"Renovating" Medical Education: Web/Gaming Tech & NextGen Med School Coursework

Question of the Week:

As the old guard of physicians nears retirement (some will remain engaged with practices well into their 7th, 8th or even 9th decades), is the influx of new healers modernizing the manner in which medical education is delivered?

There are two answers, depending on your perspective and position in the system:

1. Yes. Slowly but surely, a few schools are integrating web and gaming tech into medical education.

• Take this initiative by Ohio State, for example (Medical News Today).
  

• Or, even more promising, a single-session, 2 hour intro class on EHR use at the University of South Florida Health in Tampa.
  

• ""While there’s a general move toward technology training, the formal education around EHRs has been lacking, contends Michael Ehlert, M.D., national president at the American Medical Student Association, Reston, Va. “There are some places that have done a good job. But most schools are just scratching the surface (Health Data Management). ""
  

• For now, students aren't tested on the material, only one EHR vendor is used, and it's near impossible to do the gaping chasm that is the current confused EHR/PHR market justice in 2 hours...it'd probably take at least 2 weeks.
  

• Even so, this is a step in the right direction. I'd love to find out who the "new administrator" is who made this course happen. Better yet, I'd like to take the course. Still better yet, I'd like to bring a complementary course on engaging patients in the healthcare conversation via EHRs/PHRs (how do I talk to a patient about using these things?) to USFH. If this post somehow finds its way into the mailbox of a USFH administrator, please contact me.
  

2. No, or at least, not fast enough.

• Medical students are graduating without seeing web and social networking tools utilized as part of the formal curriculum. To teach medical stuff. Much less to teach how to interact with increasingly web-savvy e-patients who may know more about the PHR market than docs do.

• The good news: they'll figure it out themselves and start well-read blogs, like Graham at Over My Med Body. Then they'll graduate, and that knowledge goes with them from med school out into the 'real world' of medical practice. Now who's teaching the next round of McDreamys?

• The bad news: if we don't give them the tools in coursework training, they'll have to use their own spare time (which someone may have told me was scarce during med school) to bring HIT to administrators and create concept courses to teach peers AND administrators/fellow physicians, as Berci Mesko has done with his presentations on Second Life in medicine/health 2.0.

If we're working towards a more consumer-centric, patient-directed system, the educational component of such a revision must not be neglected.

And med students desperately need this kind of information and training included in curricula, NOW. As in next semester. As in 2 months from TODAY.

Not 3 years from now after lengthy Board meetings, celebratory approval, news releases, additional tenure-track positions secured and outside consulting agencies engaged.

After all, CMS/Medicare will run a 1-year pilot program testing PHRs in North Carolina (The Medical Quack).

But who's going to pay for docs to be trained on how to use the PHRs CMS decides to utilize?

Since Uncle Sam is already cutting docs' pay a bracing 10.6 percent, it seems an especially cruel twist to tell those in NC that they'll need to learn to incorporate PHRs into an already time-crunched, tech-deficient day.

And how are the schools going to find money to teach these courses?

"One reason medical schools might not offer formal EHR training is because they don’t have the money or resources to support it, Eichenwald-Maki says. She suggests organizations apply for grants or look for partnership opportunities with other schools so they can find a way to bring EHRs into the classroom (Health Data Management)."

Vanderbilt constructed their own proprietary system from scratch. I have a friend who selected Vanderbilt over an uppercrust NY school (hey DM, good choice).

Here's where it pays to utilize collaborative hives of dispersed global innovators with an interest in augmenting the current system *cough* *cough.*

I'm not advocating for med curricular anarchy here - but rather the addition of new, catalyzing lectures and courses that speed up the reaction time from first exposure to formation of a new compound - consumer-centric care.

If you can't beat 'em, join 'em. Berci Mesko, Ted Eytan, some Nexthealth.NL folks and I will be working on concept courses/lecture series to 'renovate' medical education.

This initiative was just born Friday, so give us some time. Like 2 weeks (we need the VCWear shirt that snarks "We Move Quick"). Better yet, give us some ideas. Some thoughts. Some emotions. Some complaints.

If you're just going into med school, what do you want to learn about how to interact with patients? What types of HIT and social web tech would you like to integrate into practical training?

If you're just getting out of med school, what was your medical education missing? How could courses have been augmented? Do you want to know what docs, interns, residents, med students are doing and saying on the social web? How physicians are using blogs? How different strata of healthcare professionals are using webmedia to connect?


We're working to set up a social networking site now, or feel free to Twitter any of us (@jenmccabegorman, @NCurse, @tedeytan) for more info.

Much of what we're thinking revolves around our own experiences (positive and negative) with the system, in several countries:

1. Ted Eytan, physician, blogger, new Kaiser patient, strong consumer-centric advocate - US.

2. Berci Mesko, medical student, blogger, lecturer, HIT & genomics guru, strong web-based medical education advocate - Hungary.

There are admitted gaps in our knowledge (US med school student? European physician?), so if you're interested join us in kicking ideas around online.

Some conceptual questions tickling my gray matter to frame course coverage include:

• What are we failing to do as providers when we fail to integrate cocreation and maintenance of a personal health narrative into the practical, formulized scope of care delivery?

• What value are we NOT adding to care intersections by neglecting to utilize HIT and the social web in practice?

• Patients are finding patients and sharing personal health narrative (use of term, storytelling, people think in concepts not definitions - reason we go from spoken storytelling to written word - meaning is always created with CONTEXT (also semantic web implications) and VALUE arises from that meaning, often then commercialized).

• Where others "are" on their personal health narrative helps us revise our own. What online tools (Patients Like Me, Organized Wisdom, CarePages, Diabetes Mine, etc.) are helping us share and speed up the evolution of consumer-centric care?
  

• Where are physicians interacting with patients at the participatory, patient-directed care level (if anywhere?) and how can we create more spaces and practices for physicians and patients to share in the responsibility of determining what's next for each invididuals personal health narrative?
  

Projected Health Benefits of California's Plan to Decarbonize

Someone's finally taking a stab at quantifying health benefits of going green. It would be nice to see other states start including health savings estimates in future budgetary planning documents (not just sustainability plans).

The state of California estimates savings of $1.5B to $2.4B in healthcare spending by reducing carbon offsets.

More info found on page 28 of this PDF report released today during a webcast of the California Air Resources Board meeting (hat tip to Alexis Madrigal of Wired.com for the link and liveblogging "How California Plans to Radically Decarbonize."

Public Health Benefits

Preliminary Estimates for 2020

Total Economic valuation: $1.5 billion to $2.4 billion

Avoided minor restricted activity days: 330,000

Avoided work loss days: 57,000

Avoided acute bronchitis: 780

Avoided asthma-related & other lower respiratory symptoms: 9,400

Avoided hospitalizations due to cardiovascular causes: 130

Avoided hospitalizations due to respiratory causes: 71

Avoided premature deaths: 340

*Based on preliminary estimates of reduced fuel use from measures

2008 - Year of the Consumer in Healthcare (From Somewhere Near the Halfway Point)

We've just passed the longest day of the year (Summer Solstice: June 21st), so let's take a look at what forces are shaping the perfect storm driving participatory healthcare.

But will 2008 really be remembered as the "Year of the Consumer?"

Read the following developments and decide for yourself...

• Boston is the place to be for Health 2.0 startups. 3 pages of them. Apparently, if I hopped a plane to Cambridge to see Doc Searls (who recently became an ePatient himself) and Harvard pals at the Project VRM meetup July 14-15th, I'd stumble across approximately 17.5667 HIT/consumer-centric Health 2.0 firms per square mile. Perhaps the next phase is testing this hypothesis in the field.
  

• Steve Case, of Revolution Health, the underwhelming, overfunded startup (that does what exactly?) deems 2008 the "Year of the Consumer" in healthcare. As long as Revolution doesn't start stuffing my stateside mailbox with free Revolution Health login CDs a la the AOL glory days, like John at Chilmark Research I'll remain rather passively dispassionate about Revolution's chances. Although Steve's suffering with the execution, I do think we'll look back on his pronouncement in 3-5 years and agree 2008 was the year when things began to take off. Really, I think we'll see this mark the year where tech geeks and VCs began to get interested, which means 2010 will be even bigger (a la the year when the Guppie Whole Foods-shopping, Prius-driving crowd gets all warm and fuzzy about using PHRs)- plus, it's a nice, round, futuristic number. We may even see some killer apps created when antripreneurs like Dr. Jay Parkinson join up with entrenched gray suits like Mr. Schultz..maybe by 2010 I can hop into a combined Starbucks/Hello Health shop to see the doc (after chatting with her via American Well's online health marketplace) and pick up a vitamin-enhanced venti jet-fuel, maybe some community sourced locovore produce, at the same time, while sending glucose updates to my SugarStats network, on my way to my virtually linked cowork site with Nexthealth friends (note: almost all of this is possible now except there isn't a Hello Health in the DC area, and Starbucks doesn't sell food from local coops - yet).
  

• Personalized medicine is becoming, well, too personal, according to the state of California. Docs are back in the midst of the milieu, acting as enforcers, ahem, gatekeepers between consumers who want to pay chunks of their own capital to swab a cheek and get genetic data direct from firms like 23 and Me. But what about recent research that shows your genome may, gasp, evolve throughout your lifetime? Surely, consumers can't possibly handle this information...human development and the growth cycle isn't something with which any of us deal with on a day-to-day basis. Sure. Well, they've got one thing right, it isn't something with which many of us deal gracefully, unless we're nonchalant enough to hang our DNA sequence over that little Pottery Barn table in the front hall. That's a great legal argument, by the way, California - don't give us the data because we can't handle the truth. Probable cause for restricting genetic testing to firms which require a doctor's orders: big bucks from some lobbying group.
  

• The ePatient epidemic begins. ePatient Zero announces ER visit, diagnosis, and details treatment via video, liveblogging, links, photos, and updates announced multiple times hourly on Twitter. Check out the one, the only, the amazing and wonderful nexthealth consumer @Dutchcowboy for the future of participatory healthcare. Not only is HE actively participating in care - all his Twitter followers are as well. But be warned. This is not a spectacle people. This is someone dealing with very real issues of illness and the violent reevaluation of self that goes hand-in-hand with such a diagnosis. Treatment is only the start, and social networks can help ease the strain. So, ahem, to the Boston-based buddy who told me no one would want to share x-rays of their broken leg? Touche my friend. If you read it quickly with a squinty-eyed glance it doesn't hurt quite as much: itoldyouso...
  

• In other news, checklists are great, says the WHO, which makes it really super-duper official - surgical teams are human. They sometimes make mistakes. They can benefit from a routine preflight safety check. So can patients. Huzzah, healthcare is saved! Let's see how many consulting firms are engaged before the year is out to design said miracle checklists...
  

Sorry folks, today's Onion-style post is definitely one of those glass-half-empty looks at the state of "our system," where it's headed, and how quickly it's moving there - which today seems to be a pace just slightly above fossilization.

That, and I'm probably suffering from acute lack of sleep, spending the week getting used to being a new aunt.

Wait a minute - now I see why all those residents and interns write cynicism-infused posts that drip with the very ether of sleep deprivation! Finally I understand you my brothers and sisters of the sandy-eye syndrome...but it's all a labor of love, that's for sure. Well, at least for me. Holding my baby niece until she falls asleep is probably a hell of a lot more fun then some 347+ hour ER rotation.

That being said, there is hope on the horizon.

Coming soon to a medical school curriculum near you - a concept course dealing with how NOT to be a total boob when engaging consumers in the healthcare conversation...

Collaborative Learning in Health 2.0; 23andMe in Second Life

Today I attended a presentation by B2C genomics firm 23 and Me in Second Life. The meetup was organized by Berci Mesko of ScienceRoll.

You can see my blue dinosaur avatar in the middle of this "postcard" (avatar name: Niffer Quandry).

It was my first foray into Second Life - I'll admit I'd been hesitant to venture into the SL world after hearing large numbers of Second Lifers use it as an online Red Light district.

However, I didn't have to wade through cyberhookup offers...organizer Berci Mesko was kind enough to Tweet me a teleport link.

He's got great coverage of the event here. I'll be attending any Second Life events Berci organizes, and would encourage you, dear readers, to do the same.

You can also search Twitter for "#23andme" to follow some livetweeting (Berci Mesko's Twitter name is @Berci).

After being able to follow the latest in 23 and Me's strategic planning via a live chat, I'm now a Second Life convert.

A few reasons I'll use Second Life for Health 2.0 collaborative learning:

1. Better ROI - Guaranteed: It was a hell of a lot cheaper than traveling to see 23andMe present. Cost to attend: Free. Information obtained: Priceless. And if you don't like the content, you can just fly away. Literally. Unlike at a conference, where you (or your employer) has paid big bucks to put you up for the duration. And the collaborative benefits are huge. Health 2.0 firms tend to be responsive and agile early adopters of social networking and new tech, so it'll be interesting to see how many use SL in future PR/communications campaigns.

2. More Interesting Q&A: People asked wackier questions and really pushed the envelope during the post-chat Q&A portion. Interesting questions = more valuable, revealing answers. I asked if 23andMe had any plans to partner with a genetics counseling firm as an add on service for consumers who were interested in this a la carte, which was completely off topic. I didn't get an answer, so I'll try again via other channels.

3. Flying in Second Life was a blast (hey, I didn't say they were all GOOD reasons...).

4. Credibility is established beforehand. Berci organized the Medical Bloggers Panel I'll be participating in at Medicine 2.0 in Toronto this September, so if he says he's putting on a meetup, I'm there. Like an invitation to join a panel or conference call from a trusted colleague, I know the quality of anything Berci puts together, so I knew it would be well worth time spent logging in and creating an avatar, etc.

5. Speed. You can organize a press conference, presentation, or interview in Second Life within hours. A brick-and-mortar event would take days (at least). This allows hospitals and healthcare companies to respond quickly to breaking news. At a bare minimum, an SL presentation should augment your current strategy. But you can be much more creative with the medium, like using it to demo designs for a new facility. Several hospitals, including the Palomar Pomerado group, are already using Second Life to increase strategic transparency, online and offline. In effect, Second Life provides free focus groups on steroids.

Speaking of speed, timing of the presentation couldn't be more fortuitous.

Although the Second Life chat didn't dive specifically into California's cease-and-desist debacle, 23 and Me just released a politely worded refusal (check out Wired coverage here).

Let's see how long it will be before someone in Cali picks up the transcript from today's Second Life event and uses it....My guess is 48-72 hours.

And I bet Wired will pick up buzz about the event on Twitter and use some material inside the next, oh, 4 hours (Alexis, are you reading?)

Private Healthcare Consultants Filling in the Gaps? Spotlight on PinnacleCare: Part I

From "Firms give health advice for a price," by Linda Wertheimer, in today's edition of The Boston Globe:

"Private health consultants are trying to fill a gap in healthcare created by overworked primary care doctors who have less time to coordinate patient care, while also catering to the desire of a growing number of patients to take charge of their healthcare. Consultants, many of whom are registered nurses, social workers, or physicians, help clients find specialists and also will make calls to ensure that a patient's various doctors are communicating with each other."

Personal healthcare navigators don't come cheap...These interim healthcare consultants price services hourly or remain on retainer.

Fees range from $150/hour to $100k/year.


So what do you get for your money?

Let's take a closer look at one firm, PinnacleCare, a "professional health advisory firm" providing "one call access to the best in class worldwide."

A PinnacleCare standard family membership rings up at 10k according to the Boston Globe. It includes:

• "24/7 expert management of their healthcare issues, large or small"
  
• email/phone consultation with a personal health advisor
• face-to-face time with a personal health advisor
• health advisors supported by crack research team of MDs and PhDs
• preventative/primary care coordination
• health investment advice (HSA reviews? insurance plan selection assistance? not sure what this encompasses...)
• acceptance of family members "regardless of age or present health"
• "emergency assistance"
  
• foreign travel assistance
  

I've requested a membership info kit; I'll review the information and post Part II after speaking with a PinnacleCare rep.

Why keep an eye on the nascent personal healthcare navigation sector?

Although 3,600 members isn't exactly a booming market, PinnacleCare alone is doing brisk business:

"PinnacleCare serves 3,600 members across the country and abroad, including the families of 20 billionaires, said Dr. Miles Varn, a former emergency room physician and the company's chief medical officer. "

""We consider ourselves a health advisory service much in the same way people have health managers and financial planners," he said.""

Two interesting ways the sector may evolve:

1. Increasing competition in the space as private firms form.
2. Increasing competition in the space as hospitals themselves form health navigator/care coordinator departments which provide a la carte services to the higher income self-pay population.

Either way, a gaping market opportunity exists.

A quick search of the Washington DC Craigslist page returned zero results for "care coordinator," "healthcare navigator," "healthcare concierge," or "healthcare coordinator" in the services section. The same search in the 'jobs' section returned only opportunities in existing sectors such as medical office administration, home health and nonprofit healthcare.

"It's about everybody being overwhelmed by healthcare (Joanna Smith, psychotherapist, Healthcare Liaison) " - our system won't become miraculously simpler to transverse any time in the near future.

"Differences" & Inviduality in Healthcare Delivery

Life is glorious. I am an aunt.

Yesterday my sister labored 20+ hours to bring Ellen Noel into the air-breathing sector at 4:39AM, assisted by her physician and 'salad tongs' (forceps) - quite the experience.

Hearing Kate's pleasure at forgoing a C-section because she had a physician who collaborated rather than controlled, a new aunt can't help but see what's going right and what's going wrong in healthcare.

This is how it's supposed to work - healthcare as a conversation - a doctor who listens to your concerns.

Who puts your health first, your wishes second.

Always. In that order. Health nipping at the heels of desire.

Ted Eytan tweeted this morning that he's switched to Kaiser Permanente. Verbatim: "it's official. I'm now a member (patient) of Kaiser Permanente. I will only receive care from organizations that are member centered."

Perhaps one day Ellen will break an arm. Or have an acute attack of appendicitis. Or worse.

Whatever the diagnosis, our mission, should we choose to accept it - to ensure she'll enter a care setting where the physician gives her more than 2 minutes and a bottle of pills.

Where she's an individual not a case study.

Where her individual health narrative is respected, recorded, and notable for her differences (per Doc Searls live from the hospital) rather than simply her 'sameness' to others with similar diagnoses.

Other industries get this - there's room for difference in both the practitioner approach and treatment of the consumer.

Do all airline pilots fly the same? Nope. They have a set pattern, certainly a route. But style surely counts for something.

Style, individuality, 'difference' is the determinant that separates a bumpy landing from a smooth one.

It's the same in physician-patient relationships, and subjective valuations of hospital care experiences.

Style, service design, surely count for something.

Which is why hospitals find allowing "mystery" patients to subjectively rate care such a slippery slope.

But here's a really scary thought...maybe a doc's style, or 'in person' visit skills, won't matter much to baby Ellen after all.

Perhaps by the time Ellen is wrapping the world around her expressive little fingers she'll interact first with a physician online, or through a mobile device. Perhaps if she develops diabetes she'll test her blood levels without sticking herself with needles several times a day.

I can't map out Ellen's healthline for her. And I can't predict what amazing HIT developments will evolve as she grows.

All I can do is work behind the scenes to make sure the system she encounters is as open-source as possible, allowing her to be a 'free range' human. She should be able to access care when and where she wants to or needs to, online or offline.

Birth is a miraculous thing in any form (or species), but when it's family, well, my only job is to stand and try not to fall over under the weight of responsibility that comes with a new life. This little girl will be raised by a village.

The only way initiatives to involve patients in the care planning and delivery process will work is if we operate as a global village.

As a result, advocacy work e-patients are doing has never seemed so vital, so immediate.

That means propping each other up when we're down, hit below the belt by illness and injury, or lost in the maze of the medical system (@Dutchcowboy, Doc Searls, @icmcc).

I held my little niece for almost 40 minutes this morning. We sang Blackbird (ok, I sang, she snored and gurgled and grunted a bit - a fitting accompaniment).

Then we talked about light things like world peace and what we should eat for breakfast (me - eggs and koffie. her - colostrum).

Ellen has no earthly idea she's my muse. But her arrival is refreshing the way I view our healthcare system and its potential - and mine (perfect timing, little girl).

I'm rocking her sleeping form thinking hard. What is my work here? How do I change healthcare? How do I help figure out "what's next?"

Poet Mary Oliver says it best in the poem "Messenger," from "Thirst (2006):"

My work is loving the world...

Am I no longer young, and still half perfect? Let me
Keep my mind on what matters,
which is my work,
which is mostly standing still and learning to be
astonished.


Perhaps I'm living in an ideal world.

After all, what serious adult person lists "learning to be astonished" as an occupational goal?

But that is what the US healthcare system needs, now more than ever. People willing to wonder, to ask "why." People willing to wonder how things could improve. And people willing to design systems that may improve care and move us to "what's next."

You have to regain a sense of wonderment, astonishment to ask "why" repeatedly.

In my ideal world, I'm a person rather than a "template." In my ideal world, my experience as a person who is also a patient is at the top of the health narrative foodchain, rather than the bottom.

Then again, those who learn to be astonished often astonish others.

Stick around for awhile Ellen. We're going to need plenty of muses. We were only waiting for this moment to arise.

Reasons to Celebrate - Personal and Professional

1. The Personal: After 3 days of slow labor, my sister is, even at this moment, working to bring my baby niece into the air-breathing sector. After hours in the Birth Center waiting room at Carilion New River Valley Center, we're all a bit loopy, but this is the first baby of our generation, so forgive the emotional mushiness. Hurry up, Ellen! We're waiting. Mom will tell you I'm not the patient type...

2. The Professional: At AHIP last night - the biggest Health 2.0 move to date. American Well partners with Microsoft (in a "strategic collaboration") and takes on the entire state of Hawaii. Congrats to all involved for carrying us closer to consumer-centric care. The challenges are huge, but I can't think of another team that could tackle the task with such confidence, panache, and an actual chance at success.

Consumerism in Healthcare: The Roles of Hope & Cynicism

Three days ago on Twitter, @dweilage, aka Drew Weilage (Our Own System) and I were tweeting about the roles of hope and cynicism in healthcare.

As 'younger' healthcare bloggers, both of us are concerned about burning out. We're choosing a career in an industry one of my graduate school contacts compared to a "donor wagon." We've all heard the sinking ship analogies.

One of the best places at a conference to listen for the 'real scoop' behind the scenes is in bathrooms. If you've never tried it, I highly recommend keeping an ear out during the coffee break rush.

Earlier this week at the Center for Information Therapy's Wired event, two healthcare execs were discussing whether or not they'd "bail out" before retirement (in the bathroom). Many of us enrolled in MHA/MHSA programs (Master of Health Administration, Master of Health Systems Administration) are asking ourselves if we should head for greener pastures and pursue MBAs.

Health management and administration students/early careerists blogging are, in some ways, almost worse off than the formerly warm-and-fuzzy-help-all-humanity type med students whose tailspin into despair we read live online.

You think people hate insurance agents? Lawyers? Try mentioning to anyone in the medical community you want to get your hands on a hospital and run the hell out of it. First, they doubt your mental acuity. Second, they doubt your management skills.

I can't tell you how many times I've had people tell me to "forget healthcare" and go into a more innovative sector with a rosier outlook. One COO of a children's hospital in California who had a Fortune 500 background said he'd probably leave the healthcare field at the end of his 3 year contract. There were "too many moving parts" with "no common goal" at his hospital.

My advice if you're in healthcare administration: Learn to duck and run or learn to turn the conversation quickly to more neutral territory, like, say the Olympics in China. Better yet, light some fires. Get things moving. Connect the people interested in "what's next."

People are charged up about the state of our healthcare system, and seems like everyone's got a good/bad hospital story. Once you mention you're studying/working in healthcare management, you'll hear tales of angels and demons. The good news is, both kinds of narrative teach us what we're really getting into here...and what we might be able to do about it.

I can't tell you how many times I've had people tell me to "forget healthcare" and go into a more innovative sector with a rosier outlook.

The thing is, I want a rosy outlook for our hospitals.

I want to see them working on entrepreneurial R&D ventures. I want to see them looking harder at business models that may improve efficacy and empathy in care delivery. I want to help them source the most innovative communication methods out there - the ones that would influence me to take a second look.

Although the medical blogosphere is rife with cathartic venting about the state of our healthcare delivery system, what these postings often lack is a sense of almost painful, naive optimism, a glass half full look at where we *could* steer the system if we pour hearts, minds, and dollars into the damn thing.

As my sister prepares for the birth of her baby, I'm finding the impetus to look at both reasons for hope (hello rose-colored glasses) and reasons to be cynical.

Today, let's take a look at consumer-centric care from both the optimistic and pessimistic perspectives. What reasons do we have for hope? What reasons do we have to be cynical?


Reasons for Hope:

• Consumers want the next president to prioritize HIT. I say again, CONSUMERS WANT CONSUMER-CENTRIC HEALTHCARE, and improved access. More than half of us. Probably more like the "Middle 80"% of us...at least in Maryland.
  

• Double-edged Sword: Privacy concerns shouldn't hold us back. Your healthcare data is no safer in the hospital, stored on a laptop (computer-based or OS based as opposed to web-based like in a PHR), or, even on backup tapes in a contractor's car. We need better privacy protection in healthcare in general, whether we choose to store personal health data online or on the back of a Better Homes and Gardens magazine.

• Capitol Hill is taking a closer look at healthcare.
  

• "As the industry shifts from a wholesale to a retail model, a new market of consumers is demanding clearer information and personalized support. A company that pays careful attention to their needs, desires, and habits stands to gain a significant advantage over its competitors in this quickly burgeoning market." - McKinsey Quarterly "What Consumers Want in Healthcare"

• Talking to patients about delays in the ER is a primary method to achieve higher patient satisfaction scores. Good news because 1. it requires staff to talk to patients! about wait times! and they may ask other questions! and 2. it means an evolution towards care that takes subjective experience measures into account ("empathy" rather than just clinical excellence, or "efficiency" of care).
  

• Hospitals want to begin weaning themselves off Medicare, who is "a lousy payor." This opens the door to strategic innovations that depend less on guaranteed payments from CMS and more on payments from consumers. New 'Starbucks of primary care models' accept cash or charge, like the "cash up front" subscription model employed by Jay Parkinson's Hello Health.
  

• Some hospitals are using mystery shoppers, or "undercover patients." This means groups like the AMA are beginning to consider the 'empathic' component of medicine, the subjective side of care delivery that consists of a patient's experience.

• Online medical advice goes social, via Trusera.com.
  

• The double-edged sword: Sometimes consumers want to be involved participatory partners in care and sometimes we just don't want to know. Case in point: Cancer care and 'end of life' conversations with oncologists. The good news is that the mainstream press is covering this at all...which is vital because "people crave these conversations, because without a full and candid discussion of what they're up against and what their options are, they feel abandoned and forlorn, as though they have to face this alone."

• HHS is paying Booz Allen Hamilton a nice chunk of change to examine security/privacy threats in HIT ("medical identity theft"). This is a good thing, since it means sometime in the next 40 or so legislative cycles we might see Congressional action meant to protect privacy in the online healthcare marketplace. Wait a minute, that means Congress regulating the online healthcare marketplace...we may want to move this one down under "Reasons for Cynicism."

• CCHIT convenes a PHR task force and workgroup. Unfortunately, as e-Patient Dave points out, both groups lack an e-Patient (chalk another one up to dual placement on the "Reasons for Cynicism" list).
  

Reasons for Cynicism:

• "Faced with health care decisions, consumers are concerned, confused, and unprepared." - McKinsey Quarterly "What Consumers Want in Healthcare."

• Our payment system sucks. Until we incentivize physicians for care rather than volume, we won't succeed in providing consumer-centric care that 1. the consumer wants and 2. the doc is paid to deliver.
  

• Misinformation abounds. Motivations are hidden. Questionable coverage is out there. But in a transparent marketplace, consumers figure out pretty quickly who the charlatans are...we show trust by opening (or closing) our wallets. Unfortunately, very few people can tell us how much healthcare will cost us, even on a per episode basis.

• "...having the PHR industry shift to relying on claims data is an admission that the notion that consumers would become efficient, thorough record keepers of critical health information is a bust. I'm sure vendors will still give lip service to the idea the consumers should enter their own information, but I predict it will soon be played down a great deal." - Anne Zieger, Editor, FierceHealthcare

• Patients rarely use online ratings to pick physicians. However, this could also be due to a lack of physician participation and an amalgam of smaller sites without a clear leader (functionality, design, community strength), such as the "TripAdvisor" of doc rating sites.

• California cracks down on gene testing via the web.

The end result of this research: Make up your own mind. Do you choose to examine "what's next" in healthcare from the perspective of an optimist, a cynic, or both?

We need both. To reenvervate American healthcare we need people looking at what's possible, as well as what's probable. The only question is, how are you feeling today? Glass half full, or glass half empty?

Healthcare for the "Middle 80"

“Head for where the puck is headed, not where it is...” - Hugh McLeod

“I think the internet could revolutionize health care just like it has revolutionized the music industry, the travel industry, and the newspaper industry. And with all due respect to this beautiful shrine of a Newseum, those industries got run over by the clue train instead of jumping onto it.”
- e-patient Dave (Center for Information Therapy's 7th Annual
Wired Conference, June 12-13, 2008 @ the Newseum, Washington, DC)

“You say you want a revolution, well.....you ask me for a contribution, well, we all do what we can...” - The Beatles

Ain't this America...

It's 10:22 am on a sunny Saturday morning.

My baby sister and her husband stand outside greeting a new neighbor. My sister is 38 weeks pregnant with their first child, my niece. The new neighbor just got out of nursing school, recently finished her OB/GYN rotation. She wants to be an L&D nurse.

My sister's house in Blacksburg, VA, is part of a unique green development for working-class families. My sister, her husband, the new neighbors – they are the “Middle 80.”

And our current healthcare delivery system is failing to seize new opportunities to communicate with them.

They are the part of the pie American economy presidential candidates salivate over, the part of the American economy aware of outsourcing to the Pacific Rim, engaged in green behaviors if they want to be, banking online, trying to make a living in an economy taking a head dive.

The Middle 80; our new lower, hard-working, sometimes college-educated, lifestyle oriented middle class. And more than half of them think our next Commander In Chief should make HIT a top priority.

They read and write poetry, watch DVDs on friend's laptops, choose not to have a microwave, attend wine tastings at local shops on Fridays, and last night hosted a campfire-party for 50 to bon voyage church friends moving to Richmond, complete with bay-blue and white pennants and coordinated wrapped plasticware.

The Middle 80 is, far more than we give them credit for, resourceful.

My sister created “We'll Miss You” penants from green, blue and cream calico fabric after she didn't find any to her liking. When likeable solutions are not presented in the marketplace, the Middle 80 craft them from bits of knowledge gained via experience and the references of friends, family, and yes, neighbors.

I've written before about the 10-80-10 rule in healthcare, where 10 percent of consumers will be unwilling/unable to be engaged, participatory partners in care, 10 percent of consumers will be 'hyperhealth' hyperengaged, tech savvy, and all over Health 2.0 services like white on rice.

And then there's the Middle 80.

When I translated the 10-80-10 rule from sales to healthcare, there wasn't much hard supporting evidence that the same percentages would hold true for consumer behavior in healthcare. Turns out, consumers are consumers.

Lately though, there's been some pretty substantial research to support it; Susannah Fox of the Pew Internet and American Life Research project reported more than 80% of the American public uses the web for healthcare related search (and Google uses that study to sell health advertising here).

And the Kaiser Permanente study hyperlinked here and above tells us 65% have gone online to get information about a medical condition. 73% think the benefits of being able to access healthcare records online outweigh privacy risks.

And that study is a year old. Think of how the world has changed in a year. Think of how the healthcare delivery system has not.

Let's look for a moment at how American healthcare is missing the boat for the Middle 80, like my sister, and what she chose to do about it.

Memorial day weekend. My sister and cousin were traveling back to Virginia from Southern Maryland.

A curve, a wobble, and the van carrying my baby sister, her baby, and my baby cousin flipped to the right side. After admittance and constant monitoring, all were released from the hospital with clean bills of health, except for one little thing; my future niece was now in breech presentation.

Her doc suggested a c-section and put it on the OR schedule for June 18^{th -} 39 weeks.

We're bustling around the house getting ready for the day, headed to Wal-Mart to pick up groceries and cook up a freezer-full of food for the first weeks after the baby is born. My sister's alto voice is strong as she tells me the latest chapter in her personal health narrative. She is determined to convey how and why she chose to become a proactive participant in her care.

My sister: “I had never asked them why they scheduled it for 39 weeks rather than 40 weeks.”

Many more patients than we believe, even those who trust their physicians, literally, with their lives, are scared.

Scared of what may happen, yes, but also scared to ask questions of care-providers.

When she learned she was pregnant, my sister read quite a bit about natural childbirth, explored homebirthing options, accounts by midwives, doulas, etc. when she learned she was pregnant. However, she'd read almost nothing about cesarean sections.

My sister does not own a television. She does not own a microwave. She does not have a computer or internet access at home, which is why I'm sitting in Bollo's coffee shop in downtown Blacksburg, sipping a skinny mocha, typing this story.

But my baby sister – she wasn't satisfied with not knowing why her doc had scheduled the c-section for 39 weeks. She wasn't satisfied with not knowing the risks. She wasn't satisfied with feeling scared.

So what did she do about it? What just about anyone in their 20s does now. She went online.

She used the computer at work to search for information on Google using the search terms: “c-section,” “when should I have a c-section,” “external version” “how should I flip my baby.”

Based on what she read online, after asking her doc if this particular potential solution was appropriate, she went to the gym and laid upside down on the incline bench with her butt higher than her head for 10 minutes. She stopped when she got dizzy, and felt “embarrassed and discouraged.”

I asked my sister why she looked online for this information. Her response? “Fear.”

My sister: “My perception of what happens if you're not willing to educate yourself is that the doctors will make decisions for you and it'll happen. They'll just tell you that this is the way it's gonna be and that'll happen. I felt safe, don't get me wrong. I felt like I would have been taken care of and that they would have made healthy decisions for me, but maybe not my optimal decision.”

My sister's OB does 5-10 versions a year. 3-4% of babies have some kind of breech presentation. 65% of external versions are successful at around 37 weeks (Blogger's note: Revised after original posting; if I've still got this wrong please let me know in the comments). About 4% of originally successful external versions fail -the baby flips back around. Sometimes this is natural – the stubborn babies don't want to turn, some can't due to neuro-muscular defects.

Question to my sister: “Why didn't you ask your doc or schedule an appointment to talk about your fear first?”

Even though she trusts her physician absolutely to do what's best for herself and her baby, my sister said she went online due to a variety of complicated, interrelated factors including time and a desire to learn for herself what options were available, and hear what other moms thought. “I can tell he's rushed. I feel like he's always been frank with me, has not sugarcoated anything.”

For instance, early in her pregnancy, she prepared a list of questions. One of the first she asked her doc: “What do you see as the risks and benefits of natural childbirth?”

His response: "First let me tell you about my experience with pain. People experience pain differently. Some women can come in at 2cm and are writhing on the table, and some women come in at 8cms and think they're having indigestion.

I think it's really sad when I see a woman dead-set on natural childbirth and she's in pain, or the labor doesn't progress, or the baby goes into distress and she requires an epidural or a C-section (or other intervention) and “it ruins the birthing experience.” They lose the focus of the miracle that their baby is being born."

"On the other hand, women come in planning to have an epidural and it's the middle of the night and they're waiting on the anesthesiologist, or you get it and it's not effective, again, the focus is taken away from the miracle that's happening."

Me: “This was a great answer."

My sister: "More than the risk and benefits of natural childbirth, I think he was speaking more to the mindset of either, the experience.”

She's the part of the consumer healthcare experience no one thinks is happening, but it's out there happening, 80 percent of the time. At least.

I'm wondering how she and her doc have managed to fit so much conversation and cooperation in determining her optimal care plan into 2-4 minute windows. Me: “How long are these visits with your doc?”

My sister: “There have been visits that have been half an hour long, there have been 5 minute visits. It depends on whether or not I have questions. I have to be prepared to make the visit that long. They're not gonna stay in there. Why would they? They have a whole waiting room full of people.”

“When I was at the hospital and he was flipping the baby, he also had 3 ladies in labor, two dilated at 9cms and 1 pushing, and he was still responsible for taking calls at the hospital.”

Literally and figuratively, docs have their hands full. And they're not getting paid to juggle the optimization of care for every patient who wishes to participate.

Our payment and incentivization system is turning docs into mechanics, but we're not giving them the tools they need to keep us running at the levels we want. It's like an experienced, certified, knowledgeable mechanic being confronted with a next-generation hybrid car, and trying to fix the thing's engine with the only tool she's got - a sledgehammer.

The Middle 80 percent of today's medical consumers are the hybrids, and the bulky, imprecise tools we're giving our docs to operate with are the sledgehammers.

This is the other part of the 'consumer' experience in medicine we're all forgetting. Patients aren't the only consumers in the coming “consumer-centric” system. Physicians are consumers of goods and services that increase their ability to treat patients efficiently and empathically, or they would be if better options were out there.

But that's a blog post for another time; let's go back to the 'patients as consumers' thing for a bit.

Part of the problem with the current state of consumer-centric care is that we have problems accepting that simplifying offerings for patients doesn't necessarily mean creating products for the “lowest common denominator” as one Center for Information Therapy's Wired attendee put it yesterday morning during a roundtable discussion.

In one sense, it doesn't matter that the average health literacy level is the equivalent of a 5^th grade reading level. Though the average reading level in the US as whole hovers around a shameful 8^th grade level, this hasn't stopped our economy from moving past the industrial age, to the service age, and finally to a knowledge and innovation economy, driven by supply and demand market forces. US healthcare, however, is still stuck in the 'industrial age' model of care delivery.

The “industrial age” approach to healthcare assumes that the same model will work for everyone in the Middle 80. And you know what they say about assuming.

This completely misses microsegmentation which has swept the global consumer economy. If we aimed for the “lowest common denominator,” we'd aim all offerings at the lower 10 percent, and miss the Middle 80 entirely, both here and abroad.

But in many ways, we already are missing them.

EMR and PHR platforms marketed today are consumer-centric, proprietary, closed-end systems that are bulky, clumsy, and slow-moving. Several tech and web players have semi-decent models, but their organizations lack the coherence needed to make confluent applications palatable to the Middle 80.

When this coherence factor arrives, it will herald the arrival of 'nexthealth' (remember from this post that nexthealth = content + community + commerce + coherence, when healthcare consumers, all of them, can 'dip' online and offline for access to healthcare/wellness goods and services).

An application (or 20) that meet the Middle 80 where we live, play, work, love has yet to arrive, but it's on its way. It'll be here sooner than you think.

Someday soon this post will seem unusually prescient. It's not.

All it predicts is that some few healthcare and HIT entrepreneurs are aiming where the puck is going, and this approach will bear fruit. They will succeed in changing how patients and physicians, two underrated, underrepresented healthcare consumer segments, view healthcare planning and delivery, as both an art and a business.

The Middle 80 is out there, actively searching for 'what's next.' The question is, are you building some part of it for them, or will you watch, bewildered, as the evolution of consumer-centric care passes you by?

Magical Thinking Healthcare Strategy, David Sobel @Wired

Dr. David Sobel, Medical Director, Patient Education and Health Promotion for The Permanente Medical Group takes the podium.

Quote of the week: "There's a lot of magical thinking out there if you could just get the incentives aligned."

David tells us to look at information therapy as if it was a drug. Followed by a whole lot of other mumbo jumbo, but interesting analogy.

This is a great way for hospital exec teams to examine HIT. Look at adverse reactions. Complications. Contraindications. Dosage. How would the system administer it? Target it via 'personalized medicine' approach?

Also an excellent way to look at collaborative efforts within social networks/media...if you're a Health 2.0 company looking at partnerships, pretend you're a drug. Now - what (or who) is contraindicated? What gets in the way of your delivery channel? How do you surmount the blood-brain barrier?

Another great question about behavior and measuring efficacy of information therapy...Is the active ingredient in medical therapy actually the medical content? Is it really the content of the program that changes the outcomes? I'd argue NO before even knowing his answer, it's content + community that changes behavior.

Yep, right on. Sobel says it didn't matter what the content is, if the process of engaging the patient doesn't increase sense of control, self-efficacy.

Active ingredient is not JUST changing behavior...Dr. Sobel relates research study in chronic disease self-management.

Findings:

1. Changes in health behaviors were not predictive of improvements in health outcomes ("I felt better, I felt more in control" - those with poor outcomes said "It doesn't matter if I feel better, I'm not in control")
2. Self-efficacy or confidence was associated with positive health outcomes.

Content itself, when well done, can also change people's thoughts and feelings.

Confidence itself can influence the decision to change a behavior - and that influences thoughts and moods.

So Sobel's Rx for Information Therapy is similar to the Nexthealth basic parameters of Health 2.0 -CONTENT + COMMUNITY (for a more complete definition, check out Ted Eytan's blog).

First time I've heard a discussion based completely (and statistically) around the role of confidence and control in improving health outcomes.

Sobel mentions that people who are optimistic, confident, etc. are not 'immune' from illness, but tend to statistically have better outcomes.

Information Therapy (Sobel's term), or nexthealth (our term) on steroids looks like this:

1. More than content and medical information.

2. It's about decisions and behaviors, but also about thoughts, feelings, attitudes, moods, and emotional connection (consumer firms, Apple, Whole Foods, Starbucks, Virgin America - they all get this).

Sobel says: "A lot known about human health and behavior that has yet to inform or revolutionize the way we provide care."

His prediction: Changes in health information therapy research and solution offerings will come NOT from medical sphere, but from behavioral sciences and consumer-marketing organizations.

You heard it here first folks (well, except for the gajillions of other times THCB, Health 2.0, and many bloggers on the blogroll at left have hosted posts discussing consumer-centric care evolution). And pay attention. Kaiser is often at the forefront of trends in HIT adoption and care delivery modification.

Technical difficulties: David wanders back to the computer - "Take a deep breath. Pausing in silence is not hemorrhage."

At Wired, there is a whole lot of chatter about 'talking' with patients and 'revising the healthcare conversation.' Sobel's point is a good one.

Take a deep breath. The system IS hemorrhaging.

To stop the bleed, it takes knowing when to speak and when to pause in silence. You can't plan for what's next in the middle of noise pollution.

Medical Home Concept: Will the Patient Centric Medical Home (PCMH) Model Save Primary Care?

This morning at Wired kicks off with Dr. Michael Barr, VP, Practice Advocacy and Improvement for the American College of Physicians.

Dr. Barr introduces tenets of PCMH (Patient Centered Primary Care):

• Personal physician
• Physician directed medical practice
• Whole person orientation
• Care is coordinated
• Quality and safety
• Enhanced access to care
• Payment to support the PCMH

Designing and delivering care via a "patient centered medical home (PCMH)" is a "team sport" - a physician acting alone can't deliver patient-centric care via a medical home concept.


So who's part of the team?

• PATIENT (funny, he left this first one off the list - um, by accident I'm sure...)
  
• Physicians
• Nurses
• Techs
• Radiologists/Specialists
• PTs/OTs/STs etc.
• etc.

I'm following right along with Dr. Barr (head nods in evidence), until he delivers this little gem:

"What we're talking about is practice evolution."

Um, not really doc.

This is why debates about the medical home concept drive me batty.

At conferences, in the literature, talking to physicians, I've seen dozens of variations on the medical home model.

But in reality, medical homes are NOT practice evolution. This isn't rocket science. PCMH = common sense primary care.

What is common sense primary care?

1. Common sense primary care is patient-centric.
2. Common sense primary care is team-based.
3. Common sense primary care makes use of HIT tools to improve care.
4. Common sense primary care provides care coordination via staff/tech.
5. Common sense primary care offers accessibility.
6. Common sense primary care pays physicians for more time spent with patient and for results rather than episodic DRG delivery.

That last one the loo-loo that trips up most reform efforts.

The current US system (much of it) provides REVERSE incentives to improving care efficacy - in our fee-for-service environment the medical home, patient-centric, consumer-directed care will ALWAYS fail. Why? Physicians are paid to deliver SERVICES or TREATMENTS rather than CURES or HEALING.

There's another reason I get twitchy during model home discussions - they're window dressing that have little real value to changing behavior (physician OR patient) and improving care.

Why? A perfect environment for which to design tools that encourage and reimburse for continuity and coordination of care already exists - the PATIENT.

The patient is, literally, the 'medical home' within an efficient, empathic system.

Let's start with a question: What is the ONLY node in the entire healthcare system that connects all the other nodes? The PATIENT.

What is the ONLY thing various players have within the system? Caring for THE PATIENT.

ALL goods and services in the healthcare sector, at some point in the food chain, pass through (sometimes literally) THE PATIENT.

Physicians advocating for the medical home concept, great job, but if you don't include the patient as number 1 in the list of players your show will never sell out.

Liveblogging: Center for Information Therapy WIRED Conference

I'm at the Newseum today & tomorrow liveblogging/tweeting from the Ix show, where Matthew Holt (Health 2.0 Conferences) thought it would be funny to put "Ranger" as the title on my nametag.

I'm getting some interesting comments, but I've certainly been called worse...

For tweet coverage, head to Twitter and search for "jenmccabegorman."

For blog entries (Matthew Holt, Craig Stoltz, and me), check out The Health Care Blog.

Back to pounding the keyboard...

Good News/Bad News - CCHIT To Certify PHRs

CCHIT To Certify PHRs

Good News: The government is paying attention to PHRs.

• Personal health records will make an increasingly vital contribution to developing "value-based care" (Mark Leavitt's terminology, not mine, although I like it...).
• PHR recognition is an important step to developing a more participatory model of consumer-centric care.
• Perhaps docs will be paid to help patients develop PHRs; perhaps docs will be paid to interact with PHRs via billable hours for CMS (currently getting paid to use/implement EHR pilot program just getting underway; DC/MD is one of four 'locations' in Phase I of the pilot).
• It's encouraging to see Google, Microsoft, and Wal-Mart reps on the task force roster.
  
• They're currently looking for a "patient representative" to join the working group (e-patients PLEASE apply).
  

Bad News: The government is paying attention to PHRs.

• CCHIT just appointed a 17 person panel (Personal Health Record Advisory Task Force) to look at this, beginning in 2009. They'll be doing an "environmental scan" in July.
• I'd like to see a fiesty, startup HIT person on the list.
  
• Perhaps docs will get paid to help people interact with PHRs. Then BOTH EHRs and PHRs would place 'primary' control of medical data firmly and fully in the hands of the provider/practitioner, and cement it there. There goes the dream of developing a personal health narrative via a consumer-centric PHR.
  
• Where is Safeway? Organized Wisdom? American Well? Diabetes Mine? Other Health 2.0 companies with skin in the game who are strong advocates for PHRs and consumer-centric care?
  
• How many people think they'll miss something?

John at Chilmark Research has a great post here.

UPDATE: Dr. Ted Eytan is serving on the PHR Task Force. My faith in the order of the healthcare universe is one step closer to being restored...

UPDATE 6.12.08: Sue Reber, CCHIT, reports that a patient representative has been chosen, but may/may not choose to release his/her name. The patient rep is a veteran.

Hospitals WANT Guitar Hero Healthcare

"Hospitals want involved patients" - from the Chicago Tribune.

Good piece, but a bit outdated.

The Joint Commission's Speak Up! Program has been around for a few years (at least since I used it as a Patient Advocate 'rounding' in 2003-2004), but you rarely see a specific staff person within the acute care setting responsible for implementing the program.

Our hospital, however, had a team of 5 Patient Advocates rounding on inpatient floors discussing the Speak Up! Program with patients and families.

What, we found, however, upon administering the program is indicative of the healthcare system's larger 'chronic' issues....

The process looked a bit like this:

1. PA enters the room, cheerily confirms identity with double checks (name, armband) - after asking if we can chat about the program and if the patient would like privacy while we do so.

2. Hands patient or family member/friend/caregiver/partner Speak Up! brochure while we give the pitch, usually multitasking and wiping staff board, refilling water pitcher at bedside, etc. Some people don't want the paper or the pitch, so PA asks if any other questions or any assistance we can provide.

3. Asks if patient has any questions or if we can be of assistance. 9 times out of 10 answer is resounding "yes" and issue is NOT related to Speak Up! program but medical care continuity (ie are my labs in yet? When will I be discharged? Who is my new nurse? What's for lunch?)

4. Chase down medical staff (nurse, tech, or in VERY rare cases doc) if it's a medical issue. Otherwise repeat we are 'only' PAs and not qualified to give medical information, but we have feet, and lungs, and can thus chase down and corner medical staff who can give correct info. (This would be why I wore sneakers, Nike Prestos, to work).

5. Bug caregiving staff incessantly if big issue, deliver message and confirm 'report' handoff verbally (and usually in my notebook with time and staff name cited in case I later had to do a variance).

6. Return to patient room and report progress on issue/contact resolution. Deliver sunshine and a smile (or 50).

Final findings from a year spent as a Patient Advocate:

1. Patients want to be involved. (10-80-10 rule: 10 percent unwilling/inable to self-advocate and be participatory, 10 percent hyperengaged, Guitar hero healthcare types, and middle 80 percent may be involved at varying levels).

2. Family members want to be involved.

3. Many doctors don't know how to treat patients who are verbally self-advocating...but if someone whips out a notebook and starts taking notes during the conversation they're on best behavior.

4. Communication between docs and nurses is often FUBAR. The blame baton is passed back and forth like care delivery communication is a contact sport. The rest of us, including patients, are relegated to acting as befuddled spectators.

5. Top issues of concern to patients are related to the 3 Cs: cure, care, communication.

Every initiative that purports to encourage increasing 'guitar hero healthcare' or 'patient involvement' must take systemic deficiencies in addressing the 3Cs into account. To ignore any of them is to court systemic failure.

Right now Ted Eytan is continuing to push on the most complete, viable definition of Health 2.0 for consumer-centric, patient-directed care advocates. Take a look. It's important work.

Until we can define 'involved' patients at a basic level, hospitals will have a hard time connecting idealistic goals to real strategic planning.

Patient involvement, CONSUMER involvement, is a vital component to figuring out 'what's next' for Health 2.0, and beyond.

Yesterday I sat in a nearly empty room at HIMSS DC Summit 2008 watching Jay Parkinson present the first truly consumer-centric GP practice model (here's some WSJ coverage).

Jay's new practice, Hello Health, is opening it's first storefront July 1st in NYC. Pay attention policymakers, hospital execs - the future of healthcare is closer than you think.

Startup in a Hospital - the Transcript

Jen: Ok so Maarten den Braber and I are on the train, after a Nexthealth meeting on Wednesday, the fourth of June - it's 11:33, we're just about to arrive in Utrecht.

Jen: Um, we decided that when we present our paper on the semantic web sparking health 2.0 in Vegas - ah - since we're bootstrapping Nexthealth NL, we need to find a way to get into town and get involved in the healthcare scene there...so - we wanna do "Startup in a Hospital."

Jen: The idea is to stay in a hospital in Vegas for 3 or 4 days, before the conference, to find a hospital contact who'd be willing to let us videoblog from the room - and present possibly some portions of our talk, since what we're talking about is 'nexthealth.'

Jen: Kind of action items to get that going is to contact...Dorrit at InterimIC, see if she knows anybody in Vegas, email Paul Levy, to see if he knows any hospital executives out there, to put out an all post bulletin to our networks via LinkedIn and Twitter, to also talk to some of the docs and med students that we know in the blogosphere to try to find somebody in Vegas...

Jen: Again, we're thinking "Next Hospital," (nexthospital.com), "Startup in a Hospital" (startupinahospital.com), live videoblogging...if we had any kind of video capability on the train we would be doing this, but instead we're just hitting you with the really really low-tech option of an actual tape recorder. Thank you GE for our - circa 1985 recording of the birth of this startup. One of many to come.

Maarten: Startuphospital.com? So...
Jen: Startupinahospital.com?
Maarten: Startupinahospital?
Jen: Yeah...

Maarten: So we should ask - maybe for The Netherlands we should find a sponsor....we need to get our tech gear sponsored - so we'll need videophones, we'll need webcams, we'll need to be able to stream live from the hospital...for the conference...
Jen: Nokia, Apple...(laughs)

Maarten: We'll have to get the, uhm, oh! We'll, we'll try to pitch it to Vodafone. We'll ask Vodafone. They sponsored something at MoMo - we'll get them to sponsor videophone - so Startup in Hospitals...
Jen: Nokia, Vodafone, we're the bloggers you really wanted to meet but didn't have time to at MOMO 6 in Amsterdam, so we'll be in touch.
Maarten: Oh...
Jen: By the way, we need all this equipment in, umm, 4 weeks time because the International Conference on the Semantic Web is happening in Vegas from the 14th to the 17th of July, so, yeah, get back to us quick on this.

Maarten: Ahhh, what else do we need? What else do we need?
Jen: Branded scrubs!
Maarten: ?
Jen: Anybody want to sponsor us while we are videoblogging from our Startupinahospital.com? What are we calling it? Hospitalstartup.com? We should be wearing branded scrubs! With nexthealth.nl and our sponsors, so Vodafone, if you want to sponsor us, that would be really great and we'll wear scrubs...

Maarten: We'll call Scoble and get on Fastcompany.tv...
Jen: laughs.
Maarten: laughs!
Jen: Also, um Jason Calacanis (nice middle name) at Maholo, ah, yeah, we'll be calling you too, Andrew Hyde, Brad Feld at Foundry Group and TechStars, we'll be calling you guys. We're the people who keep annoying you with healthcare and entrepreneur startup slogans for VCwear.com...


Maarten: Hospitalwear.com, Hospitalstartupwear.com - we'll have to launch here, we'll have to launch our own version online!
Jen: Right so if you guys don't help us we'll compete with you.
Maarten: (laughing) - So...

****Train noise - conductor (in Dutch) - Maarten needs to transfer at this station - great flurry of activity ensues as we pack stuff away****.

Maarten: Yeah see you in Vegas. Next time I think in scrubs. Inside a hospital. Doing a startup. Maarten: Oh! We can get Madonna to sponsor also.
Jen: Celine Dion, the Luxor hotel, this list goes on and on.
Maarten: And, and, and we get a free room at the MGM Grand. If we're not comfortable enough.
Jen: Yeah and some high stakes chips, that, that would be really nice too...PS- we are crazy!



As if you needed our help in figuring that last part out...

Biggest Hospital Marketing Idea of the Year: Startup in a Hospital - Riffing on Startup Plane

So anyone know a really, REALLY innovative, freewheeling hospital executive in Las Vegas?

We're talking an absolute maverick here...

One who would let two crazy healthcare entrepreneurs and firestarters from Holland camp out in a room for 3-4 days leading up to SWWS 2008 (July 14-17th)? (Note: We don't care if it's the resident on-call room or a patient room, as long as it's not the morgue).

Nexthealth co-organizer Maarten den Braber and I (to our great surprise), had a paper accepted a WORLDCOMP's SWWS 2008 (International Conference on Semantic Web and Web Services).

This is where the creme-de-la-creme of web tech academia and brainiacs of the semantic web meet up and geek out for 4 days. It is way, way out of our league (and that's putting it mildly).

Somehow, the organizers and review panel saw our stuff and mistakenly qualified it as a "Regular Research Paper (RRP)."

This means at the show we have 20 whole minutes to fumble about and try not to make complete idiots of ourselves while we present our paper, ambitiously titled "The Semantic Web Sparks Health 2.0 Evolution: A Roadmap to Consumer Centric Care."

On the way home from a Nexthealth organizational meeting last night, we were sitting on the train throwing around ideas about how to prepare for our presentation (other than imbibing on copious amounts of sugar, caffeine and tranquilizers, a la any college all-nighter or typical weeknight for a tech entreprenuer).

Nexthealth itself started in the same wacky, offhand, organic way.

Maarten den Braber, Martijn Hulst and I 'met' up via the online community at Hospital Impact (thanks Tony Chen) just before my move to Holland.

We were all blogging about healthcare and working in the sector. We decided an informal offline meetup over coffee might kickstart an interesting conversation about global healthcare delivery and innovation.

Three weeks later, with the additional work and devotion of Jeroen Kuipers, Jacqueline Fackeldey, and Niels Schuddeboom, that series of emails and online chat morphed into the first Health 2.0 Unconference in Holland, with 50 people attending.

Here's the real kicker - in true Web 2.0 fashion, before arranging the actual Unconference, neither Martijn, Maarten, nor I had met in person (Martijn Hulst and I didn't ACTUALLY meet until the day of the Unconference).

We just connected the dots and provided a place for online contacts to meet in the brick and mortar world, and the whole thing took off. Luckily, none of the three of us were bots, so we all showed up too.

Pretty soon (meaning during the beer and conversation period immediately after the Unconference) people started asking 'what's next?'

We all went home, sat down at our computers, threw up some Powerpoints on Slideshare, answered questions at the Ning community, did some reading, and thought hard about the answer to that question.

Within a few days, we were writing, blogging, Tweeting, and Skyping about how Health 2.0 will evolve and shape 'what's next,' or "Nexthealth."

From its birth at the Unconference, Nexthealth, which started out as an idea Maarten and I geekily whiteboarded one night, grew into a website, Open Hospital sessions, and a bunch of other applications.

From that nerdy brainstorm around the whiteboard, and via countless cocktail napkin, flipchart, and Post-It evolutionary stages, Maarten and I developed something a bit more in-depth - the graph and research we're launching, called Nexthealth, the model 'roadmap,' at SWWS.

We knew any tools built would need to be both top-down and bottom-up, connecting individual 'firestarter' innovators with existing implementors (the "gray suits" of the current hospital and healthcare world). We also firmly believe they have to be 'open-source,' available to all, freely, and released into the wild as quickly as possible.

So we drew out a way to help them get from where they are, to plot a course to where they want to be (working from a base of the Health 2.0 movement in the US, defined/founded by Matthew Holt and Indu Subaiya) - a map to figure out 'what's next' for healthcare in Holland.

Nexthealth lets existing healthcare stakeholders plot an evolutionary course to consumer-centric strategy and delivery (using existing constituencies, structures, and service lines), and the model is all about encouraging a platform of collaboration, rather than competition.

So that's all great. But here's the kicker.

Maarten and I need time and a healthcare-friendly, always-on environment to launch, videoblog, conference in, Tweet, Plurk and all other manner of unmentionable Web 2.0 activities with our Nexthealth folks in Holland, and our friends sparking healthcare change worldwide, prior to the presentation.

Last night we were trying to decide when and where to stay in Vegas before the conference (being bootstrapping entrepreneurs, bloggers, and a grad student in Maarten's case, our options were a bit, ahem, limited).

Plus, a hotel room is boring and a bit too typical for the kind of things we get fired up doing...

Joking around, and probably still buzzing on the energy we always generate during nexthealth meetups and mindstorms, I blurted out "Startup in a Hospital."

To an infinitely embarrassing degree, this shows how obsessed I am with the TechStars community and the amazing stuff those guys and gals are doing (fast, and with frighteningly small amounts of cash but a stable of connections that I'm sure makes even Marc Andreeson salivate).

Both Maarten and I have been following the startup, tech, and venture capital worlds separately as a hobby.

So we're both huge fans of "Startup Plane," with Andrew Hyde, which resulted in the creation of VCwear.com. (Watch the video here).

I don't have a nifty videophone here in Holland (long story, it's difficult to get a phone with a contract as an expat) I whipped out my old-school GE voice recorder and we jokingly recorded the concept for "Startup in a Hospital."

Here's the pitch:

• For 3 days bed and board, you get 2 hyperconnected, witty (we think), personable healthcare innovators, firestarters, bloggers, authors, and consultants.
  

• We will, literally, be blogging, planning the startup Nexthealth.NL and corresponding with our colleagues in Holland (Martijn Hulst, Jeroen Kuipers, Jacqueline Fackeldey, and Niels Schuddeboom), and preparing for our SWWS 2008 presentation from our hospital beds.

• We want to be wearing branded scrubs with our sponsors logos. Hospitalstartupwear.com it is. We're happy to wear your hospital logo, in any means/manner short of a permanent tattoo.
  

• We'll be coming and going and gearing up for our presentation, so we won't get in the way. Too much. But we will be our normal, startingly forthright and bitingly sarcastic selves (how we are when we're not busy being cheerleaders for global healthcare change), so if your food sucks, we may blog about it.
  

• Think of us as your test patients. Have a new wing? New hospital design? Did you just implement Planetree? The Disney Be Our Guest program? Want to test noise, lighting, odor and other atmospheric impacts on rest and relaxation levels of patients and guests? We're willing to be your guinea pigs. Please, no pharma testing, though that might make for a VERY interesting SWWS presentation...
  

Here's the fine print:

• Some people will be grossly offended by Startup in a Hospital. Two beds? Wasted for people who aren't sick? The US hospital system is wrecked and you're doing some crazy Startup in a Hospital gag, giving rooms to people who don't NEED our care? (Well, that point is debatable - a psych room might be particularly fitting).

• Your hospital lawyers and General Counsel may tell you this is a really. really. bad idea. Without the proper release forms in place, they'd probably be right. Which is why we'll put our John and Jen Hancocks on just about anything. Ask yourself one question - what would Dr. House do?

• We will adhere to HIPAA. We realize the incredible seriousness of privacy in the hospital setting. We will not videotape or blog about ANY hospital patients or physicians. Although if we encounter a hot doctor we may in fact create a McDreamy-esque nickname, we will not post his/her photo on hotornot.com.
  

• We will videoblog ONLY from our hospital room, where the Startup in a Hospital magic is happening. We will not videoblog ANY hospital employees, unless your CEO wants some face time, in which case we're thrilled to oblige. We will not interfere in any way, shape, or form, with hospital operations and care delivery.
  

• We will sign any and all release forms your team of legal eagles may require.
  

• We realize this has to be arranged incredibly fast. That's just the way we roll. You should probably email your Board right now. You should look at our LinkedIn profiles (Jen McCabe Gorman, Maarten den Braber). We are happy to provide credit card and Passport info, our life stories, and submit to background checks (about that one time in San Juan...).

In all seriousness, if we come stay in your hospital, we will behave. We think this is actually an amazing opportunity for a hospital to do something really innovative and newsworthy, with very little risk.

I've been an inpatient following ortho surgeries 6 times. My mom is an RN. I know what it's like to be sick, in pain, and scared in a hospital.

I'd like to know what it feels like to build something amazing there - a recovery tool for the entire system.

Come back tomorrow for the transcript of the "Startup in a Hospital" recording. (Yeah, we're old school like that...)