netherlands
  • @NoorFSiddiqui Remedy – or how to save lives with Google Glass
  • @DrMartineau On Glass and challenges in hand surgery
  • @drtom_kareo Kareo CMIO, passionate about helping small medical practices successfully leverage technology
  • @kylesamani of @pristineIO How to obtain success with google glass
  • @Geek_Nurse of @SocialHealthIs Development & design of wearable devices for the ecosystem

I’m glad to see Rafael Grossmann, MD kick off the conference with the appropriately titled “In the Beginning…” By the way, @ZGJR was featured on Drudgereport! 🙂

And Kyle Samani of PristineIO, see my 10 Questions for Glass in Healthcare Pioneer Kyle Samani of Pristine.io.

Here are some of my own articles about Google Glass in healthcare:

The first describes my project interfacing Google Glass with a state-of-the-art business process management system to manage hospital housekeeping tasks.

Workflow, Healthcare’s Most Misunderstood Software (with Apologies to Dr Pepper)

I dedicate the following to workflow management advocates in healthcare…

There’s people out there who don’t understand us. They say we’re everything from message interfaces to user interfaces. Is it true? (NOOOO!) And you know and I know it but do they know it? Oh sure, there’s people that know about workflow. Because they manage it! But there’s some people that’ve never managed workflow. Because they don’t understand workflow management. What are we going to do about that? (Make them understand!) How? (Get them to manage workflow!) Because when they manage workflow they understand workflow. And I see a day, when workflow management will be in every healthcare organization in America. And folks will look back on you and they’ll say, should healthcare workflow management last a thousand years, this was healthcare workflow management’s finest hour.

Above was adapted from the following, based on a 1970 Dr Pepper TV commercial.

There’s people out there who don’t understand us. They say we’re everything from medicine to pepper sauce. Is it true? (NOOOO!) And you know and I know it but do they know it? Oh sure, there’s people that love us. Because they tried us. But there’s some people that’ve never tried us. Because they don’t understand us. What are we going to do about that? (Make them understand!) How? (Get them to try us!) Because when they try us they like us. And I see a day, when Dr Pepper will be in every home in America. And folks will like back on you and they’ll say, should Dr Pepper last a thousand years, this was their finest hour.

PS Here’s another funny Dr Pepper ad, ending in the Misunderstood jingle

PSS Funny where inspiration comes from…

#HFES2014 International Symposium on Human Factors & Ergonomics in Healthcare

The 2014 International Symposium on Human Factors & Ergonomics in Healthcare is currently going on in my hometown Chicago, but I’m not there! 🙁 Oh well, I’ll follow the excellent tweets containing the hashtag #HFES2014 (or is it #HFES…?). I’ll add some here, surrounded by commentary. As usual, I’ll focus on usability and workflow. Please come back as I’ll be adding more tweets (such as, maybe, yours!) and more commentary as it occurs to me.

Just a little habit of mine. I like counting the number of “workflows” in healthcare workflow-related documents. I know I should also count potential synonyms such as “process” and maybe even normalize by deciding by total number or words…. but too much work! It’s just a superficial, but nonetheless surprisingly useful, signifier.

The next few tweets link to conference abstracts about healthcare workflow.

Third-party tweets:

If true, I find this shift troubling. One of the most potent criticisms of meaningful use is that it’s been too much about how (specifically, micromanaging workflow), not enough about clinical and financial outcomes and whether meaningful use actually improves them.

I absolutely agree with the idea that modular development is essential to the creation of effective, efficient, flexible and satisfying software systems. I would go on, though, to advocate use of workflow technologies to combine and execute these modules effectively, efficiently, and flexibly. Take a look at the following abstract from Usable Clinical Groupware Requires Modular Components and Business Process Management (I’ve bolded the key phrase):

“Future extensible clinical groupware will coordinate delivery of EHR functionality to teams of users by combining modular components with executable process models whose usability (effectiveness, efficiency, and user satisfaction) will be systematically improved using business process management techniques.”

“poorly supported work processes [cause] suboptimal, non-standard care, poor decision support, dropped cases”

Again, I absolutely agree with the above characterization of the relationship between work processes and those bad things…., but what’s a “work process”? It’s workflow! OK, lets think about this for a minute. What do we use to management information? Information technology. What do we use to harness solar energy? Solar technology. So, how should healthcare management workflow? How about: workflow technology?

See following tweet:

  • Research on human trust in automation and how trust affects interactions
  • How team interactions are affected by automation
  • Models of effective human-automation interaction/autonomy

Cool! Looks like full text is behind paywall, but at least abstracts are available. I even see a professor I took a graduate course from during my Industrial Engineering degree! I’ll tweet some of the papers and embed them here.


Selected papers from the most recent issue of Human Factors (mentioned by @akiani_fr on the #HFES2014 #HFES thread).