HIMSS09 Tuesday Wrap Up

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Tuesday was my third and final HIMSS09, I had to catch an evening flight back home to be at work tomorrow. Realistically, three full days of crowds, vendors, and education sessions is pushing my limits, but I digress. On to day 3.

Session: Connecting Rural Healthcare Providers to Academic & Tertiary Medical Centers

The session was conducted by Dan Furlong, Project Management Officer for Medical University of South Carolina (MUSC) who was filling-in for their CIO, Dr. Frank C. Clark. “If any of you are hear hoping to meet Dr. Clark, I’m afraid you are going to be disappointed.”

Like everywhere, South Carolina has health problems and they have set out to lead an effort to” improve the health of rural residents by giving them access to the medical expertise found in the academic and tertiary medical centers located in urban areas.” The project will connect 65 rural hospitals and 13 rural clinics and provide access to this medical expertise. The project is funded by a in two ways, from an $8 million FCC grant and matching funding from the project’s governing body, the Health Science of South Carolina comprised of several institutions (MUSC, Spartanberg Regional Medical Center, Palmetto Health, and Greenville Hospital System). As of today, the backbone is in place and the contracts are signed, they are awaiting FCC funding to be released. In the words of Mr. Furlong, “We have found we move a whole lot faster tan the federal government.”

The most interesting aspect of this session was not just the content presented, but the way the audience joined into the conversation. It seems there were representatives from at least 7 other states that were working on their own connectivity projects and Dan invited and encouraged some great collaboration with the folks in the room. The education session turned into a working session and while I was not particularly interested in the details/tacit knowledge being exchanged, it was fascinating to watch.

Session: Who Should Really Be Flying the Project Management Plane?

The session was presented by Dan Furlong and Mark Daniels from MUSC. While Dan’s former presentation was interesting, this session was one I circled right away when I first looked at the HIMSS09 agenda. I believe HIT alignment with clinical operations is the key to success. Dan and Mark seem to be completely in line with this type of thinking.

MUSC has been through the typical IT adoption/integration model; a physician says it would be good if…, the IT department listens then sets out to build it, development and testing happen within IT, the project is completed, and the originating physician says, ” That’s not what I was talking about.” Recognizing the futility of this approach, MUSC set out to change their project management approach. First, they hired a physician CIO and promoted the position to the VP level. From there, they developed a governance process to encourage buy-in, support, and strategic alignment with clinical operations. Next, they developed a Project Management Office and formalized the project management process; focusing on checklists like those used in the airline industry.

The result of this work is seamless alignment between IT and clinical operations. In fact, physicians are so heavily engaged in leading projects that MUSC experienced issues over the title “project manager.” In the end, they had to provide education to separate the role of physician leadership from the process management conducted by project managers. Like all implementations, there were bumps, but the model is working well for MUSC today.

The best part of this session was the “quote feast” generated by the presenters

  • Developers always embellish
  • Failure does not require scapegoats
  • Seats without commitment are best left empty
  • Projects have no coach seats

Session: Driving IT Innovation and Quality Across the Enterprise

This session discussed the challenges of connecting disparate systems found as UPMC and was a nice overview of the process they used for integration. Like everyone else, data quality is an issue for utilization of data in the system.

Seems to me that the data quality theme will be one of the major topics for HIMSS10. How will we address data quality? Does limiting those with input access to data solve the problem or is it oversight and integrity checking. Perhaps both approaches are needed. Automation can be an answer, but not everything can be automated and are still facing the daunting challenge of getting what is in the clinician’s head into the medical record for all to share.

With that, I’m off to the bag check and on to O’Hare. Later tonight or tomorrow, I’ll post a overview of my experience at HIMSS09 including pictures and some video (I think). Thanks for reading and tweeting along.

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HIMSS09 Day 2 Reflections and Day 3 Expectations

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Monday was another packed day at HIMSS09. I’m starting to see some real themes developing at HIMSS this year:

  • ROI
  • Interoperability
  • Frustration
  • Person to Person Connectivity

First, ROI. As a sign of the economic times and a maturing of the HIT industry, many are asking, “How is this making money?” or “How is this saving money?” The good news is, I’ve seen many examples of significant efforts that are doing both, saving time and making money. The Conifer Kiosk project I discussed in yesterday’s wrap up springs to mind. Their conservative estimates point to $5 million in real savings just in reducing printing costs.

Interoperability. There is a growing sense of urgency in the realization that we are all working on HIT initiatives, but they all don’t talk to each other and the simply MUST speak the same language. I can send a text message to any cell phone carrier and it works. Why not healthcare?

Frustration. See above.

Connectivity. The primary role in a conference like HIMSS is to connect individuals who share common issues or can help each other find solutions. This year, HIMSS has an increased focus on social networking and the connections being made in that space have been outstanding. The best part of being here is the realization that we have a massive peer group.

On to today. I have and evening flight back home today and will only be able to attend three sessions. On my list today is learning about MUSC’s effort in connecting rural hospitals with academic medical centers, finding the answer to the question, “Who should really be driving the project management bus?”, and then IT strategy re-engineered. I also hope to spend a little more time with the vendors.

What are your thought through this point in the conference? Drop a comment here and share your reflections or expectations.

Here’s to HIMSS09 day 3!

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HIMSS09 Monday Wrap Up

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Welcome the second full day of HIMSS09. After yesterday’s marathon sessions and opening reception, I was a little slower in getting out of bed this morning, but still made it in time to hear George Halvorson’s keynote address. Of course, it was a two coffee morning.

The keynote started with a video of people on the streets of Chicago discussing their feelings on medical records and the access that is available for their own records. The responses ranged from hilarious to disturbing; here are two of my favorite lines:

  • I’m a physician in my 50s and my goal is to make it out of practice before being required to implement an EMR. EMRs cause 4-5 months of financial turmoil and they have not shown any ROI.
  • I live in a small town and they know everything about me. My medical records are available behind the desk in my doctor’s office. If I needed my records, I could just go there and grab them.

I guess we still have a long way to go.

Liz Johnson, HIMSS Vice Chair started things off with a couple of administrative tasks and a quick overview of yesterday. She then discussed the financial report for HIMSS that basically closed before the economy went south. Operating revenue increased by 7% over the past fiscal year and HIMSS is financially sound and poised to lead HIT now and in the future. That was good to hear and judging by the attendance this year, next year’s report will likely be similar.

George Halvorson, Chairman and Chief Executive Officer of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, did a great job in setting the stage by outlining some of the most interesting issues facing HIT today. A couple of interesting quotes/facts from his talk:

  • The business model of care is based on maximizing the number of things that have fees. We have 18,000 billing codes for procedures and not one billing code for a cure. No billing codes for improved health.
  • A Rand study found caregivers got care right only 50% of the time for adults and less than 50% for kids.
  • How often doe diabetics get the right care? According to Rand, 8%. If we could move that to 80%, it would cut the number of kidney failures in this country in half.
  • He sits on the board of the IOM and their goal is to see 90% of care based on scientific evidence by 2020. In what other industry would we set the bar so low?
  • You’ve seen the commercials for new Alzheimer’s drugs and the warning to inform your physician if you are taking various medications before starting on their drug. How pathetically sad it is when we ask Alzheimer’s patients to inform their doctors of the drugs they are taking?

Kaiser seems to be ahead of the curve in their HIT implementation and I would have liked to have another 30 minutes of his talk. I am planning to pick-up his new book, Health Care Will Not Reform Itself. The proceeds from his book are going to a medical charity in Oakland.

HIMSS09 Conference Floor

Session: The Intersection of Healthcare Reform and Health IT

This session featured Georgia Congressman and physician Phil Gingrey and former Wyoming Governor Jim Geringer. Both men have a history and strong interest in healthcare and after some opening statements, got down to some serious Q&A.

The session opened with discussion of healthcare reform and HIT reform and how the two are required to make any serious change. “If we automate a bad system, all we will have is a really fast, bad system.” Both men seemed to be advocates for wellness and looking beyond episodic care to public health. “Prevention is the key to moving forward; prevention of illness and prevention of bad health.”

One of the most compelling questions came from an individual who outlined how federal regulations (Red Flag Rules, Stark, HIPAA, FDA Regulations, etc.) are putting a squeeze on smaller hospitals and making it harder to keep the doors open. Governor Geringer had the most interesting response, he said, “Your first obligation is to tell somone. The world is run by those who show-up.” While at first I was put off by the answer, the more I thought about it, the more I like it. He encouraged using the Obama Administration’s emphasis on transparency and accountability as a reason to expose just exactly what the federal government is doing to squeeze healthcare providers. Governor Geringer’s quote, “The government’s roll is to recognize when to get out of the way.”

In the end, both men were clearly on the side of fully integrated EMRs which brought another interesting question. Apparently, many supporters of a Michigan RIO have pulled out of the effort to develop their own EMRs and earn their slice of the stimulus package HIT pie. What can be done to address those who were working together and now are off on their own? Neither had a great answer to the question and sited the need for cooperation and interoperability, but missed the general point. Is the ARRA actually being somewhat counter-productive in regard to HIT? We will see.

As for not answering questions, Congressman Gingry had some great comments:

  • If I were doing this and it was within my power, I think the adoption of a fully integrated ERM would be goal number 1.
  • Patients don ‘t wan t the government standing in the exam room between them and their provider.
  • I’m not sure if that answered your question, but I’ve learn politically if you don’t like the question, answer another one.

And that brought me to a big two hour, visit your favorite vendor break. I recognize why HIMSS wants this break, but I don’t particularity like it. The good news is, I had time to write the first half of this post and catch-up on some communication. Suggestion for next year’s HIMSS, more Recharging Stations!

Session: Using an EMR to Find a Needle in the Haystack: The Next Generation of Clinical Decision Support

The session was conducted by Dr. Robin Helm and  their EMR ManagerSandra Olsen who work for St. Joseph Family Medicine Residency in Northeast Wisconsin. They went live with their EMR in 2001 and completed,  feature build-out in 2004, and now are looking into ways to leverage the data that is now available in the system. “The EMR was not important unless we cold improve patient care.”

So, to improve patient care, they started by developing  a quality improvement model

  • establish benchmarks
  • select champions (utilizing both nursing and physicians is a key)
  • set goals based on benchmarks
  • write reports
  • provide education to provider or patient
  • create interactive programs
  • apply to other disease populations

They have used this model to improve immunization rates, improve the quality of diabetes care, extend screening for led-related health issues, and many other issues. A side benefit to their system is the availability of quality metrics that can be leveraged on multiple improvement efforts and are used to benchmark physicians against their peers; blinded of course.

My sense of their system is, it is relatively basic, but quite effective. You don’t have to have the most impressive system to improve clinical quality; you just need the data in a structured and meaningful way.

Session: From Kiosks to Web: Self-service Opportunities in Healthcare

The presentation was conducted by Jeff Nieman and Ron Kelley Conifer Revenue Cycle Solutions (an off-shoot of Tenet Healthcare).

This session was one of those moments when your realize that there are people who “get it” out there. Conifer has produced kiosks for online bill payment and patient sign-in that are incredibly successful and producing real cost-savings while improving accuracy. The basic premise is, we want to have self-service and if it’s done right, it will make a big difference.

“Self service is doing exactly what you done before in a self service way.” You don’t need to create a new process for self-service, just do what you do.

In 2008, the first year of the system, they had the following results

  • 19,821 patients used the self-service kiosks
  • 97.3% of patients successfully signed-in
  • 84% of patients did not want a printed paper copy of their forms
  • on average, patients took 2.6 minutes to check-in
  • 98% of patients were satisfied with the tool
  • 48% of users were 55 or older
  • 33% corrected their records, improving accuracy of their data

Those are solid numbers and really point to what is going on in the world today. We want automation and self-service. Go to a supermarket, the airport, a Home Depot, they all have kiosks and everyone from kids to seniors are using them. They save time, save paper, and improve accuracy.

Great quote, “If you are not online and paperless, you are missing a huge opportunity for cost savings.” Their ROI model is based on a cost of $.25 per printed page and with the reduction in paper of 80%, they are saving over $5 million annually. That’s a lot of green.

Next up, the HIMSS09 Tweetup. Looking forward to meeting all the tweeps running around here.

HIMSS09 Tweetup

The first annual (I hope) HIMSS Tweetup was a smashing success. I enjoyed meeting as many of the HIT tweeple as I could and hope to stay in touch when we get back to the real world. Kudos to Cesar (@himss) for pulling this together!

This is a very long post and if you didn’t make it to the end, I completely understand. If you did, please share your thoughts on the HIMSS09 conference.

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HIMSS09 Day 1 Reflections and Day 2 Expectations

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After a night’s sleep and a couple of cups of coffee, I’m thinking back to yesterday’s opening day of HIMSS09 and some themes have come to mind.

First, due to the economic conditions, I expected to see a lot of empty chairs and downsized vendor booths at HIMSS this year and was delightfully surprised. I guess the billions of dollars for HIT in the economic recovery act are keeping the HIT industry moving forward.  Regardless, HIMSS is a much better conference when there are jammed sessions.

The second observation involves the utilization of communities and leveraging of Web 2.0 tools in augmenting and improving the experience at HIMSS this year. Many of us have been tweeting at conferences for a while, but now it is being embraced by the event and the impact is significant. Through the use of Twitter and blogs, we get not only a record of events, but the subtle nuisances found through the interpretation of the messages and how they impacted the individual writing the post or tweet. Yesterday’s Meet the Bloggers session was a lot of fun and I personally enjoyed meeting the other bloggers and the great discussion we had in the room. I only wish we had more time and a bigger room…

As for day 2, I expect to see a continuation of day 1. The George Halvorson keynote should be a highlight of the day and I’m also looking forward to the official Tweet up at 5:30 today. There is nothing better than actually meeting your virtual community fact-to-face. As much as we should embrace technology, we will always still need that personal interaction.

What are your thoughts about HIMSS09?

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HIMSS09 Sunday Wrap Up

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The first full day of the HIMSS 2009 conference is now officially over and featured a number of highlights for me. Things got off to a rousing start right off the bat for me. Yesterday, I wrote a post about what I was hoping to see at this year’s HIMSS conference and as early as breakfast, I found someone who shares my vision for HIT.

Dr. Douglas Winesett is a Pediatric GI specialist for the University Medical Group in Greenville, South Carolina and he was good enough to let me share his table at breakfast this morning. Dr. Winesett spends about half of his day seeing patients and the other half engaged in information systems to, “have a better understanding of what is happening in the IT world and be able to speak intelligently to our IT staff.” The challenges facing his organization are found throughout healthcare, but his approach was consistent with what I believe is the ultimate goal of HIT, to improve clinical operations and resulting in better outcomes.

We discussed scenarios where a virtual office visit would be appropriate and the types of issues that would be outside of the virtual world. We talked about the sum of human knowledge and how it continues to grow exponentially; to a point where it is not realistic for anyone to keep up with the changes in the industry…even doctors. Here is an opportunity for HIT to fill the gap, give the physician the tools to make informed decisions by providing all relevant data including medical history, outcomes measures, and the latest research, all in real time. A great start to the morning.

Next came my first session: MDs Who IM @ Work: Online Messaging Improves Physician-Patient Communication.

The session featured Dr. Richard Levine of Columbia University and Stephen Rosenthal of Montefiore Medical Center. Dr. Levine started by explaining how he recognized early on that “the patients were ahead of the us and we were behind” when it came to IT. They did not have an EMR and therefore did not have a culture that embraced technology. He said the biggest challenge and biggest barrier to change were the physicians. In 2005 they launched their system with the goal of connecting the physician-patient-community. Today, that system allows patients to request appointments, make virtual office visits, consult a doctor, contact the office, and exchange medical information with the hospital. The doctors who have embraced the system are becoming advocates due to the efficiencies gained. Dr. Levine reported the system allowed him to fill “5 or 6 prescriptions to 5 or 6 pharmacies in about 3 minutes.”

Next, came a similar story from Mr. Rosenthal and Montefiore. They had made a significant investment in the implementation of their ERM and wanted to find ways to leverage the information it contained. The created MyMontefiore system and use the tag line, “get on a health click.” To promote the utilization of their system, Montefiore utilizes a call center. Lessons learned from both implementations include;

  • Physician champions are a must for successful adoption
  • Outreach and education needed to help doctors understand advantages of the system
  • ePrescribing is a true success and the “hook” to accelerate adoption

Next, I attended a session called: Making the Connection to Personalized Care: The Moffitt Cancer Survivorship Portal

Survivorship is the effort centered on returning a cancer patient into the community for ongoing care through the creation of a “passport” or documentation of treatment and care the patient received while under cancer treatment. The goal of the survivorship effort is to extend the continuity of care beyond a cancer center and provide for better patient outcomes. Moffitt has recognized the need for this effort and has a plan in place to build a patient portal to leverage their research and extend the reach of their cancer center into the community. One of the primary lessons learned through the planning and development is the need for quality control over the data that is being pulled into the system. As always, the output is only as good as the input.

While I was in the second session, the conference had an official welcome ceremony that involved a number of athletic demonstrations from Chicago’s 2016 Olympic bid process. Here is a video from that event.

The final educational session I attended was called: Keeping the Continuum Current: Bridging the Physician/Health System Communication Gap

This presentation came from Dr. William Jordan and Kim Hummel of the University of Alabama Health System. UAB was experiencing difficulties communicating with referring physicians and obtaining clinical information in a timely manner. The answer to their problems was to develop a physician portal that integrates with their EMR. The EMR development began in 1999 with transcribed documents and now includes encounter records, images, and orders. In 2007, a pilot was developed to provide web-based access to referring physicians of the EMR data.

To access the system, physicians apply for access and the UAB Physician Services Department collaborates with Information Security to issue an RSA token to grant EMR access. To promote awareness of the system, UAB utilizes two physician liaisons to visit community doctors, they exhibit at various medical conferences, and encourage their physicians to write personal letters to community physicians inviting them to use the system. The pilot began in 2007 and they hope to have over 1,000 physicians registered by September. To determine the success of the system, they took a group of physicians who used the system and measured their total referrals in the fiscal year before they were in the system then the referrals sent after they started using the system. For the group, they found and increase of 157 patients after implementation.

After the morning education sessions, it was time for the opening keynote address from Dennis Quaid. Quaid and his wife experienced a near tragic event with their twins when they were accidentally given 1,000 times the normal dose of Heparin twice. Quaid told his story to help reinforce the need for system improvements in healthcare to prevent these type of errors from occurring in the future. His story has resonated with many and is another reminder for us all to be striving for the day when errors like this are a thing of the past. Here is a video of the keynote address I shot:

After a long stroll through the massive vendor exhibit area, it was time for Meet the Bloggers in the Tech Lab. I was invited to present at this round table session with some true innovators in the blogging community and felt privileged to offer my experience to the group. It was fantastic to meet the other bloggers in person and put a face to a Tweet. For more on the session, go to www.himssconference.org/techlab/.

The day concluded with a conference reception, a long line at the shuttle bus, and some giant snowflakes on the way back to the hotel. The day was long, but well worth the effort.

Here’s looking forward to tomorrow!

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HIMSS 2009 – What Do I Expect to See

I’m sitting in the airport in Houston waiting to board my flight to Chicago and started thinking more about this year’s HIMSS conference. When you add the challenges created by the current economic situation to the renewed focus on healthcare, the demands on HIMSS to deliver have never been greater. Professional development allotments and travel budgets are shrinking rapidly and when you do travel, it has to be worth the expense.

With these thoughts, one has to ask, what are you expecting to see at this year’s HIMSS Conference to justify going? For me, I’m hoping for a couple of things: one, evidence of a maturing of the IT industry in healthcare and two, ideas, success stories, and innovation.

Maturing of HIT

How could something that has been around for as many years as HIT need maturing? While HIT has been an important part of the healthcare system, it still remains somewhat of an outsider when it comes to clinical operations. Too many organizations have IT departments that function outside of the core business of healthcare, the treating of patients. Yes, you need IT to support business transactions, but the real magic in HIT will be realized when lives are saved and costs are reduced.  In other words, when HIT has helped to improve the quality of care offered to patients.

What does that look like when HIT is involved in clinical care? You will see integrated EMRs supporting and guiding clinical decisions, data exchanges improving the entire continuity family to physician, cheaper and more accessible access to quality care, elevated awareness and emphasis on wellness, and a true reduction in the cost of care.

For me, it’s time for HIT to show its value. Too often we see the promise of IT improvements and ROI justifications fall short due to implementation, scheduling, planning, or project management problems. We can all sight projects that started with the best of intentions that fell flat at some point along the line. It’s time to deliver projects that make a difference and actually deliver reduced cost and improved care. The successful project should not be the exception it should be the rule. It’s time for HIT to grow-up.

Ideas, Success Stores and Innovation

I know there are many others out there in the HIT world who share my opinion on the maturity issue and they have been working hard on the effective and successful projects I’m describing. What I’m hoping to hear is a growing number of those projects coming to light. I want to see organizations that are pushing the envelope and challenging the old ways of doing business. I want to see those who are using innovative technologies to penetrate bureaucracies and extend the reach of health care to patients around the globe. I want to see the promise of HIT being realized in ways I had not even considered.

Hearing these examples will help me add to a growing peer group of those who are committed to the idea of innovation and improvements through HIT and who are delivering on that promise. Growing a network of peers is the ultimate reason to attend a conference like HIMSS; it attacks those who think alike and gives us all opportunities to share stories, generate ideas, and lean on each other from time to time. While I suspect I will meet many peers in person, thanks to Twitter, blogs, Facebook and other technologies, I will meet many more virtually. In the end, a peer group is a great thing to have.

In about fifteen minutes, we will start our decent into Chicago. The money has been spent, the time has been taken, and now it’s time to deliver.

For those interested, I will be live tweeting during HIMSS via Twitter (@timjedwards) and posting daily conference wrap-ups on this blog each night. If you are going to be at HIMSS, send me a tweet and let me know how things are going. I’m also going to be presenting at the “Meet the Bloggers” roundtable session on Sunday. Stop by and say hi!

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Why Can’t Healthcare Be Like Ordering a Pizza?

I had a very cool experience this past weekend, I ordered a pizza online. I know it doesn’t sound like much, but Domino’s Pizza has a very slick interface that was both functional and entertaining. To begin, the ordering process involved a “build your own pizza” option complete with a picture of my pizza that changed as I added the first topping, split the pizza into halves, continued adding toppings until the pizza in the picture matched the one in my mind. Creating the pizza had an almost video game quality that was both functional and fun.

Once the order was placed, I immediately saw a status window showing where my pizza was in the process. “Anna started building your pizza at 6:04 PM.” Add to that a nice graphical illustration of the steps remaining and a flashing status bar, and I could actually visualize where my pizza was in the process. “Anna put your pizza into the oven at 6:09 PM.” I found myself quite satisfied by the sense of access I had to the pizza creation process and the assurance that my order was placed.

Finally, the most important step, the pizza arrived and when I opened the box, it matched the picture! A novel step I realize, but the best interface in the world does nothing if the product produced is suspect. Again, Domino’s got it right. They used a simple 5 star rating system on four key steps in the process and wanted to know how I felt about the entire pizza ordering process. The interface was slick and right there with the status bar where I could easily respond to the questions.

When I finished my pizza, I realized why I liked the experience so much; this is how IT should work. Technology gave me unparalleled access into the pizza ordering process, allowed me to get exactly what I wanted and monitored my satisfaction with the product and service along the way. If it can be done with something like pizza, why not something more important like healthcare? Why can’t healthcare be like ordering a pizza? That got me thinking, what would the pizza process look like in a healthcare system?

Placing my order = Scheduling an appointment

Let’s start with a search of the available physicians and services offered and select exactly what I need for my appointment. Maybe I could get recommendations as to the quality of the physicians or procedures from other patients and have direct access to research to help me decide the best solution for me. Maybe I could have access to someone within the system who could help me with my request; to make sure I make the correct selection for my issue. Of course, I would need integration from my insurance company to make sure the services I’m requesting would be covered. Once I make my selections, it would be nice to see a calendar of times for my appointment allowing me to schedule my visit around the kids baseball games, getting the carpet cleaned, and after the meeting on Tuesday.

Building a pizza = Appointment prep

A good pizza is built with many toppings. For my appointment, the toppings can be the free flow of medical information from my other health providers, my insurance company, the current provider, and me.  Things like family history, medications, allergies, and my own medical history need to come together to make sure I have the best possible outcome for any medical procedure. The extra cheese in this analogy would be making sure that I, as the patient, am as prepared as possible on the day of my appointment including knowing what to expect from the procedure and how long I will be at the office. When all the toppings combine, it could be a very tasty dish.

Delivery of pizza = Delivery of service

On the day of the appointment, I should know what to expect then actually have my expectations met. Why should I have to wait for an exam room to come available? After all, you know I am coming, why I’m coming, and exactly what I want to have happen. I should expect to have things scheduled to maximize my time as well as the physician’s and his or her staff. Of course I would have to do my part as well, making sure I followed the appointment instructions, edited/completed any necessary patient information, and arrived on time to the office.

In the end, my positive experience at my Dr. Domino’s would lead me to be an advocate for the office and rate them highly for others in my virtual communities. You would see me tweeting about the experience and sharing feedback with other potential patients. After all, one happy customer can have a big impact in today’s connected world.

Is this a realistic scenario in today’s complex healthcare model? Patients are not exactly like pizza toppings; we don’t always come in the same flavors, shapes and sizes, but health IT should be better than it is today. The lesson of the Domino’s experience is learning from what is possible and adapting it to the healthcare industry. Can it be the same? Probably not, but it can certainly be much better than it is today.

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Congressional Budget Office Weighs In On Obama’s Health Care Proposals

Yesterday, the Congressional Budget Office released its report on the Obama health plan:

Claiming back some of the rewards given to doctors for improving productivity could save the government Medicare program up to $201 billion over the next 10 years, a congressional analysis showed on Thursday.

The move, which could pressure healthcare providers to find new ways to improve productivity, would produce greater savings than adopting medical information technology, as advocated by President-elect Barack Obama, or capping medical lawsuit awards, as favored by some Republicans, the study showed.

The productivity option was one of 115 examined by the nonpartisan Congressional Budget Office in its 235-page “Budget Options, Volume 1: Health Care,” released on Thursday. The CBO does not offer recommendations.

Better record keeping and a move to pay-for-performance could result in increased savings. Improved productivity seems like the obvious choice, but at least we are talking about it. Could this finally be the beginning of a true Health IT push? What is interesting here from a social media perspective is what you can find on the CBO Director’s Blog:

Serious concerns exist about the efficiency of the health care system, but no simple solutions are available to reduce the level or control the growth of health care costs. Steps to restructure the insurance market and to encourage people to purchase less extensive coverage could reduce the use of treatments that provide minimal benefits, but enrollees would face higher cost sharing or tighter management of their care.

Other approaches—such as the wider adoption of health information technology or greater use of preventive medical care—could improve people’s health but would probably generate either modest reductions in the overall costs of health care or increases in such spending within a 10-year budgetary window.

That sounds like good news for HIT and for patient safety. The “serious concerns” statement should make us all sit-up and take notice. I beileve it is time for our indusitry to recognize the need for change on a broad scale and start to work on solutions from within the industry. While I’m optimistic about Federal reform, I’m just not 100% confident that more governement intervention is really in the best intrest of our industry in the long run.

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Webcast: Healthcare 2015: The Impact of the Obama Presidency

Today, I attended the webcast called “Healthcare 2015: The Impact of the Obama Presidency” presented by IBM. The presenters included:

  • Dr. Peter Budetti, MD, JD Chair, Department of Health Administration and Policy, University of Oklahoma Health Sciences Center
  • Dr. Paul Grundy, MD, Director of Healthcare Transformation, IBM Healthcare and Life Sciences
  • Mr. Len Nichols, Director, Health Policy Program, The New America Foundation

Dr. Budetti began the presentation pointing out the differences in the 1993 healthcare efforts and the present situation. For example, in 2009 the White House will have staff with more experience working with congress and there is a stronger commitment on both sides to work together. This time the major medical groups are supporting universal coverage where it was fought in 1993. Another key difference is the engagement of the end users of health reform, creating the site change.gov to solicit input on change.

Here is another example of the role of social media and online communications. The tools that help get Obama elected are not being turned to resolve issues in healthcare. Once again, healthcare institutions and providers who are not involved in the social media space are completely missing the boat.

The key message I heard from Dr. Budetti was, the government is asking for involvement from a better-educated consumer who is more engaged and prepared for change then in 1993. The result, new business opportunities are on the horizon for those who are paying attention.

Len Nicholas agreed with the general sense of Dr. Budetti’s presentation, but had more reserve in his talk. He stressed the need to focus on infrastructure for health. He also believes President-Elect Obama has recognized the importance of speaking with one voice on healthcare reform and the voice will be Tom Daschle.

Nicholas stated health information technology grants and loans will be part of the new stimulus package and the focus may be on outcomes. He indicated the most exciting news of what is happening on the Hill is a ground swell of effort to talk about medical effectiveness and spread the sharing of best practices in medicine, the expansion of the medical home, and a move away from fee for services and toward a fee for outcomes or pay for performance.

Personally, I think this type of change may be a ways in the future, but it is definitely needed. The first step has to be creating of common containers and protocols that will allow for outcomes study and measure to be established. One cannot argue the need for these types of systems when you consider the number of patients who are injured or die from bad medical information.

What did the presenters think of the prospect for economic recovery and its impact? Our economy is in uncharted water, there is a reasonable expectation of recovery by mid-2009 early-2010, but there are no guarantees. If the downturn continues, all could be out the window.

The economic recovery a component of health reform, but Nichols stated that bipartisan support and involvement might be the key to long-term change. He indicated that a lot of the Obama’s campaign rhetoric was based on cost savings that are not realistic and the realization of that fact will have an impact on the healthcare debate. As of now, he believes the Republican strategy is still unclear and evolving and will key on the activities of individuals like Senators Grassley and Gregg.

The two issues affecting bipartisan support are:

  1. Building a public insurance plan to compete against private insurance. The plan could be something like Medicare which would not be supported by Republicans or more like state employee plans which would garner more bipartisan support.
  2. The role of the employer in the insurer model will also elicit strong reactions from both sides of the isle.

At the end of the day, unlike 1993, there is a feeling of strong bipartisan support for health reform and the presenters believe the legislative committees will be authoring the bills. That should mean greater support from Congress.

Why will Daschle be more effective this time? He was part of the Clinton healthcare team in the 90s and profoundly impacted by the failure of that effort. Daschle saw that the failure to cooperate was the cause of the downfall and the reform effort was completely lead by one-party.

During the Q&A section of the talk came the million dollar question: Should I wait to implement an EMR until the stimulus package is announced and will there be money for me if I don’t have an EMR? This question is the core of the Obama campaign in my opinion. The question of what can government do for you? Right or wrong, what sensible business owner (a.k.a. practicing physician) would not take federal money to build or grow their practice?

The presenters responded by saying it is hard to see exactly what will happen with the stimulus package, but the package will contain very large funding amounts. Further, they indicated that government programs don’t typically award funds to existing systems preferring to help with more ground-up implementations. However, in the world of increasing competition for dollars, being able to show a successful implementation and making a case for rapid deployment and expansion may be an effective strategy. Bottom line, check-out systems that are certified and offer the best interoperability and data integration to plan for any future transitions to new systems. While you are doing your research, keep an eye on Washington for stimulus language to come out after the first of the year.

From where I sit, we live in some very interesting times in healthcare and today’s conventional wisdom could be tomorrow’s unemployment line. It’s time to start thinking differently in healthcare; start thinking about embracing technology.

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World Healthcare Innovation and Technology Congress Day 3 Wrap-up and Summary

The final day of the World Healthcare Innovation and Technology Congress began with a bag, Scott McNealy from Sun discussing how Open Source works for healthcare. McNealy’s presentation was incredibly entertaining; equal parts insightful information and stand-up comedy. Here is a sampling of quotes from McNealy:

  • We must go digital. Just look doctors handwriting and you’ll see, we must go digital.
  • Open Source is a very old concept that we’ve been doing since 1982. If I can go a little Al Gore here, we invented Open Source.
  • Public key encryption schemes are the best option. If you have a secret in your code, it will be discovered and breached. Humans cannot keep a secret. What if the Trojan horse was made of glass? Would they have let it in?
  • When I hear “enterprise license agreement,” I think, “The first hit of heroin is free.”
  • Technology has the shelf life of a banana; it will be outdated before you can roll it out.

McNealy’s message centered around the very real impact Open Source is having on the market and how that success can be brought to healthcare. Sun has spent $26 Billion on research and development and is currently involved in the creation of the Nationwide Health Information Network (NHIN).

Open Source has tremendous advantages including avoiding “format rot” in archiving information. What happens 20 years from now when someone needs to open a document created in a proprietary tool like MS Word? Or better yet, how does one render a document created in the Wang system? With Open Source you can bundle the files with the rendering agent.

In a nutshell, McNealy says there are 7 reasons to be open

  1. Lower barriers to entry
  2. Increased security
  3. Faster procurement
  4. Lower cost
  5. Better quality code
  6. Open standards last longer
  7. Lower barriers to exit

As a recovering developer, his comments on better code peaked my curiosity. Basically, developers are very protective of their reputations and releasing code into an open environment for the scrutiny of other codes ensures the code is top-notch. Open Source code tends to be written cleaner and documented thoroughly; coders are opening their robes and exposing themselves to the world. They want to look good.

My favorite comments dealt with the privacy question and how it works the same in the Open Source world. First, “Somebody a long time ago someone said you don’t have privacy, get over it. Oh wait, that was me.” And the second quote, dealt with what is perceived now as a secure delivery system, the US Post Office. “You take an 8 x 11 piece of paper, stuff it in a folded paper envelope, seal it with spit, write unblinded information in the outside in the to and from areas, give it to the Federal Government for a couple of days, stick it into a tin box, all with the hopes that it will get there.” Yet somehow we worry about the level of encryption used on networks or go so far as to print everything and take them out of the secure networks to set them on a desk.

In closing, McNealy had one more comment on healthcare that resonated around the room, “There is only one industry more screwed-up than computers and that’s healthcare. You kill everyone eventually, I know you are working on it.”

I found more in that 30 minutes of Scott McNealy then I’ve found in entire conferences. I’m very appreciative of him and his taking the time to speak with us.

Next up, was a presentation on Direct Practice Medicine by Scott Shreeve and Jordan Schlain, two physicians who are delivering healthcare differently. Their belief is it’s not always about the throughput, it’s not always about speed, it’s about relationships. The business model involves seeing considerably less patients to avoid the “hamster wheel” syndrome of running faster and faster but not getting anywhere. Their patients subscribe to their clinic and have 24/7 access to physicians who actually know them and spend time getting to really know them. To pay for the services, subscribers increase decidable in their health insurance and use the money saved to pay the monthly access fee.

What I found intriguing was the level of detail in the understanding of the patient and access to care provided with their model. I’m not a physician, but I suspect most physicians enter practice to get to know and improve the lives of their patients. Somewhere along the line we have deviated into short episodes of disparate care that may be causing more harm then good. Having said that, I wonder what happens to patients who need care beyond what is being delivered in this manner, but I do like the concept. I’m going to watch the continued expansion of this model in the future and you can go to currenthealth.md to learn more.

Unfortunately, after this session, I had to be off to the airport and a return to the real world. However, on the way back, I take a couple of learning with me from the congress

  1. Healthcare is in the midst of a fundamental transformation that is being driven by customers, globalization, economic factors, and an unprecedented influx of technology
  2. Social networking on online communication have a central place in healthcare, both in the delivery of care and the support of the care process not to mention uniting the growing army of reformers who are finding support and ideas in the community.
  3. We still have a long way to go.

I want to thank the organizers of the congress for their hard work in putting together an event that was both informative and entertaining. One suggestion, in the future, you audience members are very tech savvy. Give them tables and outlets so they can document and report on the event, look-up resources being discussed, and possibly participate in events online. Beyond that suggestion, I look forward to next year’s conference.

For more on the congress, try these:

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