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A Blog by Paul B. Silverman

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Right Answer, Wrong Question- New CIO EHR Survey

New Survey- “CIOs Say Usability, Search-Related Problems Prevalent Among EHRs”

iHealthBeat reports on new Frost and Sullivan survey focused on CIO EHR perspectives. I believe we need to refocus today’s EHR dialogue on the many benefits EHR provides- this vision seems to be missing. We are playing catch-up to many countries who have embraced EHRs. Survey highlights and summary of my comments posted on iHealthBeat . I see many parallels between the e-commerce revolution in the 1990’s and today’s EHR debate. Copy of my unedited comments below.


Right Answer, Wrong Question…

Asking CIOs how they feel about EHR’s, you would expect comments that today’s EHRs are challenging, slow, and have operational problems. That is the right answer, but in my view the wrong question. While the information gained provides insights into perceptions, the more important question to address is from the CIO perspective, what do they see as the most immediate EHR applications they need to change and/or enhance their current operations, including meeting ACA guidelines and improving their cost/performance benchmarks. What I am suggesting is let’s move the discussion to focus on specific process enhancements that EHRs will drive. My thinking is driven by what we saw in the e-commerce market evolution.

E-commerce, new electronic services that displaced paper, was a driver of the Internet revolution in the late 1990’s. Many saw the vision that cost/performance benefits, not paper or admin cost reduction was the real driver here, but we faced formidable challenges, e.g., lack of standards, privacy, multiple technology platforms, training issues, complexity compared to ‘simple’ paper forms, and others.

From my perspective, sure sounds like exactly what we are facing with today’s migration to EHR. So looking back, what did we learn and what does experience tell us about today’s EHR “revolution.” I see three key directions based on my experience.

First, e-commerce winners understood that changing process, not solely displacing paper, was the key benefit. For example, using electronic purchase orders rather than paper saved paper and admin costs and were more efficient, but they also enabled analytics to optimize supply chains and improve profitability- that could not be done with paper. This was a key point driving e-commerce revolution which myself and others reinforced, i.e., “implementing e-commerce systems will cost more, but you will achieve cost and operational efficiencies and improve your competitive position.” This was not accepted by all at the time. Key point here- today’s EHR’s may cost more but they don’t just automate paper-based record keeping- they really open the door to create new processes and dramatically reshape healthcare. That is the message we should be reinforcing backed up with solid cost- effective applications.

Secondly, new e-commerce applications emerged and many new ventures were spawned contributing to e-commerce market growth. And these were entrepreneurial ventures, targeting sectors and all value chain functions to improve operations, e.g., supply chain management, distribution channel optimization, marketing analytics, and so on. Market growth at the time was fueled by venture capital and creative entrepreneurs, not the major firms. In today’s EHR environment, expect to see many new ventures accelerate in areas of remote telemonitoring, predictive analytics, and others- healthcare is a significant target, long overdue for major cost performance step up, and EHR is the accelerator to make it happen. VCs in my view are still behind the curve here but I believe approaching a critical mass here.


Finally, e-commerce was a global business and, at the time, many new technologies and e-commerce structures emerged overseas. Today, recognize that many countries have EHR adoption rates greater than 90 percent, and we are playing catch-up with EHR adoption at less than 70 percent and CIO resistance based on the survey . In these overseas markets today, EHR is embraced and driving new applications, analytics, and solutions which I expect will play a role as the US market for enhanced EHR achieves what I believe will be exponential growth in the next decade.

Paul B. Silverman writes about entrepreneurship, healthcare, and strategy management. He serves as Managing Partner of the Gemini Business Group, LLC, a consultancy firm, and Adjunct Professor in the R.H. Smith School of Business at the University of Maryland. Contact:; blog; follow @globalbizmentor

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WSJ Article: “VCs Should Back Gadgets for the Sick, Not the Healthy, Doctors Say”

WSJ Article/Comments “VCs Should Back Gadgets for the Sick, Not the Healthy, Doctors Say”

Article in WSJ Venture Capital Dispatch notes that medical professionals believe the investment community is missing the opportunity to develop healthcare solutions for seniors and patients with chronic conditions. Today’s focus is on ‘gadgets’ targeting primarily healthy patients as noted in the WSJ article. I agree with the key points- we are seeing several exciting new healthcare/analytics markets emerge and they are moving quickly- these will attract VC funding-.

Due to space, I posted summary comments on the WSJ site and shared some ideas on opportunities – link to WSJ article and comments:

Full copy of my comments:


Agree- suggest we focus less on the gadgets and more on developing the technologies and solutions to address real needs- senior care, chronic care, prenatal, preventative medicine.  

We are missing the mark but healthcare is now positioned for major capital infusion by investors that understand the market and recognize that analytics, software, and solutions, not hardware or gadgets, will drive and scale the market. I am pleased to share comments on some new directions/numbers here.

New Clinical Decision Support Systems (CDSS) and Clinical and Business Intelligence (C&BI) systems using analytics to achieve performance improvements such as reducing misdiagnosis errors (accounts for about 10 to 30 percent of medical errors) and improving operational efficiency (estimated at $17-29 billion annually due to patient misdiagnosis). These are spawning exciting new related analytics/software ventures to reshape healthcare and streamline clinical analysis.

Look at the upside here- in 2011, a HIMSS study reported only 30 percent of US hospitals had a clinical data warehousing/mining solution. And among these users, only 35 percent of these users employed any analytic tools for predictive modeling, and less than 1 out of 5 of these users even use their transactional systems to capture data. We are in the early growth phase of the exponential growth market for ventures developing creative healthcare applications using ‘big data’ and analytics tools.

The remote healthcare monitoring market is also in its infancy, but positioned for dramatic growth. One driver is EHR adoption now being driven by ACA’s Meaningful Use rules. Integrating EHRs with remote monitoring and analytics, we create exciting new business sectors which, for example, link to medications for compliance, drug efficacy, adverse effect tracking and so on- very exciting area which I have been directly involved with.

Also consider the need, as an example, for prenatal care and chronic conditions treatment in rural areas with 25 percent of population but only 10 percent of physicians- you realize very quickly the benefits offered by emerging enhanced remote healthcare telemonitoring applications. Note these go well beyond the “gadget” market (such as a wristwatch tracking vital signs). I shared comments on EHR directions/recommendations in a prior WSJ posting (“Can Data From Your Fitbit Transform Medicine?:” WSJ Technology, June 23, 2014)

EHR adoption provides the foundation to support remote telemonitoring and other analytics-based applications. A 2012 Commonwealth Fund study showed EHR adoption rates over 90 percent in Australia, the Netherlands, New Zealand, Norway and the U.K., compared to about 69 percent in the U.S. No surprise these countries have healthcare systems that lead the U.S. based on analysis of patient outcomes and cost performance.

New EHR-related applications, analytics, enhanced system ventures represent high growth, and EHR adoption is now accelerating in the US driven by both Meaningful Use and the need to improve cost/performance- these forces will be key healthcare market growth drivers.

Summarizing, there will no doubt be a need for ‘gadgets’ but suggest we keep our focus on the real issues and opportunities such as the above, which represent high sustainable growth creating value for smart investors

Paul B. Silverman


Paul B. Silverman writes about entrepreneurship, healthcare, and strategy management. He than 35 years senior corporate management, global management consulting and entrepreneurial experience and serves as Managing Partner of the Gemini Business Group, LLC, a consultancy firm. He also serves as Adjunct Professor in the R.H. Smith School of Business at the University of Maryland. Contact:; blog; follow @globalbizmentor


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Inc. – 8 Recommended Courses for Entrepreneurs 

Interesting Inc. Article on 8 recommended courses entrepreneurs should take. Check out

I posted following comments:

Good post and pleased to contribute here.  I like to say the “traditional laws of business are not repealed for new ventures”- not all agree with this assertion but my experience with many ventures shows these skills improve probability of success. Your selection of recommended courses is a good starting point and reinforces this point which I believe is missed by many. I suggest two additional recommended course areas

– Mathematics/Statistics – new business models and ventures are using analytics to develop innovative lines of business. Conceiving, managing, marketing, financing and growing these new analytics-centric businesses in fiercely competitive markets demands new analytic skills I find lacking. These skills can provide a competitive edge

–International - all business is global and more than 50 percent of Fortune 500 revenue is derived from overseas business. Entrepreneurs should understand how to operate in the international arena, i.e., how non-GAAP differs from GAAP reporting; how to develop equity and non-equity intl alliances; how exchange rates impact financial flows and strategies- all important management skills that provide entrepreneurs with a competitive edge.

Paul B. Silverman  Advisor, Author, Speaker, and Adjunct Professor in the R.H.Smith School of Business at the University Maryland      Blog. Follow @globalbizmentor


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Comments on Healthcare Analytics- HBR Blog on Operational Analytics

Interesting HBR Blog post on how analytics will move from providing insights on improving processes to “operational analytics” actually controlling business processes.  Emphasis of the article was the manufacturing sector (HBR Blog, “Let Algorithms Decide-and Act- for Your Company”, September 10, 2014)

I posted following comments sharing a vision on where predictive analytics is heading in the health care sector….

Thanks for insightful post and operational analytics insights you shared.

Glad to share several comments.

First, if you replace “manufacturing” with “healthcare” which now represents about 20 percent of US GDP, and you understand how we can leverage predictive analytics to improve cost performance and quality, you quickly realize the high potential that lies ahead.

Here are a few high potential applications and benefits of these new capabilities which are only a small sample of what lies ahead here:

• Tracking Medical Diagnoses, Treatments, Medications, Outcomes, Costs,Reimbursements, and Relationships

ICD or International Classification of Disease Codes classifies diseases and CPT or Current Procedural Terminology codes describe services provided by medical practitioners. Tracking and examining relationships among these metrics, looking at patient data, identifying processes, and key cost and patient health drivers, we can develop ‘best practices’  … Read more comments and the HBR Blog post at


Posted “Emerging Business Models Driven By Predictive Analytics” in Business Model Innovation Forum

Agreed to serve as a member of the Business Model Innovation Forum. Good discussion here on all aspects of business models and where we are heading. I posted following comments today as an initial contribution – more information in the Forum at I am pleased to share a copy of my posted comments:

Emerging Business Models Driven By Predictive Analytics

I am pleased to contribute to the Forum and look forward to discussions with other members.

Two areas related to business models in my view should be discussed. First, predictive analytics which is reshaping traditional business models and changing the competitive landscape. These new tools analyze millions of “information records”, develop “rules” to explain the outcomes with major improvement in speed and accuracy. Note information records may include traditional databases, as well as unstructured “text analytics” from news feeds, messaging, maybe doctors notes related to an electronic health record (EHR). Seamless analysis of both traditional structured and unstructured data is a powerful new direction and where we are heading.What we are seeing are new services emerging, creating new markets, many driven by entrepreneurial firms. New clinical diagnostic services to improve healthcare outcomes and reduce costs- results show dramatic improvement. Technology Assisted Review or TAR, using advanced analytics in the legal arena to assist in identifying relevant and priviliged documents reviewing millions of documents for class action and other major legal cases. Continuous Audit, Continuous Monitoring or “CA/CM” using real time analytics in Fortune 1000 companies to identify problem, possibly fraudulent transactions pre-audit saving time and money and reducing exposure.

I have been involved in these and can cite many others. Key point- we are creating new business models here- some based on outcomes, others based on client savings maybe linked to longitudinal or total costs. So today what looks like a traditional software product, services, or solutions business may be competing with “transaction based” players, oftentimes entrepreneurial firms using creative business models and pricing structures.

Secondly, while we often focus on the internal, company- centric elements of the business model which are essential, lets keep in mind that external factors play a major role in shaping a firm’s business model and strategy. In 2013, I made this point in comments on an excellent business planning post by Accenture. You can see my comments and the Accenture link at

Bottom line here- we can expect to see many new, creative business models emerging which “push the envelope” demanding that management acquire new business planning and analysis skills. “Business as usual” will not be a successful strategy. Many of these new emerging business models in my view will be driven by agile entrepreneurial firms creating both new investment and value creation opportunities as well as challenges for traditional players,

Paul B. Silverman writes on entrepreneurship and management topics. He is former CEO of public and private companies, and Executive Advisor,Author, Speaker and Adjunct Professor in the R.H.Smith School of Business at the University Maryland Blog. Follow @ globalbizmentor

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Comments -“War and Peace” on the subway: How your iPhone is saving literature. Salon

Interesting article on how e-book market is changing. Posted comments discussing some entrepreneurship and strategy insights here

check out Salon article at


Here is a copy of my posted comments…

Interesting article. From an entrepreneurial perspective, maybe we are seeing a new opportunity emerging here. Authors and publishers think “chapters”. Why? Because we always did it that way. Write a book, say 40,000 words. Maybe 2,000 words for front and back copy so we have about 38,000 words book content. Assume you plan to have 15 chapters, each chapter will have 2,533 words. Assuming about 250 words/page, each chapter will be about 10 pages and total page count will be about 160 pages- a reasonable book structure.

But the market may be sending us a message. Forget “chapters” which are ” product driven” and arbitrary based on the above calculation.

Maybe we should consider a “market driven” strategy to address the growing market for “snippet of information readers” who are using Smartphones. Suppose we define a new book structure whereby books are divided into ” bite size” information packets- maybe call each of these “brevis”, Latin for tiny. And we set the length of each brevis at what a reader can read in say 4 minutes, maybe 1,000 words, and that is standardized. We create a new class of books structured in brevis, not chapters, which meets market needs.

I am not sure I will see a “brevis” book soon, but I shared the above to make several points. First, recognize the difference between product or technology driven strategy vs. market driven. When markets send messages on issue and opportunities, smart players listen and respond quickly. E-books changed the book industry- Barnes and Noble responded; Borders became a business school case study.

Secondly, thinking “counterintuitively” is an important skill to develop. Thinking Intuitively, you would expect readers would use e-readers not smartphones- larger, easier to read screens, and other features provide advantages. So what we are seeing here is counterintuitive, not what we would expect. Identifying and analyzing the “How’s and Whys” here is a powerful skill worth honing. Finally, be prepared to fail. I am not sure the “brevis” book will be a success but going through the planning process, understanding the market nuances, understanding what are user needs today and how are they changing- these are the real benefits. At the time of the D-Day invasion, a turning point in World War II, General Dwight D. Eisenhower commented that ” The Planning Process is Everything; The Plan is Nothing”. I use this philosophy often and firmly agree- great things can be accomplished through detailed planning, exploring “what-ifs”, and postulating market driven business strategies that oftentimes can shake up markets or create new ones. There will be failures but many benefits will also be realized.

So I will continue to think about the Brevis book, get feedback and criticism ( probably lots of it) from colleagues and friends, which will reshape my thinking I am sure. That is how we make progress.
Paul B. Silverman writes on entrepreneurship and management topics. He serves as Adjunct Professor in the R.H.Smith School of Business at the University Maryland Blog. Follow @ globalbizmentor



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Data Marketing 101: New Directions. Infographics +Predictive Analytics

Excellent article by Shannon Byrne on how startups can use Infographics – good insights here. Check out

Coupling Infographics with predictive analytics pushes the boundary here and I shared some thoughts – here is copy of my posted comments

Shannon. Excellent post. Thanks for sharing. Infographics is an exciting area and I see predictive analytics pushing the boundary further and opening new possibilities. For example as you say need to ‘mine data that’s helpful to your audience’ and you suggest several questions to address.
But suppose we mine data and use PA tools to identify drivers that are not known – predicting the ‘unknown-unknowns’ and showing these in Infographics provides exciting and powerful capabilities. For example, suppose you are showing attributes of your customers and show typical data, e.g., sales by region, sector, customer size and so on. But suppose you can also identify and show that the highest sales are driven by sales staff with certain backgrounds who sell to certain sectors. Or you identify and show how sales rank based on variations in the sales process; I.e., response to RFP, sales call center query, direct sales call, and so on.
Key point here- the relationships I suggested here and the questions to ask will be defined by the PA model not the Infographic data modeler- that is the real power of predictive analytics ‘technology and a concept still not fully understood by many.

In the healthcare sector for example, we use PA tools to optimize clinical treatments based on data going well beyond a patient’s condition and symptoms. Mining data using PA defines ‘ inferences’ and the rules between business metrics. Fast forward here and we can envision many exciting Infographic applications that will push the boundary enabling us to improve clarity and communications of complex and insightful business metrics

Paul B. Silverman is an Adjunct Professor in the R.H. Smith School of Business at the University of Maryland, former CEO of public and private companies, Managing Partner Gemini Business Group, LLC. He can be reached at or blog at, or twitter at @globalbizmentor.



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SaaS Metrics 2.0 – A Guide to Measuring and Improving what Matters- Post By David Skok

Excellent post by David Skok at using a using analytics to manage a SaaS business. I posted comments also emphasizing need to use analytics to assess changing markets/external factors for #entrepreneurial ventures. Also strongly recommend the site – excellent resource for entrepreneurs

Below is a copy of my posted comments – you can review the original post at

Here is a copy of my posted comments..


Excellent article- thanks.

Several months ago I was invited to do a guest blog post and serve as an Advisor for Funding Profiles, a Santa Clara-based company offering a powerful suite of financial analytic tools that “integrates with existing business applications to continuously translate traditional financial metrics into the language of business strategy”. For companies with thousands of products, infrastructure, and processes spanning the globe, the ability to ‘drill down’, examine ‘what-ifs’, and assess how and if global LOBs meet KPIs and support the strategic plan, is a powerful planning tool. Your post reinforces this point.

But markets and technology are moving quickly, consumer power is increasing, and external global factors will impact all global businesses which creates risk and uncertainty. In fact, one study shows macro-environment, competitive and corporate positioning factors account for about 80 percent of ROA variation among LOBs. So optimizing the company’s internal resources, processes, and KPI’s really address only 20 percent of the planning challenge based on these findings. My post “How Analytics is “Raising the Bar” for Corporate Strategy: Understanding the External Environment” talks about how new analytic tools can provide a competitive edge, creating what Tom Davenport (Author- Competing on Analytics: The New Science of Winning) defines as “analytic competitors”.

Bottom line- while emphasis of the above is larger corporations, my view is entrepreneurs that also understand how to analyze markets, external opportunities and threats, and how to use analytics with Porter’s Five Forces Model, STEEP, and competitive benchmarking tools can achieve a competitive edge. Properly used, external market analytics provide a competitive edge for evaluating, strategy positioning, and managing entrepreneurial ventures. During the past six months, I have looked at ventures in areas of wearable healthcare monitoring devices, clinical analytics, analytics for fraud detection, legal analytics, and solar energy among others. To accurately gauge outlook and opportunity for these and others, venture evaluation must go well beyond the typical “size of market, expected market share” and ‘drill-down’ to understand external market threats and opportunities. We have a way to go yet in educating the entrepreneurial community but I believe today’s “hyper competitive” dynamic global markets will help accelerate the adoption of these new analytics capabilities.

Paul B. Silverman is an Adjunct Professor in the R.H. Smith School of Business at the University of Maryland, former CEO of public and private companies, Managing Partner Gemini Business Group, LLC. He can be reached at or blog at, or twitter at @globalbizmentor.



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PR/Advertising Lessons for Entrepreneurs from P.T. Barnum

Here is wisdom from circus showman P.T. Barnum I have often shared with early stage #entrepreneurs to reinforce the last point- end game here is to create short and long term sales-  the rest is ‘showmanship’ and important not to confuse this point. Also note the need to emphasize benefits to build on adv/promotion and actually close the sale (i.e.,”explain how much fun they’ll have spending money at the booths, answer their questions…”). Good counsel and insights here for early stage entrepreneurs.

“ If the circus is coming to town and you paint a sign saying “Circus Coming to the Fairground Saturday,” that’s advertising. If you put the sign on the back of an elephant and walk it into town, that’s promotion. If the elephant walks thru the mayor’s flower bed, that’s publicity. And if you can get the mayor to laugh about it, that’s public relations. If the town’s citizens go to the circus, you show them the many entertainment booths, explain how much fun they’ll have spending money at the booths, answer their questions and ultimately they spend a lot at the circus, that’s sales.


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Healthcare Monitoring – Fast Company Market Perspectives

Healthcare Monitoring – Fast Company -“Why We Don’t Talk About “Wearable Software”

Revolution is coming in the wearable healthcare monitoring arena as we move from devices to software/ ecosystems and new predictive analytics are fully embraced. Excellent Fast Company Labs article by Tina Amirtha summarizing directions. I see significant opportunity here not covered in the article  – why pharmas will play a key role, role of wearables in telemonitoring/Telehealth, tracking medication compliance,adverse drug reactions. And wearable healthcare monitoring coupled with analytics is spawning many exciting entrepreneurial ventures

Check out the Fast Company article at My comments shown are shortened due to space – here is a complete copy:

Tina- great article. As former CEO of a public predictive analytics company pleased to share comments. First, analytics is indeed the “Holy Grail” but my view is the real opportunity drivers here are not individuals but pharmas who have the incentive to establish and grow ongoing patient relationships. Healthcare monitoring/analytics is ideal strategy to help pharmas achieve this objective. Last time I looked the 3 to 4 major pharma chains represent about $200 billion or 75 percent of the market and about 24,000 locations- independent pharmas account for the rest of the locations and market. Secondly, health monitoring devices can make a substantive contribution to Telehealth/ telemedicine – I have done work in this area and telemonitoring proponents have not fully embraced these technologies- in my view and they are missing a real opportunity. We are seeing new entrepreneurial ventures addressing this market- my experience is creating sustainable business models addressing hardware, software, analytics dimensions is a real challenge for some of the reasons you noted.

Finally, in a late 2012 blog post “Buy Health Monitoring Devices Off The Clothing Rack 
I suggested we may be buying health care monitors in Lands End, and discussed how this will impact traditional retailer strategies. Sales staff questions may move from “What size and color jacket would you like to see?” to “Can I show you our blood pressure-only monitoring jacket or our top of the line full featured model tracking glucose, oxygenation and includes a USB port?”And what about health care coverage. Expect to see some interesting issues emerge here- are you buying a jacket or a medical device; where do you draw the line? Clothing may also be an external driver to grow this market

Bottom line here- the real opportunity, which translates into hard dollar cost savings and improved healthcare quality, is using wearables and the software ecosystem to track medication compliance, adverse drug reactions, drug efficacies, and similar data. My vision is coupling wearable healthcare monitors with predictive analytics will dramatically reshape today’s healthcare system- refocusing the emphasis of today ‘ s wearable discussion and educating industry players on the possibilities here are the challenges and next steps needed to make this happen

Paul B. Silverman




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