All too often you hear these questions: What are other healthcare institutions like us doing in this space? How are the leading healthcare organizations dealing with this problem? Who is best-in-class in this and how can we learn from them? These are all excellent questions, but they need to be applied to those outside of healthcare. Benchmarking each other will produce incremental improvements and not the kind of reform needed today. Healthcare needs to recognize what customers expect in their online experience and step-up.

Do you want to streamline patient appointment scheduling? Look at the airline industry. Through the web, I can search available flights by cost, time, or flight duration, select the flight that best meets my needs, schedule and pay for the flight and even pick my seat (unless you are on Southwest…).  That is best-in-class thinking and it is what the general public is used to for online interactions. Is making a clinic visit really that much more complicated then flying a plane?

You want to improve the laboratory testing process? Take a look at the pizza industry. On the web, I can select the exact pizza I want, size, toppings, crust, follow the creation of the pizza, and know exactly where it is in the creation process. What if you applied that process to the lab? Allow physicians to order the exact test they need, schedule when it is going to happen, and provide transparent access to the entire process so they can know exactly when those results are going to be available.

You want to improve you patient check-in process? Look again at the airline industry. Airlines allow check-in up to 24 hours prior to the flight. This eases congestion at the gate, moves people through the airport with greater efficiency, reduces the staff required to process passengers, and generally improves the entire user experience. What if you took this process and used it in healthcare? Patients could check-in prior to their appointment, electronically review information and sign any required forms, and electronically process any co-pays or required fees. Patients could receive a “boarding pass” that indicates they are ready to go and be allowed to focus on the business of their care versus the logistics of being a patient. Think of the savings in staff hours, space utilization (patients are not spending minutes/hours completing forms in the waiting rooms), and the reduction in no-shows.

The bottom line; there are others out there who are doing the same processes used in healthcare who have found ways to do it better. Find those examples, study them, and adapt processes based on that new learning.

Yes, there are barriers to change and there will always be barriers to change. What we can no longer afford to do is keep our heads in the sand as an industry or only accept what others like us are doing.

The world has changed, the bar has been raised, and it is time for us to jump.

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!

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.

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.

• 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:

• World Healthcare Innovation and Technology Site
• World Healtcare Blog
• WHITC Day 2 Wrap-up
• WHITC Day 1 Wrap-up

Next up was the opening keynote address from Microsoft’s Peter Neupert focused on consumer driven healthcare changes on how online communities are creating new points of care. The disparate communications between the patients, care providers, and family and friends cause significant stress on the patients and producing negative outcomes. Online communities can deliver the same message to all concerned with the patient and ease this stress. Neupert’s message, it’s not about the technology, but the outcomes we are trying to enable. Agreed. Just not sure I want to go to the Microsoft Hospital. Probably needs to be rebooted every twelve patients…

Another interesting point was the discussion about using all this data we are collecting on patient treatment and outcomes to create logic and assist the physician in the care of the patient. While this is not a new concept, it was a good reminder of the benefits of EMRs and true interoperability, the utilization of data to improve outcomes. Let’s face it, there is too much to know to be able to handle all situations a care provider may encounter.

Frank Torti of the FDA challenged my thinking and made me look at the role of the FDA in a different light. Torti is a scientist and discussed the infusion of science into an agency that regulates products accounting for 25% of all consumer spending. The challenges to the FDA are growing due to overseas manufacturing of drugs, medical devices and food, bio-terrorism, and the accelerated change in technology. To keep up with these challenges, the FDA is turning more to science and three principles: partner more and smarter, maintain a core of scientific expertise, and be preemptive with their scientific strategy.

Next was a demonstration of “cutting-edge” technologies. The first was a merging of video conferencing and translators from LifeLinks. Their system was impressive, but the most entertaining part of the demo was seeing a member of the audience who recognized and reacquainted herself with one of the interpreters. From that point on, the demo bordered on being more of a dating service, but seeing the interface work in that fashion proved to be an effective illustration of its success. The second demo was an impressive data informatics and business intelligence tool by MedE Financial. However, I’m still left wondering, how do we get good data into systems do perform this type of analysis. We need to remove human error as much as possible.

After lunch, we broke into three executive tracks involving 4 presentations. The first I attended was on a clinical intelligence system for providers that demonstrated an intuitive and powerful tool that could be quite useful. The second was a demonstration from the Social Security Administration and their efforts with the NHIN and finding ways to process claims in hours instead of months.

Next came the two highlight presentations of the day; Consumers at the Center with Greg Matthews of Humana and Second Life and Virtual Worlds with GT Sweeney.

I had the pleasure of meeting Greg Matthews first via Twitter on day 1 of the conference. He was part of the 5 or 6 of us who were live tweeting during the event and building our own little network. When Greg realized his breakout session was in the “big room,” he put out a call to Twitter group to attend his session.

Greg and Humana are working on strange (for an insurance company) and wonderful uses of technology and social networking to improve their customer’s health. From the Free Wheeling bike program (freewheelinwaytogo.com) featured in this year’s presidential conventions to the new efforts with Exer-games, his team of innovators pushed my thinking and challenged me to figure out better ways to reach-out and engage our customers. For more on Greg’s team and their programs, check out their blog crumpleitup.com. The name says it all.

The SecondLife demo was also strong and my favorite part was watching the virtual presenter from London take over the show, talk to us from a podium, display his slides, and even gesture to the slides all within SecondLife. One can always benefit from a live demonstration of technology in action and despite the challenges, live demos are the best way to go. The possibilities for community development and personal interaction were racing through my mind.

These two sessions are why I came here; they illustrate and demonstrate what is possible to stretch our thinking. The event provided me the ability to connect virtually and face-to-face with like-minded individuals who share my interests and deal with the same pains. When you think about it, this really is a massive dating service helping you to find sole-mates who share your interests…

My day concluded with a presentation on the international perspective of healthcare and the global economy. I found two key messages in this talk. First, Denmark has built a very slick and comprehensive health information network and it is being used. They average 4.5 million messages a month from a country of 5.5 million. The second lesson spoke of the challenges in universal healthcare in a global and moving marketplace. It’s great when you have universal healthcare in your country, but what happens when you cross boarders into someone else’s universal system? Add to the mix medical tourism and there could be a steep price in the future.

After 11 straight hours of sitting, listening, tweeting, and taking notes, my back told me it was time to go. I’ll have to watch today’s closing address on the CD-ROM that I’m ordering. Overall day 2 of the World Healthcare Innovation and Technology Congress was a smashing success and well worth my time. I only wish there were more people here to listen to these presentations and share the growing excitement.

I arrived at the conference after the opening keynote address and and entered the conference during a presentation called: How the Current Economic Challenges are Changing the Future of Innovation Investment. Understanding where the business opportunities are in healthcare and specifically where venture capitalists are seeing opportunities, is a telling case as to where things will be heading in our industry.

The first question, is there still VC money out there was answered with a qualified yes; there is money, but it is more discerning in the selection process. What was interesting to me was the amount of individual investments seems to be increasing. If you have a good concept and business model, you will not only be funded, but will likely find more funding then prior efforts. Part of the higher awards may be a by-product of the recommendation for “more realistic” timelines in business models.

Other learning from the presentation, treatment will continue to dominate attention over prevention because the aging population, blockbuster drugs are still out there and even incremental improvements can create tremendous opportunities in drugs, personalized drugs will grown in importance, and 1/3 of all prescriptions are not fulfilled and many patients do not follow the regiment prescribed.

Next, I went to a panel presentation called: Moving Connectivity Across the Healthcare Spectrum: Contemporary Approaches to Collaboration Management and Web 2.0 Technologies

One theme: In social networking, the individual is seen as a node and the tools are designed to connect nodes together. This makes sense, but lacks the personal feeling that is the true driver in social networking, but it helps from an IT perspective. I believe it is that individual’s need to connect is what drives nodes to other nodes. It was also suggested that social networking can be used in medical education to allow students to “experience” health events by following patients who are using social networking to cope with their care. Interesting….

The key message here was, patients are feeling increasingly empowered to access their patient information and the greater liability may come from those who are NOT embracing these technologies. Sharing medical information with patients is no longer an option, but a requirement.

Next was the highlight of Day 1: Newt Gingrich. Newt is a politician and politicians, the good ones, always seem to give excellent presentations. Newt is a good politician.

Favorite Newtisms:

• I worked very hard to defeat John Kerry because he was left of Kennedy and I was afraid he would nationalize the banks
• The Bush stimulus package is just dumb. It’s like giving a teenager amphetamines so they could get even crazier before they crash
• It will be virtually impossible for Obama to make health a real priority. It will take 6-9 months just to sort through the wreckage.
• We are in a great time of discontinuity in world. It is not a time of marginal change

You get the idea. Bottom line, we are in a mess, but things are moving forward. Expecting fundamental and instantaneous change is not realistic and will likely cause more problems then solutions.

The final presentation was from the iRobot company showing how in-house robots could be used to reestablish physician house calls with a 21st century twist. Your doctor is giving you an examination via robotics, video, audio, and health monitoring tools. Interesting, but a bit creepy. The best quote from the presenter when displaying an elderly woman smiling at a robot in her home, “Some people find this image disturbing.” The times they are a-changing.

The evening reception proved to be very interesting as well. As fate would have it, a physician from University of Oklahoma sat at my table and we struck-up a conversation. Being both an employee and a fan of the University of Texas, I opened with 45-35. For those of you who don’t know, OU is in the national championship even though UT defeated them. I guess this is another example of how IT can make a mess of things.

Once we moved on, we had a very interesting discussion about the challenges facing both our institutions and in the end, I think we are going to work together to help them start working on their own physician portal. Funny how things work out.

At the end of the first day, I was very glad I came to the conference. To find time to think, I decided to do what must be done in DC; I went to talk to Abe. Even without the cold temperature, I always get goose bumps.

For me, the highlight of today’s presentations was one from Dr. Albert Villarin called Clinical Decision Support in the Trauma Center: A Practical Guide to Clinical, Administrative and Quality Informatics. The talk centered around an impressive use of technology to improve efficiencies and care in a busy Philadelphia trauma center. As a recovering programmer, I was intrigued to discover they were using Cold Fusion 8 as their primary development language. Apparently, reports of Cold Fusion’s demise were greatly exaggerated.

At the end of the conference, a couple of things stuck-out in my mind. First, the integration of process improvement techniques through healthcare information technology (IT) continues to make significant gains in clinical operations. I’m seeing more use of data analysis for the purpose of improving processes and producing better clinical outcomes. My biggest frustration in IT is when IT is used for IT’s sake; not to make significant process improvements. Thankfully, we are seeing more evidence of the “proper” use of technology.

The second major learning for me was the use of Web 2.0 tools that surrounded and augmented the conference, but were not actually part of the conference. HIMSS had a Twitter account and used Twitter to promote and connect attendees during sessions. Personally, I met many others who shared my interests in HIT and Web 2.0 through the use of Twitter. While the conference structure had a “lounge,” the purpose of the lounge seemed more about sales and not so much about networking. Tweeting on Twitter afforded me the opportunity to talk to others about presentations while they were occurring. In a typical conference setting, that type of cross-talk would be frowned upon. Here, it proved to be very beneficial.

For the next virtual conference, I believe HIMSS should explore adding more Web 2.0 features into their conference structure and encourage more of these connections. When establishing my profile, there were opportunities to enter an Instant Messaging ID, but who uses IM anymore? What if the conference took place in Second Life and had actual speaking avatars and meeting rooms? That would be interesting. Perhaps we could leverage professional profiles in LinkedIn to create your vCard as a way of connecting individuals. They could encourage using Twitter in lieu of the Q&A sessions. Perhaps contests could be established to promote use of these and other tools. After all, how can one learn the benefits of emerging technologies unless there is a meaningful purpose to use them?

I found a lot of value in the conference and look forward to the next one in June. I also hope HIMSS will be open to extending the networking capabilities and would be happy to do my part to help.

The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry’s membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare.

I’ve been a member of HIMSS for the past couple of years, attended the HIMSS conference in 2006, and received my CPHIMS (Certified Professional in Healthcare Information and Management Systems) certification in May of 2007. Suffice it to say, I believe in this organization and the role they play in healthcare IT.

My background includes spending time in many industries; always in an IT capacity. However, my current position is my first experience in healthcare and HIMSS has played a key role in my education and understanding of the challenges and opportunities within the healthcare industry. As we all know, finding the time for professional development and the budget for travel is becoming an increasing challenge. So, how does a professional find the time and the money to attend training? We attend virtually.

HIMSS offers a virtual conference to their members. The interface is slick and prompted my 17-year-old to say, “Cool” when he first saw it.

Of course, once you get past the glitz of the interface, it all boils down to the presentations which are delivered via WebEx. Let’s face it; a conference is only as good as the presenters and their materials. Fortunately, there were many quality presentations on Day 1, but the highlight was: “Smart Citizens, Smarter Patients: A Primer on Social Media and the Wisdom of Patients” by Jane Sarasohn-Kahn (www.healthpopuli.com). This presentation provided a wealth of information and gave me renewed hope that Web 2.0 and patient-focused care will ultimately improve both the care of patients and promote healthy living.

Now, I’m off to attend Day 2 and perhaps drop-by the vendor area. I’ll post a more complete update later today. If you attend the conference, let me know what sessions you found most useful and I’ll be sure to checkout any good presentations I missed.