My Ideal Healthcare Experience

Recently someone very dear to me had a disappointing experience. She saw a physician's assistant at group health who did several disparaging things...

• He criticized diagnosis made by her regular physician in front of her.
• He didn't listen to her concerns about shoulder pain and her previous history.
• His critical manner and disparaging comments made her feel as though she was crying wolf.

Needless to say she won't be seeing this physicians assistant again however hearing about the episode got me thinking to what an ideal health care would be so here it is...

My family would have a long-term relationship with a highly competent family practitioner. That family practitioner would see them selves as physician, trusted advisor and most importantly partner in helping manage all aspects of healthcare for my family. They would be comfortable with the level of knowledge and more complex questions that they receive from us as we learn about our own health online, willing to discuss what we have found and open to hearing us explore different options. Their guidance would be spring from evidence based best practices that are consistently communicated and applied across the discipline with tweaks as necessary that account for the individual characteristics of my family members. As a partner there would be other avenues of communication than having to schedule a visit, reducing the amount of visits necessary.

Implication

• A model of compensation that allows family physicians the flexibility to care for their patients in this fashion.

In the case of an emergency for one of my family members we would arrive to an ED that rarely had long lines/wait times and where the physicians on duty had easy access to their medical histories. Our family practitioner would automatically know about the episode and when necessary collaborate with hospital and ED physicians on the right plan of care. Again, the ED and hospital physicians would make heavy use of evidence based best practices with an understanding of the individual patient. This would all apply in the case of hospitalization sans emergency admit, i.e. giving birth...

Implications

• A model where healthcare coverage and/or urgent care clinics replace the overwhelming use of EDs as a surrogate for family medicine.
• A mechanism that allows easy ad-hoc collaboration between hospital and primary care physicians.
• An acute care setting reimbursement model that rewards hospitals and physicians that utilize evidence based care.

In the case where a member of my family has to grapple with a chronic illness or condition the family practitioner would recommend and collaborate with the right specialists to develop a plan that focused on the well being of the patient. Updates to the patent's history would be available to both physicians as needed and the family practitioner would have easy access to the treatment record as well. Again the baseline for the care plan would be evidence based best practices with changes that are necessary for the individual situation of the patient. Communication with the specialist would also not always need to occur via an encounter/visit and it would be easy for patient, family practitioner and specialist to have dialogue outside of the office setting.

Implication

• A reimbursement model for specialists that rewards the use of evidence based care.

Global Implications

• Medical schools would need to begin training physicians towards newer highly collaborative models of care where they collaborate both with other physicians and their patients.
• A industry mechanism for identifying, deploying and educating physicians about evidence based best practices.
• Medical history and updates need to flow seamlessly to and from all settings on demand. THERE IS ONLY ONE PATIENT RECORD PER PATIENT.
• Mechanisms for physician and patient collaboration need to be made available and easy to use outside of the office visit setting.
• Healthcare insurance is available to all Americans.

What does your ideal healthcare experience look like???

Ideas, Ipods and Smartphones

Today I drove to Portland to pick up my kids. They had spent two nights with their grandparents. I've made the two hour run many times (even on the same day) so the trip is uneventful, the landmarks tick off in my subconscious except for the rivers where I pay attention checking color and level. Chelle got me an Ipod nano for Christmas. I previously had an Ipod Shuffle, the memory stick variety, but I grew weary of forwarding over and over again to get to the song I'm after. Now the shuffle will be relegated to when I exercise.

I've decided that my favorite part of an Ipod is not listening to downloaded Old Crow Medicine Show tracks while driving home but passing the time of a long commute with podcasts. Podcasts are basically audio content that is published via RSS to which you can subscribe using Itunes, the Ipod pc-side software. National Public Radio has recorded and published many of their shows via podcast and I downloaded a whopping amount of This American Life, The Best of Car Talk and NPR Technology. NPR Technology is a collection of segments from all of the NPR news shows that have to do with Technology and how it affects our lives.

My cellphone, or more properly I guess, smartphone is a Windows Mobile 6 device. A Motorola Q9c that I selected because I like non-stylus interfaces, it had a very handy querty keyboard and a built in GPS. Among my favorite apps are Google Maps and the Google Search Mobile widgets. Google Maps has saved my bacon when it comes to making meetings on time and at least once when it came to a fishing rendezvous. The google search widget puts a google search box right on the front/main screen of my phone. A tool that I haven't often used is the voice note recorder. You fire it up and can record voice notes (ala the old school mini-tape recorder)for later playback.

The long drive to Portland and back goes a lot easier when my conscious mind has something to engage it and I actually can accomplish a lot of thinking while on the road but today I did something a little bit different. While I was thinking, as I found an idea that was particularly engaging I fired up my voice note recorder and recorded it. I was listening to the NPR technology podcast, all episodes back to June 2006. After I got home I looked at my voice note recorder and transcribed the thoughts into my Moleskine notebook. There were twelve in all. Considering that on the way back I had to attend to the kids that means I had about three hours to generate these ideas or about four/hour. Among the 12 there were five that may have implications at work and at least three that applied to problems that I'm actively trying to solve. There were five primarily personal ones of which two applied to my daughters (generated before I picked them up incidentally). Two of them could be considered musings for my friends and I.

My main office is about two miles from my house but at least a couple times a week I have to commute north to the regional office which is an hour away. About half of this time is spent (safely on my bluetooth) on conference calls but that leaves at least two hours a week where I could be listening to something that spurs questions and generates ideas. If I surmise that three ideas/hour will come along during that time I should have at least captured six ideas a week that otherwise would have been forgotten after a long drive to or from home.

So Ipod + podcasts + smartphone + voicenotes + Moleskine = ideas remembered, almost like keeping a dream journal. The kicker is it's fun both to listen to the news about technology AND think about this stuff. It may not go anywhere or materialize but I think I'll keep writing them in my Moleskine just to find out.

Warning - Propellerhead Update - Twitter

Alright, I decided to try Twitter out. Inspired by John Halamka's blog I setup a Twitterfeed account too. The goofy part is that I'm twitterfeeding posts from this blog to my twitter account and then using a blogger widget to display my latest tweets at the bottom of my sidebar to the right. This might be fascinating. On top of that I'm also twitterfeeding my Facebook status updates to twitter too.

We'll see how well all of this bailing wire a duct tape works shant we!

P.S. I'm adding a label for propellerhead updates to my blog so that these are easy to identify as notes on tinkering with technology from an ex Oracle DBA.

Brainstorm - Top Uses For Web 2.0 at Work

1. Support Wikis - Real time updated FAQ's for application support, problem solving and simple howtos. This shouldn't replace formal support and triage documentation but should supplement it.
2. Talent/Problem Markets - Offer problems or specific talents/skills online. Staff are rewarded for finding solutions to problems that get results AND for posting problems in the market that then get solved.
3. Management Twitter - Setup management to use a twitter like "what am I doing now" tool that keeps status in a central location. Publish to everyone so that the types of problems that managers are working on can be public. Staff know what management is working on and managers can status each other on what's up without having to setup additional meetings. Harvest comments on the "tweets" to improve employee engagement or offer help.
4. Newsletter Blogs - We're in the 21st century and the time has come to move away from newsletters and towards the modern equivalent. Just as many companies blog their news, updates, celebrations and upcoming work our newsletter could be a ongoing blog with multiple authors (even if we maintained a single editor to maintain quality).
5. Strategic Planning Wiki - Strategic planning for IT often boils down to reviewing the organizational strategic plans and brainstorming the IT internal initiatives and other projects that will support those plans. Open up the brainstorming to EVERYONE including end-users and business participants at every level.
6. Strategic Planning Markets - Unlike the talent/problem markets that utilize a Craig's List like structure for procuring help a strategic planning market would work more like the online election markets that are used to solicit people's projections for election outcomes online or equities markets that set price based on supply and demand. Once strategies and tactics are brainstormed the planning market would then open up voting to project which ones would best support and align with the organization's needs.
7. Review Board Forums - For chartered groups that review projects, proposals, designs or other instruments that benefit from a widely diverse peer review setup forums where topics or threads can be started for each item to be reviewed. Then comments can be harvested after a known deadline and submitted to the authors for consideration in the final draft.
8. Management Blogs - Managers can blog for two purposes. First, to share information on vision, direction, meeting outcomes or other key information that employees are hungry to know and understand. Second, to invite dialogue via blog comments on the information that can happen in a public forum.

Where are you finding success with these tools in your organization?

XML and Richness of Capability

XML (extensible markup language) has been around long enough, more than ten years, to span a generation of employees so it's becoming a technology norm in a lot of respects. The explosion of blogging, RSS and other online services is empowered by this technology. It has its roots in SGML (standardized general markup language) which has it's roots in something called GML that was invented at IBM in the 60s apparently. SGML is widely used in the printing industry and HTML borrowed SGML for it's structure. I wonder if that helped XML and HTML converge over time.

What XML does is very simple. It developers the tools to organize and describe nearly any type of data with a common set of tools. For example, if I wanted to build an application that organized my fishing logs I could build an XML structure that captured every attribute and element of any given log so that they could be easily stored, displayed, shared or queried. The description of this type of XML document is captured in a document type definition or DTD. Other applications can then parse the DTD and know how to store, display share or query the log also. This makes the data self describing and self organizing.

The real power here is that using these techniques and tools creates rich sets of possibilities that can lead to rapidly deploying the data for new capabilities. This richness of capability is what gives a technology or innovation staying power in a rapidly changing world. For example, UNIX has a long and distinguished history going well back into the 60s. The ease with which a UNIX platform can be used to develop and deploy complex services is the key to it's long-term success. At it's heart is the command line interface, a set of simple core commands that can be used to accomplish huge varieties of computing tasks. I have seen healthcare applications built out of the UNIX command line interface by itself. The UNIX command line provides rich capabilities for developers and administrators alike.

Richness of capability enables agility, the ability for a technology to solve a wider set of problems that also extends its useful life and increasing its value. So a rich capability technology probably isn't easily identifiable right out of the gate. Take Java for instance. When Java first came out it promised to solve a wide array of problems including platform dependence, network portability and to further mainstream the use of object oriented programming. It was moderately successful in all of these endeavors but in the final analysis really just becomes another programing language and environment, albeit a popular one. Its capabilities are no more or less rich than other language/environment combinations like .net.

I plan on exploring this idea in future posts. The hypothesis invites a variety of questions like...

• How might you define or measure a rich capability?
• What role does richness of capability play in the evolution of technology?
• To what extent are rich capability technologies incremental or wholesale changes to their previous versions or predecessors?
• What percent of disruptive technologies tend to be rich capability technologies?

Why Business Intelligence is a Bad Word

We're off and running with discovery (in depth evaluation) of an initiative that could be termed Business Intelligence or Analytics but we aren't going to call it that. Business Intelligence has become a bad word and in the never ending quest to support the needs of our hospital administrators we can't afford bad words. The challenge of communication between the clinical and IT communities is much too important. I was once told by an ex-boss that "why?" is my favorite question. Actually "how?" is my favorite. I like to understand things sooooo....

How is it that Business Intelligence became a bad word? In looking back I think there have been a variety of factors.

• Business Intelligence (BI) is a technology label and technology labels are usually dreamt up by salespeople to make product offerings sound cool. Over time best practices cause the labels to refer to some sort of architecture or other anatomy that is recognizable. The label endures however and lacking the newly evolved context suffers.
• Recently in reading an enterprise architecture text the difference between deploying IT solutions vs IT capabilities was highlighted. Deploying IT capabilities is a more forward looking and strategic endeavor. The difference however isn't always clear and when (as I have on occasion) heard IT folks talk about deploying a "robust business intelligence application" the wrong picture emerges. BI is an IT capability and should be treated strategically. Individual projects should focus on solving problems.
• When working with business leaders on developing IT capabilities it's extremely easy to fall into the "solution looking for a problem" trap. Unless the value of the capability can be defined in terms of business value or mitigation of risk it's like telling a joke and forgetting the punchline.

So again the challenge of communication between the clinical and IT world highlights itself. So if you want to start being pro-active and develop IT capabilities you best watch your language.

Blogs In Review

Being a Google blogger user I've been able to pretty easily integrate a few of my other Google tools with it and am rather fond of the result. On the right hand side of my blog you'll note a blogroll and newsreel. These are both imported automagically from my Google reader account that slurps up my favorite blog's articles. Articles that I flag with a star are automatically posted to the newsreel. I also like emailing some of the articles that are especially interesting to folks that I suspect will enjoy them. Here's a few of the characters that I follow these days...

Fred Trotter - I like to think as Fred as the Healthcare IT/FOSS curmudgeon of the group. Given the fact that my favorite comedian is Lewis Black this is definitely a compliment. He posts on lots of topics having to due with free and open source software (FOSS) as an enabler for Healthcare IT at reasonable cost.

Life as a Healthcare CIO - John Halamka's blog. He's sort of a celebrity healthcare CIO with tons of creds and experience. Some of the most interesting things that he blogs about come from his work as the Chair for HITSP (Healthcare Information Technology Standards Panel) whose work has the potential to improve integration of HIT systems across the industry. His penchant for dressing in all black reminds me of Neil Diamond for some reason.

Candid CIO - This is the blog of Will Weider who is CIO for a rather large health system. I enjoy his insights on customer service and change management the most.

Not all of my Google reader subscriptions are listed on my blogroll. There are several others as well from places like TechRepublic and even Scientific American, either science and tech research or general industry mags. It's a pretty easy mechanism to catch mostly the news that I want and post it easily to Blueberrytech. Take a gander at the others out there and see what you think...