Archive for January, 2010

Models of Care: Can They be Copied?

January 28, 2010

Can good models of efficient care be emulated in other hospitals. Much has be touted about the Mayo Clinic, Cleveland Clinic and others. The lower costs of these models has been documented. See the Dartmouth Health Atlas report on chronic care (see table on page 9).

In a video on Huffington Post Video last month, the interview at the Cleveland Clinic about the successful EMR still questions whether this success can occur elsewhere. Yes, the implementation was expensive and expensive to maintain but the benefits over paper are quantifiable in terms of quality of care and improved outcomes. Maybe the lessons of successful EMRs have paved the way for others.

Finally, Dr. Cosgrove, CEO at the Cleveland Clinic is interviewed by Fox Business News at the Davos World Economic Forum. He again repeats his contention about the need to address obesity and health care costs. Again, a model or approach to care and costs which others can emulate.

Share this:
  • Facebook
  • Twitter
  • Delicious
  • Digg
  • Tumblr
  • StumbleUpon
  • Pinterest
  • Add to favorites
  • Email
  • RSS

Medicine: Cottage Industry or Post-Industrial Care Process?

January 21, 2010

In the New England Journal of Medicine this week there is a health care reform piece titled, “Cottage Industry to Postindustrial Care — The Revolution in Health Care Delivery.”  The article, by leaders in health care quality, raises significant questions about the problems in health care delivery and a path to a solution through “standardization of value-generating processes, performance measurement, and transparent reporting of quality.”

The authors address concerns about “cookbook medicine” but rightly describe medicine as a cottage industry: “Services are often highly variable, performance is largely unmeasured, care is customized to individual patients, and standardized processes are regarded skeptically. Autonomy is hardwired into the system, because most physicians practice in small groups with limited oversight or coordination.”

How do we move to post-industrial care or even better, 21st century, technology-enabled, patient-focused care. Does that mean that small practices should join large practices, academic medical centers? The authors don’t propose that solution, but do propose following clinical practice guidelines which are flexible enough to manage individual differences in presentation. If medicine is trending toward broad implementation of clinical practice guidelines and a stronger focus on outcomes (value-based medicine), technology-centered particularly around the electronic medical record and a focus on efficiency, can small practices survive? Are will moving toward industry consolidation much like what has been experienced in banking?

The cottage industry of medicine with fee-for-service as a funding model, continues to drive up cost without adding value. While I am no economist, I believe medicine is changing and models of practice which focus on efficiency, technology and patient experience are taking the lead.

One final quote from the article: the authors characterize this cottage industry as chaos – “Chaos confounds constructive action, whereas wise standardization is a foundation for effective variation, efficiency, reliability, and rapid innovation.” Let’s hope that wise standardization through guidelines can promote the kind of rapid innovation needed to transform healthcare and that policy and funding decisions follow this direction.

Share this:
  • Facebook
  • Twitter
  • Delicious
  • Digg
  • Tumblr
  • StumbleUpon
  • Pinterest
  • Add to favorites
  • Email
  • RSS

Major Robert Wood Johnson Foundation Report on PHRs

January 19, 2010

The Robert Wood Johnson Foundation has published an 7 chapter online book about Personal Health Records. The book is a great summary of the current state of PHRs as well as initiatives promoted by Project Health Design. Chapters are:

Chapter 1: Personal Health Records 101
Chapter 2: Project HealthDesign and the Next Generation of Personal Health Records
Chapter 3: Observations of Daily Living
Chapter 4: The Health Information Technology Landscape
Chapter 5: Personal Health Records and Health Information Technology—Costs, Policies and the Incentives Driving Adoption
Chapter 6: Privacy and Personal Health Records
Chapter 7: Personal Health Records—Business Models, Open Platforms and the Challenges Ahead

Worthy of note is chapter 3 on Observations of Daily Living (ODL), the importance of having patients enter their own daily activities and disease experience into a PHR. While the chapter does not specifically mention social networking sites like Organized Wisdom or PatientsLikeMe, the implication is that these type of tools provide value, often unrealized, by most provider organizations. ODLs could also include direct input into a tethered PHR or via home monitoring devices.

Also presented well is the discussion of the Health IT landscape and the emphasis on open platforms. Microsoft HealthVault and Google Health are described as revolutionary innovations. They provide PHRs with open connections to EHRs and devices as well as a portable, web-based record empowering patients to bring their records to any provider.

They conclude with addressing business models and incentives to make PHRs successful. “Open platforms create a wide avenue for innovation in health care” and the need to move past proprietary models is promoted. I might add that existing proprietary EMRs must be able to talk to the open platforms through web services or the CCR standard. There is no excuse for not adapting to these standards to enable the transfer of data into patients’ control.

Looking toward future and the new grant recipients for Project Health Design, the authors conclude: “They will face a number of challenges, including how to capture observations of daily living (ODLs); how to aggregate and analyze those data in a PHR; how to use the findings to inform the clinical encounter; and, ultimately, how to empower patients to understand, influence and improve their health. ”

Share this:
  • Facebook
  • Twitter
  • Delicious
  • Digg
  • Tumblr
  • StumbleUpon
  • Pinterest
  • Add to favorites
  • Email
  • RSS

Health Data Rights Get Broader National Attention

January 14, 2010

First, I need to applaud CNN for creating a place to focus on the Empowered Patient. And today a special article on a patient’s right to their own data and citing two prominent ePatients – Jen McCabe and Dave deBronkart. “Lack of information kills people” – the article details several anecdotal cases of how patients were injured or died as a result of lack of correct data and medical errors. The patient having their data certainly can add to patient safety – why not have more eyes looking at patient data, especially when it about one’s own body. Looking forward to more features in the Empowered Patient.

Share this:
  • Facebook
  • Twitter
  • Delicious
  • Digg
  • Tumblr
  • StumbleUpon
  • Pinterest
  • Add to favorites
  • Email
  • RSS

Social Media and Search in Health Care

January 12, 2010

Several new stories popped up today:

  • Microsoft’s secret weapon against Google: Health search – although this reviewer sees a some temporary advantage over Google Health search, he notes that even more important is a search within a simple-to-use electronic medical records system for consumers and does not see either as doing a good job of this yet
  • Oncologists Using Twitter to Advance Cancer Knowledge: about physicians using twitter for “Disseminating, correcting, and expanding information in conversation with professional colleagues”
  • Boundary Erosion in Information Technology:  John Glaser points out how social media and other consumer-oriented technologies as risk to Healthcare IT but also sees “Boundary erosion is an underlying, unalterable trend in information technology. It will not reverse itself.” He encourages a balance between unbridled enthusiasm and blocking these technologies.
Share this:
  • Facebook
  • Twitter
  • Delicious
  • Digg
  • Tumblr
  • StumbleUpon
  • Pinterest
  • Add to favorites
  • Email
  • RSS

Interview on Social Media

January 5, 2010

My interview by Hope Leman on the Significant Science blog just today was rediscovered on Twitter resulting in significant activity. The interview, titled ”Maneuvering Medical Institutions Through the Wild Waters of Social Media” and covered the range of activities in social media at the Cleveland Clinic. This interview emerged from my presentation at Medicine 2.0 “Hospital Adoption of Medicine 2.0: A Culture Change.”

While social media strategy continue to evolve, new opportunities present themselves. Particularly significant shifts are toward participatory medicine and e-patients. As noted previously, I will continue to post about participatory research and the lethal lag time in research which may only change from patient-initiated advocacy.

Thanks again to all who have read the interview and follow this blog and my twitter posts.

Share this:
  • Facebook
  • Twitter
  • Delicious
  • Digg
  • Tumblr
  • StumbleUpon
  • Pinterest
  • Add to favorites
  • Email
  • RSS