Healthcare Transparency: Take a Page from Safeway Playbook

If the grocery industry can do it, so can we...(Washington Post)

Safeway lets you count calories - online - on items purchased with your Club Card.

The FoodFlex program will also recommend healthier choices if you pick up, say, five pints of Ben & Jerry's in a week.

Now, I don't expect Safeway will become every woman's personal nutritionist (although I'll be shopping there more often when Stateside), but I do see all sorts of interesting implications in the program...namely that the store is going direct to the consumer.

And the program brilliantly encourages me to be a more loyal customer by giving me access to something I want - information that will help me achieve my personal wellness goals.

Safeway takes a big step in facilitating personal management of our caloric intake by providing nutrition information based on purchasing behavior. Draw your own parallels to the hospital industry.

Get more info from Safeway here. Sign up for FoodFlex here.

Docs, consumers, see anything you like? Maybe we're drawing closer to a transparent era of integrated health management after all...


Disruptive Innovation: Do Healthcare Administrators Have What it Takes?

Tuesday VC Brad Feld described his experience with the Clear airline security expedition system on his blog, Feld Thoughts.

The post is interesting for several reasons. First, Brad's the only person (out of an estimated 100,000 customers) I know of using the $128 system, and the only blogger I've heard detail the actual process so transparently.

Second, Brad points out Clear is a disruptive innovation that allows him to get through airport security faster not because of its tech (or material-based innovation), but because it allows him to CUT STRAIGHT TO THE FRONT of the TWA security lines (a method-based innovation).

Now, is Clear's disruptive innovation good or bad?

The answer is both of course - there's not usually a black/white in innovation (subliminal message - Google debate, Google debate).

Like most other advances in process and systems, Clear's brand of innovation is good for some (Brad, who scoots right through after his retina scan) and bad for others (passengers already less than pleased with security measures who see this guy escorted to the front of the line).

There is, however, an alternate example of disruptive innovation in the airline industry that many consumers would classify as bad for most -US Airlines introduces the groundbreaking new $25 charge for a second checked bag.

According to the airline, 8 percent of passengers check a 2nd bag, and the policy will help offset rising fuel costs. Is it worth the customer service hassles that will ensue to execute this particular brand of disruptive innovation? Only time will tell - the policy goes into effect on flights May 5th.

It's easy to pick and choose examples of disruptive innovation from outside our industry, but let's take a closer look at who's leading the charge in healthcare.

Despite the aggravated, inflamed state of the US system, there are pretty decent examples of disruptive innovation within the industry (the retail clinic movement, specialty hospitals, social 'health' and medical networks).

The latest Forbes Magazine issue is all about healthcare, complete with a cover piece depicting a man in scrubs escaping from an ED accompanied by the headline "Stop That Patient!"

The magazine's approach in this issue represents a disruptive innovation in itself - all the articles are geared towards consumer issues (best hospitals, how to protect yourself, top 10 medical mistakes) rather than providers or star hospital players.

The issue includes a valuable piece "Bad Medicine," by David Whelan, advocating for specialty hospitals as consumer choice vehicles. Thanks to Bob Laszewski over at Health Care Policy and Marketplace Review for drawing attention to it.

First read the article, then answer the following questions.

Is your hospital's current innovation program more like Clear or like US Airways new policy?

Is it true that hospital administrators don't

Do physicians have the market cornered?

Do you agree that "Physicians innovate in health care. Hospital administrators do not?" (Dr. Blake Curd, quoted in "Bad Medicine," Forbes).

The complex answer, of course, is that disruptive innovation within an established hospital biosphere involves more than one subtype of innovation, and requires more than one professional designation to make it work.

Many can start a new entity by responding to what's 'broken' in our current system. Few can take what we've got and fix it at a site level.

Total market innovation requires repeated instances of BOTH fixing what's already broken (hospital by hospital - handwashing improvement campaigns, etc.) and also birthing organizations that seize competitive advantages with new Health 2.0 business models.

Industry innovation will succeed only with repeated instances of disruptive innovation that drive competition by departing from an established delivery framework, whether this happens inside an established hospital or via a startup sector.

For disruptive innovation from within, administrators have to first commit themselves to being disruptive innovators, accepting that there will be 'good' and 'bad' outcomes, ranked according to how different stakeholders classify outcomes in a very personal way.

Second, administrators must coordinate all types of innovation (and involved decision-makers) - the really tricky part.

Instead of classifying an administrator's job as 'innovation manager' or 'innovation leader,' efforts may be better defined as innovation optimization (hat tip to Kal).

Doblin's theory of innovation states there are 10 types, but places those subtypes into 4 (dry) major categories: Finance, Process, Offerings and Delivery. Tidd's theory also breaks down innovation into 4 subcategories: Product, Process, Positioning, and Paradigm. For further reading, Miguel Cornejo Castro has a great post on the topic here.

In the hospital setting, we might reframe the four major categories of innovation to reflect our mission. The quartet includes:

1. Material innovation
2. Method innovation
3. Management/leadership innovation
4. Medical/care innovation

There's a 5th type of innovation, too often hidden and underlying all the other types, that I'd argue may be most important for the success of internal disruptive innovation - motivational innovation (click the link for an amusing example), or "movement" innovation (click here for a more relevant industry example).

Motivational innovation provides the impetus to move out of an inert state - "business as usual."

In order to optimize creativity, harness innovation to plan and motivate the organizational hive to execute, administrators cannot design disruptive innovation strategies in a vacuum.

Administrators (and Boards) constantly undervalue how differently constituencies within the healthcare spectrum will prioritize innovation efforts. An awareness of how different sectors value the four different types of innovation above creates greater ability to enervate for change efforts.

There is no quicker way to ensure disruptive innovation's failure than to design a top-down strategy.

We pay lip service to physician relations, customer service units, nursing councils, etc., but tend to gather input from these groups only at low rungs of the innovation-design ladder.

Physicians will place medical/care innovation at the top of the ladder. Quality and safety depts. may put method innovation first. COOs, CIOs, and purchasing may put material innovation at the head. Administrators may place an emphasis on management innovation.

Although I don't agree with Dr. Curd that hospital administrators don't innovate, I do think the profession gets a bad rap for spouting off innovative goals that never ripen to full fruition. Too often benefits of an innovation initiative are not realized in the hospital setting.

The most important thing for hospital administrators to remember about innovation?

Disruptive innovation without execution is a crime against the organization.

Although innovation shouldn't be solitary practice, it's the hospital administrator's responsibility to facilitate execution.

So the question is, DO healthcare administrators have what it takes to coordinate and cultivate a culture of innovation, and optimize execution? Not by ourselves we don't...

Watch the progress of the SPIRIT campaign over at BIDMC for one organization's answer.


Medical Data and Privacy: Make it All Public?

Docs - are you more concerned about patients developing their own EMR/PHRs via Google or Microsoft, or about pharma reps surfing your insurance claims for DEA drug ID data to discern your Rx patterns?

Consumers - same question...

The privacy arguments about Google Health's trial are the same old issue, different product.

Like I said, give me a program that's already accessible by various constituents (hospitals, patients, physicians), like MSWord, and a thumb drive that I can pull out of my laptop and carry on my keychain, and voila. Why haven't I already done this? It's a pain in the hindparts, and I'd have to encode the data somehow in case I lost my keys.

I would far rather use a program developed for me, the lazy consumer, than create one on my own. If I could sign up for an independent trial (not linked to a provider/facility) with Google, would I do it? In a hot minute.

I'd even be willing to pay Google for it, say, 10 or 20 bucks a month, which allows them to increase revenues over and above their uber-successful ad driven model. AND I'd agree to watch 1-3 targeted ads that pop up right after my login page.

In fact, one way to subvert concerns about the release of private health data would be to put it all up here, on my blog. My complete medical history. The question is, am I (or any other blogger for that matter) brave enough to do that without the protection Google's program affords?

Changes the face of the debate a bit, doesn't it? Now simple password protection seems like a whole lot of safety...


Mickey Mouse & the Military: Disney Institute at Walter Reed

Great article by Steve Vogel in The Washington Post here about the Army's $800,000 contract with Disney's service best-practices arm.

I've written about Disney and healthcare before - here, here, & here.

While it might seem a bit of a mismatch to get military medicine in bed with our most beloved animation, the Disney Institute has been quietly bringing Walt's brand of magic to hospitals for years. They've also tutored the FBI and CIA, and the Navy medical corps.

If you're a new employee at Walter Reed Army Medical Center, you're not just encouraged to think of medicine as a customer-service business - you're REQUIRED to attend a 4 hour "Service Disney Style" program, for which you can even earn CME and ACHE Category II CE credits.

Why bring a discussion surrounding Donald Duck's frustration with the healthcare system to WRMC?

The short answer is that the Army is in a bit of a public relations crunch after poor conditions and lax long-term care made headlines last year.

So now commanders, including Colonel Patricia Horoho, want Walter Reed to exemplify the "best experience possible."

It's a remarkably simplistic system with highly integrated symbolic ties, but does it really work?

Creating an easy-to-understand, common vision of service ideals is one of the most complex jobs facing hospital administrators.

If you've never worked at a 'Disney' hospital, one of the biggest takeaways is terminology that helps staff coalesce around reframing the idea of healthcare as medicine combined with customer service.

In Disneyland lexicon, customers/patients are guests and staff are "cast members."

Would you consider retaining the Disney Institute to teach guest service tactics? Or would performance improvement efforts led by a team of cartoon correllaries be laughed right out of your conference room?

an online checklist to judge possible synergies between the Magic Kingdom and managing your healthcare organization's growth.

Even if you decide not to do the "Disney" experience, it might be interesting to hand this tool to your board members and management team and see if everyone really believes you're "Doing Great!"


Make Em or Move Em: Compulsion vs. Incentivization & The Era of Google

I'm in favor of applying the carrot (incentivization) before the stick (compulsory requirements).

Hospitals should get the carrot. Patients should get the carrot. Primary care docs should get the carrot. There are some players that may deserve a few hits with a big stick, but that's a conversation for another time.

Here's the thing about compulsion: When faced with an imposed quota or requirement, we either adopt a "meet em" or "beat em" strategy.

Let's look at a few healthcare examples of compulsion vs. incentivization to see what works (insert your own political overtones here).

Exhibit A: Beat Em Approach - The NHS imposes a '4 hour must treat' time that results in patients waiting in ambulances since they can't come through the hospital doors until they can be triaged within the specified time frame. Result: less ambulances available for emergencies. It's the old ER boarder strategy with a truly nasty twist (Hat tip to the Healthcare Economist).

Exhibit B: Meet Em Approach - Hospital administration does Total Quality Makeover and gets all kinds of things going in the right direction. Hospital staff, seeing efforts to remove bottlenecks are hospital wide, responds and reaches a seemingly unachievable goal. Result: entire hospital operates on a more efficient, macro life cycle, oh, and better patient care.

And my favorite recent example, the Google EHR pilot program in cooperation with Cleveland Clinic patients.

You can read on here, for a simplistic overview, or head over to Health 2.0 for a much more fiery commentary on the subject. Bob Coffield's Health Care Law Blog has great updated commentary and links. The HIPAA Blog is also running with the story.

Here's a PDF summary with a conservative view of the privacy issue from the World Privacy Forum (hat tip to VentureBeat - where David Hamilton has been providing excellent healthcare coverage).

Let me tell you how much more protected I feel now that HIPAA is around (cue crickets)...

Did I feel concerned about the privacy of my healthcare data and records pre-HIPAA? A bit. Do I feel any 'safer' thanks to HIPAA's protection? Nope. Not a bit.

And it's a pain to fill out multiple forms saying my docs can release information to my designated advocate in the event of an incapacitating injury/illness.

Not to mention anyone with a fax machine could probably fake a pretty convincing HIPAA form and get access to my medical records.

HIPAA regulated or not, why will Google's experiment work? It's offering consumers something we want, something we've asked for. They're dangling a pretty big carrot.

The easy comparison is that it's like doing your tax returns on the Internet and online banking. Initially, TurboTax and other web-based financial services providers met with all kinds of nasty press and consumer concern regarding the safety of putting our most treasured data online.

I bank online. Do I worry about whether someone with nefarious goals could access my bank data? Yes, of course, a bit. But the benefits of online banking outweigh the risks, which is I why I choose financial services providers based on their online utility.

I'll do the same with an EHR or any H2.0 tech offering, for that matter, just as I do before purchasing any good or service - look at the risks, and examine the benefits. Then I choose to buy/use the program (or not) based on what's in it for me (the carrot).

Online banking literally gave us access to our money online. Google's program will give us access to our healthcare online.

Why do I think we're ready to handle it?

In a market where it is difficult to discern the costs of services, where we're divorced from the actual financial impact of our healthcare 'purchasing' decisions, we'll take what we can get.

Lacking other data, we'll begin to make decisions about what healthcare goods and services we want based on the little information that IS available - our patterns of use and limited hospital/doc quality and ratings data. Oh, and plenty of press coverage, which is archived and searchable with, yep, Google.

In other words, we'll go with the little information we've got, and Google is going to give us as much data as we can swallow (it'll be up to us to make sure Dr. Reece's version of Health 6.0 doesn't happen).

Google's program will connect access for the two broadest portions of the toddling Health 2.0 market for us (consumers and providers) and help it mature at an astronomical rate, as they did with search, access to satellite imaging, etc.

Consumer adoption of Google's health toys will drive the demand side of the equation - but who will drive the supply side? Hospitals? Providers? HIT firms?

We're all talking about EHR and PHR systems that run on new, proprietary, custom-designed software - there's got to be a way for some tech genius to think up a format that uses programs most of us already have.

Give me a thumb drive and a document format (like MSWord) that would run on OS's like Windows, Ubuntu, or Leopard so docs could read my data at any provider site - then I might really feel my healthcare data is transferable and 'safe.'

Are you offering consumers the carrot or the stick? Pick one, and quickly, before someone else dangles the carrot that siphons off your patient population.


Total Recall: Med Device Makers Protected & Your Recall Process Primer

A top story this morning is the Supreme Court ruling shielding medical device makers from litigation in the course of a recall. ("Supreme Court Shields Medical Device Makers").

In an 8-1 ruling, the Court decided medical device manufacturers with FDA approved devices will be immune from personal injury litigation. If a device is made improperly (violates FDA specs), individuals may still bring suit.

This litigation will have lasting impacts on our industry, but navigating exactly what will happen, and how hospitals should include recall procedures in strategic planning, is a bit tricky.

How do the long term effects of this ruling, combined with recent Heparin syringe and balloon catheters, affect hospitals?

Patients, insurance firms, and hospitals will be left, once again, holding the tab...for removal recalls, patients will come back to the hospital for replacement of faulty parts, which requires another surgery and compounds their risk.

Duplicate surgeries due to med part recalls also, of course, significantly compounds the costs of original procedures.

Must hospitals start forecasting a certain amount of recalls per year and projecting costs accordingly? Should future budgets include extra OR time, plus additional surgical, scrub nurse, and anesthesiologist fees to cushion the bottom line in case of a massive recall?

But I'm getting ahead of myself -
let's take a look at how recalls actually work.

According to the FDA, a recall can encompass different types of actions, including:

  • Inspecting the device for problems
  • Repairing the device
  • Adjusting settings on the device
  • Re-labeling the device
  • Destroying device
  • Notifying patients of a problem
  • Monitoring patients for health issues

To see recalls for the past 5 years or so, click here to access the FDA Center for Devices and Radiological Health Medical Device Recalls List (Class I Recalls).

On this list, the FDA posts "
information about the most serious medical device recalls. These products are on the list because there is a reasonable chance that they could cause serious health problems or death."

Recalls are placed into 3 categories, according to "potential risk to public health: "

Class I = High risk
Class II = Less serious risk
Class III = Low risk

A recall is either a call for "correction" or a call for the dreaded "removal." (From the FDA site):

Correction - Addresses a problem with a medical device in the place where it is used or sold.

Removal - Addresses a problem with a medical device by removing it from where it is used or sold.

Here is the action a medical device manufacturer issuing a Class I Recall must take, according to the FDA. Language has been pulled directly from their "how to" guide.

Please note the lack of tight guidelines about who is specifically responsible for contacting involved patients and paying for repair/replacement procedures.

"A Class I recall is the most serious type of recall. In a Class I recall, there is a reasonable chance that the product will cause serious health problems or death.

In a Class I recall, the company:

  • notifies their customers (i.e. distributors or vendors), and directs them to notify the intended recipients of the device (i.e. other vendors, hospitals, nursing homes, outpatient treatment facilities, doctors, or individual patients). The notification usually contains the name of the device being recalled, identifying lot or serial numbers, the reason for the recall, and instructions about how to correct, avoid, or minimize the problem. It should also provide a telephone number for questions related to the recall.
  • issues a press release to notify the public, if appropriate to minimize health consequences.

FDA may also issue its own press release or public health notice."

A separate list contains 'all' medical device recalls of FDA approved medical devices (including the less severe Class II and Class III recalls). You can search the database here.

This doesn't feel like very thorough coverage, and it isn't.

For medical device manufacturers, the FDA has published a more extensive "Guidance for Industry" brief (DOP: 11/3/2003), detailing what to do to set a recall in motion. It also details the exact responsibilities a medical device manufacturer holds in the instance of a recall, including how it must communicate with customers, i.e. hospitals and patients.

You should read it, especially if your title starts with a C or your professional license reads "MD." So should the hospital's legal eagle team. So should the Board. So should the marketing and communications department, the surgical director, etc.

With the FDA data above, hospital teams still need to take significant planning steps to determine how a recall will be handled and minimize its overall effects on patient care, while maximizing the benefits of services available to individual at-risk patients.

Food for thought:
  • How many recalls should executive teams reasonably predict? One a year for cardiac devices, one a year for ortho, one a year for 'other' med devices?
  • Have your leadership teams met to discuss what they feel the hospital's responsibility should be in a recall scenario? Remember this is an important ethical issue, and physicians & nurses will have strong and valuable input. You might also consider asking patients (trustees or interested volunteers) to weigh in.
  • Are your current quality control, Six Sigma, purchasing, and OR teams keeping track of the number of recalls that affect its patients annually and tracking this trend's impacts on the organization?
  • Does your organization have an FDA contact person responsible for tracking recalls? *Subscribing to the FDAs Class I recall list is an easy way to get started. In addition, this person should be in contact with the FDA Recall Coordinator for your state - find them here.
  • Is the position responsible for tracking recalls logically housed in the QCI department and has an action plan of internal communication and coordination been established that goes into effect when a recall is announced? (i.e. FDA Coordinator calls VP of Communications, CEO, who calls BOD Chair, etc.)
  • If your staff deems it a responsibility within the scope of your mission, who in your hospital is specifically responsible for contacting all patients identified as being at risk after a recall? (the treating physician? the surgeon? the patient services office?)
  • Is the hospital tracking how many patients affected by medical device recalls respond to notification and report to the hospital for device repair/replacement?
  • Will the hospital need to start tracking how many patients do NOT seek medical care following a recall but require a later procedure due to a faulty FDA-approved device?

The closest business case parallel I can think of is the automobile industry.

When a part for our Honda Accord is recalled, we receive a notice (addressed to us personally) and we take the car in to a licensed Honda dealer for repair/replacement.

This dealer has entered into an agreement with Honda that means they receive incentives for selling the brand, and can better cover the staff and facility costs associated with a recall.

But what about hospitals?

Our industry has not traditionally entered into exclusively 'licensed' deals with a single med maker or equipment provider - you don't see "Licensed Ogee Ortho Pain Pump Hospital" signs up in the lobbies of our finest hospitals, for example.

Med device makers don't control hospital branding the same way automobile manufacturers drive branding in the auto industry, thank goodness. Medical device makers don't 'own' hospitals - we aren't their exclusive dealerships.

We have tended to use devices our purchasing departments, surgical chiefs, and administrators select for utility, rather than to accelerate branding/marketing aims.

However, this doesn't mean some hospitals aren't already quietly negotiating licensed deals with medical device makers, as they do with insurance companies.

This also doesn't mean the opportunity to create such relationships may, in some instances, bring to bear a very attractive cost efficiency - if a hospital orders scalpels from only one provider for instance, or participates in a group purchasing plan like the PRIME program offered by the Maryland Hospital Association.

Imagine, for example, if your facility only purchased stents from one firm, and entered into a licensing agreement to provide their product exclusively.

This firm orders a recall. All the hospitals 'licensed' with this med device maker must call patients back and deal with the administrative, scheduling, cost, and communication challenges that significantly alter each affected individuals continuum of care.

All the hospitals who entered into an agreement with a competing maker can breathe easy - they're safe...this time.

It's the implications of escaping "this time" and the larger picture that's important for hospital administrators to consider.

More medical devices in play on the market means better quality of life for many, but also means hospital teams will face an increasing incidence of recalls.

As a patient, I'd like to know my hospital/surgical team is going to work harder to notify me of a recall that affects my health than my car dealer will when something in my Honda needs fixin'.

As a consultant, I'd like to know hospitals are proactively establishing procedures that they'll put into place in a recall situation.

As a future hospital administrator, I'd like to know if your hospital is entering into licensed agreements with medical device manufacturers that contractually details who bears the cost burden in case of a recall.

What is your team doing to get ready for an era of Total Recall?


Calling All Hip, Sage Hospital Administrators: Lisa Haneberg Wants to Interview You

Lisa Haneberg of Management Craft is looking for a few hip, sage managers and, ahem, a certain age to interview for her next book.

Here's her call for participants:

Are you Hip and Sage?

Posted: 19 Feb 2008 09:20 PM CST

I am looking for a few smart and interesting folks to interview for a book I am working on called

Hip and Sage: A baby boomer's guide to staying hip in the workplace.
Get nimble and allow your inner sage to shine in new ways.

Hip and Sage - cool title, don't you think?

Hip and sage people are wise and revered by young and old people alike. They actively seek to work with younger generations and welcome change and progress. Heck, they often drive change. They ask lots of questions and are always eager to learn and grow.

Are you hip and sage (be at least 50 years old, please)? If so, would you be willing to answer a few questions? Send me an email (lhaneberg AT gmail DOT com).

Do you know someone who is hip and sage? If so, please share this request with him or her and suggest he or she drop me an email to arrange for an interview (lhaneberg AT gmail DOT com).

I would also like to hear feedback from professionals in their 20s and 30s. Please send me an email (lhaneberg AT gmail DOT com) answering the following questions:

1. What are the biggest mistakes older managers make in the workplace when they try to get the best work out of younger workers?

2. What qualities do you most admire in your older co-workers?



Eat Your Raisin Bran: Transparency Counts for Nada if You Don't Follow Docs Orders

Results from a Medscape survey indicate less than a quarter of patients with hypertension followed docs orders and stuck to a recommended high-fiber, low-fat diet (results here).

Hmmm...my long term cardiac/BP health or another Cinnabon?

What good does quality/cost data do us if we don't follow a prescribed treatment plan?

Consumers cannot keep expecting to deliberately sabotage our long-term health for short term gain and have the miracle of modern, multi-billion dollar American medicine fix our mistakes. Over. And over. And over.

Something's got to give. (Primary care? Emergency room waits? Medicare caps? Episodic, costly end of life care in hospitals but not at home?)

Demanding transparency in our healthcare system means we must also be transparent about our role as purchasers of goods and consumers of services - we must take some responsibility for our own wellbeing, and how our decisions affect our health.

End of story, right? Baaad patients. Baaad consumers. Follow your doctors orders!

Unfortunately, no. Docs are also giving up too easily.

In concert with the recommended diet plan, only 15 percent of the Medscape respondents followed-up with patients at 1 month, almost half followed up at 3 mos, 9 percent at 6 mos, and only 6 percent followed up a year later.

Now, the survey is fraught with challenges - a small sample size (76 self-reporters), no info on how many hypertensive patients switched out of a participating docs practice within that year mark, etc.

Still, 23 percent of docs reported NOT following up with patients after prescribing a dietary change.

Why are outfits like Jenny Craig so popular?

Because dietary change is challenging. Lifestyle changes are tough.

Aggressive follow up by caregivers is needed, as are repeated communications about the importance of sticking to the plan (and the benefits of doing so).

Docs -be transparent with us about the gains and risks we face as a result of our dietary decisions.

Consumers - if we're calling on hospitals and docs to be transparent and reveal complex outcomes data (infection rates, etc)., we damn well better get on board with being transparent about our difficulties with following treatment plans, and discussing the importance of following 'simple' non-hospital based treatment plans.

And docs, it's ok to remind us, more than a few times, every time you see us, if need be, why this is important. After all, transparency means we're partners in care decisions.

According to this survey, both docs and patients get a failing grade.

My gym used to have a lump of disgustingly congealed plastic that was equivalent to just five extra pounds of body weight sitting at the front desk. It was a very good deterrent. Usually I had a strange craving for a Subway Veggie sub after passing the desk after a workout.

If my doc held up 3 of those babies (or more) and told me that was what I was carrying around my midsection, I may be more likely to rethink not choosing that bowl of Raisin Bran.

Then again, maybe not.

Part of being a consumer means dealing with the consequences (net gain, net loss) of my purchasing behaviors.

Unfortunately, in the US we tend to bail out consumers who make poor decisions, rather than reeducating them on how to make better ones.

So what plans, as healthcare providers, administrators, and practitioners, do we have in place to educate consumers on how to make better choices?

How do we open the conversation with patients surrounding a proactive engagement with their health management processes?

How do we keep the conversation going, even when it's time to talk tough?

One step at a time...and transparency is the inevitable next round in healthcare market development.

Transparency is the 'next step' in allowing patients to feel more empowered to make healthcare and wellness decisions based on the items, goods, and services we want and need.

Health 2.0 is helping us figure out where we go next.

But if we can't communicate openly, talk transparently about data, outcomes, expectations, faults, and failures with each other, as patients, as providers, as partners in care, what good is all this data?


"Don't Smoke" Health Warnings - Dutch Style

No, I don't smoke (except for the occasional cigar) - I was picking up litter around the neighborhood this week when I saw this cigarette pack.

Normally I don't really pay attention to trash, but when I grabbed this I had to slow down to read the box (this one's for you WhiteCoat).

Now, if you saw this on a pack of cigarettes, you might think twice before indulging.

But it's the warning on the back of the box that really grabs your attention (especially if you're of the XY chromosomal variety)...

There you have it folks. Don't smoke, or suffer the (severe!) consequences.

Now, if only they would put similar warnings on McBypass Burgers...

PS - Notice the brand name? L&M Quality American Blend - coincidence, or stroke of evil marketing genius?


TGIF Roundup

The sun is shining in Delfshaven. Bulbs are sprouting, and I'm thinking about spring cleaning (gulp).

In honor of the urge to feather a spring nest, here are a few links to welcome the season.

First, if a trip to Ikea is on anyone's list this weekend, check out ikea hacker.

Any site showing how to morph a Sniglar baby changer into a Blue Man Group-style instrument deserves a link on the blogrolls.

Are any areas of your hospital undergoing a facelift? Take a page from this California McDonalds, which incorporated feng shui elements designed by Dr. Chi-Jean Liu and Long Beach design firm JBI Industries Inc.

Speaking of California, if you'll be anywhere near Palo Alto Feb. 22nd-29th, check out the impressive Stanford Entrepreurship Week lineup. (Hat tip to Guy Kawasaki).

Programs include a free "Innovating For Health - BYOB (Bring Your Own Brain) Program" that will harness the wisdom of crowds to tackle pediatric obesity here. Innovating for Health kicks off a 3 day competition, with the winner announced at the Closing Ceremonies.

Oh, and remember not to be overly familiar with your patients...no first name basis unless you're invited, especially if you're a white male physician (sorry guys).

For bright, sparkling bathrooms: Use Tang to clean toilets. No really. Now wonder Muz's Famous Spiced Tea (equal parts Tang and powdered concentrated ice tea mix) makes my stomach hurt...

And if you have any umbrellas gutted by tough winter weather, the ingenious readers of ReadyMade Magazine provide ways to recycle those lollies here in this issue's MacGYVER challenge.

Luggage bent out of shape from last year's spring and summer conference rounds?

Use the next ReadyMade challenge as impetus to repurpose crushed carryons. Send photos or projects to: MacGyver Challenge, 817 Bancroft Way, Berkeley, CA 94710 or articles@readymademag.com. Deadline: March 17th.

And speaking of being bent out of shape, this episode is horrific.

Unless a subject is threatening the lives and wellbeing of those around him, dumping a person out of his/her wheelchair, or removing other mobility aids forcibly without providing medically adequate support, constitutes an inexcusable act of violence.

Even more worrisome is that this instance involves a Florida Sheriff's Deputy. Searching a perpetrator who is being booked is commonplace - the way in which this PD employee went about the search is (hopefully) anything but. Here's the video.

Rep. Steve Kagan wants to end discrimination in healthcare (or rather, managed care) - perhaps the good Congressman should look at other areas, including municipal services. Let's make sure each community has schools, playgrounds, hospitals, and other facilities that are fully handicapped accessible (I'm still amazed many hospitals haven't made all doors easy to open while using wheelchairs or crutches).

And finally, polish up that elevator speech.

If your employees are leaving, they're not leaving the job - they're bailing on a difficult manager. Here's how to increase employee commitment, by way of Harvard Business Online.

But in a hospital setting, does an excellent manager really make all the difference if you've just worked double shifts, seen so many patients each is a blur, and are fighting HMOs for reimbursement? You can ask the coach here: askthecoach@hbsp.harvard.edu.

Or you forget the article and just be the kind of boss who sets up a Facebook page to help fund a music therapy program, like the Beth Israel Deaconness Medical Center's Healing Music app.

So what if it's only raised $360 so far? That's enough for a few more hours of healing music therapy for patients. It almost makes me regret deleting my little-used Facebook page.

Speaking of social networking, I was considering going to the movies with friends this weekend, but the real news is more entertaining.

If a chunk of space junk falls in that blooming garden early in March, don't blame the local PD.

You can, however, thank Uncle Sam for the new yard art, courtesy of NASA, the Joint Chiefs, and bus-sized satellite US 193, currently on a collision course with Earth.

Happy weekend all!


Top Gun Hospital Program Brings New Meaning to the Phrase "Frequent Flyer"

Provena Health hospitals are learning 'top flight' maneuvers from LifeWings Partners LLC, headed by former TopGun instructor Stephen Harden.

Click here to read coverage by Leslie Mann for the Chicago Tribune.

The 3 year old company is building an impressive roster - they've already worked with 75 H/HC facilities.

Provena service line administrator Joan Cappelletti says the LifeWings method is useful "when her department has shift changes or when a patient is moved from one area to another, such as from an operating to a recovery room."

LifeWings' website claims use of the system can help hospitals realize a host of benefits:

Here's some more info on reducing wrong-site surgeries.

The given figures for reducing nursing staff turnover are even more incredible - ICU turnovers reduced by 23 and 35 percent?

Where can I see these guys in action?!


"Peeling Back the Veil of Ignorance" - Health 2.0 Featured Today in VentureBeat

Very interesting coverage by David Hamilton (2.11.08), who voices good criticisms re: enthusiastic estimates of Health 2.0's change capabilities. (Health 2.0 bubble anyone?)

Click here to head over the VentureBeat and read the full text.

Hamilton makes a great point: Health 2.0's unintended side benefits, including revealing corporate & geographically influenced cost differentials for the same exact course of treatment, may be the most change-worthy byproducts of a slew of recent startups.

By attempting to increase the transparency of the US healthcare system for the individual consumer, patient-empowered sites also increase transparency for the general population.

And of course, for policy makers, if they bother to follow along.

Hamilton quotes a small, localized change:healthcare study where researchers called 6 chain pharmacies in 4 different areas of Nashville to get prices for 6 prescriptions, including Lyrica, Lipitor, Ambien, and Singulair.

Findings? Kroger charged 2x more for Singulair in a different part of town. RiteAid charged 2x more for a Lyrica fill than Walgreens.

Another study gathered pricing data for a strep test.

Shocker: estimated costs ranged from $50 to $295. Five of the thirteen providers change:healthcare called, listed by a major insurance co., were either listed incorrectly or couldn't/wouldn't provide pricing data.

Read the article, and then take a look at change:healthcare.

Next, ask yourself if having this type of information readily available wouldn't change the way you personally make healthcare purchasing decisions.


Medical Records Make Wired Magazine's "Why Things Suck" List

Not exactly something to be proud of...

Click here to read the summary.

Unfortunately prescriptions, infertility treatments, and "knees and backs" also make the list.

Are American Hospitals Suffering From Technolust?

In Alexandria, VA, TC Williams High School administrators thought they'd increase staff satisfaction by installing all the latest gadgets, including mobile pointers that allow them to change computer views without wandering back by the desk to click a mouse.

No such luck.

Teachers are concerned a "technolust" and DTA (desire to acquire) philosophy is overshadowing the larger mission of the school. Some are concerned machines are dehumanizing the 'craft' of teaching.

Patrick Welsh, a TC Williams teacher (for 30 years) and author of the Washington Post piece, defines technolust as:

"a disorder affecting publicity-obsessed school administrators nationwide that manifests itself in an insatiable need to acquire the latest, fastest, most exotic computer gadgets, whether teachers and students need them or want them."

Sound familiar?

Are American hospitals suffering from technolust?

Are we purchasing the latest 45689 slice scanners whether doctors and consumers need them or want them? Are we too adopting technology just for the sake of technology?

Welsh says "Principals and other administrators may live off headlines, but teachers live off whether their students learn."

Hospitals live off whether patients recover, not headlines.

It's great when hospital administrators implement improvements and initiatives that help patients recover, but for god's sake - give us the quantitative data already.

Hospitals have gotten very, very good at sharing qualitative patient profiles (personal success stories) as proof that the latest tech initiative was worth the investment - for at least one person.

But what's the institutional ROI? Why is that tech investment important for me as a prospective patient? If you purchase, for instance, 50 Nintendo Wii's for the rehabilitation medicine department, I want to see how "Wiihab" is improving outcomes for stroke, ortho and trauma patients.

As hospitals begin to publish pricing and quality data, this type of material should be included.

After all, if I'm comparing prices on a TKR and your price is significantly higher, I want to see if corresponding tech purchases may be worth the investment on my part.

Of course, this type of extended transparency surrounding tech purchases may provide disincentives for hospitals to offer care outside 'centers of excellence.'

If an administration is pouring money into treatment tech for cancers but I need a state of the art burn center, information about tech purchases and how they affect the bottom line may eventually factor into my decision to select your facility for care - or not.

Bottom line: If you buy the hottest machine, that's not news. If you buy the hottest machine and it immediately improves treatment outcomes for 20% of patients with a specific diagnosis, that's news. Especially if I have the same diagnosis.

Tech for the sake of tech in hospitals shouldn't make headlines. Tech for the sake of healing should.


UK Hospitals Have a "Management Problem"

According to McKinsey, whose analysts have determined that all the NHS needs is some outside HR talent. Oh, and stronger leadership by doctors.

Premise of this study:

"For health care, we...decided to test a hypothesis: that the direct involvement of doctors in the management of a hospital helps to improve its performance."

You don't say?

The article did include interesting comments on the efficiency of hospital performance tracking initiatives...

  • "Hospitals that track performance particularly well...continually monitor key performance measures and communicate information about them, both formally and informally; include the whole staff in these communications; and use a range of visual-management tools, such as electronic display boards, progress charts, and performance scorecards."
  • "Hospitals that track their performance poorly might monitor only a limited range of externally imposed performance metrics, measure the results sporadically, and communicate them solely to hospital executives."
And here's a shocker - apparently managers with clinical backgrounds are better at running hospitals...

  • "Hospitals whose general managers have a clinical background had overall management scores higher than other hospitals did (Exhibit 3). Clinical skills apparently help managers to understand hospital operations and to manage clinicians more successfully."

But they still need to adopt management best practices via cross-vertical pollination:

"The NHS...should look to other sectors, including industry and private-sector hospitals, for examples of good practice in talent management... "

If this research is groundbreaking, perhaps it's no surprise staying in an NHS hospital is as dangerous as bungee jumping and rock climbing...


Tough Love - A New ED Pain Management Model

Valentine's Day is Thursday.

The US emergency room has become infirmary, dispensary, primary care clinic, birth control provider, prison health office, pediatrician, counselor, pharmacy, meal ticket, and yes, there is a life-threatening emergent condition or trauma every so often just to spice things up.

Emergency care professionals in the blogosphere tell us it's becoming near impossible to show patients the TLC they want - issues of legitimate need and, alternately, misuse abound. Crowding in the ED is crowding out timely quality care.

The prescription? Time for some tough love in emergency rooms.

I'm not going to rehash multiple episodes of drug-seeking behavior or abuse of the system's resources in EDs detailed by medbloggers, such as the good docs over at M.D.O.D.

If you want tragically interesting examples of misuse, read entries by EMTs like Emergency Em (calling 911 and then asking the ambulance crew to take you to the ER for a flu shot? seriously?)

We're all spending a lot of time writing about the unbelievable excess use & abuse of the US emergency care system.

One could even argue we've become "frequent flyers" in the blogosphere - reporting anonymously on repeat patients, are we too becoming addicted to getting our chronic cathartic fix without seeking appropriate preventative care, i.e. trying to mend the broken model?

I'd like to propose a new method for ED pain management care and in-house referrals. Code name: tough love.

Here's how it could work:

  • Each and every time ER staff rules out other complications, emergent conditions, etc., and is able to isolate pain management as a primary issue, the ER doc transfers the patient to the pain management or "chronic pain" section of the ED (similar to a Fast Track or Urgent Care setup, with dedicated staff and physical space concurrent to the ED - don't be tempted to put this team in the basement to deter prospective patients).
  • There, the patient is seen by a specialist, a pain management doc/NP who begins treatment by gathering a comprehensive H&P and interview.
  • If (and only if) the pain mgmt ED team determines that narcotics are appropriate, they will be administered onsite or prescribed according to the team's best-practice treatment and goals. Let the pain specialists make the decisions for these patients. Let them see the repeat patients who present with chronic pain and/or pain management issues.
  • In the pain management docs black bag is a list of treatment centers, including dental clinics, county/municipal health departments, etc. Prescriptions for treatment may be doled out in place of narcotics as the team determines necessary. Patients in noncompliance with a previous treatment program referral may find they will not receive narcotic refills via this ED until they are in compliance with a program the pain management team recommends.

Here's what you need:

  • First, you must have a pain management doc on staff. All the time.
  • Second, your ED physicians must be willing to appropriately and efficiently hand off patients with pain management issues as primary complaints. You have to track systemic bottlenecks that block flow, including those to the new department.
  • Third, your administration will have to have, ahem, certain anatomical parts of steel. They have to be able to sell this idea to the Board, the medical team, the support staff, the community, the 'consumer', the media, and bare-everything medbloggers.
  • Fourth, the pain management ED team will quite often see people with 'legitimate' chronic pain issues (migraines, cancer care, etc). The pain management skills of the team must be surmounted only by their high level of empathy. In other words, hire caregivers with people skills.
  • Oh, and the lawyers will have to go over the program design with a fine-toothed comb. I'm sure the Joint Commission will want a look-see as well.
  • And of course if a pain mgmt. patient develops an emergent issue during treatment, they can be quickly transferred to an ER bed (based on triage) for appropriate care.

Who knows if this tough-love program could actually work? The answer is simple: we won't know unless someone tries it.

Maybe it's time we stop blogging about caregivers showing more compassion and customers who take advantage. To some extent, that will happen no matter what we do to address the issue at a systemic level.

Let's show patients a little love by connecting prospective need and a service line that has the opportunity to help those living with chronic pain.

Let's design a system that allows ED personnel to get back to doing what they do best: assessing and treating emergent injuries and illnesses.

And let's build a safeguard into the system so those who abuse the 'open door' ED with drug-seeking behaviors are referred to appropriate care - including treatment and rehab centers.

In other words, let's do something about the situation, one ED at a time.

Of course, this is only a stopgap solution - we still have to fix primary care.

Roll up your sleeves, folks.


When it Rains it Pours

Three grandparents in the family have cancer. One diagnosis is older and involved reconstruction of an orbit. The other two loved ones have been diagnosed in the past month.

Please, prayers for the Health Mgmt Rx. Family.

Read & Learn - New Resources

In the course of reading blogs (largely devoted to HIT, IT, and hospital/healthcare), I've come across some great resources.

With the exception of Grand Rounds, who knows when I might have happened upon these publications, so a big gracias to fellow bloggers for sharing sources.

I save time by reading respective e-newsletters - for some reason I don't feel guilty skimming these and filing articles when appropriate, but if I receive an actual hard copy magazine I'm tempted to read the whole thing in one sitting.

Here are some top picks:

1. CIO Magazine. Drop any apprehension you may feel about the title. Their CIO Insider e-newsletter is packed chock-full of approachable, useful, entertaining, and controversial copy. Plus, some of the best integration of tech news into overall strategy around.

2. Grand Rounds. A rotating summary of blog entries centered around a topic chosen by the blog 'host.' Should be on every healthcare bloggers list (to read AND contribute). Last edition here at Diabetes Mine. Submissions for next edition due to David Harlowe's HealthBlawg - click here for guidelines.

3. Wired Magazine. The coolest. That is all.

4. Associations Now Magazine. Published by The Center for Association Leadership. Great features, crisp editing - features are useful, easy to read, and represent a wide variety of disciplines.

I've also linked to FierceHealthcare numerous times. I've been a reader since the pub started a few years back and the quality is top-notch. A daily must-read. But parent publisher FierceMarkets also has good Sarbox, Pharma, and Biotech pubs.

For more outside the box news, try VentureBeat and NRFSmartbrief, covering venture capital (heavy on Silicon Valley tech) and retail, respectively.


Would You Like Extra Cancer Protection with That Custom Embryo?


And yikes again.

All it takes is 3 sets of DNA...read this Yahoo! News coverage.

Brit researchers, funded by the Muscular Dystrophy Campaign, are using intentional genetic engineering processes to selectively breed out defective mitochondria, in other words, potential handicaps/diseases such as epilepsy, strokes, MR, and muscular dystrophy.

But it's all ok, because they're not touching the nucleus, where "most of the genes that make you who you are" are located.

I feel better already. A retake on the tired old tabula rosa debate for the next generation.

Someone's Listening to Nurses...

Finally. What a state - the birthplace of Starbucks and nursing staffing consensus. Washington is looking great!

With a mom who's an RN and a MIL who's an LPN, I know this Washington State initiative (coverage by Fierce Healthcare) is just a damn good idea in theory.

Of course, many ideas are great in theory - it's that pesky practice part that's tricky.

Washington, however, has the benefit of a dispute resolution group on their side. I'd love to find out the name of that group - anyone got an inside track?

Let's see if Washington Governor Chris Gregoire manages to make her commitment to support nurses stick. Read great seattlepi.com coverage of the Washington State Hospital Association and nursing groups' agreement here.

The move to establish a state repository for best practice safety and quality information is particularly interesting - putting the significant wisdom of nursing crowds to work makes a whole lot of sense.


New Twist on the Hospitality-Hospital Industry Relationship

I'm a little late to the party on this one.

Marriott has taken one of the boldest, large-scale steps to implement integration of an outsourced PHR network. (Who's next? Best Buy? Starbucks? An AMC/hospital group?)

Financially, it makes all kinds of sense: an employer that operates in a 24-7, customer-oriented industry has a lot to gain by simultaneously enhancing employee wellness and reducing costly absenteeism.

Click here to read the Information Week piece.

Marriott's program, designed by ActiveHealth (an Aetna subsidiary), is quite a bit more than a passive central repository for individual health and wellness data.

ActiveHealth's CareEngine system, staffed by 20 full-time docs, proactively monitors the exchange of data between providers and patients.

Employees take an online 'health risk assessment' and the system begins compiling PHD.

The system scrubs clinical info, and compares it to other PHD (claims from physicians, Rx pickup/refill).

If the program notices an error, such as medication contraindication, or can discern a 'better' plan of care, it may send a notice to an employee's physician (via phone, fax, or certified letter -urgent issues necessitate a phone call). Then it copies the staffer on the contents.

Click here to watch a video from ActiveHealth showing how the system works (very basic).

From the Information Week article:

"But unlike some of the personal health records offerings being rolled out by other employers, the system deployed at Marriott also taps into a sophisticated clinical rules engine that looks to avert potential medical mistakes or gaps in care that could lead to serious complications and costs.

When those gaps or potential mistakes are identified by the system, doctors are alerted by phone, fax, or letter with a "care consideration" notification that might recommend the doctor prescribe a different treatment, order additional tests, or make another change to the patient's care. The member employee -- or patient -- is also alerted.

According to ActiveHealth, the employer doesn't get copies of care notices - they receive aggregate info showing, for example, 70% of workers have high blood pressure.

Docs - now you have dictates about how to practice medicine coming from DC, NGOs, Google, patients, AND you have them coming from a third party PHR system.

"The access we have to medical information is broader than most doctors have," says Reisman. ActiveHealth has "codifed" thousands of clinical standards and evidence-based best practices."

And what will Marriott, Aetna, ActiveHealth, and the Marriott employee do if (and inevitably when) a physician determines a change in patient care is not appropriate? Fine the doc? Impose some other sort of penalty?

What sort of liability does Marriott engender when a physician who has not seen their employees mistakenly receives personal health data via CareEngine and ActiveHealth?

What happens if Marriott employees refuse to join the CareEngine program?

Will signing your personal health data over to Marriott and CareEngine's physicians be a condition of employment, like consenting to a background check, for future employees?

It's not just Marriott - ActiveHealth has 100 other corporate clients.

Apparently Marriott's hoping the carrot approach will work:

"Marriott also is developing an incentive plan to encourage employees to complete a risk assessment online and input information into their personal health record, says Berger. "Our goal," Berger says, "is to get our associates to take a more active role in their health."

My HMO already dictates, to some extent, which physician I visit based on partnerships they've arranged. I'm not so sure I want my employer integrally involved in determining the quality of care.

What do you think? Does the CareEngine program seem like a step away from consumer-directed care, or is this a victory for H2.0?

Marriott is giving workers a way to store personal health data but placing an additional layer between consumer and care provider - does this layer hinder or help grow that relationship?


Superbowl XLII Fitness Challenge - Join Me?

Ahh, time for that annual paragon of gluttony, violence, sportsmanship (and the lack thereof), laser-focused, fan-based commerce, teamwork, and triumph that is the uniquely all-American Superbowl. Somebody's going to Disneyland.

Tomorrow, we'll watch the Superbowl with four other friends in Delft (starts around midnight here).

I admit it. Like 36.3% of the viewer population (Retail Marketing and Advertising Assoc. stats), I only watch the Superbowl for the commercials. And, of course, the excuse to eat my annual quota of nachos.

This year I'm going to try something a little different.

During each commercial, I will EITHER do 2 push-ups (not girl-style) OR 5 crunches.

Every other day I do 3 sets of 10 regular push-ups, and 3 sets of 100 flutter-kicks with 50 "hello dollies," so I'm not starting completely from scratch.

If I can move by the end of the game, it will be a miracle, but my lassitude won't be a result of overeating.

Anyone else not working during the game care to join me?

And for those of you working in ERs, may the force be with you and many prospective patients use designated drivers.


Better Than a Golden Ticket...

The chocolate in Holland is pretty damn good, but winning a stay in this Godiva room (cocoa covered walls?!) is better than winning a golden ticket...

I wonder what they'll do if the winner is diabetic?

DC Council At It Again: Latest to Tackle Implementing Universal Healthcare?

You heard it here first, folks.

Councilmember David Catania, who gained notoriety with his sponsorship of the SafeRx program, is gunning for universal healthcare in the nation's capital.

The program, titled Healthy D.C., would be partially funded by govt. subsidies and aims to reduce the district's uninsured population by 12,000.

The fee schedule would to some extent be based on income, and targets DC residents at 200-300 percent of the federal poverty level. Click here for the HHS 2008 poverty guidelines.

Even more interesting is a preliminary list of what services would be covered:
  • Hospital stays
  • Primary care
And what services would not:
  • Chiropractic care
  • Home health
Catania is aiming for a spring release - "I don't see any reason to drag our feet about it."

He'll need to have the plan evaluated by the health care community and firm up a deal with an insurance firm to provide benefits.

Mayor Fenty submits this year's budget to the Council in March - financial support for Healthy D.C. may be included.

With all the activity this year, is DC outpacing California in planning/implementing progressive healthcare reforms like SafeRx and Healthy D.C.?

With CA's Senate voting down the Governator's statewide proposal, the nation's political epicenter may very well be taking center stage in healthcare coverage. San Francisco's municipal universal coverage plan should be of particular interest to the DC Council as they move forward. Click here and here for 2 articles of note, and here for a relevant, recent blog entry.

Does anyone else find it slightly ironic that while our federal legislators spout nebulous aims for improving the nation's healthcare as a whole, the District, which doesn't have a vote, is moving quickly from talking to doing for the uninsured and underinsured?