The Takeaways: Week 38 of 2021

A periodic review of articles, newsletters, and podcasts that I found interesting, inspiring, or otherwise worth remembering.

Closed Tab of the Week

I always have many tabs open. A good number of them hang around because of the mismatch between my interest in engaging with them and the time I have available for that engagement. Here I pick one to review, think about, and close out.

Brendan Keeler, Health API Guy. A Song of Health and FHIR (June 23, 2021)

Keeler is a product manager at Zus Health, a healthcare startup that reads to me like a combination of infrastructure-as-a-service, platform-as-a-service, and maybe some aspects of an agency model. By their pitch, this lets them build different partnerships at different levels of the healthcare tech stack, where the partnerships can either integrate with some layer of a partner's existing stack, come all the way to the end user in application form, or both. Given everywhere they seem to want to plug in, it's no surprise that FHIR would be an important competency.

The essay opens with some intitial level-setting (FHIR is hard; there be dragons here), and an informed discussion of a variety of lookouts and gotchas:

  • Adoption does not mean rip-and-replace: The industry doesn't really do that.
  • There’s an adoption mirage: FHIR is a specification. Any given implementation is not likely to need to find every piece of it relevant (it could be less than the whole spec), nor is the specification a guarantee that the content of a given implementation will be only what the specification describes (it could be more than the whole spec, or exceed the relevant tranche of the spec but go into areas outside it).
  • Use case matters: Specifically, the nature of the trust boundaries your data flows will cross will matter.
  • There's variabiity across vendors: Kind of like the "adoption mirage" point, but proper to vendors and their architectural choices.

From there, Keeler develops a framework for understanding which capabilities and/or gotchas in FHIR-world are likely to be most relevant to you, an entrant into the digital healthcare space:

  1. Who are you?
  2. What's available to you?
  3. Keep it simple
  4. Get help

The first section asks the reader to map their org to (or across) three different domain: provider software, provider organizations, or patient apps. The second section uses the earlier discussion of trust use case to rule-of-thumb how deep and/or complex your need is likely to be. Section three, with adoption and variability in mind, suggests where each domain's best starting points are likely to be. Section four gives the helpful reminder that vendors can be your friend, provided you can understand your problem well enough to know the right kind of vendor.

There is a "content marketing" stratum here, but it's limited to a few inline asides presented as block quotes. Keeler closes with a set of resources. Most are general but vary by medium: documentation, an online community, a blog aggregator, a variety of video resources, and some "practice" resources.



Melissa Perri (host), Product Thinking. Episode 34: Developing Strong Product People With Petra Wille (2021-09-22)

[12:29] Petra talks about the PM wheel she created which is a framework of skills every product manager should have. Petra says this framework embodies her principles and values, and it is customized for each company she works with.


John Cutler. The Beautiful Mess. TBM 38/52: 15 Behaviors of Healthy, Data-Informed Teams (2021-09-16)

Yes, the whole thing. Maybe not all of it is relevant to your team, but certainly at least some of it is.

Ishani Ganguli, MD, MPH. Tradeoffs. Research Corner (2021-09-24)

There’s a good amount of research on the cost of administrative work to the U.S. health care system and providers. But the administrative load I see my patients deal with every day — multiple phone calls to schedule office visits and imaging scans, arranging transportation, faxing forms, the list goes on —imposes its own burden which has largely gone unmeasured.

Nearly a quarter of those surveyed said they had delayed or skipped care as a result. To put that in perspective, that’s roughly the same share of Americans who say they delay or skip care due to cost. Unfortunately, these burdens were unequally distributed in familiar ways. Adults with a disability as well as women were more likely to report doing administrative tasks and having them lead to delayed or foregone care. White adults and adults with higher incomes, in contrast, were less likely to report delayed or foregone care.

Kevin O’Leary and Ryan Russell, Health Tech Nerds. Weekly Health Tech Reads 9/26

Chas Roades and Lisa Bielamowicz, MD, The Weekly Gist. September 24, 2021

When we spoke recently with a chief medical information officer (CMIO) leading his system’s telemedicine strategy, he shared, “If there is one thing I wish executives would understand about telemedicine, it’s that it will never make doctors more efficient.” His data show the average video visit takes just as long as an in-person encounter. True, there is no physical exam, but the virtual conversations can be lengthy. And adding in time lost to helping patients troubleshoot technology, some of his colleagues report that virtual visits may actually take a little longer. He went on to explain that other kinds of virtual encounters, specifically asynchronous communication with a provider, sometimes supported by automated symptom triage engines like Zipnosis, are far more time-efficient ways to communicate with patients... But delivering telemedicine “at scale” to meet rising consumer expectations will require finding the right balance of asynchronous communication, telemedicine, and in-person visits to best fit specific clinical circumstances.

Web Smith and Hilary Milnes, 2PM. No. 753: The American Shopper (2021-09-20)

The growth of the Misfits Market is an indication of the grocery industry’s democratization. While grocery eCommerce was slow to catch on, the segment is now exploding with innovation. It’s given companies who want to rethink how we consume food and beverages a chance to build enterprise sized marketplaces despite the competition from companies like Walmart, Target (Shipt), and Instacart.

Olivia Webb, Acute Condition. The untenable crisis of hospital staffing (2021-09-23)

Even as the pandemic rages on, most hospitals have been unwilling or unable to take a proactive stance in supporting their workers. The result is that the portion of healthcare workers that have the most flexibility in finding a new job are exercising that option.


Vicki Boykis, Data, Tech, and Sometimes Nutella. It's still hard for beginners to get started with Python (March 12, 2018)

If you are a senior person and have junior people that you work or interact on online forums with, it’s a good idea to keep these things in mind. The people that have been most important to me in my career are the ones who were able to help me navigate through the maze of questions I had and turn my own mental model to decrease the amount of unknown unknowns I had.

Paul de Barros, The Seattle Times. How John Coltrane’s Seattle recording of ‘A Love Supreme’ was found, thanks to 2 local saxophonists (2021-09-20)

But the real Seattle hero behind “A Love Supreme: Live in Seattle” was Brazil, who not only had the presence of mind to record the show but may well have been the impetus for Coltrane playing the piece at all. Brazil, who moved to Seattle in 1961, had befriended Coltrane while living in Detroit. They shared a mutual interest not only in music but in chanting and Eastern spirituality — in particular, the Hindu scripture the Bhagavad Gita, which they discussed at length while Coltrane was in Seattle. That week, Brazil also booked studio time during the day to record yet another album with Coltrane’s expanded band, “Om,” with Brazil playing wooden flute. It’s not a stretch to credit Brazil with putting Coltrane in the frame of mind that prompted him to revisit “A Love Supreme.”

Erich Grunewald. The American Style of Quotation Mark Punctuation Makes No Sense (September 11, 2021)

Since a period marks the end of a sentence, it should not be placed before marking the end of the quotation. You can compare this with nested or hierarchical structures, or with stacks, or even with first in, first out methods of computing, systems theory or asset management. Under any comparison, the British style will seem preferable to the American. You resolve the nested item first, before resolving the parent.

Sari Kaganoff and Sean Day, Rock Health. Healthcare’s middle children: Potential disruptors flying under the radar (2021-09-20)

We are defining middle children as tech, retail, and fitness companies with market capitalizations between $10B and $350B. They are big enough to make an impact at scale, but not so big as to be under the same scrutiny as “big” players. Middle children tend to be consumer-focused, and they have assets and capabilities that could be used to make a play into healthcare.

Rafi Letzer, The Verge. A teenager on TikTok disrupted thousands of scientific studies with a single video (2021-09-24)

That video got 4.1 million views in the month after it was posted and sent tens of thousands of new users flooding to the Prolific platform. Prolific, a tool for scientists conducting behavioral research, had no screening tools in place to make sure that it delivered representative population samples to each study. Suddenly, scientists used to getting a wide mix of subjects for their Prolific studies saw their surveys flooded with responses from young women around [recent Florida high school graduate and self-described “teen author” Sarah] Frank’s age.

Shannon Muchmore, Healthcare Dive. Payers double down on population health programs amid COVID-19 (2021-09-22)

Report from an AHIP panel. One wonders if the new payer-to-payer interoperability rules could make it possible for SDOH programs or interventions to carry on even when you leave your insurance company for another, or move from being insured to being uninsured.

"I think a lot of times some of the social determinants of health interventions take longer to see ROI or outcome than some of our more traditional clinical interventions," [program analyst at Pennsylvania-based insurer Independent Blue Cross Julie] Weatherly said. "So I think for us it's also level setting with folks who may not have a public health background or social science background."

Casey Newton, Nieman Lab. What I learned from a year on Substack (2021-09-20)

Being captured by the audience is probably my greatest fear about running a newsletter over the long term. This is a real problem with trade publications — when you spend every day talking to a handful of companies, those companies come to sound more reasonable to you than they do to an average person. The good news is that Platformer also has plenty of paid subscribers who are outside the orbit of Big Tech: they’re academics, policy makers, consultants, and concerned citizens, and I regularly hear back from them when they think I’ve missed the mark. Also: a good number of rank-and-file workers subscribe specifically because they want to empower journalism and analysis that pushes their companies to do better.

Antonio Olivo and Rachel Chason, The Washington Post. As covid-19 patients fill hospitals, health-care workers fight fear and exhaustion: ‘Here we go again’ (2021-09-18)

There have been more than 23,000 deaths in D.C., Maryland and Virginia since the first was reported on March 14, 2020. Health-care workers are now in their 19th month on the front lines. Here are some of their stories.

A nurse giving vaccinations. A paramedic. Contact tracers. A respiratory therapist. A critical care nurse. An ICU doctor.

Now, after 18 months of putting their own health at risk for patients, [Dr. Kanak Patel] said, staffers are still treating unvaccinated patients with the same care. But, he said, it is emotionally more difficult to care for people who could have gotten vaccinated but chose not to.

Jeff Parrish, Symbolic Logic. Years of pain solved by really obvious keyboard tweak (September 23, 2021)

TLDR: Two standard keyboards.

Each keyboard is placed at a natural wide angle, so my shoulders are always pulled back. Rather than have the keyboard dictate how wide your shoulders should be, I could let my body do that.

Rebecca Pifer, Healthcare Dive. Quarter of providers saw mortality rates rise after ransomware attacks, survey finds (2021-09-23)

Falling confidence is partially due to a sharp growth in third party ties, [a survey by the Ponemon Institute] found. Providers expect the number of third parties they contract with to grow at an annual rate of 30%, from 1,950 up to 2,541 in the next 12 months. Of the third parties, 43% have access to patients' personal health information, putting providers at higher risk of a breach or hack.

Molly Worthen, The New York Times. The Fight Over Tenure Is Not Really About Tenure (2021-09-20)

Ever since then, the pressure to publish quickly has driven faculty members down ever narrower lanes of inquiry, searching for some hidden byway no one has taken before in order to claim an original (if, to nonspecialists, trivial) contribution. In graduate school, aspiring professors often hear: Don’t be overly broad in your dissertation; you’ll have to get it done and published, because hiring committees care far more about that than how prepared you are to teach a wide range of subjects. Academic freedom no longer includes freedom to be a generalist.