John Sharp is an IT Manager for a major medical center in Northeast Ohio. Areas of expertise include: ehealth, personal health records, Web 2.0 technologies, social media and project management. He is active in the Healthcare Information Management and Systems Society and the American Medical Informatics Association. The opinions expressed on this blog are those of the author.
Posts Tagged ‘Innovation’
Leveraging EMR Data to Develop Disease-Based Registries
March 6, 2010
This is my other presentation at HIMSS 2010. One of the real values of EMRs is the secondary use of the data for research. While respecting patient privacy, this kind of research can be rapidly developed from EMR data. We recommend the following steps:
- define the cohort of patients you want to study/monitor
- define the data elements you want included
- review and verify data elements with subject matter experts
- set up a regular interval to extract the data
- generate some test queries to verify the process
- monitor to use of the data (ongoing governance)
Our initial experience with a Chronic Kidney Disease registry has been a success. We recommend that research issues be considered in any purchase and implementation of an EMR.
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.
The US Chief Technology Office Promotes Innovation
July 22, 2009
A few weeks ago I heard Aneesh Chopra speak at the Cleveland City Club (podcast available). He could easily be called the Chief Innovation Officer – he is looking for opportunities to make changes using existing technology in short term projects. Specifically,
“-Using information technology to transform the way government does business
-Foster private sector innovation
-Reduce administrative costs and errors through utilization of health IT
-Change the way teachers teach and students learn”
Two projects of note are Defense Solutions, a site to submit solutions to be funded by small grants and hear in 30 days, unheard of for government grants.
The other is Data.gov, which exposes existing government data sources for use by developers including raw data, tools and geodata. Part of his approach is to encourage developers in an open source model, to create new tools and mashups which add value.
He spoke today at the Open Government and Innovations Conference. Twitter feed here.
Hot, Flat and Crowded – Ideas for Innovation
November 20, 2008
Tom Friedman’s latest book, Hot, Flat and Crowded, gives an excellent overview of some of the crises facing us – over consumption, energy poverty by many nations, and the wrong incentives for fixing the energy crisis. His suggested solutions are many including 10,000 innovations. Sounds like Health 2.0 and the health care system in crisis. I wonder if Health 2.0 is reaching the level of 10,000 innovations. However, Health 2.0 cannot solve the health care system problems alone. There need to be changes in government regulations and incentives just as there needs to be in energy.
Healthcare 2015 – IBM White Paper
January 10, 2007
The full title of this report is: “Healthcare 2015: Win-win or lose-lose? A portrait and a path to successful transformation” from the IBM Institute for Business Value. While the report begins with the usual saga of crisis in healthcare, it summarizes some action steps better than most by focusing on action and accountability. Specifically, the authors talk about Focus on Value, Develop Better Consumers, Create better options for promoting health and providing care. It is interesting that while discussing value, they don’t cite Michael Porter’s Redefining Health Care. But then this is the executive summary and citations are slim but do have an international perspective. The chart Summary of Healthcare 2015 recommendations by stakeholder is worth some examination.
