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Friday, September 28, 2007

Featured Interview

This week I had an unplanned interview with Heather McGuire of Within3.   It started out for me as a "show and tell" regarding RHIO development and my "new" self sustaining business model, which frankly still is not a proven model.  Heather reciprocated and introduced me to  Within3. The site is based upon social networking of research scientists and clinicians. In order to gain access one must be recommended by a peer.  Members are thoroughly vetted to be listed on their site.  You can see their site by clicking on Within3 above.  The site has a search function as well.  You can search by disease and it will take you to a number of authorities on the subject, not only that but it will search Pubmed and bring up their articles as well under their name. The site also has their curriculum vita and other interesting things about that person.  There is much more to the site, but I will point you in that direction to find out for yourself.  It is still in early beta....but the concept seems exciting.  If successful, this will continue the revolution in search methodology.

Thursday, September 27, 2007

Part II - Science of Spread Change

I left off last time.....

Sarah Fraser is a consultant to health care organizations in the U.K. She points out "that innovators are not normal people, and look for and enjoy change, while most people are wary of change. " For this reason innovators are poor messengers for spread change. The majority of the people are those that hold the organizaton together, go to work at 7AM and not to a conference. They care for patients from day-to-day. If innovators cast aspersions on this group, then spread change is dead. Spreading innovation must also reduce costs, and there must be a return on investment for the organization that is making change. The organization (or stakeholder) must see financial gain for adopting the "new thing".

The article (which I highly recommend to IT people, vendors, RHIO developers and the like) goes on to discuss

Pilotitis
Low Hanging Fruit Syndrome
Unworkable Universal Solutions
The fallacy of the "tipping point"
Accepting Roger's categorizations of people, ie early, late, laggards
Spreading improvement requires continuous measurement
Without leaders....there is nothing
Implement good ideas is better than spreading good practices

I highly recommend this monograph which can be found at:
http://www.chcf.org/documents/chronicdisease/TheScienceOfSpread.pdf

Tuesday, September 25, 2007

The Science of Spread


Quote of the Day:
Resentment is like taking poison and hoping the other person dies.
--St. Augustine

 

Batten down the hatches....this post is going to be rather long, not a sound byte.  Thomas Bodenheimer  M.D.wrote for the California Health Care Foundation a treatise on this subject which bears reexamination at this juncture in the development of Health IT and the proposed NHIN. Dr Bodenheimer is on the faculty at UCSF.

He summarizes the literature on "spread theory" by Everett Rogers (1962), and Malcom Gladwell's "Tipping Point" . Paul Plesk cites Rogers and Gladwell "to argue that once 10-20% of the target population has adopted an innovation the tipping point has been reached."  Plesk than goes on to discuss "stages of change", "precontemplation", contemplation and action, followed by maintenance.

It can be said that EMRs and RHIOs, and NHIN are in all phases of Plesk's analysis of "Spreading Good Ideas for Better Health Care"

He offers several tools that might help improvement champions that analyze the systems and individuals that make up the spread target population....more later

Sunday, September 23, 2007

Health 2.0 Conference Results

Three years ago I had no idea how blogging would provide a platform for everyone and anyone interested in health care. The spectrum of participants ranges from physicians, payors, patients, political pundits, and others.
This forum lies outside the framework of "officialdom"; It has become the water cooler and allows much intercourse. Early on there were some disputes and "retaliation" against employees when their opinions reached "management".....However I believe freedom of speech issues prevailed as long as there was no libel or slander involved.

This year's Health 2.0 was planned for 200 participants, and over 400 registered. The introduction piece was very impressive. I am providing the link here. Health 2.0 Intro-http://www.icyou.com/events/health-2-0-conference?folder=All

The video by scribemedia was truly impressive: http://www.scribemedia.org/2007/09/20/health-20-conference/


While most reporters waxed on enthusiastically, the San Jose Mercury News threw some cold water on Health 2.0, most of which was unwarranted. They criticized health 2.0 and the blogs as not being well grounded in 'business models'. While some blogs do generate revenue, most proponents of health 2.0 blogs or health blogs in general did not nor want to have a rigid business model....I am also sure some will develop entrepeneurial motives or at least there blogs will network them into "greener" pastures.

I also think that unrecognized is the fact that Web 2.0 applicatons are rapidly being deployed for EMRs, Practice management systems, and other applications for healthcare. These applications do away with the heavy cost of capitalizing for hardware, ie servers, etc. A monthly subscription fee covers maintenance, upgrades, and technical support.

Without a doubt the environment of health blogging is one of free speech, enthusiasm, and just plain "glory" at seeing one's words printed on the world wide web. It is a great "equalizer."

Saturday, September 22, 2007

Alternate Road to Health Information Exchange

Saturday, September 22, 2007

Roadmap (Alternate) to Health Information Exchanges
RHIO and HIE development is a highly complex undertaking and not for the weak of heart. As I was driving into Los Angeles the other morning I encountered one of the routine "sigalerts". For those of you who have never been in California and live in a rural area I will explain this is a system of alerts from the Callifornia Transit Authority whereby notifications are sent out by television, radio and internet about blocks in traffic due to "events" such as accidents, toxic waste, police activities, construction activites, etc. Recently my oldest son, who has rapidly passed me by in the world of high tech (he has smaller thumbs than I do) and I were in the car together and as we bogged down and did not move for several minutes, the GPS asked if we wanted to plot an alternate route, and suggested about five different ways around the thrombosed artery.
I believe that the current roadmap is flawed as designed and hoped for by several agencies with good intent. Our Health Train Express is now in a "sigalert status" The problems with "roadmap" is that requires funding from unknown or difficult and confounding sources such as grant making organizations ranging from county to state and federal and combinations thereof. Often times these grants are tied to the momentary "political expediency" of the moment, ie, Katrina, Homeland Security, Bioterrorism, and even "Global Warming"
Often and most of the time it is totally dependent on the whim of the moment of legislatures both federal and state, impacted by competing budgetary priorities of peace and war. education, immigration issues, and more.
The "road not taken" as Robert Frost so aptly stated requires a minimalist approach with obtainable goals that step through the process. Rather than swallowing the whole cow, we must take small bites, chew an digest each piece individually. This rather graphic and seemingly unrelated metaphor sums up a new roadmap.
It is difficult for providers and hospitals to grasp the RHIO concept because it is rather like dropping an Atom Bomb. It overwhelms most executives who are fully engrossed in just running their institutions on a day to day basis.
Developing one functionality that would maximize a return on investment in one area as a demonstration without disruptive technology gives an HIE a "foot in the door" When a user (provider or hospital) subscribes to this service for a relatively small sum the revenues derived and create cash flow for the HIE as a revenue cycle. The single functionality must demonstrate it's own cost effectiveness and ROI in less than one month. It must be demonstrated as successful in a regional pilot program. It must be self funding, elective and non binding without contractual obligation, and also offered as a 30 day free trial........more later

Saturday, September 15, 2007

Health Train Express is Slowing Down

As I travel on the health train express I have noticed the "local trains" which are stopping along the way at each station. Of course I am on the express track, or the high occupancy vehicle lane. In my 'rush' to reach my destination I am missing a lot of interesting places.

I may be posting less here and if you miss my meanderings you may find me at my new blog,
The View from Here (http://anyviewfromhere.blogspot.com/ It seemed apropos for a name for an ophthalmologist's commentary about matters of "great significance"

For those of you going to Health 2.0 enjoy!!

And thank you to Dimitriy for his great expose on Google....

Saturday, September 8, 2007

Roadmap (Alternate) to RHIO and HIE

 

RHIO and HIE development is a highly complex undertaking and not for the weak of heart.  As I was driving into Los Angeles the other morning I encountered one of the routine "sigalerts". For those of you who have never been in California and live in a rural area I will explain this is a system of alerts from the Callifornia Transit Authority whereby notifications are sent out by television, radio and internet about blocks in traffic due to "events" such as accidents, toxic waste, police activities, construction activites, etc.  Recently my oldest son, who has rapidly  passed me by in the world of high tech (he has smaller thumbs than I do) and I were in the car together and as we bogged down and did not move for several minutes, the GPS asked if we wanted to plot an alternate route, and suggested about five different ways around the thrombosed artery.

I believe that the current roadmap is flawed as designed and hoped for by several agencies with good intent.  Our Health Train Express is now in a "sigalert status" The problems with  "roadmap" is that requires funding from unknown or difficult and confounding sources such as grant making  organizations ranging from county to state and federal and combinations thereof.  Often times these grants are tied to the momentary "political expediency" of the moment, ie, Katrina, Homeland Security, Bioterrorism, and even "Global Warming"

Often and most of the time it is totally  dependent on the whim of the moment of legislatures both federal and state, impacted by competing budgetary priorities of peace and war. education, immigration issues, and more.

The   "road not taken" as Robert Frost so aptly stated requires a minimalist approach with obtainable goals that step through the process.  Rather than swallowing the whole cow,  we must take small bites, chew an digest each piece individually.  This rather graphic and seemingly unrelated metaphor sums up a new roadmap.

It is difficult for providers and hospitals to grasp the RHIO concept because it is rather like dropping an Atom Bomb. It overwhelms most executives who are fully engrossed in just running their institutions on a day to day basis.

Developing one functionality that would maximize a return on investment in one area as a demonstration without disruptive technology gives an HIE a "foot in the door"  When a  user (provider or hospital) subscribes to this service for a relatively small sum the revenues derived and create cash flow for the HIE as a revenue cycle. The single functionality must demonstrate it's own cost effectiveness and ROI in less than one month.  It must be demonstrated as successful in a regional pilot program.  It must be self funding, elective and non binding without contractual obligation, and also offered as a 30 day free trial.

More on this later........

Saturday, September 1, 2007

Surfing on the Labor Day Weekend

The long labor day weekend is upon us all. I plan to spend mine with my feet up, and with a cold drink sightseeing on the hot sands of the Southern California beach.  I even invested in a cell card, so I can now find the internet whether I am floating on my raft, in a dark hole, in a green swamp, or whatever. I realize I am surrounded by   the "can you hear me now" guy and the helicopter flying overhead (Verizon).

As far as health information exchange goes, this weekend, my network is down....