Shifting The Healthcare Spend to Consumers: CDHP Offerings Triple in 1 Year

Here's an interesting indicator in the health-care consumerism debate (hat tip to HealthLeaders Media yet again for the link).

8.8% of surveyed employers in this Pittsburgh Post-Gazette study covering WV, PA, and Ohio are offering high-deductible or 'catastrophic' coverage plans, but that's an almost 300% increase from the 2007 survey (2.5% offering CDHPs).

Even more interesting, 84% of firms surveyed by Cowden Associates "are not likely" to offer the plans or "have no interest in them."

Here's more food for thought - when the system fails to answer consumer demand according to patients' self-defined desires, we end up paying penalties like the ED overuse crisis.

When the system does not innovate, patients will create 'work-arounds,' or modified care processes that address individual supply and demand concerns.

Allow me to reach back into my English Literature schooling to illustrate the concept with metaphor (sometimes I miss the days when Shakespeare's sonnets seemed life-altering...).

Picture in your mind the stars. It's no coincidence I'm equating future healthcare innovations with the heavens rather than the purgatory which represents today's hospital consumer experience.

In the current clouded system, each consumer ends up creating an insular healthcare economy where she is at the center and pulls orbiting providers and services in at will, burning up efficiency like a supernova consumes flotsam before it becomes a black hole.

It is the invisible, heavy hand clutching fistfuls of healthcare dollars: selfish self-interest at work.

As patients, and I'd argue providers as well, MOST of the time we're each MOST interested in "this little light of mine," not the overall healthy functioning of the wider wellness universe.

And it is from this current, self-interested, fearful consumer-driven healthcare nucleosynthesis that new galaxies of disruptive innovation are being formed.

We're launching the burden of healthcare costs towards consumers already. Excuse the continuing space metaphor but I want to be sure this point is embedded.

So why aren't more companies offering innovative tech and customer service options to address increasing consumer involvement and the changing face of patient demand for performance improvement?

Answer: We're all still waiting with baited breath for the 'big numbers' and 'real success stories.' We won't believe it's time until we can track the shooting stars with the naked eye.

We want to see millions of consumers demanding better care and dozens of Health 2.0 firms merging, being acquired, or improving offerings to make their own 5 year anniversaries intact.

But if we hold our breath waiting for other organizations to be successful, we'll suffocate as they snap up market share. Successful innovations in consumer-directed healthcare will take a measured "just do it" approach, rather than a "wait and see who does it first and succeeds" mindset.

Also, innovative healthcare companies of the future will practice preemptive innovation, rather than waiting for the next supernova to take action.

Some firms are getting it right, no doubt about it, but the number of true success stories bringing in healthy revenues and planning for growth spurts is depressingly slim. Hopefully we'll see increasing evidence of new innovation galaxy formation at each successive Health 2.0 event.

Fellow blogger and Dutch consultant Jacqueline Fackeldy may have the right of it when she suggests what we need isn't more consumer-directed tech; it's the injection of 'human-to-human' marketing and communications into the current stratified healthcare system.

Successful healthcare innovators will address 'supernova' consumers where they orbit.

She terms this vision "hotealthcare," and if you'd like to learn more about it, join us April 12th in Amsterdam.

I can't promise new worlds will be born at our meeting, but I can promise we'll bring combustible elements to the table. (We've got at least one professional sparring partner in attendance...)

Here's One For All My ER Friends...

And EMTs (Emergency Em, you know who you are...)

So I'm out and about in Belgium doing some shopping today (at a place that takes USD).

In the electronics section I notice this game, which seems tailor-made for the emergency room nurse/doc demographic.

It's got everything today's understaffed, overburdened emergency room does, including:

• "Massive bosses"
• "Terrifying monsters"
• "Insane weapons"
  

Welcome to "Painkiller Overdose," where the demonically drug-seeking take over the world.

Instead of cathartically draining that burgeoning cyst of angst on your blogs, just pop in the Painkiller Overdose CD for a few hours nightly.

What's not to love about "6 new insane weapons" and "over 40 demented, unique and sickly twisted horrifying monsters," especially when they're not visiting your ED 23x weekly?

Back to more serious blogging tomorrow, and no, I didn't buy the game, although I was tempted to see what weapons they use to disarm the overmedicated...I doubt anyone would appreciate THAT best practices writeup.

Mexico Invests in Future of Medical Tourism

Excellent coverage of Mexico's expanding medical tourism industry via this Bloomberg.com article.

Although India and Thailand more often make current medical travel news, Mexico is definitely one to watch.

You're Invited April 12th: International Healthcare Salon in Amsterdam

A group of healthcare advisors, students, consultants, and bloggers is gathering for an informal chat in Amsterdam April 12th at 2pm.

We may not be drinking Chianti, but I'm sure other beverages will lubricate the idea exchange.

Any Stateside colleagues (or those on this side of the pond) who just happen to be traveling through Holland that day stop by...the salon-style talk will be casual and hopefully the conversation rowdy.

My Dutch partner in crime arranging the afternoon is Maarten den Braber, a business analyst at The Decision Group.

Maarten is also a grad student doing his Univ. of Twente Master's thesis on the strategic organization of hospitals (for those of you looking to consult internationally, check out The Decision Group's current opportunities here).

He took this idea to meet and ran with it. And of course - we met through blogging - check out Maarten's LinkedIn page here.

We'll be joined by some up-and-coming healthcare enthusiasts (?!) he met on Twitter.

Other guests include Martijn Hulst (an advisor/consultant at Twynstra Gudde), Jacqueline Fackeldey (a marketing blogger who's using the term 'hotealthcare' to describe hospitality-influenced trends).

Sounds like a great group - no cost/all benefit, and if you'd like more details post a comment and I'll see if we can't entice you to attend.

Innovation Cross Section: RIP Egg McMuffin Inventor

Invented by Herb Peterson in 1972, McDonald's Egg McMuffin kept me company many a weekend morning before I read Eric Schlosser's Fast Food Nation.

The McMuffin is one of the healthier items on McDonald's breakfast menu (relatively speaking at 300 calories, 12g of fat, and a whopping 87% of your cholesterol RDA).

The McMuffin, oft-imitated (Sheetz Shmuffin) but never overthrown, is still an innovation that defined a new era for fast food joints everywhere - portable, complete breakfast in a sandwich format. Old Herb saw a customer niche need - breakfast you could grab on the go and eat cash-and-carry-style in the car.

With Starbucks' recent move to eliminate breakfast sandwiches due to their scent-sory interference with our java experience, I wonder if McDonald's will innovate yet again and enlarge the line? The two titanic firms are battling it out for our coffee patronage (along with Dunkin' Donuts) and it will be interesting to see how this opportunity plays out for the Golden Arches.

I for one would love to see a version with less fat, sodium, and calories (use low-fat cheese, egg whites/Egg Beaters, whole grain English Muffins, etc).

Herb's sandwich is still an innovation that defined a new era for fast food joints everywhere - portable, complete breakfast in a sandwich format.

RIP Herb. Your little round sandwich defined a new service line for your industry; a good lesson for all of us.

ACHE Session: Healthcare's Response to Globalization

The increasingly flat world of global healthcare is of concern here in Holland (and of course an increasingly worldly staff composition is of concern for US hospitals as well).

Here's some good data from an ACHE Congress seminar (March 10-13th):

Central Question: How is globalization affecting the operation and management of healthcare facilities in the US?

Takeaway Points:

* Reciprocal permeability of globalization (movement back and forth of dollars and people - staff and patients)"

* "collective impact seems to be getting more intense by the year"

* "see hospitals responding in more of a bottom-up approach as opposed to there being a centralized function in hospitals - maybe we need corporate strategies for dealing with the global environment - monitor the environment for changes that are significant in the world."

* "It's happening to us..." no information on flow of dollars/personnel in terms of consultants moving back and forth - US based firms and staff establishing bases abroad.

Quote of the day: "Healthcare is a little bit late to the table in thinking about this."

MEDICAL TOURISM/Travel to Care - should have been a session in this presentation.

From the Audience:

* Medical tourism and need to staff physicians in developing markets will create opportunities.

* Hospitals going public in India. India, Saudi Arabia are having docs go back and start hospitals and recruit fellow doctors to RETURN (Boomerang Providers).

* Cleveland Clinic has 1B budget to come up with overseas revenue streams (businesses go where the growth is...they can see markets developing and opportunity for gain).

The Old Standards are Still Hanging Around:

* Treating patients with limited English proficiency is still a big deal - about 18% of US population speaks language other than English at home. 80% of hospitals surveyed report they encountered LEP patients at least monthly. 97% large hospitals (300 beds), 64% small hospitals (under 100 beds)- ALL affected (some regional variations, teaching hospitals more likely 98 % vs. 75% other hospitals).

* Move beyond anecdotes to measurement (metrics).

* Why the global labor market (movement of docs, nurses, consultants, etc)?

We are:

* moving to work

* moving for training

* pull factor = increased demand

* push factor = motivate workers to come to greener pastures

Migratory Health Worker Stats:

* US recently became largest importer of foreign nurses (implications on international healthcare diplomacy/relationships? are we viewed as 'stealing nurses?' no real statistics on how much money they lose when a nurse leaves for the States) - 80% come from developing countries

* Phillipines is largest 'exporter' of trained nurses - 30%

* "foreign educated nurses tend to work more and work harder" "doing the work that we don't really want to do"

* integration of global workforce is happening beyond the periphery of traditional border states - California 29% are foreign-trained - NY, NJ, Fla approx. 24%

* remittances ($ sent home from employees abroad) are significant source of 'international aid'

* IMGs = international medical graduates (25% of US workforce is international, India, Philippines, Mexico, Pakistan, Dominican Republic import most docs)

* States with most IMGs practicing = 40% in NJ, just under 40% in NY, 35% in Fla, state median is 17%)

* States with most IMG residents = North Dakota (what is their board, commerce dept. doing?), Wyoming, New Jersey - perhaps Visa requirements for underserved areas - also largest maybe due to influence of population density? less population equals far higher percentage of residents foreign docs?

* Top 3 IMG specialities- internal medicine (36%), psychiatry!?(31.4%), anesthesiology (29%)

* 2007 - only about 42.4% of 2,313 residency positions in primary care were filled by DOMESTIC medical graduates (THE CHANGING FACE OF AMERICAN PRIMARY CARE) - the primary care melting pot

Home Organizational Applications:

Do study based on exit interviews/new hire interviews...why do nurses leave other hospitals and why do they COME work at our hospital? Do nurses migrate internationally (externally) for the same reasons they migrate nationally (internally)? Ask nurses why they leave...answers may include:

*quality of life migrant

* career advancement migrant

* partner/spouse/family migrant

* adventurer migrant

* salary migrant*

* hours migrant*

* culture migrant*

From the Audience:

* Nurses leave because less training/orientation via preceptorship once working on units

* Lack of nursing faculty/training pushes need for more internal training programs/mentorship programs (critical thinking & communication skills - scope of practice, when to challenge physcians, etc) - hallelujah!

* "the nursing shortage in the US will be around for awhile- don't be in a rush to go" - from former Phillippines hospital administrator - 7,000 islands - average tenure 3 to 6 mos at tertiary care centers...1 year if you're lucky - fair amount of Philipino docs who are converting to nursing to practice/work in the US - larger effects on Phillippino culture - nurses acting as welfare agents, rest of family may not work

* "We're in such a hurry to put nurses at the bedside" - need for greater training and acculturation

TOP 3 Impacts of Workforce Shorage (2006 data):

1. Decreased staff satisfaction (shocker)

2. ED overcrowding

3. Decreased patient satisfaction

From the Audience - Creative Potential Solutions (They Need an IDEO Session...):

* Idea to fund schools overseas specifically to 'farm' nurses for US work? "what we need to do is create a different kind of market that doesn't ignore the need" - panelist question - argument from military administrator re: incentives to stay, come back after period of service abroad

* Innovative international exchange programs: partner with hospitals abroad. Send 1 US nurse abroad, import 5 foreign nurses. Train them. Let US nurse recruit others while in country, also send best practice research back from countries.

* Send your middle management pipeline to other countries via partner facilities. Let them get their feet wet with complexity and strong mentorship here. Established management/execs may not be willing to live the expat lifestyle. Ability to enlarge leadership pool.

Meaty summary but there are some very good lessons hidden amongst the data. Are you tracking international medical professionals at your organization?

Medical Tourism "Part of the Solution"

Great BusinessWeek interview with David Boucher, Assistant VP of Health Care Services, Blue Cross Blue Shield of South Carolina.



Want medical travelers? Here are a few tips from the article:

• You need to be accredited by JCAHOs ugly stepchild, the Joint Commission International.


• Cost: You need to be able to compete with ridiculously low prices ($15,000 for a quadruple bypass)


• Recruit US Board certified physicians. Pay them well. Keep them.


• Market to employers (groups) and consumers with higher deductible CDHPs. Few others at this early stage in the market will pay the travel costs out of pocket.


• Market to women, who "make the medical decisions for families in the US."


• Harness the "silver tsunami," market to active boomers - "in 2008, 365 Americans an hour will turn 62."


• Transparency: People will do more research in this "buyer beware" market - provide statistics on complications. This means you'll need in-house personnel to track these stats across time zones. Budget significant dollars for staff positions who track former patients who live overseas.


• Put your body where your business partnerships lie: undergo treatments at partner facilities. You'll become a physical evangelist - living proof - overseas treatments work to everyone's advantage.


• Remember a pound of prevention...examine other potential partnerships - how do they help shore you up to face the 'perfect storm' in healthcare (simultaneously increasing demand and decreasing supply)?

Speaking of travel, I'm headed back to Holland this evening and will take a 1 day jet-lag recovery break from blogging.

Tot ziens til Thursday!

Speaking of Growing Up...

This s+b article is ostensibly about how to reform the American b-school educational philosophy, but everyone who manages should read it.



Five pages later you should be formulating the strategic plan for how to ensure you're working within a 'lattice' organization, removing the 'halo effect' from decision-making, and not hiring "crown princes" (hint: genesis includes formation of small funtional groups, some without a dedicated 'managerial' head).

Baby Steps & Easter Renewal: Lessons from a Long Holiday Weekend

"Life's a shit sandwich. Every morning you get up and take a bite." - Health Mgmt Rx Mentor

"Do you have ADD or ADHD or something?" - Another Health Mgmt Rx Mentor (comment given when I couldn't sit still during a lunch meeting and was describing all the various projects on which I'm currently working).


Long weekends offer an opportunity to take enforced downtime.

Enforced because I don't do so well on most vacations - I have a hard time ramping down. I obsessively plan and research destinations and activities and tend to work on cocktail napkins, sketch ideas on hotel stationary, and write multiple to-do lists Post-Its when my laptop and phone aren't handy.

When I'm not working, I'm thinking about working. If I don't have tons of projects in the hopper pushing my personal timeline, I'm just not satisfied.

Trying to fight that drive is a waste of time and energy I'd much rather put to productive use. So yes, my name is Jen, and I am a workaholic.

Don't get me wrong - I can be excrutiatingly and luxuriously lazy, but despite a very well-integrated 'bum it' drive which goes into full effect at least once a week for a few hours (and sometimes an entire weekend), I'm usually on the computer for hours at a time.

It's been entirely too long since I took a vacation w/out my laptop (4 years and counting?), but then I'd spend valuable time worrying about when I'd next blog, what I'd be missing by not checking email, etc.

As an analyst and consultant who conducts quite a bit of web-based research, it's just not practical to be without the computer, even if I don't keep it on 24/7.

I have cut back recently.

I did NOT bring my laptop to my sister's half day baby shower on Saturday (even though I almost rationalized bringing it so I could immediately download pics and create a slide show onsite).

Living overseas has also helped - I'm an ocean away from my network, which means I have to make more effort to stay in touch, but not necessarily literally 'plugged in.'

In Holland I have a phone that's JUST a phone.

No camera, no emails, just the occasional text message. I also disabled the email feature on my Blackberry - no sense wasting money to check emails on a device I use for a few weeks once every couple of months.

When I came back to the States for this trip (Health 2.0 in San Diego, followed by the ACHE Congress in Chicago, followed by a MEDBANK ExecComm meeting and event), I noticed most people pulled out phones/devices to check emails multiple times during our meetings.

This never bothered me before - that's just the way things are here, and definitely the way things were for me working at startup.

Then, watching a beautiful sunset over the Potomac yesterday enjoying a glass of wine and good conversation with a mentor who's meant alot at various points in my life, again I realized the most valuable thing I can give is my time.

That means setting aside devices and trying to be more fully present during conversations I later realize have much more import than I'd give them at the outset.

Because I was consciously practicing this tactic this weekend, I didn't miss a valuable lesson one mentor taught (unintentionally).

After an hour or so hashing over work, volunteer and Board stuff, he showed me some paperwork describing a startup mentoring program developed for Associated Builders and Contractors members. He agreed to participate as a mentor; the first meeting is today.

After skimming the materials, I asked if he'd prepared subjects. What would he talk about to these students? Had he looked up the primary consultant who would be providing leadership style data? Did he know who would be participating - had he read any student bios or blogs?

The answer to all three of my questions was "No."

My mentor explained his big plan - he'd show up, listen to what people wanted, ask questions, and go from there.

This was my first thought: "Wow, that is absolutely the worst approach I've ever heard. If I was a student I'd want to see an agenda and make sure this is going to be worthwhile, and that the mentors will have useful information to give."

Then it hit me like a ton of bricks - he's absolutely right on.

I'd over-prepare and bombard the class with my thoughts on leadership styles. I'd have things so planned out and over-analyzed I'd be hard-pressed to find time to really set aside MY agenda and listen to what THEY need.

Even worse, while listening, I'd 'hear' things that I'd use to validate in my own mind the efficacy of my presentation...in the back of my mind I'd be thinking "mmm hmmm, my third point addresses that scenario exactly."

I'd be so busy patting myself on the back that I wouldn't have hands free to shake someone else's.

So, if the most valuable thing I can give someone is my time, and my honest efforts to listen, I have to practice talking less.

This is a challenging spot for a consultant - we're paid to talk and write and analyze and insert our opinions and make a living based on our evaluations of topics.

The thing is - I won't be a consultant forever.

Planning or selling without implementing is like drinking diet soda - it's good and fizzy but somehow not as satisfying.

Consulting is a great gig that lets you meet a ton of people, get down and dirty with a chosen sector, experience a wide range of management challenges, and defuse potentially explosive situations on a day-to-day basis.

But it serves as an interim solution, like operating in crisis mode, entering the Peace Corps, or going into ER medicine because trauma gets you going - I've done it for the rush, which I have to admit I enjoy.

It's time to move on and challenge myself when results other than my own performance are on the line.

Probably everyone has 'baby step' moments like this - times where you realize you're 'growing up' professionally and are shocked to realize how immature you actually are.

Growing up, you develop a sense of self awareness.

You learn how your own body moves and interacts with the world at large. Then you have to learn how to play well with others and subsume ego to have positive, productive interactions.

The professional equivalent of that maturation may or may not follow your logical chronological process - I've met people that seem to be devolving professionally as they get older and their career ascent phase winds down - they revert to childish grabbing behaviors out of fear and a seemingly intractible desire to recapture a primary attention-getting position.

The thing is, we don't talk about our professional toddler moments.

Sure, it's easy to talk about phases of a career in terms of concrete accomplishments (volume sold, deals closed, awards given, books published, etc.), and we career mark achievements with all the passion of a new parent composing a baby book, but for some reason we're afraid to talk about learning how to do our jobs better in terms of growing up.

This Easter, I committed myself to paying more time and devoted attention to my professional 'growing up' process...as painful as it may be to admit it, I'm still an adolescent.

That means I need more guides along the way (friends, family, mentor, bosses from whom I'll accept and respect criticism and guidance) and I need to stop the professional equivalent of looking at myself in shiny surfaces as I pass through.

This next phase of growing is early adulthood, and that's about sticking, about consistency, about learning what I value most and using that self-knowledge to establish a stable basis for daily 'being.'

Baby steps, Jen, baby steps.

Healing Words: Poetry Enters the Hospital

Those of you interested in the cathartic psychogenic powers of writing about health, illness, recovery, and death - mark your calendars: In July, PBS Plus will air "Healing Words: Poetry Enters the Hospital."

The 1-hour documentary is co-directed and co-produced by Joan Baranow and Dr. David Watts, whom I had the pleasure to meet during the first Squaw Valley Writers Community Writing the Medical Experience workshop in 2003.

The film features poetry therapist John Fox, CPT (who presented at Squaw that year), director of Shands Arts-in-Medicine Program ad author of Poetic Medicine.

Central questions include:

1. Does art help people recover their humanity and waken soulfulness?

2. How can the arts assist in the practice of healthcare?

3. What IS a healing environment?

From the very talented producers:

"Poetry serves to remind us of the spiritual mission of medicine. We believe that healing is an art, not merely a skill, and thus the practice of medicine should be founded upon a ethos that embraces the whole rage of human emotio...Poetry will tell the stories of our bodies and our hearts during the stress of illness, birth, and uncertain recovery. This program is about participation in our own health. We believe Healing Words can introduce a new way of caring for self and others."

Please, do your healthcare organization a favor - visit http://www.poetryandmedicine.com/ for more information, and set aside an hour this summer to watch Healing Words.

Required Reading: Target Hits the Bullseye in Succession Planning?

This excellent article, by Jennifer Reingold for CNN Money, is a must-read. Who knew the Target CEO personally interviews for the top 600 company slots?!


Hospital administrators being recruited for a C-level spot should take a look at CIO's "Managing Expectations: What Will a Potential Boss Want From You?" Masters program graduates evaluating administrative fellowships should also remember to evaluate culture when choosing a post.


And to round up this week's trifecta of required reading, check out Nordstrom's new commitment to green packaging...how much of what we use in the hospital system could be converted to products using post-consumer waste? Cups? Plates? Bags?

Finding an Elder-Care Giver Online: Latest Health 2.0 Resources

Great piece on CNN Money today. My family is examining home care for a grandparent now, and I can tell you it's not an easy choice, even with additional information on the web.

One bit of advice: Consider buying long term care insurance. Now. With home care costs running about 3000/month in my small, rural hometown, I can only imagine what it would cost in some higher-rent areas.

Abercrombie & Fitch Trauma Center: Hospital Branding and the Court of Public Opinion

A recognition plaque in exchange for a donation is a stock in trade tool for many foundations and development offices. At my undergrad alma mater, you can buy an engraved brick in a paved walkway...I always loved reading the inscriptions between classes. For other SMCM alum, Goodpaster Hall, the campus' first 'green' building with Silver LEED certification, also has naming gifts available.

Donors often get 'named' facilities as a reward for significant institutional contributions, whether the dollars in question go to stadiums, classrooms, bathroom stalls (a la Brad Feld's personal pet project), or hospital trauma centers, like the new A&F Emergency Department and Trauma Center at Nationwide Children's Hospital in Columbus.

Read interesting commentary by Gienna Shaw at HealthLeaders Media detailing the 10M donation (first announced June 2006 - ground breaks this year - center opening slated for 2011).

Think there would be as large a ruckus if, say, Proctor & Gamble sponsored the Center? What about a manufacturer of popular prophylactics?

Is it more about where the donation comes from than the money itself, or the purpose for which it will be used?

Would your hospital accept a donation from a 'controversial' consumer goods company if it came with naming rights attached?

What if Trojan, Absolut (you have to be over 21 to enter their site), or McDonald's wanted to sponsor a service line facility?

How is the Abercrombie & Fitch/Nationwide Children's sponsorship arrangement so different from the time-limited contracts that allow firms to sponsor major sports stadiums?

Would Nationwide have been smarter to put a tenure on the naming rights so it could generate a source of renewable income for capital improvements, say, every 10 years?

With 4-6% margins in the best of times (and we're heading into some dark economic times where hospitals are even buying back their own nonmoving bond offerings), don't hospitals have a responsibility to aggressively and innovatively pursue sustainability via contracts, gifts, and other revenue-generating options?

Now, I wonder if Nationwide will have Abercrombie, ahem, art decorating the center walls...or A&F brand polos as the new staff uniform?

HealthGrades Releases List of 50 Best Hospitals

HealthGrades rating of America's 50 best hospitals has been released - click here to read (Adobe PDF file).

Congrats to all the winners.

On Being a Patient: Acknowledging Dualism of Sensuality & "Patient" Self

Most of what I write at Health Management Rx is professional and dry, divorcing my sensory experience as a patient from the goals I have for our industry as a professional.

Every once in a great while, though, I'll draw more esoteric material from my personal experiences with trauma, surgery, and recovery.

The physical experience of illness - hospitalizations and surgeries- is certainly dehumanizing and debilitating.

However, if your mind is relatively clear and your condition lasts long enough, there are also moments of extreme lucidity, where the urges of the flesh become paramount, concrete.

Illness laser-focuses your stream of consciousness...everything else in the world slows down around you, allowing significant time to dwell on sensations remembered.

Having been a patient brings a unique viewpoint...and I find it vital and cathartic for those of us who have been there to acknowledge and share how living with a chronic condition changes the way you think and feel.

I want to challenge our perceptions of patients as people completely divorced from needs and wants by illness. Many of us struggle to be people living with conditions, not being driven solely by our diagnoses.

Some of the feelings in this post were excrutiating to acknowledge, and are almost as difficult to share.

Everything is more challenging with a chronic condition, and thus, perhaps, more rewarding - nutrition and voiding, verifying 'normal' range of motion, even the sense of self that evolves naturally from independent movement. You are a plush pile of firing synapses clothed in a flimsy gown.

Simultaneously you become both more aware of your body as a physical, grounded, map of skin and sensuality, but also distanced from its recreational pursuits, the importance of 'fun' kidnapped by baser physical functions like constant low level pain.

Sometimes you can't stand the taste of plain water. The smell of flowers, laundry detergent, and certain foods is overwhelming. Each sensory experience is altered, and so is how we perceive the purpose and function of our bodies, in which 'business as usual' was so often taken for granted.

Because so much of the rest of recovery is often devoid of pleasurable sensation, any truly sensual interlude stands out in stark relief in the mind's eye, to be regurgitated later when you are a sterile patient rather than a physical, feeling, wanting person.

At the best of times, our physical selves may frighten us, and this is when we can predict how they will operate!

When our medical care team is reconstructing our physical selves, Frankenstein-like we wait to see what the new "me" will look like, how it will move. A fear of pain often results in a desire to block out other sensation, including pleasure. Long illness forces the patient to take fresh stock of the way our bodies and minds work together, and how we want to live within our physical selves.

I often felt most connected to my physical body lying naked and prepped on the OR table. At such times, just prior to the countdown, knowing you will wake up with a different physique transversed by fresh incisions, it is impossible to think of much else.

With three close family members recuperating from massive surgeries (a craniotomy, a Whipple, a modified radical mastectomy), I find it suddenly important to articulate that the sensual self does not die during surgery.

Like the rest of our individuality, it can be recovered...it will twinge and fire and make itself known again as the flesh and mind heal together.

These two poems, written during and after ortho surgeries following a car accident, emphasize the sensual side of being a patient, of feeling for self in the shifting tides of treatment and recovery.

To all hurting and healing, waiting for the wanting to return, don't worry - for most of us it does. Stronger than ever.



Harvest 7/13/03

I am post surgery slim-
hips bare sharp scythes curved
around fertile crescent-
one singing frantic arias of longing
for the kidnapped iliac slice-
spooning air,
shifting wet on sterile sheets…
Shafts of dark wheat between my legs,
shafts of titanium spear ankle bones.
Salt of the earth, salt on my brow,
palms, pubis-
side effect of post-op fever,
straining to ignore

the seductive push
of the pain control pump,
foreplay of the finger pulse oximeter,
slipping on, warming to skin,
seeds of slight-pain dream in the blood…
Awareness of recovery room cracker
clinging, like a lover
to the sea-wave texture of my soft palate,
honey of my piquant unsterile breath,
the thirst, envy of exploding fizz,
soda’s carbon coming on my tongue.
Don’t mess, young vulnerable doctors,
with my subjective pain scale-
I’ll have to show you
my pleasure’s past ten.





The Resident



I waltz into pre-op
with only a slight hitch
that becomes a slide.
You are shaking my hand,
a young orthopod.


You aren’t yet filled
with the grand medical air
that floats out of reach
for most mortals.


Our clasp of fingers
is warm and moist and tasty.
For an instant, the
contact is grounded,
human to human
woman to man.


No patient patience here,
you are almost my age,
and our eyes speak well,
complementary, complimenting
shades of blue and gray.


All this passes us by
as you see again the form
of the usual suspect,
and we click to the format
expected and accepted,
now not rote
but protective roles.


Too much sharing
in that look,
a current of interest
that has no business
in pre-op
or even post-op,
You, a new physician,
snap back
to that doctor place.

I slide up the gurney,
slip off a moonboot,
try not to think of you
as I strip off clothes
and skim on
a flimsy sheer sheet.


Soon you will see me,
a separate crooked ankle
needing a bone graft.


And even though
I will lay
silent and naked
on your table,
(my eyes
anesthesia-closed),
you will work harder
to cut our connection
than you will
remembering the proper way
to harvest hipbone.

Copping a Feel - Dissertation of the Year Award: Haptics & Physician Education

Erik Vidholm just defended his dissertation at the Center for Image Analysis at Uppsala University February 8th.

Vidholm's haptic, pen-like 3D mouse technology not only holds promise for advances in radiological diagnoses, but also for hands-on (excuse the expression) physician education and virtual specialist collaboration.

If several docs, using Erik's haptic technology, can consult, say, on the placement/size/shape of a tumor prior to a WHIPPLE, facilities could use e-health advances to augment limited surgical services with virtual 'expert witnesses' who would help define a top-notch treatment plan.

Read the excellent article here in Virtual Medical Worlds, another Health Management Rx e-newsletter favorite.

Happy weekend all!

2 Most Powerful Healthcare Lobbies in the Next 10 Years

Forget the American Medical Association. Besides being kicked out of recent Senate Finance Committee hearings, they're woefully slow-moving and frustratingly nonspecific when describing today's challenges.

The 2 most powerful presences on The Hill pushing politicians for healthcare change will be:

1. The AARP. They've got the money, the membership base, the management insight to approach consumers where they live and buy, and the might to influence policy for millions of seniors. Watch for ranks to swell as active Boomers 'come of age.'

2. The megapolis hospital systems like Mayo and the Cleveland Clinic. These multisite powerhouses have more active economies than some small countries. In terms of revenues, populations served (more than half a million patients at Mayo and over 3M visits at Cleveland Clinic locations) and number or employees (almost 50k at Mayo alone), they'll become the new Detroit. Big 4 auto power will be replaced by Big ? hospital lobbies. Mayo's already getting started, sending out feelers and publicizing suggested policy change, including this "wish list for the next president" (StarTribune).

Make contact with someone deeply embedded at each of these organizations. Start with the person who fills the AARPs Policy and Strategy, Strategic Policy Advisor-Health role.

Get on their press release lists. Subscribe to e-newsletters like Mayo's Housecall. The AARP Magazine (with the world's largest circulation list) is a must-read, for all ages.

They'll be making news; you'll need to be proactively anticipating policy sea change.

Hacking Defibrillators & The Value of Hallway Conversations

Interesting research in this morning's issue of the Washington Post, from the Medical Device Safety Institute at Beth Israel Deaconess Medical Center.

Apparently PHRs and EMRs are not the only susceptible e-health products; even defibrillator transmissions (those not encrypted and sent to bedside readers) can be hacked.

As a healthcare consumer, why am I not worried about this? Even if I had a defibrillator I'd be vastly more likely to die from a hospital acquired infection or a medication error.

For all those who attended Health 2.0 Connecting Consumers and Providers last week, John Sharp at eHealth has a brief commentary here. He points out the most valuable thing to emerge from the conference would be a 'mashup' of firms that help consumers and providers comprehensively manage conditions.

At H2.0, some of the startups were looking for new staff.

GoBigNetwork is a new (to me) site that specializes in the startup space (great for those of us crazy enough to be serial startup pros). Of course there's always Craigslist and Idealist, where I found my last two organizations, as well as the more neo-traditional means of recruiting (hallway conversations, networking, blogging, etc).

Speaking of hallway conversations, one of the most valuable aspects of attending the ACHE's annual Congress is, without doubt, the unexpected opportunities to meet interesting people and share resources.

Yesterday standing in line to buy a Red Bull (guilty), a hospital administrator in Ohio shared two resources on the Green Revolution in hospitals.

At breakfast, Alan Burgess, CEO of Tehachapi Valley Healthcare District in California, shared challenges faced implementing Evidence Based Leadership Development ("I'm doing a lot of mentoring").

Before lunch, Andrew Starr, Administrative Director of Integrated Surgical Services at St. Luke's Hospital in Pennsylvania, gave me a candid overview of benefits he saw realized obtaining FACHE certification.

And yesterday, following a rather disappointing overview of the US healthcare industry's response to globalization, I had the pleasure of meeting John David, Karen Libby of Deloitte's San Francisco office and Beth Sweeney, a Global Market Development Consultant pursuing her Master's at GWU. Our informal conversation about international consulting, career goals, and how to market 'nontraditional' consulting experience to hospitals was more valuable than the formal presentation.

These are the kinds of interactions your entry fee can't buy, and also the reason why it's so important to remain available and offer comments at any professional event.

Unfortunately, you can't always predict the hard ROI for attending a large conference, especially when attending for the first time. Fortunately, you CAN always generate ROI by having valuable conversations with interesting new colleagues. Thanks all for making ACHE time (and money) well spent.

More Innovative Than Health 2.0: Ruckus Nation is Kids Getting Kids Moving

The only thing more energizing than a room full of entrepreneurs defining Health 2.0 is a contest full of kids redefining wellness management by creating fitness products.

The semifinalists of this year's inaugural Idea Crossing Ruckus Nation challenge have just been announced. Take a look here. Note: Idea Crossing also sponsors the annual "Innovation Challenge" business case competition for MBA students.

To participate next year and help winnow down the entries, sign up to be an online panel judge. It only took about 3 hours to read through the assigned plans and was well worth the experience.

Trust kids to reframe using a pedometer as fun...congrats to all the entrants for their effort and the semifinalists for raising a ruckus!

Live: ACHE Congress 2008 - Chicago

I'll be blogging from ACHE this week.

After attending Health 2.0 in sunny San Diego, the annual congress of the American College of Healthcare Executives, titled "Redefining the Healthcare Landscape," provides a stark contrast.

Health 2.0 is charging ahead and changing the way the healthcare establishment connects with consumers. ACHE IS the establishment.

The good thing is both parties, the staid, slow-moving current establishment as well as the shock-me-with-high-tech Health 2.0, realize that the landscape is changing.

This convention is 'old school' healthcare.

I'm the only one I've seen blogging live from any session. Q&As after speakers are more an opportunity for high-ups to emerge as 'thought leaders' rather than ask tough questions.

Poster sessions present the necessary and basic building blocks plethora of quality and performance improvement initiatives hospitals must take to reduce, say catheter site infection rates.

Hallway conversation centers on hotel quality, generic descriptions of the woe that is physician relations (according to administrators), and, from the students, tales of last night's adventures on the town.

After the entrepreneurial fervor of excitement at H2.0, ACHE is a bit of a let down.

It's much more difficult to meet a CEO you admire in this type of cattle-car environment.

It makes me question why I believe a career in the heirarchical, troubled world of hospital administration is the right thing for me.

I'm sure other graduate students, especially those to whom shaking hands in suits still seems new and nerve-wracking, may find themselves asking the same question.

What is our motivation for joining this industry?

The day to day work of hospital management isn't sexy stuff - but it's absolutely necessary for improving the service of hospital-based healthcare.

And there is no challenge like healing a hospital system and integrating all care provider and patient activities to achieve optimal wellness.

I'm off to a session on the Globalization of Healthcare...and I love a challenge.

Guitar Hero Governance: Recruit Gen X & Y Health Pros for Your Boards

Lest I repeat myself and become exceedingly tiresome (too late), I'll let Graham at Over!My!Med!Body! do the intro on this one.

He's got some interesting commentary after watching Google's Eric Schmidt at HIMSS.

Although I'm not in full agreement with the rest of Graham's post (patients ARE consumers of health goods and services, whether or not they are the primary payers for such transactions), he is right on with this excellent critique of Google's Health Advisory Board:

"Dr. Schmidt talks about young people, and how we already see the future of what will happen with society, what changes will occur and how quickly and says that the older people like him need to be ready to change and adapt. But I’d guess no one on their Health Advisory Board, with the exception of Matthew Zachary, is under 40 or 50; few if any likely have a Youtube account or Facebook profile. If young people are so in the know, get our opinions!"

I could write a book on the subject of bringing Gen X and Gen Y Directors onto Boards (hmmm), but for now, let's titrate this future-of-governance thing down to simple solutions.

You. Need. Healthcare. Leaders. And. Thought. Leaders. Under 40 (Under 30). On. Your. Boards. NOW.

Recruiting fresh new voices to join your board is a big component of 'guitar hero healthcare.'

Here's one organization that deserves the Health Management Rx healthcare industry best practice award - Swedish Covenant Hospital in Chicago is recruiting young (20s and 30s) volunteer Associate Board Members here.

They're looking for "dynamic young adults" to fundraise, create events including the Annual Charity Bowl and local happy hours (of course), "connect with the community to raise awareness" at events, and participate in community service activities that help cement SCH's charitable vision in concrete activity.

SCH is using talents and skills many young workers will have (socializing, event planning and organization) and tapping in to our desire to serve community in a capacity that 'counts.'

This is a perfect way to break younger Board members into serving, working together to accomplish specific goals on limited timelines, and interacting with older, more experienced Board members and executives.

I joined my first Board at 26, as Vice Chair.


I was recruited not for my time in the field or the quantity of my experience (just 2 years out of my undergrad cap and gown), but rather the quality of my personal brand of professional verve (I can't help it, I love what I do) and ability to quickly analyze and synthesize best practices from other industries and translate those into potentially applicable models. Or so I've been told.

Despite all I bring to my Board, the relationship isn't equally reciprocal - I'm learning far more via my early involvment in the world of nonprofit healthcare governance than my colleagues are receiving from my term of service.

They have the grace and foresight to know I'll apply lessons learned to each new venture, and the patience to put up with my learning curve (and all the questions that go along with it!)

To young healthcare professionals interested in Board service, here are some ridiculously simple steps to get you started:



1. Learn your strengths. Be able to sell them.

2. Always be open to learning more about your weaknesses. You'll always know less about these than you think you do.

3. Commit yourself to being a work in progress.

4. Learn how to take a compliment.

5. Learn how to give honest, constructive critiques.

6. Learn how to fundraise and recruit.

7. Ask questions (of anyone and everyone).

8. Listen more than you speak, or speak more than you listen. Develop situational awareness and use it.

9. Seek out the Board of a nonprofit whose mission you're invested in and arrange an informational interview.

10. Don't be afraid to push the envelope, but keep in mind Board involvement is about service, not self.



If you want to take a quick look at what's out there, try searches on Boardnet, Idealist and Craigslist to look for local opportunities.


Remember, you don't have to take the giant leap into nonprofit governance by securing an immediate Board appointment.

Other ways to get involved and evaluate cultural fit include serving on committees for organizations like your local hospital, fire department, EMS/Rescue service, municipal services vendors, libraries, and small nonprofits.

And to the students, interns, docs, nurses, administrators, consultants, EMTs, patients/consumers and other medbloggers in our little world - go forth and seek ye boards to serve! They're out there, and they need us.

Hospital administrators - check out SCHs program. What's the value proposition for implementing a similar program at your hospital? Do you have a Gen X or Y Board member already in mind?

For those of you who want more detailed info, I'd be happy to chat over ideas on how to get Gen X and Yers involved in 'entry level' Board service. Leave a comment and I'll get back to you.

Another Lo Tech Reminder - Staff Appropriately

Without proper staff coverage in the hospital, not one quality improvement process or innovation mentioned on this blog, or any other for that matter, means a ^&*% thing.

Thanks Scalpel for linking to ER Nursey's great post.


Take notes all...another reason we'll see see select consumers gravitate to health IT via Health 2.0 - we want to stay out of the hospital for as long as possible.

You want us to stay out of the ER when we have a nonemergent condition.


Any telemedicine, e-health, or online chat with a doc that delays a hospital visit for me also saves money for my insurance companies and places less of a burden on caregivers.


Keep working staff to death and we'll save even more via hemhorragic attrition! Hurray!


Hire well. Staff appropriately. Maintain- no -increase support.

Hi Tech Tomorrow, Lo Tech Today: What Percentage of Your Patients Have Advance Directives?

In the next few weeks we'll hear all kinds of buzz about the plethora of high tech health IT firms presenting at this week's fantastic Health 2.0 Spring Fling.

In the midst of this swirling idea cloud, let's remember there's significant low-hanging fruit we can encourage consumers to pick and co-direct treatment along their personal care continuum.

Here's a low tech approach we should encourage -the creation, safe storage, and appropriate distribution of an advance directive.

If you really want to empower patients and engage them as consumers, try this aggressive goal; by April 16th, 100% of patients over 18 should have an advance directive on file.

Why April 16th? Why not?

A partnership between the American College of Healthcare Executives and state/community organizations have designated it National Healthcare Decisions Day, and it's coming right up.


A website gives recipes for activities: http://www.nationalhealthcaredecisionsday.org/.


And speaking of consumer directed healthcare, how many of you, dear readers, have advance directives?

Does your designated healthcare advocate have a copy? Your local ED? Each of your treating physicians including your PCP?

End of life and long-term care decisions always seem to be needed when we least expect them. In other words, now is the best time to clarify your thoughts and codify them in a legal document outlining your wishes.


Practice what we preach - there's both personal and professional work to do here...

Event Horizon: What's Next for Health 2.0

My review of Health 2.0 is a bit of classic Health Management Rx "glass half full, glass half empty."

Having just returned from two days of the whirlwind that was volunteering at the Health 2.0 Spring Fling, I can say the conference was a huge, energizing success, but also a bit like ripping off a Band-Aid a few days too early.

You know there's fresh, promising skin underneath, but it still hurts a bit more than expected if you just can't resist looking at the healing wound too soon.

Figuring out this new healthcare landscape is painful.

Navigating the offerings at H2.0 leaves a bit of a mark and a very slight bitter aftertaste of frustration. Very few firms demoing are viable or really attractive as-is - I was hoping to find more firms ready for the Band-Aid to come off NOW, useful to patients and doctors NOW, not months into future redesigns.

Like most meetings, you get a return that's reciprocal to the effort you put in. But I'm not sure anyone at H2.0 could say there wasn't an energy (albeit a rather unfocused buzz) in the rooms. Here's Dan Kogan's review on the Health 2.0 blog.

I met interesting people with excellent ideas and engaging personalities whom I knew only from blogging, including David Hamilton of VentureBeat and Scott Shreve of Crossover Health (read his March 5th entry for an excellent analysis of the emerging space).

The crowd was youngish, largely male (I'd say about 70% without exact figures), IT dominated, entreprenuerial, and embodied a 'seeking' mentality. Everyone was looking for their space and keeping an eye on developing firms. Some were seeking capital and a few had potential capital to burn.

You know it's a good conference when you have a hard time deciding to listen to the panelists, a VP of Business Development 'selling' why they're engaged in healthcare consumerism, or some very high-octane conversation debating merits of panel offerings at the table next-door.

Health 2.0 meetings are fascinating not because they single-handedly hash out a definition of where we're going in consumer-directed healthcare, but rather because they provide a spectrum of offerings that demonstrate how various entrepreneurs are trying to answer that question.

Their answers to this question help shape our views, and the industry. These are the first-movers, people. 2 or 3 will succeed. Many more will fail. But the failures teach us just as much about what is missing from the healthcare experience as the leading players, if not more.

Health 2.0 is a blast because even coffee chat reiterates businesspeople are passionate about bringing consumers of goods and services (both patients and providers) into the fold.

At an IDEO brainstorm event we all watched a video and then had to QUICKLY design a product or service to pitch to VCs addressing concerns and needs for people living with diabetes. Our group developed a buddy system (based on the sponsor model in AA) to connect newly diagnosed diabetics with 'experienced' and well-seasoned consumers. We called it, tongues-in-cheeks, The Sweet Life. I wish we had more opportunities for this type of on-the-fly innovation that rules out nothing outlandish, and I hope the IDEO participation is a fixture at each Health 2.0 event. The IDEO staff are just as interesting as their methodologies (how're the photos Webster? Can I get some copies?)

And of course, there's a lot of money to be made in becoming a defining H2.0 firm and being at the forefrunt of next-wave development. Entrepreneurs are no dummies; they are successful if/when they enter market spaces filled with potential for change, lots of payors, and weak traditional offerings.

What's the point of H2.0? Is it a movement? Is it well-defined? Is it shaping the industry?

Answers: Yes, no, and yes.

Subjectively, it's a movement allowing firms to coalesce around a need for consumer-directed goods and services, whether the consumers are patients or providers, or both.

Objectively, Health 2.0 as represented at the Spring Fling, is a healthcare industry category, for now largely IT based and entrepreneurial in spirit and size, that connects disparite segments of the hospital/healthcare market.

A very rough list of subsectors includes:

1. Search/seek/find services (find a doc, etc.)

2. Ratings (rate a doc, rate a hospital, etc.)

3. Back office for providers (helping docs take back healthcare mgmt, including online med reconciliation, e-health provision, emailing patients, etc.)

4. Consumer Buys (direct purchases for consumers of 'new' services such as $1.99 generic online chat with a doc)

5. Connectors (translating EHR/PHR data, connecting patients to docs who are in their HMO network, connecting people with newly diagnosed conditions to others who live with the illness, etc.)

Everyone I spoke to is not only actively engaged in 'changing healthcare' into a consumer/service based industry, they're putting their money (and management expertise) where their mouths are.

What's the point of going to future Health 2.0 events?

First, at Health 2.0 we'll see continuing clarification of the space - organizations will use lessons from the conference to differentiate and define subcategories.

Second, it makes business travel and industry learning exciting again. Don't underestimate the power of the status quo on limiting innovation.

Healthcare conferences can be a glut of traditional views, heirarchical assertions of what's working in the market, and talking heads who have burned out - they're no longer passionate about the enterprise or the possibility that their organization will play a role in changing offerings and improving care.

Most often, I learn more about what's working (and what's not) in the healthcare industry from reading the bloggers on my blogroll. Sad, but true. They're telling me, passionately, what's up to date. What's about to change. What their customers want. What they need to do business in the business of making us 'well.'

And perhaps that's the seminal realization of my time at Health 2.0, the lightbulb theorem.

In an admittedly self-selecting audience (all attendees and presenters actively believe consumers must be engaged and directing the forward momentum of healthcare), we all buy in to the idea that customers are the decision-makers (a central tenet in any other sector - I'm still not sure how we miss the boat so badly in healthcare), and will have increasingly vocal input as to how we should change healthcare.

Of course, if we really want the Health 2.0 debate to shape forthcoming wellness management offerings, we'll have to work much harder to get dissenters to attend and present.

We need some speakers present who believe consumer-directed healthcare is just crap. Let's electrify the debate a bit to accelerate development.

We also need more press, bloggers, editors, and authors who will be critical of the space and ask the tough questions (including "how on earth will that business model pay for itself?")

We're moving towards an idealistic, but also necessary, view of reframing healthcare offerings as wellness management, rather than merely disease treatment.

Of course our ills will still be encapsulated with goods and services, treated in an episodic fashion. Of course. But we'll also see an increasing numbers of providers (docs like Jay Parkinson and Enoch Choi) talking to us about how to focus on being WELL.

Here's an open question to Health 2.0 firms that should be at the heart of a root qualitative analysis: How do you help the system treat me as a person, rather than a pulse?

And of course, how will you monetize the data, format, and methodology that helps me navigate the system along my personal care continuum?

The most interesting firms at Health 2.0 provided ways for docs and consumers to communicate about how to live WELL.

The best firms, regrettably only a handful in my opinion, combined deep management benches with sound business models and also provided a real 'wow' moment when demoing services.

They include Myca, Phreesia, Vitals.com, American Well, Diabetes Mine (although technically a blog not a commercial H2.0 biz, Amy Tenderich's site represents the best of patient-centric, consumer-directed peer-peer info services and community), and a few others.

So here's what I think we'll see in the Health 2.0 sphere in the next 1-2 years (an eternity in any tech niche...):

1. Functional Gut Checks: Firms present at Health 2.0, Connecting Consumers and Providers, will be asking themselves tough questions in the coming weeks. Does my business model work? How will I be sustainable, or not? Do I want to be bought? Is my mgmt team strong enough to seek VC competitively? Does my offering encourage translation and transmission of data across formats and sources (i.e. does it encourage interoperbility?) Does my name, branding, image, and format work for the space and is it successful in attracting press, search results, buyers, etc.?

2. The M&A Wave: Several of the presenting firms (who demoed during H2.0 and then answered questions by a panel in what turned out to be an excellent format for rapid learning) provided similar offerings with a weak differentiating factor. And the presenting firms are the creme-de-la-creme of their segment. For each firm that presented, there are 5 to 50 more doing the same thing with less value who weren't invited to show their stuff onstage. This will result in mergers, acquisitions, and continuing buy outs by bigger, more traditional industry players trying to squeeze into the H2.0 space.

3. "Me Too" Development: Some of the firms at Health 2.0 were seriously checking out the competition. There will be a race to add functionalities so firms can compete (the "we do that too" mentality).

4. Paint a Pretty Picture: We'll also see design innovations as many of these firms move past beta - many sites were crowded, a few glutted with overly obvious advertisements that are turnoffs to savvy consumers. Some took a page from other industries we already trust for online commerce and designed their interfaces accordingly (to look like my online banking entry page, for example).

5. Job Hopping/Management Musical Chairs: The social aspects of Health 2.0 conference-going are valuable for both those examining employment in the space and those needing a fresh injection of engaged employees. Most of the startups are moving at a frenetic developmental pace. These execs will want to look to fellow attendees for potential hires. Here's a plug for my fellow volunteers, an impressive, international bunch with great attitudes and even greater skill sets. Many of us are in grad programs and volunteered our time for Matthew and Indu because our radar tells us "there's just something going on here." In addition, some execs are heading blah firms and some companies had green benches but great business models. I think we'll see some exec. switches in the coming months, or at the very least additions to advisory boards.

6. Shop Til We Drop: Consumers want into the space. Badly. We'll use online versions of word-of mouth referral (blogs, communities, social networks), print reviews (major news and online media), and search offerings/services provided by trusted firms and practitioners to access our health information and shape personal wellness goals.

To traditional healthcare providers using old-fashioned methods - you've underestimated us. Badly. 60% want online access to records and testing, according to this Deloitte survey (at EHR Decisions, the CCHIT blog). If we can't get them online, we'll demand access, as did Dorothy Tillman, who was arrested for not submitting her request in writing (read the unbelievable story on A Scanner Brightly, by Jaz-Michael King, here). Continue to do so at your peril - and ours.

It's no surprise that the realization of consumer-directed healthcare's growing importance was the big 'aha' moment at HIMSS 2008 (Thanks to John Sharp at eHealth for the post). I'm stunned more HIMSS attendees didn't pick up on Health 2.0 and attend the Spring Fling.

Bet I'll see many more of you in 6 mos. at the next Health 2.0 show in San Francisco.

Attendees were challenged to think of a 7 word description for the next generation of Health 2.0. Mine would be almost idiotically simplistic: Listen to my concerns. Help me live - WELL.

Hospitals: Offer "Navigating the Health System" Courses

Someone at the Consumer Federation of America has decided this week should commemorate "America Saves Week" (or, more realistically, "America Doesn't Save But Should Week").

To celebrate, Wachovia is going into the workplaces of corporate partners and talking to employees about savings.

Hmmm...a financial services provider educating employees (and potential customers) on effective savings behaviors, plans, and goals. I like it.

Of course, this approach has an added development benefit (from the Charlotte BusinessJournal):

""This is going to help Wachovia build its business," Steve Brobeck, executive director of the Consumer Federation of America, said Thursday at a savings seminar for Wachovia employees in the Two Wachovia tower in uptown Charlotte."

Hospitals and healthcare organizations should consider adopting this best practice approach to consumer education.

Many facilities already offer 'community' health courses and events, including parenting classes, free BP screenings, etcetera - but we aren't reaching out to engage our consumers (patients and other stakeholders) and sharing our deep knowledge about how to navigate the complexities of the healthcare system.

Cooperate with other community stakeholders who have an interest and an engagement with improving the safety and efficacy of the healthcare process.

For instance, an example of a "Navigating the Health System" course may include partnering with a university and having some healthcare administration students, pre-med students, and faculty present 'minicourses' on asking your doc questions, how to take notes during a preop appointment, how to write an advanced directive and where to file it at the hospital, what to bring for an inpatient stay, etc. If nothing else, you'd have some parents and fellow students in the audience.

You might also invite local representatives from clinics and Health Departments to give specialized talks on offerings of interest, like "Flu Shots: FAQs, Risks, & Benefits."

A final caveat - if you're already offering courses like this and attendance is poor, you're probably doing three things wrong.

1. You're offering topics that your community isn't interested in discussing - you're not touching a 'hot button' issue.

2. You're not publicizing enough or in the right mediums.

3. Your organization might not have the solid reputation for quality and safety in the community administrators believe you enjoy.

You can address the first two mistakes relatively easily.

Organizing a "Navigating the System" course doesn't have to be hard, or expensive.

You'd be amazed what insights you can glean by having a patient advocate/greeter ask visitors what type of talks/seminars they'd like to attend.

Have employees who are willing to help ask family and friends. Sit in your own cafeteria and listen to what people are talking about. How do healthcare developments and issues intersect with other 'real life, real people' challenges?

The good news about patient education - it's never too late to begin engaging your community and teaching consumers how to navigate the increasingly choppy waters of our US system.

This week I'll be blogging from Health 2.0 about companies engaged in doing just that - slainte!

Dr. Vigilance to Head DC Dept. of Health...

Seriously.

Happy Sunday - for those of you at Health 2.0 I'll be in San Diego from late this evening - Wednesday morning - see you there!

GPS and Geriatrics? Health 2.0's Greatest Potential Lies in End-of-Life Care Coordination

GPS units on walkers? Awesome!

Read this post on Engadget.

Now THIS is the kind of market-based innovation I hope we'll see more of from Health 2.0 entrepreneurs.

It's also why the biggest market potential for Health 2.0 (and subsequent dot-0's) is towards the tail end of a patient's lifeline. (To talk more about this theory, meet me at Health 2.0 on Monday).

So what about the current Health 2.0 wellness networking and rating-sites glut?

It's similar to the crowded, current social networking market - we've got LinkedIn, Facebook, Myspace, and a host of others. A handful will emerge as market leaders, but many startups will die a quick death due to lack of funding, lack of users, or both.

H2.0 entrepreneurs - do yourself, and us, a favor - think carefully before you start another networking site.

You'd do better to frame a firm around a "golden years" offering that improves quality of life and safety for seniors. And then figure out how to get it covered by Medicare. And HMO's.

With current offerings that take a SSDD (same stuff different day) approach, you're competing for the attention of a host of highly engaged, tech-savvy users in other age categories. Unless you really impress us, we won't further the relationship beyond initial registration.

But many older folks are adopting Web 2.0 tech, and looking for ways to ensure communicating healthcare news and decision-making is a family affair.

Case in point: the very first people I knew using VOIP were my grandparents, both in their 80s. They got a nice Mac, a webcam, and signed up for Skype so they could VOIP with my dad in Minneapolis.

Moral of the Story: If a firm offers new tech (or adapts existing tech to new applications) targeting end-of-life care (65 and over, sorry all who are in this ill-named grouping), not only do you target a rapidly growing demographic, but you can engage significant secondary involvement from the large numbers of middle-aged children, family members, friends, and caregivers who support aging parents.

In other words, your user base will include people like me, but you'll also capture dedicated users from other age groups - people like my dad, grandparents, aunt, uncle.

Homework: Check out sites like CareFlash, that help make healthcare a family affair, even when we can't be there in the flesh.