Sunday, December 27, 2009

Seven things to watch in 2010

Since we're at the end of the year, I thought I'd give you seven things to think about in 2010. These are trends I see happening in healthcare IT, especially with the Meaningful Use criteria upon us. Remember, my list is free, and you get what you pay for. :)

1. Embedded Informaticist - If you don't know what this is today, you will soon. These are the key, crucial people you will need to make your EMR and CPOE efforts work. Without them, your C-suite will eventually confront : Do we rewire our hospital's departments, policy mechanism, and educational/training mechanism, or do we unplug our EMR? Having a good CMIO will help you organize them. Look for a labor shortage in Clinical Informatics as soon as the ink dries on Meaningful Use. Look to the AMIA 10x10 class to help you grow your own embedded informaticists. If you don't have them early in your EMR/CPOE/clinical documentation implementations, you will eventually throw your money away.

2. "CMIO" versus "Physician Champion" - Many places confuse the two. Confuse them at your own peril. In 2010 a lot of places will be learning about the difference between the two.

3. Flower - This project is noble and has teeth. I'm one of the early architects, so how can I not tout it? If you're not sure what Flower is, it's basically a way of cutting through chaos and competition, and developing a clear national healthcare IT standard so that patients medical information is more portable and accessible. We're developing the technical details and marketing. The point? It's going to be a patient-led effort to organize healthcare. Remember : The patient is the boss. Ignore them at your own peril.

4. Confusion - Meaningful Use should be ready soon, and the political landscape is shifting RAPIDLY. The Beacon Communities funding opportunities will be forging new healthcare landscapes and political alliances that nobody ever thought possible. While all of this is promising, how it will actually pan out, and who will not be able to keep up, is harder to predict. Should be an interesting year.

5. Transparency - I see healthcare as needing to become more transparent - The patients are demanding it. Prepare to open balance sheets, have frank conversations that you never thought reasonable, maybe even (gasp!) doctor/administrator/patient partnerships to help build a better community. With healthcare reform in the air, partnerships will be crucial. If your organization isn't politically nimble enough, or your C-suite doesn't get energized on this, the next few years will get more difficult.

6. Healthcare shortages - While most of the healthcare reform seems to be focused on proving more access, little else other than HITECH has any muscle to improving efficiency or costs. As the baby boomers age, we don't have enough resources to provide the care they grew up with. The current healthcare bills don't address tort reform, and in my opinion both the House and Senate bills lack the muscle to turn around our current system. In my head, the bills are like a tiny parachute trying to stop a car from hitting a brick wall. The problem : Some people will point to the bills (tiny parachute) as the "reason the car hit the brick wall". A bigger parachute would help, but in our current system we don't have the political support for that. I expect the "give more access and don't fix the efficiency" approach will be a problem. Be ready for a lot of people to point to the tiny parachute as the reason the car hit the wall.

7. Patient-led reform - As I described in #3 above, the patients are our bosses - Ignore them at your own peril. I'm very impressed with the ePatient initiatives - The patients are figuring out why healthcare isn't meeting their needs - We're all too busy competing! (It's important that they know - They're the boss!) I anticipate the ePatient movement will continue to grow as social media allows them to organize and discuss their beef with modern healthcare. Look for the strong leaders in this movement to accomplish what government and insurance companies and healthcare can't. ePatient leaders also help educate the many, many people who have strong opinions about healthcare reform who actually have little actual experience with healthcare. If there is one place healthcare reform can happen, it's in the ePatient political arena. If I had to fix the nation's healthcare, I would look to some of these people to help lead the political movement, and partnerships between them and front-line clinical staff will be crucial. They have political clout nobody else has.

That's it for now - Hope everyone had a good 2009, and let's all work together to make our good healthcare system even better in 2010!

Thursday, December 10, 2009

Flower Power

So a few months ago, myself, and two of my healthcare IT colleagues, Kipling Morris and Nicholas Boisjolie, were sitting around discussing, "Why don't we share information effectively in healthcare?".

As we traced down the multiple reasons, they boiled down to :
1. Government regulations
2. Poor implementation of current healthcare IT technology (many hospitals lack the informatics support to use their EMR well)
3. Competition between EMR vendors.
4. Competition between hospitals.
5. Competition between doctors.
6. A lack of a common standard technical "Esperanto" to let the data flow.

Google Health and Microsoft Healthvault have "cloud-based" EMRs (generally called a PHR - Personal Health Record) - And there are SOME hospitals which transfer their data to these, but it's mainly because Google/Microsoft developed partnerships with these particular hospitals, and invested heavily in developing electronic interfaces.

Still, these required a significant effort to get these places up-and-running. And the rest of us? We would still hypothetically have to send our paper reports to a scanning company who will then make it electronic and transfer it to Google Health / Microsoft HealthVault.

Even though there are a handful of common protocols (.CCD - Continuity of Care Document) and .CCR (Continuity of Care Record) - Most EMRs don't have a standard way of sending the data to these PHRs.

So Kip, Nick, and I were talking about the lack of communication, and how it impacts patient care. We are working hard to improve this, but it seems to be an uphill battle, frought with issues :
  1. Political issues
  2. Financial issues
  3. Educational issues
  4. Technical issues
  5. Regulatory issues
  6. Clinical issues
So we then wondered - Suppose we even DEVELOPED this electronic healthcare "Esperanto" - How would we get all hospitals to start using it?

(If I were a patient, I would want a hospital that spoke this language!!)

So then we wondered : "Why don't patients ask for this?"

The obvious answer : Patients know there is difficulty coordinating their care electronically - And they want better - They just don't know how to help a hospital do this better. (The technical standard to do this would be quite complex!)

So then we wondered : How can a patient ask a hospital to use a particular electronic standard?

And then we thought : What if we gave a NAME to this technical standard - So that a patient could ask for it?

Then we started to imagine : What if Wilford Brimley had a commercial on the Superbowl, where he talked about a hypothetical standard for information interchange : Flower.

"I almost had a medication error because my primary doctor didn't know what my cardiologist had just ordered... And then I almost had an extra echocardiogram in the emergency department because they didn't know what my cardiologist had ordered. But now, with Google Health, powered by FLOWER, all of my doctors can trade their information easily!"
This would introduce the American patient to some concepts :
  1. Medication errors happen because of poor information interchange.
  2. Extra tests happen because of poor information interchange.
  3. Flower is a way hospitals could trade information better.
  4. Sharing information better could improve their healthcare.
So then, we imagined : What would happen if patients started asking for Flower by name :
"Dr. Stanley, does your office speak Flower?" "Dr. Stanley, does your hospital speak Flower?"
  1. Patients would suddenly show up asking for Flower.
  2. Front-line doctors would suddenly start asking administrators about Flower.
  3. Hospitals would start asking their EMR vendors about Flower.
  4. EMR Vendors would suddenly hear a lot about Flower.
  5. To remain competitive, EMR vendors (even legacy systems) would need to speak Flower.
I shared the idea a bunch of times on Twitter, with almost nobody noticing, but it was during a particularly passionate blog thread about patient care where I re-posted it, and suddenly, the idea caught on.

So, it appears I've launched a healthcare technology revolution.

For it to be successful, however, this has to be patient-focused.

We've already given it the formal Twitter hashtag : #hcflower

Keep your eyes peeled - We'll see where this goes...