But we had spent all the opportunities that we could access at the particular phase of our Trinity College Dublin campus company start-up! Then we found HealthBox. And to our surprize and delight we were accepted!

So we left our day jobs in medical practice, consulting and visiting professorial roles in Ireland. We followed the path of many many Irish and other nationalities before us, and went to America, as the land of opportunity that welcomed new ideas. Kevin, Enda and I spent 3 months in Chicago. We incorporated as a US company and became very excited about the opportunities in the US. Despite the health, healthcare and economic challenges faced by the US and the Western world, the mood was so upbeat. The US will invent its way out of the problem – was the call to action.
The 3 months was like a compressed MBA, and we learned so much. We polished our pitches and polished and polished……..until we were professional, and all the other 9 teams with us. By the end of the 3 months the teams and the HealthBox team and our mentors had bonded. The ten companies had become a family, we had common visions and aspirations, as innovators, risk takers and entrepreneurs in the making, if not already established.
We appreciate the thought that went into our program and the efforts put in by Nina, Dan, Jenna, Yashu, Anu and John. We felt so supported by Milena. IDEO were magic. We really appreciate the support and encouragement of all our HealthBox mentors, and in particular to the amazing mentors and supporters of HealthBox.

So now it is over, we are sad to part. But many of us will continue to network and connect, some of us might even partner. And now the nail biting time…. Our transitions from prototype to operational and commercial products are now deadly serious. Our investment rounds…. But there are bright lights on our horizon and lots of promise. And many new ideas in the pipeline as well.

It is not good bye but see you soon..

Dr. Carmel M Martin, MD PhD.

The Care Innovations Summit, Washington, DC January 26th, 2012 was a huge event attracting over 1000 in-person attenders and more than 2000 online attenders. It was a rousing occasion and stimulated excitement and enthusiasm, with the aim of motiving innovation and the adoption to scale of innovation already demonstrated to work in smaller scale.

Better health, better care, lower costs was the foremost idea. Many different approaches were highlighted in three case studies about: i) care delivery/primary care innovation case study; ii) care delivery/chronic disease innovation study and iii) cancer: journey toward better health, better health, better care and lower costs case study. Ignite Talks Prizes and Challenges identified key pain points where new approaches and ideas would help many of the US health service delivery systems.

The presentations were varied and interesting, yet what emerged. Lots of exemplary locally driven activity and a wide range of terminology emerged. In fact, on closer analysis the key themes emerged.

All the selected presented identified changing system dynamics of care with better information. ‘Data is the oxygen’ was a term repeated often. Providers and changing provider roles, structures and remuneration were central to transforming systems. A lesser theme was engaging patients and communities in self-determining their care.

The US health care systems and all health systems are by definition, not static, linear and ever appropriately assembled. Polarities, contradictions and tensions in values and non-linear dynamic systems with feedback loops are the norm in health systems internationally. There is no doubt that simple and complicated approaches to many health service problems have been successful [2]. The checklist is identified as a major disruptive innovation in health care – and we are asked to model our practices on the discipline of the cockpit in planes and the pit stop in motor car racing circuits. [1] This is laudable and timely as many simple and complicated operations conducted by individuals and teams particularly in surgical and emergency situations will be improved and lives will be saved and health-outcomes improved. However, many technical as well as value questions will never be easily answered in the dynamic and ever-changing challenging environments.

An attempt to transform primary care into a sum of checklists in the UK, such that if boxes are ticked payments follow, has not improved outcomes beyond existing trends. What works well in some domains of health care do not work well in others. Making sense of options and dilemmas in a realistic time frame is essential to inform decision making in a complex health care system environment [3]. How do we make sense of how to make sense of different approaches in and across health sectors – particularly engaging patients, families and communities? Engaging with sense making dialogues and knowledge development to aid decision making in complex adaptive clinical practice and health systems management is a pressing challenge as health care continue to struggle to adapt to changing internal and external constraints of achieving better quality at lower cost. The real challenge for CMS and other players is how to make sense of complex adaptive systems in different contexts[2]

Sense making activities centre around key areas and leaders who have demonstrated how to make sense of patterns in different layers relevant to human health:

• Communications Brenda Dervin[2];
• Organizational studies Karl Weick[3];
• Intelligence and multi-ontology sense-making – the Cyenfin framework Dave Snowden[4];
• Mathematical modeling –West
• [5],Stephen Guastello[6], Katerndahl[7] and others; and
• Artificial intelligence and informatics –pattern recognition[8], data-mining[9]computational linguistics[10]

Sense making is about identifying patterns and their meanings, so that individual or collective responses can be made.

1. Gawande, A.A., The Checklist Manifesto2010, New York: Metropolitan Books, a division of Henry Holt and Co.
2. Dervin, B. and L. Foreman-Wernet, The Sense-Making Methodology reader:  Selected writings of Brenda Dervin.2003, Cresskill, NJ: Hampton Press.
3. Weick, K., Sensemaking in Organisations. Foundations for Organizational Science, ed. D. Whetten1995, London: Sage. 1-231.
4. Snowden, D.J., Multi-ontology sense making: a new simplicity in decision making. Inform Prim Care, 2005. 13(1): p. 45-54.
5. West, B.J. and P. Grigolini, Complex Webs : Anticipating the Improbable2011, Cambridge ; New York: Cambridge University Press. x, 375 pages.
6. Guastello, S.J., Chaos as a psychological construct: historical roots, principal findings, and current growth directions. Nonlinear Dynamics Psychol Life Sci, 2009. 13(3): p. 289-310.
7.  Katerndahl, D.A., R. Wood, and C.R. Jaen, A Method for Estimating Relative Complexity of Ambulatory Care. Ann Fam Med, 2010. 8(4): p. 341-347.
8. Horvitz, E. From Data to Predictions and Decisions:Enabling Evidence-Based Healthcare. Series on Data Analytics1, Computing Community Consortium, 2010.
9. Riaño, D. and European Society for Artificial Intelligence in Medicine., Knowledge representation for health-care : data, processes and guidelines : AIME 2009 workshop KR4HC 2009, Verona, Italy, July 19, 2009 : revised selected papers. Lecture notes in artificial intelligence, subseries of lecture notes in computer science,2010, Berlin ; New York: Springer. x, 194 p.
10. Vogel, C., N-gram Distributions in Texts as Proxy for Textual Fingerprints, in The Fundamentals of Verbal and Non-Verbal Communication and the Biometrical Issue, A. Esposito, et al., Editors. 2007, IOS Press: Amsterdam, Netherlands. p. 189-194.