Waiting For The Killer App & Why I Don't Give a S%$# About PHR Security

Just before moving to Holland, I received a letter from the community hospital in my old hometown, where I was both a patient and an employee.

letter informed me that my medical record was stored on a laptop that was stolen.

This wasn't my first experience dealing with identity theft. Nor will it be my last.

When I was 17 and applying for federal student aid, I learned my social security number and name had been appropriated and used to apply for credit cards.

Since I wasn't in my thirties living in the Midwest, this was relatively easy to clear up. I just had to prove my identity and then reapply for student loans (overlay heavy sarcasm here). I had to take back possession of my data.

Studying Shakespeare with an SMCM contingent in England during the summer between my junior and senior year of college, someone in London made a copy of my debit card and used it to bookroll a pub crawl in Ireland.

Again, relatively easy to clear up, as my Passport didn’t have a Dublin entry stamp in it, but I was missing some money for awhile (again, insert sarcastic overtones). Again, I had to take back possession of my data.

Why am I not more concerned about my identity or medical history being accessed inappropriately, even stolen?

Because it’s already happened. To millions of us.

My world didn’t end. Identity theft can be debilitating, yes.

So can injury, illness, and not being able to remember what medications you’re allergic to and get that information transferred to your new ankle surgeon.

The simple fact is, if identity theft hasn’t happened to you yet, it probably will. Sooner or later. Most likely more than once. This is, literally, the price we pay in an interconnected, web-linked world.

Even worse is the way the healthcare industry co-opts my personal health data.

To the healthcare industry...

Why do I have to take back my healthcare data from you in broken pieces and recreate the trail of my personal health narrative the same way I have to repossess my financial data from identity thieves?

Being able to access my information anywhere means it is slightly more vulnerable, but only slightly more so. And that’s a price I’m willing to pay to access my bank account online from anywhere I am in the world.

The banking comparison has been made often, but isn’t yet tired (or tested), since no PHR provider has built out offerings with a comparable level of service to what many financial institutions provide.

Banks have taken reasonable steps to ensure the safety and security of my account, both online and offline.

I trust my bank enough to walk up to an ATM machine and put in a small portion of data and pull out cash. Is that transaction risk free? Of course not. But my risk has been offset ENOUGH for me to believe the benefits outweigh the potential risks.

Other online commerce platforms have done the same. I no longer fear using my credit cards online - in fact, if I can't use PayPal or a credit card, you're not likely to get my business.

As I select my next doc, if you're not using email, you probably won't get my business.

I’m willing to pay a similar price to be able to access my health data and craft a personal health narrative online from anywhere I am in the world.

We need to stop pretending healthcare is the industry in which our vulnerability opens us up to the most potential for avaricious theft and misuse of data.

This is a naive, overly simplistic excuse used to dismiss the end value of using personal health records and giving consumers shared control over the co-creation of a personal health narrative.

Get over it. We already co-create our personal health narrative – what do you think a history and physical interview consists of? The doc asking questions, the patient giving largely subjective answers, and then that information being ‘objectified’ and codified into that provider’s medical record.

What slays me is that we do this over and over and over.

Talk about inefficiencies and misaligned incentives rampant in our healthcare system...we have to recreate meaningful interactions and establish a solidified platform of shared data at the beginning of EACH and every visit with a healthcare provider.

And it's not new information, building on backstory to establish timely relevance, it's the same old H&P data that's stored 500 other places in disjointed medical records.

If my doc could access my personal health narrative and then ask questions directly relevant to my history (“Still having trouble falling asleep?”) we might actually get somewhere in the 2.45 minutes she has to sit and talk with me before tearing off a prescription sheet.

This is an old, tired argument.

We’ve been trying to get PHRs implemented for 40 years, yes. Currently less than 2% of the American population is using them, yes (per Revolution Health's Jeff Gruen at WHCC). But the pace of adoption will accelerate.

We won’t be able to limit the exponential growth of personal health data for long.

Personal health narratives are becoming increasingly interwoven into the daily societal lexicon. Presidential candidates are sharing details about emotional struggles related to infidelity and the battle to quit smoking.

Let’s get real. We’re comfortable accessing our health information. More than that, we don’t just want to access it, we want to share it.

If you’re having a hard time imagining widespread personal health exhibitionism, wander anywhere near someone talking in public on a cell phone. Chances are you’ll overhear more personal health/wellness information than you’d ever gain from stealing his/her medical records.

When we say consumers aren’t ready to accept these privacy risks – I have one question for you: Which consumers are you asking?

Are you asking those of us who visit a doc more than 2x a year for a preexisting condition?

Are you asking those of us who have 2.345 kids and need to tote information from allergist to pediatrician to orthopedist to dentist and back home again?

Are you asking those of us who have a ‘zebra’ condition that requires we be an active, participatory partner in care in order to help educate our docs about what works and what doesn’t?

Perhaps as a consumer I am "20 years ahead," as one friend put it this weekend.

We were discussing a concept for a killer app SaaS portal that partners with existing Health 2.0 and 3.0 companies and provides a backend PHR function.

The debate got rowdy when we started discussing how long it will take for the same percentage of the American public to use PHRs with the same self-assured, immediately assumed utility we use Google (8M health searches a day via Google, by the way).

My argument was that maybe I’m 2 years ahead, but not 20.

Cigna, WellPoint, Aetna and co. are already committing to making members' personal health data portable outside their existing coverage plans.

Still, this is giving consumers some control but not the tools that allow us to cross-pollinate that data across various brick-and-mortar and virtual healthcare delivery interactions.

I told him to try one simple, personal means test: Gather all his records from the past 5 years of doctors visits and try to get them transferred to a GP here in Holland. See how long that takes. Say goodbye to the rest of your calendar year.

Even if he does just call physicians’ offices and request faxed records, good luck getting all the coding and billing info and getting complete access once you tell them you’re in Holland. You’ll bear the burden of proof for demonstrating that you’re ‘you’ and you want access to records.

Personal health record developers – take notes. Don't try to limit my access to my own information.

Make the web-based platform easy enough for me to use so that I can email records right to my doctor or hospital.

As soon as someone provides a PHA (personal health application) with a bare minimum level of security and the portability I’m looking for, I'm there. And I’m your number one evangelist, your ‘ground zero’ patient tester.

If one doesn't enter the market fast enough, well, perhaps I'll just create it.

And that’s another important distinction.

There’s a reason PHRs and EMRs aren’t working. They aren’t enough. What we need most isn't a PHR. It’s a multi-functional PHA.

It's an opensource, multifaceted killer app, an SaaS portal that provides a single access point to multiple health/wellness nodes like American Well, Organized Wisdom, and Phreesia.

To entrepreneurs (and especially Google and Microsoft) - forget the PHR.

Give consumers an offering that provides a single gateway for me to access health content, wellness communities, and perform related purchase (commerce) activities. Give me FreeMED combined with functionalities for patients.

These tools are great starts, (hat tip to The Healthcare IT Guy) but they're missing the consumer-centric coherence that's essential to 'nexthealth' or Health 4.0 (content, community, commerce, and continuity).

I can't go any one place, access a single personal health application, and do anywhere near everything I want/need to do with my personal health data.

Here's just one example of how consumer interaction with the system would change: Imagine what would happen if I could login to a single PHA portal and resend claims/insurance data to the medical billing company that's trying to charge me full price for a covered visit?

Then the industry would REALLY have to adapt to meet consumer demands.

To developers - give me this capability and more.

Go straight for a PHA that lets me chat with a doc online, print out a Wisdom Card, and schedule an appointment. Let me login to SugarStats.com from your portal, and simultaneously export my latest glucose readings to 1. my linked PHR, 2. my mobile phone, and 3. my doc.

Give me the access, let me create the record, let me download information, let me access communities, let me show my doc or nurse how to pull up my PHA on the web and create shared meaning – let me be your disruptive innovation embodied.

Give me some of the responsibility for maintaining my health. Start with letting me access my own health record.

If you can't even let me maintain my own PHA, how are you ever going to loosen the hold on the reins for me to take a proactive role in working towards my personal wellness goals?

If you don’t, well, someone else will just have to accelerate that 20 year timeline.

Crazy? Sure is. Most game-changing innovations are.

From George van Antwerp @WHCC:

“Data is only exciting if you can do something with it.” [Reed Tuckson]

Final food for thought, from "How to Fix the Web," by Rob Scoble, Fast Company, May 2008:

"It’s time that we stop hoarding customers and their information in silos for fear of them straying. If you love them, set them free.”

PS - If you think keeping my records offline keeps me safe, think again...

Blogging Against Disablism Day - May 1st, 2008

We're up to 82 bloggers at last count.

Please consider donating your time May 1st to post about the effects of/your experiences with disability discrimination.

Visit Goldfish's page for more info.

What it's all about:

Blogging Against Disablism Day is an annual event in which disabled and non-disabled bloggers throughout the world unite in the cause of equality.

On May 1st, bloggers shall write about their experiences, observations and thoughts about disability discrimination (disablism, sometimes ableism) and what we might do about it.

One of the best things about health and medblogging is the ability to combine our voices. Please consider adding yours.


Why You Should Worry About American Innovation

And the complete lack of respect we show for pure research, in more industries than healthcare...why haven't we seen more media coverage of a female US astronaut completing the longest time an American has spent in space?

Most days I don't read everything in my email inbox - I triage by contacts, projects, news, and suspected trash.

Today, resting a bit from live-tweeting at WHCC and the 20+hour round trip back to Rotterdam, I scanned more news than normal.

I happened upon this article by complete accident. Luckily, it was one of those blessed 'aha' moments that happens serendipitously during web searches.

Why haven't we seen more about the woman who set the record for longest spaceflight in US history?

I'm afraid we're not respecting true innovation - in any industry, be it spaceflight or healthcare - when it doesn't have a specific dollar value attached.

Limiting 'creative storms' would have prevented us from going to the Moon - and inventing Velcro and Post-Its accidentally along the way.

Simple elementary school definitions of science and technology - applied science - come to mind. In what ways are we pushing the pure scientific process out of healthcare management?

Luckily, it turns out the critics who proclaim the death of American scientific/medical innovation are wrong - or, at least they aren't entirely right.

American astronaut Peggy Whitson, the first female International Space Station Commander, now holds the record for most time in space (among US astronauts). 192 days she spent up there. More than half a year.

As part of Expedition 16, Peggy and her team conducted various research, including the effects of longterm space flight.

Think about what you and I will spend the next half year accomplishing.

Whatever we do to advance the science of living, to learn the effects of various environmental impacts on the body and mind, let's remember America still has the potential to be a world-leader in innovation.

The only real question left is - do you want in on the ride?


From WHCC: Thoughts on the Medical Home Concept

We're talking a lot about money and business models that work here at WHCC. We're all looking for ways to implement consumer-centric care - how will a primary focus on the patient become embodied in our healthcare system?

One term mentioned repeatedly here at the congress which gives some hope for those seeking practical implementations and physical loci to "do" primary care well...next year I hope we see more presentations on creating a medical home (both virtually and in the 'brick and mortar' world) from companies that do it well, like Erickson Retirement.

The medical home is about primary care. Primary care puts patients "primarily" at the center of the care spectrum.

The medical home is about care coordination. Care coordination is about putting the patient "primarily" at the center of the care spectrum, and then ensuring they stay there as they seek services at different locations.

Unfortunately, "primary" patient-centric, consumer-directed care in the US has devolved into the desperate pursuit of paperwork needed for payment.

We shuffle patients through the system as quickly as possible. There's no time for docs and nurses to talk with us about our care goals, much less cooperate with healthcare consumers to nurture a warm, fuzzy, familial connection built via belonging to a medical home.

The medical home concept has been thrown around a lot at The World Healthcare Congress this week.

Unfortunately, the fragmentation of healthcare is matched only by the fragmentation of legal localization (different state, different statute), an unfortunate complication to be sure.

This co-dysfunction will make it very difficult to establish a brick and mortar medical home - what if a patient travels over state lines?

This is also the reason we're creating medical homes online - virtual PHAs (personal health applications) will rule the web and then they'll bleed innovation offline. The elusive "killer app" mentioned by Dr. Jeff Gruen of HealthVault will drive that bloodletting - unfortunately no one knows when and from whence it will arrive.

Examples of existing brick and mortar medical homes are often culled from countries overseas - The Netherlands, New Zealand, and Switzerland win the awards for most mentions by panelists speaking on every topic here at WHCC.

But you don't have to add a bunch of frequent flyer miles to view the medical home concept in action.

If you're here at WHCC, you're a 10-minute walk or a 5-minute cab ride from one of the best examples in the world.

Your destination, 1717 Columbia Road, is one of America's few remaining medical homes.

Christ House is a 33 bed medical home serving people who are homeless in Washington DC.

My first experiences caring for populations with unique disadvantages developed here - as did a lifelong commitment to serving underserved populations and making sure every consumer of healthcare and wellness goods and services has a 'voice' in the system.

I hope all here, particularly policymakers and pundits based in the Beltway area, will take this open invitation to tour Christ House seriously.

Last night some coworkers from Christ House gathered to celebrate the life of one of our patients who passed away. This calm, smiling, quiet little man spoke many languages and desperately wanted to return to work.

I met him just before I left Christ House to move to Holland, but in his 4 months at Christ House my teammates there became his family. When he called back to the nursing station during one of his hospital stays, his closing line was: "I'm coming home soon."

Here's a call to action for healthcare organizations at WHCC.

Think, hard, about what it takes for patients to feel that sense of medical home...how do you make consumers feel like we're coming home soon?


The Safeway Effect - Saviors of American Healthcare?

This entry is crossposted at the World Healthcare Congress blog.

Day 2 kicks off bright and early (8am start) with the Healthways Band Strat 5 belting out “Here I Am Baby.”

The good morning America musical interlude is followed by Safeway CEO Steve Burd taking the stage.

Steve bounds up out of his chair to take the podium. He’s a great metaphor for his company - these guys just can’t sit still. The grocery chain is doing some of the most innovative things in today’s healthcare economy.

This isn’t my first time following Safeway - when the company introduced the FoodFlex program for consumers, Health Management Rx broke that story here.

When the organization discovered a 10-fold difference in the costs of care for a procedure within a 30 mile radius of corporate HQ, they decided to develop an internal measurement for ‘cost effective’ services. Employees can find a list of cost-effective providers by zip code.

As with other services provided by the Safeway plan, workers are welcome to go ‘outside’ the hub, but they’ll pay extra to stray from the corporate medical home. Safeway’s argument is this: Give employees financial accountability for healthcare choices and they’ll begin to make healthier decisions.

Steve uses some interesting real-life examples of how the Safeway plan impacts employee behavior:

  • A staffer had a bowl of Hershey’s kisses sitting on a desk. The bowl was removed because it was “not consistent” with the goals (no word on whether the employee who brought the chocolate on board removed the bowl).
  • In the Safeway cafeteria, an employee can order whatever food they want (”cheeseburger, onion rings”) but they’ll pay “full market price.” Healthier meal options are actually subsidized by Safeway.

Some of Hurd’s graphics representing quantitative are a bit surprising - the assertion that 80 percent of Type II diabetes is preventable or reversable, for instance. These figures definitely bear closer examination.

The grocer is tackling corporate wellness engagement at the individual level with healthy meal subsidies, but they’re also creating larger groups to motivate each other.

Workers getting each other involved helps alleviate the faint taste of ‘1984′ that lingers…this is exciting stuff, but its also a large employer thrusting themselves between staff and the system. Do the benefits outweigh the risks of this positioning?

Safeway is concretizing the competitive drive for employees to be connected with care (and with each other) - they’ve organized 7 health and wellness teams. When Steve reports corporate earnings this Thursday, he’ll also report on progress of the teams.

This morning Steve announced an initiative that “may be an American first” - the creation of an employer funded, employer managed medical concierge coordination service created for cardiac disease and cancer – employees can call and they will be walked through the process of treatment at major treatment centers.

Steve also thinks labor unions are a natural partner in employer-driven wellness initiatives.

Both parties, he explains, are concerned about skyrocketing healthcare costs putting the squeeze on the bottom line. Unions want those dollars to go towards higher wages - companies want them back in the kit for investment and growth.

It’ll be interesting to see who Safeway hooks up with next in its single-handed drive to improve healthcare.


Happy Earth Day From World Healthcare Congress 2008

In honor of Earth Day, my personal effort is to save multiple packs of Post-Its, hundreds of cocktail napkins, programs, flyers, and any other sort of disposable material at the 3-day WHCC.

The organizers are certainly helping - water stations in the hallways are stocked with glasses rather than disposable cups or water bottles.

Let's see if they maintain the same green policies at tonight's networking events.

And as to saving Post-Its...those of you who know me know I have a compulsive concept sketching addiction - if there's no whiteboard handy I'll go to town on any pressed fiber product in reach.

As such I've decimated many many Post-Its in the pursuit of the next great blog post.

Twitter, however, allows me to skip all that and virtually 'write' Post-Its (my 140 character messages) in real time.

I'm tweeting live from WHCC right now - you don't even have to create an account (free) to follow my posts (free) - just search for "jenmccabegorman."

I've heard from 2 buddies its almost like being there, so come on over and check it out.

For more formal postings, a bunch of Health 2.0 folks are blogging live here - welcome to virtual, environmentally friendly WHCC coverage (well, except for all that electricity usage for my laptop, Blackberry, etc).


Maryland Gets Million+ to Reroute "Unnecesary ER Visits"

CMS just awarded my former homestate Maryland with a cool $1.78M.

Great coverage by Sue Schultz in the Washington Business Journal here. Sue also covers the healthcare funding beat for the Baltimore Business Journal.

The CMS capital injection will fund a task force composed of "3 regional healthcare teams" staffed with "several community care providers."

The team is, among other things, charged with "avoiding unnecessary emergency room visits."

MDs Department of Mental Health and Hygiene will get $732,216 this year for "creation of the teams" - that's $244,072 per team if all dollars are directed right to the bottom line, but there's no way they'll see that much in the budget line after DMHH gets an administrative/overhead cut.

This is a much nicer salary than 'community care providers' would earn as primary care docs - I'm wondering if they'll have a waiting list of PCPs lined up to submit applications.

And that's not even counting how much it will cost for them to hire a plethora of healthcare, public policy, and strategy consultants who will tell them how to form the teams.

In 2009, the budget for the teams goes up to $1.056M. If the teams have been formed by the end of this year (yeah &^%, ahem, yeah right), that means next year each team gets $335,200.

Figure a team of 6 - 4 providers and 2 consultants. That's a salary of $55,866.66 a year. Is this enough incentive to get a doc to tell a patient they shouldn't be in the ER?

And will DMHH provide legal coverage for the task force teams, since it's almost inevitable one of their providers will face some sort of litigation (helloooo EMTALA).

That's a good chunk of change for figuring out how to politely tell people who overuse the ER to go to he$%.......and if anyone from DMHH is reading, I propose you immediately retain Drs Scalpel, GruntDoc, and Whitecoat to advise you on how to do this with panache.

Unless they're planning on turning non-emergent patients away following triage, I'm not sure how much they'll get for the money.

This part of the article is what really worries me:

"In each of the region's, [sic] the state will try to redirect patients using the emergency rooms inappropriately to community care providers to reduce uncompensated care "costs at local hospitals."

So where will the task forces implement these new reforms?

According to Sue's article they will cooperate with "a regional hospital." It will be interesting to see which hospital was chosen. There are some big system players in the area, including Hopkins, University of Maryland, and Medstar.

Maryland isn't the only state to benefit from this windfall - CMS gave $50M out to 20 states.

If CMS ultimate goal is to indeed "slow spending growth" and "maintain access to coverage," I'm not sure 300 task forces would be enough to change the culture of ER overuse, let alone 3.


Defining Health 3.0 and 4.0

Reading through reviews of the Health 2.0 Unconference NL, I realized we'd hidden some pretty important definitions in lengthy descriptive coverage.

Guilty as charged. This post will hopefully make it easier to find definitions of Health 3.0 and Health 4.0.

A group of us here in Holland are working on Health 4.0,
which combines the Health 3.0 principles Dr. Jeff Gruen, Chief Medical Officer @ Revolution Health, names (see attribution here) and adds coherence as the penultimate connector.

If we look at the dot-o movement in healthcare and wellness management numerically (in semantic web terms), we can distill the evolution of the concept down to something like this:

1. Health 1.0 = content

2. Health 2.0 = content + community

3. Health 3.0 = content + community plus consumer-centric commerce

4. Fully realized Health 4.0 = content + community + working commerce models + coherence (connectors)

On Saturday we had the first Health 2.0 Unconference in Amsterdam, where both practical and philosophical concerns on how to bring about consumer-centric care (human-to-human) were big topics of conversation.

There's a further review of the Health 2.0 progression to 3.0 (and goals for eventual 4.0 evolution) in my nitty gritty review of the event.

So has Health 3.0 arrived?

I think we're on the way, with some firms starting to reach for the 4.0 pinnacle, in which consumers can access care research, tracking, delivery and integration using both online and offline models.

There are a few companies with viable business models that create a platform for sustainability.

Three top picks include Organized Wisdom, Hello Health/Myca, and American Well.

It's no coincidence one of these firms uses systemic buyers to fund/funnel services to consumers via payer platforms (insurance companies), a revenue model that stands out in the current ad-funded glut.

The other two provide open access linking consumers to healthcare providers, and ALL THREE link patients/healthcare consumers to docs in one way or another.

Again, it's the 3Cs of Health 3.0 - Content (Organized Wisdom Wisdom Cards), Community (all), and Commerce (American Well partnering with HMOs to offer doc access services direct to consumers, Hello Health providing self-pay concierge doc services).

Newcomer Limeade also makes the cut (more on Limeade later), and SugarStats.com provides content + community and the interconnectivity we'll come to expect from Health 4.0 firms (you can send stats to your doc).

More examples later, but if you want to learn more you should be in Vegas next month attending this.


Wrasslin' the Consumer Landscape: Mergers & Lessons for Managing Failure to Thrive

Organizations that embody Health 2.0 principles (content+community) adopt a consumer-centric view.

For a moment let's step back from the merry-go-round debate about why it behooves hospitals and other HC firms to do so.

Once you do decide to go consumer-centric, there's no going back.

So let's explore the new challenge hospitals will face when they finally realize the vital importance of marketing to selective buyers (meaning people - who happen to be patients - proactively engaged in becoming partners in care).

Consumers might think your company sucks.

If so, they take their wallets and walk (or crutch, or wheelchair, or cruise the web) to a company offering a better combination of products and people-to-people interaction, paying a premium for firms that succeed in offering 'hotealthcare' and embodying human-to-human marketing.

In addition, once you move from a commodity-business mindset to a consumer-based culture, you have to realize the competitive environment is completely fluid. Failure to thrive can hit at any time.

Just because you're the king of the hill one day doesn't mean your audience will love you tomorrow (thanks Amy for helping illustrate the concept).

Just because consumers think you don't suck one minute doesn't mean our loyalty is guaranteed. You can't assume we'll be happy to bring our business through your doors the next day based solely on your past performance.

You can't rest on a legacy. There's always another competitor waiting to take your place (quite cheekily in this case - click the "intervention" tab for a laugh).

Let's take another example from recent retail/consumer-goods news, which you know (unless you've been living under a rock) is where medicine 2.0, web 2.0, health 2.0, biz 2.0, etc. are driving the future of wellness management.

Brick-and-mortar movie rental chain Blockbuster is trying to sneak a hostile takeover offer for consumer electronics retail store Circuit City in under the radar while the US press is preoccupied with the MS-Yahoo menagerie, falling housing prices, airline industry snafus, uninspiring political choices, and other woes.

Luckily, The Washington Post caught on, and published this article, by Qlan Mui.

I sent the article to a tech/consumer electronics guru in my social network, with whom I've had many conversations about consumer-directed care (poor guy), and here's his reply (edited for some "choice" language):

"Well, after Best Buy came along, Circuit City has always been a sad excuse for an electronic store. Their layout sucks, stores are old, and stock poo poo. The only thing they used to have going for them was their educated staff/customer service. Best Buy comes along, improves upon those things but lacks customer service. Majority move to buying from Best Buy.

Blockbuster, once the king of movie rentals, has always had to adapt to other companies and their services/business practices. Hollywood Video comes out, lets you rent for longer periods of time, Blockbuster does the same. Then Blockbuster comes up with that "rent the movie, bring it back whenever, but please by such and such date." Netflix comes out, Blockbuster does the same thing but "oh, you can bring movies back to the store! Don't have to wait for them to flow through the mail system."

So, you've got two companies, once the king sh*& of the land and one wants to buy out the other? When is the last time either company did something that made some other company switch it up and do the same thing?"

Takeaway Points for Hospitals:

  • In the evolution of consumer-centric healthcare, consumers take content, create communities, and share feedback. Look before or you'll find yourself behind...what are consumers saying about your company?
  • Make sure your layout "doesn't suck" (how easy is it to navigate the halls? your payment and registration systems?) and your stock-in-trade (service line offerings, soft 'touches' at each point of the care spectrum) isn't "poo poo." I suggest using alternative wording to emphasize this point at your next Board meeting...
  • You can still win with good customer-service - customers trust companies who place us at the center. But you can't win with ONLY good customer service. New care delivery channels are emerging literally overnight. You have to know your consumer like never before, and provide access to care in ways we wouldn't have dreamed of 5 short years ago.
  • If no other hospital is imitating you, you're a dead in the water and a prime M&A candidate.
  • Proactively improve consumer offerings BEFORE you have no other choice but to buy or be bought out (or close the doors).
  • Consumers like my newbie-analyst above feel like we 'own' the products and, more importantly, the brands we buy. Each purchase goes into the pool of identity we create through selective purchasing. How does your healthcare channel help enhance my wellness and personal identity?
  • Speaking of stock in trade, it's still about clinical results first, and consumer relationships second. But with 'discretionary' care replacing primary and even emergency care in the US, the gap is closing quickly. Do you make more money from emergent or optional/elective care?
  • If you're not sparking change, you're eating some other competitors' smoke.
So is your hospital the type to fan the flames or eat the dust?


Health 2.0 Unconference NL - The Nitty Gritty Review

On April 12, 1955, Dr. Thomas Francis announced the success of Dr. Jonas Salk's polio vaccine trials.

Salk was a workhorse completely committed to his cause - he spent 5 years developing the vaccine and then a year testing it in the field.

It took more than 7 years of his life, but Salk's preventative R&D helped eradicate the polio virus' devastating effects. 2 years after widespread use, polio cases had fallen 85-90 percent.

53 years later, a movement in preventative wellness management is tackling the largest, 'unspeakable' problems in healthcare.

Health 2.0 promotes proactive, preventative measures to optimize individual health (and thereby improves collective health), putting the patient at the center of the care model.

With 2 years of HealthCamps, conferences, and most recently the Health 2.0 Unconference NL, the movement started by Salk-style workhorses Matthew Holt and Indu Subaiya has gone viral worldwide.

When Maarten Den Braber, Martijn Hulst and I started emailing about our interest in Matthew and Indu's concept and planned the first Health 2.0 event in Europe, we had no idea we selected such a portentous date - you can't beat the success of the polio vaccine's annivarsary.

Is it arrogant to propose the Health 2.0 movement has the potential to make an impact as big as Dr. Salk's vaccine? Undoubtedly. But then again, refocusing on the patient has the power to positively impact healthcare delivery in a way that hasn't yet been quantified.

Maybe there isn't a cure for what ails healthcare, but Health 2.0 may very well be a vaccine.

The "Three Musketeers" who organized Health 2.0 NL are equally committed to the cause below, and left Saturday's event with a deeper commitment to linking worldwide consumer-centric healthcare events and supporters.

The big 'unspeakable' problem we're all trying to address (from Salk's vaccine to Health 2.0) is this - healthcare is an inherently reactive organ trying to be a predictive one. (So is medicine 2.0 - so is Wall Street for that matter...)

In a dingy, dark, suitably 2.0 loft building (Volkskrantgebouw) in Amsterdam (see Flickr photos here) a group of almost 50 people gave up their Saturday afternoon (on a rare gorgeous, sunny day in Holland) and tried to figure out how to move Health 2.0 from the visionary stages to the very real implementation phase.

There were balloons, vibrant voices, now-infamous junk food and tooth-destroying beverages (soda, coffee, beer, and sugar free Red Bull for the addicts in the house) - also more Macs than an Apple Convention. The only way this would have been more of a true "dot-0" event is if one of us took off our shoes mid presentation (or wore Adidas sandals a la Mark Zuckerberg).

Although there was plenty of buzz, here is why Health 2.0 will become a force to be reckoned with in Holland:

Everyone at Health 2.0 NL was fully committed to grounding the nebulous concept (for ourselves) and opening up the discourse for all to define the movement (consumer-centric care, human-to-human marketing, web 2.0's content+community).

Yet, we all kept an eye on potential benefits of implementation in practical terms for various market segments (providers, payers, patients, govt., etc).

It was a perfect meeting of the minds - we had both prophets and producers.

I speak for most there when I say we 'got the buzz,' but also that we moved pretty darn quickly to asking tough questions about Health 2.0 -including:
  • "what does this actually look like in practice?"
  • "which is most important, clinical results or customer relationships?"
  • "does our system even need quality/clinical improvements in Holland?"
  • "what does Health 2.0 NL have in common with US Health 2.0? How are they different?"
  • "what do successful Health 2.0 business models look like - for providers? for payers? for govt? for patients?" (case studies - can it make money? can it make people healthier? can it reduce costs?)
We're trying to define, direct, and then disseminate Health 2.0 efforts, opening the door for consumer/patient discourse, in the real world here in Holland.

To do that, there are 3 types of people needed to move consumer-centric, human-to-human care (Health 2.0) forward:

1. Innovators - inspiring creators/visionaries ("us)
2. Interrogators - inquiring critics ("them")
3. Implementers - those who harness benefits of clashes between innovators and interrogators and "do"

When I was preparing for Health 2.0 NL, I assumed we'd have a crowd of all Type 1 people - inspiring visionaries.

I'm happy to report I was utterly wrong. We had plenty of interrogators. Some attendees provided tentative stabs at what implementation would look like in their organizations (consulting firms, marketing/communication firms, web/tech firms, hospitals, insurance firms, students, etc).

This means in Holland we're not just excited by the possibility of being involved in something 'big,' we're focused on harnessing H2.0 and developing ways to evangelize to providers and payers and bring offerings to consumers "where and when they live" at a price SOMEONE is willing to pay (who pays for consumer-centric care is an entirely different animal).

At Health 2.0 NL this weekend, I suggested the success of this movement requires not only continued coordination of efforts among the three types of people above, but an equally strong commitment to integrating two types of complementary (rather than competing) initiatives:

1. efficiency and;
2. empathy.

For more details, you can view my amusing (I hope) PowerPoint here at SlideShare (and access the complete suite of presentations - and I guarantee they're much more professional and constructive - given this weekend here at the Health 2.0 NL group).

Tip: Ignore the joke slides and head straight for the meaty definitions - without the dialogue I use during the presentation they're not useful (unless you really like photos of ninjas or MGs).

For the purposes of advancing consumer-centric care, efficiency initiatives improve clinical outcomes, while empathy initiatives improve the consumer-centric patient 'experience.'

In other words, efficiency+empathy initiatives combine the hard 'science' of medical practice (and medicine 2.0) and the 'softer' side of a service design that addresses a patient's total wellness interaction with a provider, product, or service.

You'll see in most coverage of the event that people here in Holland are asking excellent questions about implementation - including when the next Health 2.0 Unconference NL will be held.

For a taste of what we're in for check out
31volts - and read the guys' review here (thanks Marcel and Marc).

A people who inspired the term 'going Dutch' are appropriately focused, of course, on costs of implementation and exploring business case models that work.

As a result, we'll be scanning the globe for successful Health 2.0 companies who bring in revenue and provide positive ROI to speak and sponsor the next events (look for a larger conference in early 2009).

I can talk until I'm blue in the face about companies that I think fit the bill, but I'm biased - I've been to both US and NL events.

Let's take a closer look at what the Dutch attendees are looking for:

Jacqueline Fackeldey, of Fackeldey Finds, had an excellent presentation on a concept she invented called "hotealthcare," which is built on an empathic "human-to-human" approach.

You can find Jacqeline's show at the Slideshare group link, and here's her coverage of the event itself (in Dutch).

If you're doing human-to-human marketing in healthcare, we want to know more.

Head over to MedBlogNL for coverage of the event with 2 more PowerPoints also available at SlideShare.

If you're a provider or payer adopting or adapting eHealth initiatives (and especially if you're implementing them into brick-and-mortar practice), we want to know more.

The Dutch blog Zorg voor Klanten has nice, concise feedback here.

If you're organizing a health 2.0, medicine 2.0, web 2.0, business 2.0, or other 2.0 event that boils buzz down into substantive business cases, we want to know more.

My favorite comment, tweeted live from Dorrit Gunters, says: "Health 2.0 is gezellig."

It's difficult to translate the 'gezellig' concept exactly into English, but loosely it means Health 2.0 is comfortable, Health 2.0 is 'cozy' with a sense of the 'right' kind of closeness.

If your organization is making healthcare interactions more comfortable for consumers (or providers!), we want to know more.

Here's a longer review (in Dutch) by Erwin Blom, a review at Medical Facts, and coverage at Medisch Contact.

If you're an inspirer, innovator, interrogator, or implementer who wants to be involved in the next Health 2.0 event, we want to know more.

If YOU want to know more, contact one of your 3 intrepid organizers:

  • Jen McCabe Gorman (jennifermccabegorman@yahoo.com | twitter.com/jenmccabegorman)
  • Maarten Den Braber (mdb@twister.cx | twitter.com/mdbraber)
  • Martijn Hulst (martijnhulst@gmail.com | twitter.com/martijnhulst)

* If you'd like to chat in person, I'll be blogging from the World Healthcare Congress in DC next week.

A special note:

Transparency and access to information and care are central tenets of Health 2.0, or consumer-centric care.

All the materials the Health 2.0 Unconference NL has posted online are open-source, but please adhere to the Creative Commons license. (Dutch) Basically, graphs, photos, etc. may be reposted, reused, and recycled with attribution (especially if it has someone's name on it or photo next to it).

Some final food for thought...

If we conceptualize Health 2.0 (consumer-centric care) as more than a movement - as a concrete subset of the current healthcare industry - many products and services do (or will) fit in this sector - not JUST health information technology (HIT).

The great news is that the timing is right to push transparency in the hospital/healthcare marketplace; big players are beginning to quantify the benefits of transparency (whether it be in a hospital, on the factory floor, or in a graphic design firm).

These benefits extend to more than patients - they also extend to providers in the healthcare environs (and have the potential to provide hard HR benefits such as reducing turnover).

One example: Deloitte just released the 2008 Ethics & Workplace study (hat tip to Lisa Haneberg@Management Craft, who got me started flapping my wings with this blog last year). The study reports over 80 percent of respondents agree leadership openness creates a more ethical culture.

Another example: In Singapore, Sun Microsystems just supported a healthcare/tech mashup (hat tip to Maarten Den Braber).

At the practical level, what we're all talking about is the development of a comprehensive suite of PET (Patient Empowerment Tools).

Whether Health 2.0 products are offered virtually or at a 'real world' brick and mortar healthcare/wellness site, whether they're hardwired into hospital infrastructure or more nebulous web-based applications, these goods and services put the patient at the center.

Which is exactly what we're trying to do here at Health 2.0 NL. If you're a person who is also a patient, and a consumer-centric service or product has empowered you to become a partner in your care - we want to hear from you.

A brief note: If you write a review of Health 2.0 NL, link to any blogs/presentations/photos, or respond to any of the information above in a web-based format, please be sure to use the tag 'health20nl' so we can continue to build the community.

To Niels Schuddeboom, Jacqueline Fackeldey, and Jeroen Kuipers, Marston @ SugarStats, and Peter @ BubbleFoundry - you are amazing and we'll have a blast with things as we all move forward together.

One final note of thanks, and perhaps the most important one.

I've already mentioned our fabulous four sponsors, but I need to heartily thank everyone present this weekend who put up with my deplorable lack of Dutch and graciously presented ideas and feedback in English.

Your generosity in making allowances for my language difficulties definitely made the day "gezellig," and I've found a new home here in Health 2.0 NL.


Health 2.0 Unconference NL ROCKED

To all of you not at the Health 2.0 Unconference NL today - I offer my apologies from across the pond - you missed something truly incredible. You're hereby invited to the next shindig.

You missed an event that - well - there aren't words right now.

I've never been a part of anything quite like it (but I'm a blogger, so of course I'll get over the lack of words sentiment quick, fast, and in a hurry).

50 people crammed into a room in an industrial loft building in Amsterdam talking about Health 2.0, batting balloons (long story), trading cards and commentary, munching on some superb and utterly non-healthy Dutch treats, asking questions that would make O'Reilly blush- in other words, pretty much paradise.

Our sponsors (KNMP, The Decision Group, building better care - site coming soon, Bubble Foundry, and Twynstra Gudde) : you have participated in the first international Health 2.0 event.

You made this possible. Your support and encouragement gave us the will (and working capital) to live and finalize details while Twittering about presentations and guests at 2am. We thank you (and thank you, and thank you).

Our presenters: you brought the unconference to a level we didn't imagine when we envisioned a casual chat about the global state of healthcare over a few beers.

You define Health 2.0 in Holland (as well as good business-sense, creativity, and innovative spirit), and have lessons for the global consumer-centric healthcare movement (content, community, commerce, and coherence). We thank you (and thank you, and thank you).

To my fellow Musketeers Maarten Den Braber and Martijn Hulst - well, guys, I love you.

What can I say. In the early words of the conference (how we were all feeling) - "Um, wow."

We had almost double the numbers expected, including journalists, insurers, consultants, analysts, students, artists/writers, etc. etc.

Tomorrow I'll have less mushy thoughts and more analytical commentary, including a transcript (complete with messy translation) of the liveblogging and Twittering that tells the story of the first Health 2.0 international event.

We're just getting started over here in Holland - look for the next event in a few months, with increased audience participation and 'collective disruptive service design' a la 31volts ("the Dutch IDEO" who also promised us a barbecue - guys we heart you).

Maarten left this evening and couldn't get Health 2.0 off his mind, even at the Trashed Out event in Amsterdam, where he painted the messages above for us.

Maarten, my friend, there are few things better than link love, but this beats that hands down.

Martijn, on his way home to his wonderful, supportive family (he and his lovely wife have a 3 week old son!), wrote us this message:

"For a couple of years I'm blogging and talking about the Internet and Healthcare, about Health2.0 and about the thing that Health2.0 is much more than an internet-application, than something of geeks (who are sitting 24/7 after their pc and playing warcraft or something). It's a movement of people who are willing to change the relationships in healthcare, to change the paradigm and to get something started. Thanks to you both we did something start today. The room at the Volkskrantbuilding had no windows, no view on the outside, but the energy and vibe was of people who are willing to think different and do things different. It was a room with a view!"

It was indeed, Martijn, a room with an incredible view.

Beste to all, and thanks for your help in wishing the birth of the Health 2.0 movement in Holland a hearty 'succes'. There's plenty more to be done, and we look forward to being your 'partners in improving patient-centric care.'

- The Health 2.0 NL Team


Pucker Up: K.I.S.S. Communications in Healthcare

Let's keep it clean and simple for a Friday (it'll get plenty dirty and disorganized tomorrow as Holland healthcare/tech luminaries cluster for the first Dutch Health 2.0 unconference).

It should be ridiculously simple to establish trust among consumers, and communicate the value your healthcare organization provides.

All you have to do is be sure each and EVERY message and interaction ('touch') reinforces the patient's perspective that we are receiving consumer-centric care designed just for us.

This doesn't have to be painful for your communications team, and it doesn't mean you relegate good medicine and safe patient care to the sidelines.

Case in point: the short, very sweet message I just got when I confirmed my subscription to Method's email blast.

Instead of a boring line telling me how to perform the almost inevitable future-unsubscribe, I was greeted with this little bundle of literary cuteness:

"Welcome to our cozy club of people against dirty. You know that scene in "It's a Wonderful Life" when the bells ring every time an angel gets his or her wings. Well, you can imagine the cacophony of bell-ringing right now in our little office in Richmond. Not real bell ringing. It's more of a metaphor. But that'll give you an idea how excited we are that you've joined our little cleaning revolution. "

Really, it's high on the cheese quotient, but it brought a smile to my face, and I actually read the whole confirmation message.

Plus, now I'm blogging about it for you wonderful people, so it just goes to show a little investment in creating a corporate style reading as highly personal secures a high rate of return.

While we're on the subject, Method's whole site is clean, crisp, and easy to use. They obviously subscribe to the frameless manifesto.

Your hospital site should do the same - now's the perfect time to clean up your act.

Grand Rounds...

Dutch style...


Health 2.0 and Beyond: Hospital System Newest Player in Retail Healthcare Market

MedStar Health and Consumer Health Services, Inc. will staff 4 MD and DC area RiteAid pharmacies with docs, creating a new player in the retail clinic sector with PromptCare.

Check out this story in The Baltimore Sun, and an AP article here. Here's the news release on MedStar's site.

As the articles mention, using docs is a departure from what's become standard minute-clinic operating practice...usually locations are run by NPs and/or PAs.

PromptCare docs will also have admitting privileges to Baltimore and DC MedStar Health facilities including Georgetown University Hospital, Montgomery General, Franklin Square, Harbor Hospital, Good Samaritan, and Union Memorial.

The clinic docs can access MedStar records, creating a new network of personal health portability.

A la the Starbucks model (cash and carry for a consumer good), patients at PromptCare can pay with cash, credit, or their well-loved insurance plastic.

Administrators are of course hopeful patients wanting to use EDs for non-emergent conditions will visit PromptCare sites instead-essential it's offsite sourcing of urgentcare/fast-track type service lines.

The news is also interesting because it marks the entry of a massive East Coast hospital conglomerate into a space that's been typically run by quick and nimble entrepreneurial startups.

At this Saturday's Health 2.0 Unconference NL we'll be talking a bit about the evolution of Health d0t-0's.

I'm defining Health 3.0, the next generation of 2.0, in terms similar to the 3Cs of web 3.0: content, community, and commerce (we've already got content and community, now Health 2.0 firms are working to create consumer-centric commerce models that work).

MedStar's PromptCare clinics fascinate because they're jumping right over Health 3.0, leaping ahead to implement what I think we'll see with the arrival of Health 4.0.

An iteration marked by the need for coherence, Health 4.0 will integrate consumer-centric care models into established, traditionally slower-moving, "brick and mortar" healthcare organizations like hospital systems.

In other words, it's taking the care to where consumers live, work, play, and purchase...we'll see Health 4.0 relationships meeting the healthcare and wellness consumer in her natural habitats, just as MedStar is doing with this new model.

"Health care has been late to having a consumer focus, and consumers are increasingly demanding service in a variety of settings that are much more convenient," said Eric R. Wagner, a senior vice president of managed care for MedStar, a nonprofit. "We're taking health care to a place where consumers already are."

And here's an even better way to take it to where consumers live - true Health 4.0 will bring brick-and-mortar integration of ONLINE care delivery, not just research and coordination of care.

PromptCare could herald the arrival of Health 4.0 by integrating online services, including a way to check wait times on the web.

If I'm a consumer and trying to determine which location to visit, let me hop online at the PromptCare website and check out IN REAL TIME how many patients are at each clinic site, AND (here's the kicker) their wait times to dispo.

That way I, as a healthcare consumer, can figure out where the longest wait will be and go to a clinic with more available space/time to serve.

I don't want to wait for care, and your clinic providers don't want me to slam their busy site with my runny nose when I can go to another PromptCare across town that's catering to a single patient.

With this type of online, web-based HIT system, PromptCare (or any other retail medicine outfit reading this blog) can create a more efficient, more-customer friendly system that aggregates the total net benefit of consumptive capitalism.

With an online system showing me where the bottlenecks are (a la Yahoo! Traffic), I can create my own workaround and choose a different route, and thus assume a participatory role in creating more effective care delivery for myself (and thus for all others traveling the same highway to health

RiteAid already offers online Rx records, so they're a natural partner for this type of Health 4.0 effort (it'd be interesting to see how many consumers are using this service)

This realization of Health 4.0 would have multiple consumers making choices that are essentially self-interested but also have the significant side benefit of increasing the efficiency of the care delivery system as a whole.

MedStar - who would have thought a hulking regional hospital system would herald the next generation of healthcare evolution? It's developments like these that renew my pride in working for a better healthcare system.


Health 2.0 Unconference NL Taking Off - DC World Healthcare Congress

The Netherlands and America have shared many good things...

The Speedwell & Mayflower, thrifty concepts of commerce and entrepreneurial colonization, a love of frites (fries) and gut-churning coffee, and an outlet with the sole purpose of determining how consumer-directed, patient-centric developments will impact the healthcare marketplace.

Here's Dutch-American diplomacy at its best - now we're sharing Health 2.0.

Last night, Health 2.0 was featured on Dutch Radio Online during an interview with Twynstra Gudde's Martijn Hulst (one of the 3 musketeers organizing the event including yours truly, along with The Decision Group's Maarten Den Braber).

I met these two over at Tony Chen's Hospital Impact, and 3 weeks after Maarten and I agree to arrange a friendly intercontinental chat, wham - the first European Health 2.0 brainstorm event is on its way.

For all the grisly details, check out the invite (PDF format).

In true Web 2.0 fashion, Ning is our social networking site of choice (though we're also addicted to Twitter):

Here's the Health 2.0 Unconference NL BarCamp wiki:

Today must be a propitious day for big announcements.

Health Management Rx will be liveblogging from the 5th World Healthcare Congress in Washington, DC April 21-23rd. Coverage will also be syndicated at the newest Dutch healthcare blog Health 2.0NL (launch soon).

Fellow Health 2.0 vets and bloggers Dr. Vijay Goel and George Van Antwerp will also be covering - Vijay is moderating a discussion titled "Consumerism: How Far Does it Go/How Disruptive is it to the Existing Players?"

If you'll be at the World Healthcare Congress, wander on over to the media/press cluster and say hello to your friendly hometown expat blogger...should be a great show!


On "Medical Homes" & Healthcare as a Business

The most constructive critiques are usually a double-edged sword, and this one's no different.

Today the latest issue of the Journal of Healthcare Management, published by the Foundation of the American College of Healthcare Executives ("for leaders who care (R)," and of which I am a member), arrived via my friendly Dutch postal carrier.

Here's the sweet spot...

It is the FIRST issue of JHM that I've been unable to put down (in just over a year of devoted, cover-to-cover reading).

In fact, it is the first issue I found directly relevant to current healthcare management issues. Usually (sorry ACHE) I reserved JHM for bathroom reading.

Editor Kyle Grazier sets the right tone with her editorial. This issue, finally, is "A call to arms."

Articles included succeed in raising "awareness, attention, and action." Hope this quality coverage continues.

JHM has also chosen to run 2 new columns, the most interesting being Sandy Lutz's ongoing discussion of "current trends and future implications of consumer-driven healthcare."

Each issue of JHM starts with a 'famous person' interview, highlighting someone in the field of healthcare management (usually FACHE certified, naturally).

This issue interviews Lucian Leape MD, an adjunct professor of health policy at Harvard.

Dr. Leape has heaps of experience in the field, more letters after his name than I can ever hope to obtain, and makes a hobby out of testifying for Congress about healthcare safety and quality issues.

I agree with many of his views (including the fact that we'll have a national effort in the US to enforce patient safety goals in the near future).

However, one sentence on page 75 made me check while filling out my mutual admiration society card. And here's the sword...

Dr. Leape says: "Part of the reason for this is that the American healthcare system puts so much emphasis on the business of medicine."

It's here, Dr. Leape, that I beg to differ.

In fact, it drives me nuts when I hear this line.

This is NOT the problem. We don't place too much emphasis on the 'business of medicine.'

The problem is that we're trying to morph a cottage, craft-based industry composed of loosely organized individual practitioners into a working, centered, corporate-efficient business model nearly overnight.

But we're failing at it.

If we weren't, we'd recognize the value of getting and retaining human capital (staff).

If we weren't, we'd recognize the value of getting and retaining customers (patients).

Integrating a 'business of medicine' approach and creating a care environment that puts safety at the forefront are not mutually exclusive strategies.

Creating a safe, productive, empowering, efficient, empathic environment of care (for both populations) is THE primary tenet necessary to achieve both goals.

A well-run business would recognize this and realize ROI in both profits and people, dollars and dreams realized, loyalty and less lawsuits.

It's not that we have too much 'business' in healthcare Dr. Leape - it's that we have too little.

The latest 'care' based healthcare initiative slaps a new customer-friendly tag on an old search.

Pundits and analysts (many of whom I respect and whose views I admire) are looking to solidify the amorphous concept of consumer-centric care around a universal 'medical home.'

To all those looking, forget it. We're grasping at straws.

This is the healthcare industry equivalent of Arthurian legend.

No single heroic stratagem will pull the sword from the stone and save the kingdom.

Stop searching for a larger-than-life solution - a much more self-effacing hero already exists.

The 'medical home' we're all looking for is embodied (literally) in each patient we see, each consumer we 'touch' with a Health 2.0 communication.

Stop thinking of 'safety' initiatives as universal measures that can be implemented mirror-image in each clinical setting.

New checklists and protocols to prevent medical errors most appropriately begin centered around the experiences, prognoses, and wellness goals of each patient, taking into account clinical pathways and docs orders, of course.

That's not just safe, empathic medicine Dr. Leape, it's good, efficient business practice.


Healthcare Stocks Good Buy During a Recession?

That's affirmative, according to Seeking Alpha analyst/writer Andrew Hart.

In recessionary periods, particularly this next one, Hart believes healthcare will be a "respectable value." Good to know someone still feels that way about the industry, and we're a decent way to pad your portfolio in anticipation of increasing turbulence.

Very interesting tidbit: Healthcare stocks outperformed the S&P 500 in each of the last 3 recessions.

So we're willing to invest plenty of money buying healthcare stocks when the chips are down, but not in bulwarking the system so it also excels in times of plenty?

Do we need to invest in rebuilding the healthcare/hospital industry from the ground up, or can we continue to pour billions of dollars into "facelift fixes" - including massive renovations and capital expansion projects?

That's a tough question, and luckily there are new players finding their own answers.

As usual, private investors and industry will step in when a sector is weakening and encapsulate value propositions with new business models.

Here's a new (to me) Health 2.0 firm doing just that - check out SugarStats.

The site has been instrumental in helping some users reduce blood glucose levels - here's a comment:

"Today, I can proudly say I have effectively been able to reduce my blood glucose levels by almost 10% in the past month, by exercising more and becoming more aware of my eating habits and glucose trends, thanks to SugarStats.com." --Manny Hernandez, TuDiabetes.com Founder

10% reduction in blood glucose levels. How's that for ROI?

So Health 2.0 firms can quantitatively improve wellness for users - finally an example of money (and time) well spent in the healthcare industry.

If you're coming to the Health 2.0 Unconference in Amsterdam next weekend (stay tuned for location announcement), you'll have the chance to meet SugarStats founder Marston Alfred, and ask him for yourself why investing in the future of consumer-directed care is a good buy, recession or no.


Wait Times & Inefficiences -Need an ER? Make an Appointment...

A hospital here in Holland wants to hire me as an advisor. I very much want to be a part of their team. It's a great match, and we're both anxious to take the relationship to the next level - i.e. my first day of work.

Unfortunately, I wasn't born in this amazing land of tulips, common sense, and thriftiness (nor am I an EU citizen with high workforce mobility granted under the free mover arrangement).

Therefore trying to get a Temporary Work Visa (TWV) and gain legal access to work in Holland seems like an exercise in learning forebearance.

Luckily, I don't give up easily, but it's frustrating nonetheless to fantasize that if I could just schedule ONE visit with an actual representative at IND to go over all the paperwork, submit it, and have an interview, the decision could be made to grant me work permission (or not) in about 4 hours.

Here is an ugly, rough-and-tumble estimate of resources used thus far in pursuit of ONE temporary work permit (for a contract of 1-3 years - and I don't have the thing in hand yet):

1. One Dutch hospital HR specialist working, let's say 20 hours over a 3 month stretch since the position was offered (minimum) to research the process, contact the office in charge of my NATO residence permit, and contact the Dutch immigration department (IND)

2. One Health Management Rx blogger working, let's say 30 hours over a 3 month period to contact offices, make copies, ask questions, and do research online.

3. One hospital executive following efforts of both HR specialist - let's say he's spent 5 hours total responding to inquiries, asking for updates, and himself researching our options

That's a minimum of 55 hours spent trying to obtain one work permit. On Friday I found out I'd need to fill out and submit more forms to Dutch immigration (IND), and then wait for the agency's response. Add another 3 hours to read the 26 pages and fill out the forms. So we're up to 58 hours.

That's a lot of hours, a lot of follow-up time, and thousands of 'touches' to chase down one permit.

Unfortunately, I'm getting just a small personal taste of the professional frustration many ER providers feel every shift.

Similar bureacratic inefficiencies about in medicine.

Ian Furst, a Canadian oral/maxillofacial surgeon blogging over at Wait Time & Delayed Care, proposes an interesting theory for reducing wait times and improving patient satisfaction in the ER - consumers should call ahead and schedule a time to come in.

Ian writes a great blog, and is also one of the most prolific healthcare bloggers reading/commenting on other blogs.

So he's one of the few bloggers I take seriously when he recommends call ahead service to the ER that looks a bit like ordering a pizza from Papa John's on a frantic Friday evening.

And he's absolutely right that "unless we try something new" the ED snarl will continue to sap strength from the system.

Time is money, and it's also the most valuable thing we can give to another person. Why not pencil in visits to be sure such a precious resource is spent wisely?


Want to Save a Hospital?

Now's your chance...

This hospital is a breath away from closing its doors after 103 years of service.

St. Francis Hospital in Chicago desperately needs a buyer.

And a turnaround team. They've got the goods, now they apparently need the management, money and guidance...

Anyone up for the challenge?

Jamaica Gets it Right with Universal Healthcare

Free healthcare for all in Jamaica, and the first few days are going well...

Here's one blogger's take from last year, before the island nation implemented free healthcare for children.

Good comments on abc.com here.

Today I spoke with a friend in the IT field who holds dual Jamaican-US citizenship.

One parent still lives in Jamaica. His reaction to the news that Jamaica is offering universal coverage for adults, delivered in an optimistic tone - "I think it's great, but we can't afford it."

Seems paying for comprehensive coverage is a "universal" problem - unless we're willing to combine the resources and infrastructure of a public system (funded via tax revenues), with the resources private firms are willing to offer.

If you're interested in taking a trip to da island to check out the healthcare environs, contact Dr. Jacqueline Watson at Health Concepts International.