Dell: A Multi-Billion Dollar Technology Start Up

Dell World Has a Strong Healthcare Focus

I attended the 2013 Dell World Conference at the Austin Convention Center this past December. It was very interesting especially in light of Dell going private shortly before the event. During his keynote Michael Dell gave attendees a glimpse into his plans to catch up with the cloud and reinvent the firm he started years ago right up the road from where we met. Dell also announced a $300 million Strategic Innovation Venture Fund that extends its existing $60 million Fluid Data Storage Fund to cloud computing, Big Data and mobility. Startups in these areas now have a shot at funding, channel resources and go-to-market know-how from one the world’s largest technology companies. With its funds, Dell is making investments with other venture capitalists and strategic investors and acts as a board advisor and resource for the companies. These resources could be technical, business counsel or market strategy assistance.

Highlights from Dell World Opening Keynotes


Many of the Dell World sessions with a healthcare focus were centered around cloud strategies and storage solutions, as well as touch enabled devices. Below August Calhoun, Vice President and General Manager, Healthcare and Life Sciences at Dell, outlines the three priorities for Dell's healthcare efforts including:

1. Private or Hybrid cloud solutions which are HIPAA certified
2. Big data, including storage and data warehouse solutions
3. Touch enabled solutions in partnership with Microsoft and Intel

I also spoke with Sid Nair, Vice President & Global General Manager, Healthcare & Life Sciences at Dell Services, for his perspective working in Dell Services on what he sees in store for this next year. He brought the following issues into focus:

1. Compliance and regulatory issues
2. Optimization and integration
3. Analytics

It will be very interesting to see how Dell continues to position itself in the rapidly evolving healthcare marketplace. During a video testimony at Dell World, Tenet Healthcare Corporation gave some glowing feedback on their over 20 year relationship. It was noted that the single biggest check Tenet writes each year is to Dell, primarily due to the IT services contract Dell inherited when it acquired Perot Systems. Last year Tenet's subsidiary Conifer Health Solutions also acquired Dell's Revenue Cycle Solutions line of business for hospitals and healthcare systems. This acquisition increased the annual patient revenue Conifer manages for its client hospitals to over $21 billion. There were a great many sessions as well as solutions on the exhibit hall floor they were geared towards healthcare. One of the best was a panel moderated by Dr. Andy Litt, Chief Medical Officer of Dell Healthcare and Life Sciences which you can view HERE (free registration required).

Dell Hosts Thought Leaders in Healthcare Think Tank

In 2012 an intimate group of healthcare IT experts gathered at the HIMSS conference in Las Vegas for an evening of listening, collaboration and discussion about the challenges and opportunities that matter most to the healthcare IT industry. Then again in 2013 Dell hosted the second healthcare think tank, "The future of information-driven healthcare." These events were shared over a livestream broadcast where participants could attend virtually and submit comments and questions using the #DoMoreHIT hashtag on Twitter. Now this year, we are at it again with "At the Crossroads: Technology and Transformation in Healthcare."

This time it is being held a few weeks after HIMSS in order for everyone to take a breath and digest the high points of conference. We will again be  using the #DoMoreHIT hashtag and it will be broadcast on Livestream HERE.

This year we will focus on three broad topics, The Connected World, Aligning the Players, and Analytics to Drive Change, but we will not be constrained and I expect some great discussion since we have some pretty smart people in the room. Participants to the roundtable discussion will include:

Dan Munro - Contributor, Forbes @DanMunro
Drex Deford - CEO, Next Wave Connect @DrexDeford
Janet Marchibroda - Director, Health Innovation Initiative, Bipartisan Policy Center @BPC_Bipartisan
John Lynn - Founder, HealthcareScene.com @TechGuy
Dr. Joseph Kim - Chief Editor, Medicine and Technology.com @DrJosephKim
Dr. Wen Dombrowski - Chief Medical Information Officer (CMIO), VNA Health Group @HealthcareWen
Kevin Riley - President, Kevin Riley & Associates | modelH @KevineRiley
Nora Belcher - Executive Director, Texas e-Health Alliance @NoraBelcher
Shahid Shah - Chairman, HealthIMPACT @ShahidNShah
August Calhoun, Ph.D. – VP/General Manager, Dell Healthcare and Life Sciences - @AugustCalhoun
Sid Nair – Vice President/General Manager, HCLS, Dell Services - @nairsid
Andrew Litt, M.D. – Dell Healthcare and Life Sciences - @DrAndyLitt

Analytics: Realizing the Value of Health IT

This is my post on the value of health information technology for National Health IT week. So far we have not yet fully been able to realise the value of health IT. While great efforts at adopting electronic health records and interoperability and  we are beginning to see some results from the billions of taxpayer dollars invested, we still have a long way to go before we see the true value of health IT.

Healthcare has been slowly moving through three waves of digitization and health data management: data collection, data sharing, and data analytics. While the data collection and sharing waves have been having some success, spurred on by the HITECH Act and implementation of electronic health records and health information exchanges, they have not yet significantly impacted costs or quality in healthcare, the third wave is ready to crash on our shores and I believe we will actually begin to see an IT infrastructure than support the new payment and care delivery models which are emerging.

This third wave of analytics will enable large numbers of healthcare organizations to realize some significant returns on their IT investments and thrive in the healthcare marketplace of the future. Developing a consensus model for adoption of analytics capabilities could help healthcare leaders and vendors succeed by providing a common roadmap for the deployment of these capabilities. But much of the success of these analytics platforms will depend on the underlying architecture and I think the "late-binding" data warehouse model holds the most promise.

The term late-binding dates back to at least the 1960s, where it can be found in Communications of the ACM. The term was widely used to describe languages such as LISP, though usually with negative connotations about performance. In the 1980s Smalltalk popularized object-oriented programming (OOP) and with it late binding. Alan Kay in History Of Programming Languages 2 laid out the fundamentals of OOP and late-binding architecture in The Early History of Smalltalk section. In the early to mid-1990s, Microsoft heavily promoted its COM standard as a binary interface between different OOP programming languages. COM programming equally promoted early and late binding, with many languages supporting both at the syntax level.

The late-binding data warehouse model is a just in time method and is more adaptable to new analytics use cases and data content than those that make use of early binding and tightly coupled enterprise data models. Late-binding is a method of assembling data from disparate sources just in time for particular analytic use cases, known as the late-binding model of data warehousing, is starting to gain traction in healthcare as many provider organizations gear up for population health management. The advantage of this approach is that it allows users to combine disparate data very quickly for targeted analyses without locking data warehouses into a predetermined data model.

This late-binding model for use in healthcare analytics was developed by Dale Sanders who after witnessing and reflecting upon the failure of several multimillion-dollar data warehousing projects during his work in the US military, saw the same patterns in data engineering as those in software engineering prior to OOP. In the late 1990s, while employed by TRW Inc., he was sponsored by the Pentagon to study advanced decision support in nuclear warfare operations, a project called the Stratgic Execution Decision Aid. He turned to the healthcare industry for what he expected to be role-model examples of computer-aided analytics to drive better decisions in time-critical, life-critical situations but instead found almost no examples, with the notable exception of a scattered few such as at Intermountain Healthcare in Salt Lake City.

Last month I was able to get a peek behind the curtain at the Health Catalyst analytics solution, which Dale has been helping develop. Health Catalyst is a data warehousing company that recently has gained a number of customers and investors among large healthcare organizations. For example Partners HealthCare System has joined with the investment arms of Kaiser Permanente and Indiana University in an $8 million equity investment in Health Catalyst. Health Catalyst uses a late-binding data warehouse model. There is a very good Slideshare on Late Binding in Data Warehouses that helps to illustrate some of the concepts.

Last year The Advisory Board Company acquired clinical analytics vendor 360Fresh. 360Fresh offers two products. Pulse360 uses text and data mining to extract information from EHRs and other systems to provide answers to clinical and quality questions. They also have Track360, which is a clinician care coordination and workflow tool designed to streamline provider handoffs, provide alerts, and improves patient communications. Both of these products are targeted for use by academic medical centers, independent community hospitals, and large-scale ambulatory providers. 360Fresh will augment The Advisory Board Company's Crimson offering which provides retrospective data review, by adding real time analytics capabilities.

Dale Sanders, along with colleagues Jim Adams, Ernie Hood and Meg Aranow of The Advisory Board Company; Denis Protti of the University of Victoria, British Columbia; Dr. Dick Gibson, Providence Health and Services; Mike Davis of Mountain Summit Partners; along with Dr. David and Tom Burton, both of Healthcare Catalyst, worked to develop an eight-stage Analytic Adoption Model similar to the seven-stage EMR Adoption Model (EMRAM) from HIMSS Analytics. This model was initially described in ElectronicHealthcare in September 2012. The hope is that this model will enable healthcare organizations to fully understand and leverage the capabilities of analytics so that we can begin to see the real value of health IT in laying a technology foundation to achieve the triple aim.

This model borrows lessons learned from the HIMSS EMRAM, and describes a similar approach for assessing the adoption of analytics in healthcare. The Healthcare Analytics Adoption Model provides:

• A framework for evaluating the industry’s adoption of analytics
• A roadmap for organizations to measure their own progress toward analytic adoption
• A framework for evaluating vendor products

HIMSS Analytics has also partnered with the International Institute for Analytics (IIA) to create a benchmarking survey designed to measure and score clinical & business intelligence and analytics maturity in healthcare organizations. They will use the DELTA model (data, enterprise-focus, leadership, targets and analysts) to assess analytic capabilities. I expect we will see a lot more about the Healthcare Analytics Adoption Model as the work continues to progress. This will lead us into the future of health IT where value will ultimately be realized.

Here is a good Slideshare on the Healthcare Analytics Adoption Model being developed:

Perspective on Big Data

The Government Big Data Forum was held in Washington, D.C., on March 6, 2012. The conference brought together government thought leaders and industry experts to discuss best practices around Big Data technology, trends and issues, and focus on lessons learned regarding the successful implementation of Big Data analysis for mission needs. The keynote by Gus Hunt, the CTO of the Central Intelligence Agency (CIA) "Perspectives on Big Data Mission Needs" was spectacular and worth taking the time to watch.

Mr. Hunt is responsible for setting the strategic technology direction to enable CIA's missions, for driving the rapid insertion and adoption of new capabilities to keep pace with technology change in the commercial sector, and for engaging actively across the Intelligence Community (IC) to share and communicate IT solutions. After discussing their approach and mission, Mr. Hunt outlined the four big bets the CIA is making in technology:

• Big Data 
• Operational Excellence
• Serving CIA by serving entire IC
• Managing Talent

These big bets are backed by their Key Technology Enablers:

• Advanced Mission Analytics
• Enterprise Widgets and Services
• Security as a Service 
• Enterprise Data Management – the Data Harbor
• Cloud Computing

The presentation is below:

Perspectives on Big Data Mission and Needs Gus Hunt CIA CTO