D-U-N-S Number assignment is FREE for all businesses required to register with the US Federal government for contracts or grants.

Request online: http://fedgov.dnb.com/webform/displayHomePage.do;jsessionid=81407B1F03F2BDB123DD47D19158B75F

Register business with Central Contractor Registration (CCR)

 http://www.ccr.gov/

Federal acquisitions regulations require all prospective vendors to be registered in CCR prior to the award of a contract.

Online Representations and Certifications Application (ORCA)

https://orca.bpn.gov/login.aspx

You need to provide additional information about your company and business activities here.  The Federal Acquisitions Regulations (FAR) section 52.212-3 Offeror Representations and Certifications-Commercial Items explains the information you will be asked on ORCA. (http://www.acqnet.gov/far/current/html/52_212_213.html#wp1179194?cm_sp=ExternalLink-_-Federal-_-GSA)

8a SBE Federal Government Certifications WBE (Women Owned Business); MBE (Minority Owned Business); DBE (Disadvantaged Business Certification; and VOSB  (Veterans and Service Disabled Certifications)

http://www.osdbu.dot.gov/Related/SBA.cfm

Optional certifications, but advantageous if your firm qualifies for any of the above certificiations.

Register with Federal Business Opportunities (FBO)

https://www.fbo.gov/index?cck=1&au=&ck=

Register and receive email notifications of business opportunities

Disaster Contracting

FEMA and the Army Corp of Engineers now require that firms register separately with the agencies.  The email changes for each agency’s department.

United Nations

http://www.ci.undp.org/ptd/venreg.htm

Also requires separate registration with PTU (Procurement Travel Unit).

World Health Organization:   Company Profile for Services Attached

http://new.paho.org/hq/index.php?option=com_content&task=view&id=186&Itemid=277&limit=1&limitstart=3

Registration with the United Also required for almost all contracts.

Wireless Health News

• mobilehealthnews
• FierceMobileHealthcare
• MobileHealthWatch
• Aging In Place Technology Watch
• Telecare Aware
• Healthcare IT News
• iHealthBeat
• Medgadget

Wireless Health Collaboratives

• Continua Health Alliance
• West Wireless Health Institute
• Center for Aging Services Technologies
• Digital He@lth Initiative
• Wireless Life-Sciences Alliance
• American Telemedicine Association

Wireless Health Research Groups

• 802.15 WPAN Task Group 6 Body Area Networks (BAN) @ IEEE
• Assisted-Living And Residential Monitoring Network (AlarmNet) @ UVA
• Body Sensor Networks @ ICL
• Efficient Computing Group @ Rice
• Embedded Systems and Signal Processing Lab @ UTD
• Integrated Networked Embedded Real-Time Technologies In Application (INERTIA) @ UVA
• Proactive Health Research Group @ Intel
• Responsive Environments Group @ MIT
• Wireless Communications Group @ ETHZ
• Wireless Health Community @ UCLA
• Wireless Sensor Networks for Medical Care (CodeBlue) @ Harvard
• AgeLab @ MIT
• Oregon Center for Aging and Technology (ORCATECH) @ OHSU
• Intelligent Assistive Technology and Systems Lab @ UofT

Wireless Health Platform Technology

• AMBER @ Visonic
• Body Sensor Network Node @ ICL
• Health @ Google
• HealthVault @ Microsoft
• QuietCare Systems @ GE
• Technology Enabled Medical Precision Observation (TEMPO) @ UVA
• Ultra Low Power Intelligent Sensor Interface and Transceiver Platform (Sensium) @ Toumaz

Wireless Health Market Research

• AARP Healthy@Home
• Parks Associates Digital Health
• Forrester Aging in Place
• Brookings Institute Customer-Driven Medicine: How To Create A New Health Care System
• Deloitte Technology-Enabled Care at Home
• Berg Insights mHealth and Home Monitoring Research Series Summary
• ALFA Largest Assisted Living Providers

Wireless Health Regulation

• FDA Device Advice
• FCC Rules and Regulations

I like that. Maybe it isn’t for everybody but that’s the way I would like it to be. God willing, so it shall be. It’s a nice dream and today I know that it is not only possible but affordably available for a few hundred dollars in Consumer Electronics equipment. This is not new technology. In Internet terms, some of the stuff needed to do this is antiquated. That’s good news, however. Old technology is very affordable and often, very inexpensive (think dollar store).

It has been possible to turn my dream into reality for a long time now, well in Internet time anyway. It has been possible at least since 1989 or 1990. That’s when the World Wide Web came to be.

So, why hasn’t it happened sooner?

I think for a number of reasons. For one, the number of people who understand this new technology has been fairly low. At the beginning of the technical adoption curve, Innovators and Early adopters typically represent minorities of the greater population. In the early days of the World Wide Web, these folks were busy scooping up the low hanging fruit. They moved to those areas where there was the least resistance and greatest opportunities.

Personal privacy is a principal right held dear by most Americans. It is a right granted to us in the 4^th Amendment of the United States Constitution. There has been a lot of debate lately around privacy on social media platforms like Facebook. This is a debate we need to have and I believe we are far from resolving what privacy will look like as a norm in the Internet Age. Some people even say privacy is already dead. Actually, there are many layers of privacy. We all know this as members of American culture. There are things that we will share in the intimacy of our own homes with friends and family that we would not share publicly. We as human beings, and so says our constitution, have a reasonable expectation of privacy.

There is an even deeper level of privacy. There are personal and private things that we share with almost no one or definitely with only a select few. For many issues it’s considered impolite to do otherwise. We do not as a matter of practice, share with just anyone the frequency and texture of our bowel movements….and to the guy who was sharing that information with someone in a restaurant booth adjacent to mine the other day, please stop doing that. Go see your doctor for crissakes and tell her about it. I don’t want to hear it, especially not over my lunch.

Precisely!!!

There are things that we as individuals share with trusted professional caregivers that we do not even share with family members as a matter of regular conversation. This is the level of personal privacy I am talking about, medical records. We have very strict customs, rules and laws about how information like that should be handled by trusted individuals and agencies. The bottom line, however, is that the individual has the right to share that with whomever they want.

Ok……but it’s one thing to share in a most rude and insensitive manner…..and yes sir from that restaurant booth a few days ago, that was rude and offensive….but that conversation is soon forgotten by most in a short time….but not me sir, I will not let it go……I digress. It’s totally another thing to share this on the Internet. The Internet never forgets and with only a little extra effort, if that conversation had occurred on the Internet instead of a booth in a restaurant, we would know who was inflicting himself on me during my lunch.

As I write this essay, there is an interesting interview being conducted by Steve Kroft of CBS 60 Minutes with Julian Assange, the founder of WikiLeaks. Whether I agree or disagree with Mr. Assange’s position, whether you feel he is a hero or traitor, I cannot escape evaluating my own positions on some fundamental tenets of American Democracy in order to form an opinion. I have to decide how I feel about the need for governments to maintain secrets and balance that against my own predisposition toward believing that governments deserve suspicion and scrutiny. Every person must reexamine their own heart relative to issues of secrets, freedom of speech, and privacy. This is the depth of disruption that a disruptive technology brings. It forces us to reconsider our most deeply held beliefs, those beliefs that we believed before the disruption to be rock solid. The disruption actually re-weaves our social fabric.

Consider that the Protestant Reformation began (1517) in Europe 77 years after the invention of the printing press (1440). The Protestant Reformation did not occur because of the printing press but neither would it have been possible without it. Many mark the beginning of the Protestant Reformation with the publication of Martin Luther’s 95 Theses. It was the printing press that made it possible for Luther and his followers to disseminate widely these theses that were originally tacked to a cathedral door. The printing press represented a form of communication that had previously been unavailable in the history of mankind. The full power of the Catholic Church was leveled at this movement but because the Catholic Church did not understand this new medium yet, they fanned the flames of revolution by using outmoded forms of sanction, like excommunication. The subject of their wrath, Luther, and his followers were free to fight back with mass produced thoughts that were free to anyone who had the ability to read them……what was only years before considered impossible, was now a fact. People had a voice, had something to say, and dared to speak to power.

This is the nature of disruptive technology. The Internet is such a technology.

Some of the early thought leaders of the Internet Age spoke to this disruptive phenomenon and chose the Protestant Reformation as a metaphor to frame their conversation. Eric Raymond wrote the Cathedral and Bazaar (1997). In this piece Mr. Raymond contrasts the top down process of producing content in the Industrial (printing press) Age to the bottom up process of the Internet Age. The top down process is represented by the Cathedral and the bottom up process symbolized by the Bazaar. The cathedral is old thinking and the bazaar is new thinking. Rather than building a massive structure that serves one purpose and is hard to change, we now do business in a free, open, and collaborative market where business of all kinds is transacted rapidly. The market is ever changing, ever evolving. It is the bazaar.

This metaphor was continued when some guys got together and wrote the Cluetrain Manifesto. The centerpiece of this work is their 95 Theses. This was written over ten years ago. Take a look at these 95 theses and consider how you think they fit in your understanding of the world now, in a world with ten more years of internet experience. They were describing the new rules of business, law and culture in the Internet economy. It was not a mistake that they chose to do this with 95 theses and it is not a large leap of logic or faith to see how their theses are much the same as Luther’s were nearly five hundred years ago, a clarion call to everyone that the locus of power had shifted in all of society.

Wow, ok professor….but what does this have to do with alarm systems and aging in place?

Because, the human value of personal privacy is closely held and not easily challenged or changed. People have been slow to share this kind of information across such a public and unforgiving medium, the Internet, for good reason. It would take a big tragedy or crisis to penetrate the skin of this deeply held value. That day is here.

For good or bad, the door is now open. Home Care will never be the same. I think a smart Home Care Agency owner will bone up as fast as possible on Smart Home technology and Internet technology. If you don’t have skills in that area, find a business partner. Our customers will expect that we carry as a matter of regular business, a full line of Consumer Electronic products to help them manage aging in place. This is how you will find business in the bazaar, the new marketplace. There is a robust and unfettered conversation. It is controversial, some times frightening. It shapes whole societies and cultures. It is capable of destroying whole industries and it can create new ones that were previously unimaginable.

And if you guys can weather that storm, my dream will, God willing, come true. You have a few years to get it right.

My Final Days, a Reverie by Mark Shea is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
Based on a work at wp.me.

The Home Care Agency of the 21^st Century will be the same as it is now in very many ways and in the most important way. We provide human companionship, human care, human assistance, and most importantly, human touch. Humans will die without these things. We not only crave the companionship, care, and touch of others. We need it. Without it, we fail to thrive and this is particularly true for babies and the elderly. We know this at our core as humans. This is why solitary confinement is considered an extreme punishment. The work of a caregiver is to comfort, to assist, and to love, whatever may come and with any luck, it might be a healing. We are there to help people die too. We help them to die with dignity and as comfortably as we can manage. We soothe families. We laugh with them and cry with them. We cannot be replaced by machines. We are the human element that must remain.

Now comes the machine and the network. The Personal Emergency Response Systems (PERS) Industry has new entrants in the market. I mentioned a couple of these already, BeClose and Grandcare. We have had other PERS products in play in the Home Care business for some time, Phillips Lifeline, for example. The PERS systems that are prevalent today are good for certain people and in certain circumstances. Buttons are usually attached to a pendant worn around the neck, a bracelet, a belt clip, or located on a console in the home. Push the button and an emergency response network is set into motion. Of course there are false alarms but those are a small price to pay for the chance to respond to an actual emergency.

These products are not the right tool for many people however. First, you have to remember that you have such a device. Many seniors and others who need these systems have cognitive impairment, including memory loss. One principle purpose for these is to help someone who may have fallen, is injured and cannot get to the phone. Another problem is that people who fall are sometimes unconscious. Passive monitoring systems, like BeClose and GrandCare, do not require that a button be pushed. The patient does not need to be aware or remember that they have a PERS device. These passive systems can be alert others connected to the system, an alarm can go out, if there has been a lack of motion in the home over a given period. This will not be as fast as the pendant to initiate an emergency response but neither does the person have to lay there with a broken hip until someone finds them. Now, pair a passive monitoring system with a PERS button and you have both systems working for you.

For people who are not in the Health Care business, you may want to know that fall risk is a major area of concern, particularly for eldercare. Each year, one in every three adults age 65 and older falls. Falls can lead to moderate to severe injuries, such as hip fractures and head traumas, and can even increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable. For more information about falls and fall prevention, see the CDC article Falls Among Older Adults: An Overview.

Passive monitoring systems can do more than monitor falls. With a skilled analysis, movement and events triggered by switches in the home can predict fall risk. Studying and analyzing these patterns of behavior and system events can give us many clues to what may be happening with this person relative to health and safety. Intel is working on some very interesting devices. One of these is their SHIMMER system. SHIMMER stands for Sensing Health with Intelligence, Modularity, Mobility and Experimental Reusability. These are lightweight, wearable, Bluetooth-enabled monitors. They can track the motion and gait of patients in an effort to better understand and prevent falls. We can know in advance if a person’s fall risk is increasing and act proactively before the fall occurs. A wonderful thing but when wearing my hat as Home Care Agency owner, I wonder what my liability would be if I were partnered with a family in monitoring their loved one and I were to miss these data that predict fall risk and the person falls. Home Care owners will need to think about how expectations are set with the family and make sure there is a service agreement or contract that explains what you can and cannot do.

No matter the data that any surveillance system can capture or any computer can calculate, in our business it takes a human to act upon that information. We can set an alarm in a monitoring system that is triggered when a person doesn’t move in the home between 10AM and 10PM. There are probably many reasons someone would want to track such a thing but let’s say in this case that the family caregiver is worried about falls. The family caregivers want a phone call to remind them to check on Mom if there is no movement in the home for over two hours during non-sleep time. Mom is on vacation, so, there is no motion in the home for two hours and the system sends an alarm. The system worked. It did what it was supposed to. It sent an alarm. It takes a human to interpret what really happened. This alarm will notify someone who will know to turn the alarm off while Mom is gone but this took interpretation on the part of the caregiver. This is one simple example of why caregivers cannot be replaced. Machines are not capable yet of discernment and interpretation. They are definitely not capable of compassion or love.

“So, why did I talk so much about the Internet and disruptive technologies in relation to these devices in the first two articles?” you might ask. I am talking about this because these passive monitoring systems connect to the internet. They are connected to a Web server. A Web server makes it possible for the family and whoever they want to add to their Web dashboard, to view Mom’s activity from wherever they are in the world as long as they have access to the internet. I leave it at that for now but I assure you, many powerful, compelling, and innovative things can be done because of the connection to the Web. Anything possible currently on the Internet, now becomes available to the family on their dashboard. One of the ingenious aspects of this technology is that the business end faces the caregivers and the passive end faces the patient who does not even need to know or remember that it is there to realize it’s benefits. In addition, some systems like The BeClose do not require that the patient have a landline phone or connection to the Internet. Devices can access the Internet through the cellular network. The command unit in the patients home only requires that cellular service be available. This offers the benefits of Information Age technology to people who do not understand or even want to be involved with the Internet. These systems provide a translation point between people who are digitally literate and those who very likely are not digitally literate.

The family now has a way to keep an eye on their loved one, even though they cannot be there all of the time. This will work for many people in many situations. This may very well be all that they need for now or ever for that matter. They can purchase the system, install it, monitor it, and develop their own care plan that they manage within the family from the Web Dashboard. On the other hand, they might need some help. They can create a triangle of care by partnering with others. They can add these other people who could be friends, neighbors…..anyone really. Now imagine if they partner with your Home Care Agency. You become a partner in the triangle of care. You can assist or even drive the care plan.

You will have a care plan that is available to you, the Home Care Agency, as long as you are in the circle of care. You will now be able to offer Home Care services ala carte. Let’s say you or someone working for your agency sees the number of trips to the bathroom increasing during the day. You could contact the family to tell them that this is a behavior pattern that experience tells us could be a Urinary Tract Infection, you probably should think about taking Mom to the doctor to check it out. The family can do that and they are happy that they have included you in the Triangle of Care. A situation that could have developed into an acute condition and possibly a health crisis, has been averted. On the other hand, the family may not have anyone in the family available to take Mom to the doctor and ask if you as the Home Care Agency can do that. Why, yes you can. You already have done an assessment; you already have a care plan, now it’s simply a matter of dispatching a caregiver for this one service. Families will now be able to buy from us or do for themselves a large number of Home Care things. We can send a coach for individual family training on a whole host of activities. We can provide classes. We can provide products and services that have nothing to do with Home Care; hairdressers, dog groomers, restaurants, handymen, gardeners….let your imagination run wild.  You as a Home Care owner can now partner with local businesses to provide these services. You become the conduit through which these local businesses can access your community. They are not allowed into the triangle of care, except through you as the representative of the family and patient. You list the most reliable, the best in your area. Because you represent, or could represent, a significant number of families or patients to these merchants and service providers, you have something valuable to sell, to families, patients, and local businesses. Family members who live anywhere in the world, can now buy a product or a service for their loved one because they want to do it and because they happen to have a few bucks left over this month and want to share a little treat with Mom. You offer them a real way to do this. This is one example of the Concierge level in the five levels of the new Home Care Agency that I described in The Home Care Agency of the 21st Century (Part 1). This represents new revenue streams, new services, and new opportunities that were previously unavailable to you. This is the power of the Web. This is the significance of having a device connected to a Web server.

Now you have a few examples of how this Triangle of Care can be leveraged in a network, on the World Wide Web. In the next essay, I’ll discuss the first level of the new Home Care agency, Consumer Electronics point of sale.

The Home care Agency of the 21st Century (Part 2) by Mark Shea is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
Based on a work at crackerbelly.wordpress.com.

I try to think of every link that I create on the Web as a promise. Please don’t go away. This really is an essay about the Home Care Agency of the 21^st Century.

As I thought about this essay, it was hard for me to know where to start. Context is important. The piece of the picture that I have that is probably represented by the fewest number of people reading this document and maybe the most important, is my Digital Media and Social Media perspective. This doesn’t make me better than you. It just means I can see something of the whole picture that you cannot. I need you to help me see your piece too. This topic involves so many different industries, perspectives…..well, it is a complex issue, one that we don’t even have a common language to discuss. Digital Media and Social Media enable all of us to share with each other to get a better look at the big picture and these media do this in some very democratic (small ‘d’) and surprising ways.

In the last essay I wrote about the impact that the Internet has had on journalism. The same will happen to Health Care and Home Care in the United States. I will tell you more about why and how I think this will happen. I have faith that if we all work together and share our perspectives, we can avert a great tragedy, the ‘Y2K +10 Problem’ discussed in Eric Dishman’s Ted talk. The great tragedy is not the total and complete transformation of Health Care and Home Care. That transformation is what will happen as a result of the tragedy. The tragedy is the catalyst for the total and complete reform of our system. It is because of my study, research, and work in Digital Media and Social Media that I believe this to be true. We’ll talk about Home Care Agencies but I really think it’s important to begin to gain understanding as a community and discuss this Internet stuff first. Feel free to disagree. That’s how this works.

We are different tribes converging on the same place to parlay and all of us are not sure how friendly the other guys are. These essays are from the world as I see it when I have my Digital Media hat on. Some of you know me and most of you don’t. If you want to know who the heck this guy is and why he is talking about this really weird stuff, you can take a look at my LinkedIn profile here. I speak for no one in these essays but myself. This is just my opinion and I am not speaking for any other company that I do business with…..this is simply all me. And consider before you bother reading any farther that you are looking at an article on a site with crackerbelly in the name.

Still with me? Wow….ok.

The problem is that we all have a piece of the picture but none of us has the whole picture. Here in these essays I intend to offer my hypothesis for what the whole picture might look like, now and in the future. This is my version of the story as I can see it from where I stand at this moment, in this place, and as it is filtered through my own bias. This means that I need you and many others to give just little glimpses of the picture from your perspective. I do not have the whole picture and this document is very much a Beta.

With just 140 characters at a time, people can create a big picture for any situation or problem by making very small and distinct observations, lots of them. I hear from people all the time who say something like, “Twitter is stupid because nobody wants to know what I’m eating for breakfast”. I tell them that General Mills cares or should care. Right now Chris Mills is getting a lot of their hate mail. Hopefully Chris and the General have this whole thing worked out.

The point is that there is a conversation going on and it is happening whether you want to acknowledge it or not. Did Twitter enable the Tunisian Revolution or not? Some say yes, some say kind of, and others say no. The Internet is a technology that now liberates mankind to have conversations that are like this, dynamic, fluid, global, profound, and unbound by time. We can talk over time and distance from different places. We are no longer bound to conversations in the town square. We can talk to people all around the world simultaneously or can do it by shifting time. This is possible and people do it because they have access to fairly simple and affordable electronic devices that connect to the World Wide Web from a robust network that is available over fast connections to a large number of the people in the world. The Internet is not restricted by time or place. On the Web, you no longer have to read the same newspapers or live in the same town to have a conversation with people who are interested in the same things you are. The world is flat after all.

We can help each other to understand the big picture on any problem that seems bigger than any one of us. We can work together to find very small things, very big things, seemingly insignificant things, or to solve the unsolvable. This is why I believe the World Wide Web surpasses numbers, written symbols, and the printing press, some pretty heavy hitters on the most disruptive technologies on ‘the history of humankind’ roster. It is important for everyone to know this because if they don’t, they simply won’t believe what I have to tell them. It is just too unbelievable. You will have no context to found a belief upon. You might stand on the shore of an Internet sea like the indigenous people of South America, who hundreds of years ago had Spanish Galleons anchored in their harbor but they could not see them because they had no context. They had no idea what they represented. How could they? This is why I think it is important to talk about it first. We need context.

Retro-Disclaimer: I should have added this to the beginning of this essay and the last essay. I’ll go back and do that tomorrow.

This is the nature of publication on the Internet. The Internet is dynamic, it is fluid and it never forgets. Every version, every iteration is Beta. Beta is a software development term meaning “under construction, enter at your own risk“. The whole Internet is an ever evolving social experiment, enter at your own risk. The point of publishing a document in the age of the Internet is to begin a conversation, to get it out in Beta. You begin where you are and develop from there with the help of an incredibly large number of people around the world who can and will help you to accomplish truly incredible things. It’s the very thing we are doing here.

So far I have been sending my rambling thoughts through E-mail, LinkedIn, Facebook and a Tweet here and there. Now, however, I am inviting friends and colleagues from other areas of study, other disciplines, and other industries to the conversation. I expect this conversation to fork off onto other social media platforms that cater to their particular interests and professions. I expect there will be conversations as engaging as ours here. The Internet or more specifically, the World Wide Web, is dynamic and fluid…..and represents a pool of perspectives that is infinitely diverse. If we all add our dot to the picture and then step back, maybe….just maybe….we will be able to get a true big picture. It never forgets for many reasons but if you doubt me, check this out.

Because it is dynamic and fluid, I’ll try to capture what is happening on other threads and bring them back to one site. For now it is here on wordpress but soon I’ll move this conversation to http://www.crackerbelly.me. I just registered the domain name. Like it? It cracks me up. Crackerbelly is my alter ego and I’ll tell you soon enough who he is. For now, just know that he is the character with a funny name who wants to talk about a mind-blowingly important thing. ‘Crackerbelly dot me‘ because Crackerbelly speaks for no one but him….me….self, well you know. He lives in Forks, Washington and he is a not so successful Home Care Agency owner, Lights Are on But Nobody Is Home Senior Care Agency. He is desperate and looking for a way to save his business. While doing research and analysis he discovers something startling, something scary, and something that gives him hope. What does he see? Home Care Agencies may very well become the hub upon which the entire Long Term Care industry pivots and at times he thinks maybe the whole Health Care Industry will pivot on, if not the Home Care Agency, then the home. The Home Care Agency could be the conduit through which average folk grant access to their care plan. The power of the Health Care system is about to shift away from a centralized system to a distributed system where most of the power resides with the individual. This is the disruptive and trans-formative power that the Internet brings to institutions, cultures, beliefs, and economies. It is in this context that we need to understand the Home Care Agency of the 21st Century. I know this because I have already seen it happen elsewhere, in other times and other industries. I want to let you know what is coming. It will be real cool and real scary. The essays that follow are in the spirit of this new world, the World Wide Web.

To some, I promised to share what I believe to be the tiers of work (or, if you prefer, revenue streams) for a Home Care Agency in the 21st century. I’ll discuss these more directly from my perspective as a Home Care Agency owner in my next essay or perhaps from Crackerbelly’s perspective. My word count is getting way too high in the lower left hand corner. I better close or lose my audience, if I haven’t already, to death by a wall of words and monotony. Here are those levels of work as I see them now:

1. Home Care Consumer Electronics (point of sale)
2. Home Care Consumer Electronics (support, subscription, design, customization, integration, architect, consulting, hosting)
3. ‘Senior-ization’ of living spaces (Home Modification)
4. Concierge Services (mom wants a hair-do…..why not)
5. Home Care, including new services made possible by sharing the Web Dashboard with individuals

If you have stayed through the trailing credits then you are a true fan of Digital and Social Media. That being the case, try to answer this if you can. What is the significance of the license that I have on this page? If you don’t know, you might want to find out. It’s really cool and really scary. Check it out.

The Home Care Agency of the 21st Century (Part 1) by Mark Shea is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
Based on a work at wp.me.

A wave of change has arrived for the health care industry. Even the most powerful representatives of health care, government and business will be unable to stop this incoming tide. I can say this with relative certainty because I am a Baby Boomer. 79 million people, 26% of the US population, are about to get old. According to Pew Research, as of January 1, 2011, 10,000 Baby Boomers per day are having their 65^th birthday. This will continue for the next 19 years.

Wherever and whenever I have been in my life, I have experienced the strain that the sheer numbers of people in my generation place on an infrastructure. I experienced it in schools from Kindergarten through College. Classroom size was a problem but that was secondary to the need for physical classrooms. New schools needed to be built and lots of them. Another example, people of my generation didn’t like being conscripted to serve in the military and when we had a sufficient number of our generation eligible to vote, we imposed our democratic will. The draft was eliminated. So it has gone throughout my life. The list of situations, institutions, industries, and economic sectors that have been impacted and forever changed by having to respond to the sheer numbers of my generation is quite long. Now I am 56 years old. The Greatest Generation, my parents’ cohort, is straining our health care infrastructure to the point of breaking. Right behind them comes my generation. The health care industry is not prepared to handle us. The first baby boomer filed for early retirement and Social Security benefits in 2007.

Eric Dishman, an Intel Fellow and director of health innovation and policy for Intel’s Digital Health Group gave a lecture last year at Ted. He calls the “senior-ization” of the Baby Boomer generation, the “Y2K + 10″ problem. Something significant happened near the stroke of midnight as the new millennium was ushered in and it wasn’t, as so many people predicted, the crash of our worldwide information systems. The United States changed from being a country that had a larger number of younger people to a country that had a larger number older people. Older people use the health care system far more than younger people. And, it is the “Y2k + 10” problem because it is ten years after the year 2000 that Baby Boomers begin to retire. That day is here.

Today, America’s elderly are living longer and the cost of health care is rising dramatically. Those two factors are going to make it incredibly expensive to take care of all of these retiring Baby Boomers.

Meanwhile, the sad truth is that the vast majority of Baby Boomers have not adequately saved for retirement. For many of them, their home equity was destroyed by the recent financial crisis. For others, their 401ks were devastated when the stock market tanked.

Company pension plans across America are woefully underfunded. Many state and local government pension programs are absolute disasters. The federal government has already begun to pay out more in Social Security benefits than they are taking in, and the years ahead look downright apocalyptic for the Social Security program.

We will have to leave it to historians to say where the health care industry falls on the technology adoption curve for personal, distributed, shared, and social computing. We are far from finishing these chapters of our story in human experience. What we do know right now is that the Health Care Industry is not the first economic sector to experience the disruptive effects of these technologies. To understand what kind of shift this will be for the health care industry, consider the changes seen in the music, video, recording, publishing, and journalism sectors over the past ten to twenty years.

By way of example, let’s turn to journalism. Print newspaper companies are folding at a rapid rate. Broadcast news, radio and television, are not faring much better as they try to compete with content on the World Wide Web. Now anyone who has a computer and broadband access can be a journalist or correspondent with the ability to publish their content to the world for free. People no longer need to have access to massive printing presses that cost millions of dollars to build and maintain. The technology to publish and market to a worldwide audience is now affordable, ubiquitous, and available to almost anyone who wants it.

So, if these media are waning, is there still going to be a need for journalists? Yes.

There are still journalists and there is still plenty of work for them to do, important work. Some people who consider themselves to be journalists simply don’t know where to report for work. This is quite literally true. There are an ever dwindling number of jobs that are linked to a printing press or traditional radio/television broadcast network. How, where, and why journalists ply their trade is rapidly changing. According to the U.S. Bureau of Labor Statistics, the job prospects for News Analysts, Reporters, and Correspondents will decline by about 6% between 2008 and 2018. That isn’t great news for them but it isn’t Armageddon either.

In the vocation of journalism new opportunities are opening for wordsmiths who are so inclined. Some of the new opportunities don’t even have names yet. I wonder what we will call a transmedia story-teller? Maybe simply “transmedia storyteller” but who knows what it will end up being? And people who never would have thought to refer themselves as journalists are now called bloggers and given press passes.

It is not only companies and their workers who experience the disruptive impact of these computing technologies. We all share in it. The very fabric of our culture is being re-woven. In the area of journalism we as a society are grappling with questions like: Is the Fourth Estate in jeopardy or will it re-make itself in a new form? And so it will be for health care. We will be questioning and challenging the basic tenets of the way health care is provided and consumed.

Whole industries that were considered inviolable just 20 years ago are now dying and being replaced by new ones that could not have been imagined just a few years ago. If you were able to travel back in time to 1999, how would you describe Netflix as it is today to the people there? Our language is being bent to this technology. Consider google: a word that found a beginning in the early days of the 20^th century as a children’s’ book, then as a cartoon character’s last name, that became the name of the number represented by 1 with a hundred zeroes after it, and then to name of an internet company. In the common vernacular, google is now a verb meaning to search the internet.

New consumer electronic devices are appearing on the market now. Some have been around for a while, for example, the Phillips Lifeline. Products like Lifeline are good for certain situations and for the right person. Unfortunately it requires someone to push a button to call for help and many seniors have trouble remembering to wear it. For the price of a television and a monthly cable bill, families can now install a passive monitoring system. Affordable passive monitoring systems, such as BeClose and Grandcare, are now arriving in the market. Now, the senior does not have to interact with the technical system at all. Activities of daily living like movement in the house, getting up, going to bed, going to the bathroom, and bathing can be monitored. The opening and closing of doors can be tracked. Medical devices like blood pressure cuffs and blood glucose testers can be connected to these systems. Medications can be dispensed at the correct time and in the correct dosage. The family caregiver, who can be anywhere in the world, can see this data on a Web dashboard. The customer pays for a monthly subscription that gives them access to this dashboard. They can add whoever they want to the dashboard.

The people who have access to the dashboard can monitor and analyze the data to identify and proactively act upon potential health and safety problems. For example, if the frequency of trips to the bathroom is increasing, this could be a sign of a possible urinary tract infection. This can become a serious problem for a senior if left untreated. The family will know that it is time to get Mom to the doctor or, in the future, have the doctor come to her.

The family caregiver can now monitor the situation on their own; team-up with neighbors, family, and friends; team-up with professional caregivers; and any other person that they want. The family now has an opportunity to interact with doctors, nurses, psychologists, social workers, clinics, hospitals, home care agencies and nursing homes. Long term care is moving to the home. This doesn’t mean that the other institutions that currently serve this need are out of business. It means that they are going to be placed in a position where the patient or their family has control over who has access to the care plan. The individual is now in control of who they want to have access to the care plan. They choose who is in the triangle of care which is comprised of the patient, the family, and professional caregivers. Families will now be able to not only use these systems for proactive health and safety monitoring but they will be able to use them in defensive ways. The BeClose system for example does not depend on a landline phone or broadband connectivity. The system accesses the internet via cell coverage. Now families can monitor their loved one in the nursing home. They will know when someone enters or leaves the room and how long someone stayed while they were there. By the way, it will be quite easy to add a camera and microphone to these systems for monitoring if that is what people want.

The health care system in the United States is floundering. The health care system continues under an industrial age business model. Eric Dishman calls this the mainframe mentality. The management of patients is done in an assembly line fashion. The assembly line only has capacity for so many widgets (patients). The assembly line has specific purposes and methodologies and has very little tolerance for alternative methods and purposes. The assembly line is a massive machine that is engineered and difficult to change. The assembly line does not understand unique and individual needs. The assembly line does not allow direct input by consumers to customize the output. The cost of creating an assembly line of their own is out of reach for most people. The cost of products produced by the assembly line is getting out of reach for many of its consumers.

This is the time when a disruptive technology has an opportunity to take root. There is a crisis that existing institutions are unable or unwilling to resolve. If people cannot get access to the goods and services that they want and need and the tools are available to do it for themselves, they will take matters into their own hands. These new systems coming to market now are just the first wave of many more to come. We can predict this with relative certainty because we have seen it happen already in other industries. The internet, broadband connectivity, cell phones, software and affordable consumer electronics placed in the hands of the individual will transform the healthcare system. Long term care will be the beachhead of this assault. There will be many attempts by large institutions that are heavily invested in maintaining the status quo to stop this power shift. Laws will be passed to try to stem this shift of power from the institution to the individual. We can anticipate that there will be much debate, name calling, and general grumpiness. It is highly likely that people who are using these devices to manage their own care will be branded as some kind of criminal. Our children who share music files with each other are called pirates, for example. The individual will not care because they will no longer need the institution as much as they did before. The individual will be empowered to interact and have conversations directly with resources, like doctors and nurses that they previously did not have access to. Individuals will be empowered to develop personal health care systems that serve their needs.

The winds of change are upon the health care system and the revolution will begin with long term care.

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.

1. Analysis of the role of technology.
2. Analysis of the effects of networked information economy on individual autonomy.
3. Examination of the shift from the mass-mediated public sphere to a public mediated sphere.
4. Emphasis and discussion of individual action in non-market actions.

The signs are all around us. Newspaper revenues are on the decline and some have predicted the demise of the fourth estate as we know it. Book publishers caste about in search of a new model. Benkler’s own publication is printed by Yale University Press but is also available on his Web site for free download under Creative Commons license. The entertainment industry is undergoing major transformation. It is no longer necessary to distribute music or movies on rivalrous media. The digits of computing have made non-rivalrous options available. The opportunities to share, mix, and re-use content abound. The power to produce compelling content that can be shared widely is now in the hands of the individual. Enterprise level software is produced by volunteers. This is software that legitimately competes with industry giants such as Microsoft, Apple, and Oracle. Benkler offers a powerful and persuasive argument for an economic model that explains this profound shift in the way that a significant portion of humankind communicates and the economics of that shift. He calls upon powerful examples of social production that have arisen in the first 5,000 days of the World Wide Web:

• Wikipedia
• Seti@home
• Linux
• Slashdot
• Google

In the old industrial information network, the cost to enter the market was prohibitive. Large and expensive presses were needed to produce printed mass media. For entertainment, expensive cameras, recording devices and studios were required. Broadcast media required access to one of only a few channels available and then millions of dollars in equipment and staff to maintain a network. The motivation for engaging in these enterprises could really only be one thing, revenue. Now, anyone with an $800 computer, a broadband connection, some software, and a little talent can reach millions of people. Money is no longer the only reason for participating in content production. People engage for a variety of reasons, for example, status, reputation, community, truth or fun. The ninth largest Web site in the world, Wikipedia is produced almost entirely by volunteers. Today everyone is a content producer. Very few cell phones come without cameras. Blogs, wikis, forums, and social networking site gives anyone with a connection to the network an opportunity to contribute.

Benkler’s arguments find their roots in the free software movement and the hacker ethic. Benkler argues strongly for setting information free and enabling wherever possible, the ability for people to share and collaborate. He argues that government’s role, particularly in North America and Europe, has been heavy handed on the side of the status quo. At times, there is a temptation for me to step back from Benkler’s arguments and wonder if he is just another wild eyed academic liberal who has lost touch with the world in a finely feathered nest called tenure. Under analysis, however, I feel that his arguments hold. Due to technology the way that people communicate has changed. It is a change that is on the scale of the alphabet or the printing press. It has happened and it is undeniable. His perspective on this shift is undeniably liberal. I would be interested in reading a conservative companion piece to balance his view but to date, I am aware of no equal.

I highly recommend The Wealth of Networks to anyone who wants to understand the economics of the internet and digital media. If you have time to read one book on this subject, this is the one to pick. It can be dense. It can be challenging. This is not a book that you will breeze through in a weekend. Rather, it is thought provoking and can inspire contemplation and further investigation. In my opinion there is no higher praise for a book. I predict that this is a book that you will reference time and time again.

I have $200.00 burning a hole in my pocket. Once it occurred to me that I could get 10,000 people to do something as inane as draw a sheep for me for the low, low price of .02 cents per sheep, my week has not been the same. It just seems like too much fun. But what will it be?

· Draw something that starts with the letter A, the letter B, the letter C….through to Z times 200.

· Send a picture of what is under the cushions of your couch.

· Read a sonnet and send the recording as a wav file.

· A penny for your thoughts times 20,000.

· Draw the man in the moon

· Tell me where to take my next vacation

Why does this appeal to me? I really don’t know but it seems to be a collective piece of art. It is a gestalt exercise. A collection of similar acts by many different people fires my imagination. This is one of the things that I love more than anything else about the internet, its generative nature. In its randomness, from its serendipitous goofiness, comes remarkable creativity. In it I can see reflections of the human spirit. This for me is like the ability to create my own little flash mob experience for a few dollars.  The Amazon Mechanical Turk will have me scheming for some days to come. Once I strike upon the ideal bit of fun, I’ll share it here. Of course, I’ll give you a chance to earn your own two cents.