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Showing posts from February, 2011

Healthcare's Apple-Like Ecosystem At the VA?

Is the health care industry in line for a 21st-century makeover - mobile electronic health records, remote patient monitoring, and a new corporate culture, friendly to the open-source systems and workplace democracy in which tech innovation thrives?

Yes, says Craigslist founder Craig Newmark in Fast Company magazine. In fact, he believes healthcare could be as easy as, well, Craigslist.   With Newmark's consulting advice, the U.S. Department of Veterans Affairs is leading the way:
"Last November, Adobe won the VA’s first Blue Button competition, a name inspired by the vision of an easy, single-click-access electronic health record (Newmark was one of the judges). The winning system includes an interactive platform, complete with intuitive graphic art and simplified statistics.
."Additionally, the VA will open source its new health care ecosystem, permitting a community of developers to co-construct the new database and allow outside institutions to modify the codebase for…

The Math Of Healthcare Value

"ACOs are about improving health outcomes. 1990s style managed care was about reducing utilization."

I ran across that statement yesterday, exactly where I can't remember. I think the author is right about the different emphases but wrong to imply the terms 'outcomes' and 'utilization' could be mutually exclusive.  Doing so misses the point - which is, then and now, all about VALUE.

Let's define Value as:  [What we GET / What we PAY].

What do we GET from health care?  Outcomes. Results. Better health.  Longer lives.  Pain relief.

What do we PAY?  In total, it's [how many x how much], or [utilization multiplied by unit costs].


Value = [What we get / What we pay].


Value = [Outcomes / (utilization x unit costs)]

Maximizing value - getting more and/or paying less - requires focusing on all of the equation's elements - outcomes, utilization and unit costs.   Yes, the 1995 response to Hillarycare might have been utilization-driven, a…

Retailers Improve the Customer Experience With iPads

Chicago Tribune: Retailers use iPads to improve the customer experience.  Some interesting ideas for health care.
"Retailers are using iPads as mobile catalogs so sales clerks and shoppers can browse inventory not available on store shelves. They are fastening the tablets to counters so shoppers can design their own products. They are arming sales associates with the electronic clipboards to gathering customer data. And they are testing the device's potential as a portable cash register."Says a California boutique owner,
"It also makes our jobs easier, because if we are busy with another customer, it gives our clients something to do, so it doesn't feel like they're waiting."That might not work in health care, where NOBODY EVER WAITS.

ACOs & Consulting Snake Oil

“(Many) organizations...won’t have the skill sets necessary to achieve the kind of care coordination, successful chronic care management and data capture and analysis that’s going to be required” of accountable care organizations. “Certainly there are consulting organizations that could be very helpful, and plenty will be selling snake oil.”

(Quote from Bruce Merlin Fried, a partner at SNR Denton US LLP, as told to AIS’s ACO Business News.)

"Movin' On Up!"

Should hospitals be allowed to improve their business prospects by moving to a new neighborhood? That's the question being asked about Adventist Healthcare's plans to relocate Washington Adventist Hospital from Takoma Park, MD to White Oak.

Adventist says the move is an urgently-needed response to changing and challenging times.  Competitors say the move is really about cherry-picking higher-income patients and forcing substantial numbers of Medicaid recipients to seek care at closer hospitals already burdened by poor payer mixes.

Interesting choice: improve one hospital's financial results while adding to the stress on other providers.    The Maryland Health Care Commission will decide.

When Capital Markets Talk, Smart Leaders Pay Attention

Michael Sachs, Sg2 Chairman, on what the capital markets are saying to and about health care:
"The (capital) markets are responding to a myriad of issues facing health care organizations—declines in utilization, the full impact of health reform and general acceptance that the cost of health care is sapping America of needed resources to fund job growth. The capital markets are saying that the industry’s current pace of response to these issues is inadequate, and this will bring about massive change in health care.

"I just met with a very impressive group of health care CEOs who explained their strategies for transforming their organizations for the new era. But I came away from the meeting feeling as though I had heard the same words 15 years ago during the managed care era. There were major discussions about the need to invest in information systems, to the tune of $200 million in some cases. The CEOs showed lots of organizational charts describing physician integration mod…

VA Announces 2011 Industry Innovation Competition

The Department of Veterans Affairs (VA) today announced the opening of the 2011 Industry Innovation Competition to identify, fund and evaluate promising innovative technology proposals to improve the quality of health care for Veterans.

Public and private companies, entrepreneurs, universities and non-profits are encouraged to propose new ways to:
Leverage telemedicine solutions to provide audiology services to Veterans who live far from medical centers. Create and implement enhancements or novel uses of VA’s “Blue Button” personal health record.Design innovative prosthetic socket designs to improve the fit and comfort of prosthetics.Fully automate sterilization of medical equipment.Empower Veterans with Self-Management Technologies for Vocational Rehabilitation.For more about VAi2 please visit

The Daily Dose; Ideas, News & Opinions

NYTimes: Rethinking the office building for net-zero energy use.

From PRWeb via Yahoo! News: MindMatters' solutions for innovation are helping health care organizations tap into and act on latent ideas and expertise.

From The Lincoln, NE's physician-owned Nebraska Heart Hospital to be sold.  Frankly, I've always seen this - eventual sale to a deep-pocketed hospital - as the end-game for physician owners.  Cashing out is just another way to get paid, notwithstanding all the window dressing about hospitals and physicians working together for the good of mankind.  

From Enterprise City blog and Crain's Chicago Business: " Ellen Malloy: Experience not required but enthusiasm is."  Leaving what's comfortable in favor of a social media-fueled reinvention, learning as you go.

Quote for the day:  The continuing (or just-ending financial crisis, depending on who you believe in these matters) has caused me to re-read "Against The Gods: The Re…

States Face Retirement's Health Costs

Baby boomers are retiring and they're living longer than decades-old projections said they would.  For some states, retiree health costs are growing 20 percent per year.   Can the health care industry survive by bankrupting its own customers?   Let's think about that for a moment.  Ummm, no.

Because that's what's happening, slowly but surely.  Is the problem really one of demographics?  Really?  Or are boomers' health care needs being poorly served by a rapacious, ruinously expensive health care megalopoly?  One day, mayors and governors will awaken to the fact that their biggest obstacle to cost control may not be public employee unions but health care's edifice-driven bureaucratic narcissism, fueled by budgets seemingly without limits.

I know that's harsh and pardon the rant, but I don't see ACOs and their ilk solving the problem unless/until they become vehicles for fundamental cultural change and not the latest lawyer-devised means of separating hos…

Geeks Shall Inherit the Earth!

After they invent The Next Big Thing with assistance from The Geek Group and Inventables.   Let's continue our journey through innovation, production and reinvention, shall we?

After this post about my interest in creating a tinkerer's paradise, I heard from Casey DuBois, a Linkedin connection, about The Geek Group, a Grand Rapids, MI not-for-profit that's way ahead of me.  (No surprise there!)

From The Geek Group's website:
"Imagine if you could go to the workshop of the Mythbusters and hang out as one of the gang. Or what it would be like at spend your free time working in Bill Nye's labs, or hang out with Mr. Wizard. That is what the Geek Group is for. Instead of being just a face on a television, we are a real brick and mortar facility with all of the equipment, labs, and tools that most people only see on television. This is a place where you can not only get up close and see giant robots, lightning machines, lasers and all other manner of science and rese…

HHS Launches Health Indicators Warehouse

WASHINGTON--(BUSINESS WIRE)--Today, the U.S. Department of Health and Human Services (HHS) launched a new web portal providing important health and health care indicator data to support innovations in information technology. The Health Indicators Warehouse represents a vast collection of health and health care indicators along with new web 2.0 technologies to support automated data services through application programming interfaces (APIs).

“We recognize that one of the keys to better health and health care is data-driven decision-making at all levels and the HHS warehouse lowers the barrier for development of technologies to achieve this goal.”

HHS Secretary Kathleen Sebelius said, “The Health Indicators Warehouse provides a new public resource needed to fuel development of innovative information technology applications needed to improve health and health care decision-making.”

HHS featured the resource as an important step toward addressing data transparency and the agency’s commitm…

Nokia/Microsoft Combination: Doomed?

Don't you love "we're collaborating" announcements from industry also-rans?  Highly-paid executives talking through their hats hoping nobody notices the lack of ANYTHING RESEMBLING AN EXECUTABLE STRATEGY!

How do I know this one's doomed?  From Yahoo! News and the Associated Press, Nokia's Elop likens his company's position to '..a burning oil platform with "more than one explosion ... fueling a blazing fire around us."'  And Microsoft's Ballmer has big plans:  "We need to, and we will, collaborate closely on development ... so we can really align and drive the future revolution of the mobile phone."

Let's see.  Collaborate, align, drive, future, revolution...and all in a single sentence.  Never a good sign. It sounds a little like "...pardon us while we mix and match from Nokia's toolkit and from Microsoft's..."  Never mind that the latter's next big idea in mobile technology will be their first.…

"Making People Sick In the Pursuit Of Health"

Testing often and diagnosing early leads to lives saved and lower costs, right?   Maybe not, say  Dartmouth researchers and physicians H. Gilbert Welch, Lisa Schwartz and Steven Woloshin, authors of "Overdiagnosed: Making People Sick in the Pursuit of Health,"

It's a provocative thesis for every woman considering her next mammogram or man his next PSA test.  Will the test find disease?   More importantly, will it find disease that would have caused harm if left undiscovered and untreated?

The answers are not as obviously in favor of testing as we've been led to believe.  And anybody relying on more testing to save money has not done the math (as hospitals morphing into ACOs will conclude once they're managing clinical and financial risk for a defined population.)

(Thanks to the Chicago Tribune for the heads-up.)

Two Views Of the Future Of Employer-Sponsored Health Coverage

RE: the future of health insurance, Booz&Co calls forecasts of the demise of employer-sponsored coverage "greatly exaggerated."

I hope they're right; I fear they're not.  Believing that large employers will continue offering coverage - at increasingly ruinous rates - out of a "sense of moral responsibility" is pure fantasy.   They saw no moral obligation when the issue was off-shoring jobs and they won't in this case either.  Nor, with slow-growth economic conditions projected to last as far as the gimlet eye can see, do they believe  themselves in much of a battle to "attract and retain talent."  

Worse, they're herd-followers.  The more organizations dumping health insurance, the more we'll see jumping on the "we're doing it to stay competitive" bandwagon.  And so much for that.

Small employers probably do have a larger sense of obligation, God bless 'em.  Their issue is health coverage's sheer unaffordabili…

Why I Blog

Novelist and essayist Joan Didion said this: "I write entirely to find out what I'm thinking, what I'm looking at, what I see and what it means. What I want and what I fear."

Now replace "...write entirely..." with  " entirely..." and there I am, though without a shred of Didion's gravitas.  I have discovered I'm not afraid of much except, maybe, stagnation.

Thanks for sticking with me as I work things out.

Why Innovative Ideas Fail

From Jeffrey Phillips writing for Blogging Innovation, here are "4 Reasons Why Innovative Ideas Fail."  I can attest to the list, having failed in all 4 ways and a few more besides.

According to Phillips, innovations fail in the marketplace based on one or more of four key issues:
Ideas don’t solve an important problem for a customer.  Possible solutions: generate insights through scenario planning and Voice of the Customer research.Ideas take too long to get to market/Shifts in needs.  Possible solutions: flexible funding cycles not tied to a strict budget calendar and a well-tuned innovation process. Ideas underfunded or poorly launched.  Possible solutions: Do the "reveal" like Steve Jobs to create excitement around a launch.Ideas require too much work to adopt.  Possible solutions: understand the entire value chain, create bridges between existing and new with clear migration paths.Thanks to Sam Basta, M.D. for the heads-up.

The Next Big Thing Is Waiting In Somebody's Garage

A deeply-held tenet of innovation theory is that companies innovate and consumers buy. New research from M.I.T.'s Sloan School of Management suggests that this traditional division of labor may be breaking down.

Financed by the British government, the survey found that "...the amount of money individual consumers spent making and improving products was more than twice as large as the amount spent by all British firms combined on product research and development over a three-year period."

User innovation is a major force in areas as diverse as open-source software, sporting equipment, the Internet and social networking (e.g. Twitter's List and Retweet features), even medicine and technology.  The study estimates that users produce 77 percent of the innovation in scientific instruments.

In my work on business incubation, I've run across an idea I call a "tinkerer's paradise."  Take one of the many vacant factories here in SW Michigan and stuff it full…

Majority of Tests on ER and Inpatients Never Followed Up

From David E. Williams, writing in MedCity News:
"As discussed recently (in an article about med mal reform) I don’t buy the idea that excessive testing is mainly attributable to ’defensive medicine,’ i.e., doctors doing too much for fear of frivolous lawsuits. Rather, there are other reasons for ordering unneeded tests, such as profit motive on the part of the doctor or hospital, a desire for more information for decision making, habit, lack of familiarity with low-tech techniques, patient preference, and diagnostic company sales efforts. If med mal reform happened tomorrow, I’d be willing to bet plenty of excessive testing would still occur and that some other excuse would be given to explain it. Only payment reform, provider education and changes in patient demand are likely to make a big difference."Williams is referring to this article from FierceHealthcare reporting on a recent Australian study finding that up to 61 percent of inpatient test results and 75 percent of te…

Project Approval In One Easy Step

Attention: health care professionals! If you have a project needing your organization's APPROVAL, you MUST frame it as well-known and well-understood, something that everybody else is doing, an area in which your organization may even be a little bit behind and must now race to catch up.

In other words, "...everybody else is doing it!  We need to do it too."  Great, let's vote! All in favor?

If you want your project to be TURNED DOWN, feel free to use these words and phrases in any combination: innovative, new, "speed to market," cutting edge, leading edge, different, "consumer-preferred," unique, pushing the envelope, differentiation, ahead of the curve, untried, "setting us apart," experimental, "strategic separation."

In other words, "...nobody else is doing it! We'll really set ourselves apart by trying it."  Ummm...what? Wait! What?

Blue Cross Plans Improve Access With CRNPs

Extending some kind of insurance to forty million people when/if Obamacare takes hold presents health care with an opportunity AND a big problem.  The opportunity: new customers and increased demand.  The problem: we're thousands of physicians short of having adequate capacity to care for all those new customers.

Already we're hearing calls for massive increases in Federal funding for the training pipeline - medical schools, residencies, etc.  Some increase is probably a good idea.  After all, what's the use of having a ticket to the big game if it doesn't buy you a seat in the stadium?

But I doubt the pipeline can ramp up quickly enough, even with increased funding.  That leads to the search for alternatives.  There are, after all, many ways to build caregiver capacity besides simply producing more physicians.

We might start by redoubling efforts to increase the efficiency of practicing physicians - less paperwork, fewer hassles, better systems and processes.  More pr…

Putting Apple's iPad To Work In Your Hospital

Lots of uses for the iPad. Doctors crave it.  Employees want it.  Legacy IT vendors...ahh...maybe not.  They didn't invent it, can't control it, don't like it.  Still, it's more a question of 'how soon' not 'whether.'  Get in front of the wave or get steamrolled.

From IT Business Edge Network: a slideshow of 10 business uses for your iPad.  I can give you 50 more if you're curious.

From the American Medical Association: Health care embraces the iPad as physicians jump on board.

From MedCity News: now there's an FDA-approved radiology app for the iPad.

Still unsure about Apple's platform?   Diabetes apps (this one from London-based Cellnovo) are being described as the "iTunes of diabetes care."
"David Kliff, an independent diabetes analyst, who publishes the Diabetic Investor, wrote on his web site that Cellnovo’s approach is a “somewhat radical departure from the traditional approach to the market, which is more concerned with…

Posting ER Waiting Times Pays Off

In meetings yesterday with a hospital that recently started posting ER waiting times.  They've documented 3-4 PATIENTS A DAY who checked waiting times online and, as a result, decided to come to this particular facility over several competing options.

True, this is a hospital where waiting times are generally short, thanks to consistent and sustained attention to ER throughput.  But as I always say, increased business is the best recognition for all that hard work.  Good for them.

I raised the issue of hospitals posting ER waiting times in this post a few weeks ago.  Better to be first and proud than last and sheepish.

Feds Settle Case Of Facebook Firing

Employers should think twice before trying to restrict workers from talking about their jobs on Facebook or other social media.  So concludes a lawsuit against a company that fired an employee for negative Facebook postings.

"...image-conscious companies may be taken by surprise that the law protecting employees who want to discuss working conditions extends to social media sites, which can potentially be viewed by thousands or even millions of people."

It's amazing how companies view transparency and honest feedback as threats, not potent business strategies.   Executives are schooled to value feedback.  I'm sure most of them do, until they hear something uncomfortable. 

Mayo Clinic vs. WebMD

The New York Times kicks off a debate about on-line health information and advice, the role of advertising and the possibility of undue influence. Which approach is best - WebMD's or Mayo Clinic's?

Mayo Clinic's approach is my personal preference, though I think calling WebMD "synonymous with Big Pharma Shilling” is a tad unfair.

The article is certainly correct (and maybe a bit charitable) in calling health systems "late to the online health information party."  After years of strategic dithering, providers have nobody to blame but themselves for the huge information vacuum that many less-credible sources rushed to fill. 

Regrettably, after surveying the costs and difficulty of retaking information credibility's high ground, many providers will decide not to bother.   Why might this be a mistake?

Here's why: as information-intensity goes, health care is one of the planet's MOST information-intense enterprises.  Think about it.  Those controll…

Healthcare in 2020, From Ogilvy PR

From Ogilvy Public Relations Worldwide's "Fresh Influence" blog, here are  "7 Predictions For How Healthcare Will Evolve By 2020."

Behavioral targeting, auto-triage, health care in your local supermarket, personalized video, health tourism, gaming-enabled health transformation, brain-computer interfaces...

It's an intelligent list of thought-provoking "What-if's..?"
"Reading through the scenarios, (it's) easy to imagine a distant future where technology and healthcare finally begin to work together to create a better world of care for us all.  (The) post highlights seven of the most powerful ideas from the report along with some potential implications for anyone in marketing and communications.  To request the full report containing 20 predictions, send an email to Mention that you read about the report on the Fresh Influence blog.

Is Gray the New Green?

Quite possibly says the New York Times, in an article about the demographic pitfalls and market possibilities in an aging baby boom population.

The article highlights a collection of interesting ideas with the potential to change what we think we know about aging, about product and service development, and about delivering health care to a population projected to be "very different seniors."
"...longevity-focused researchers including (M.I.T.'s Professor Joseph F.) Coughlin, whose blog is called Disruptive Demographics, are betting that baby boomers, unlike generations past, will not go gentle into the good night of long-term care. In fact, a few research groups at institutions like Oregon Health & Science University, M.I.T. and Stanford, along with foundations and the private sector, are devising policies and systems for an alternate scenario: older adults living independently at home for longer periods, whether that home is a private residence or a senior commu…

Advocate Good Samaritan Hospital - 2010 Baldrige Award Winner

Congratulations to Advocate Good Samaritan Hospital, the leading hospital serving my old neighborhood, for winning a 2010 Malcolm Baldrige National Quality Award.

Learn more at the 23rd annual Quest for Excellence® Conference. Registration is now open at for the April 4-6, 2011, event showcasing the best practices and lessons learned of the seven 2010 Baldrige Award recipient organizations along with those from past awardees.

Hospitals Respond To Facebook Babies

From today's New York Times: Hospitals re-think "video on demand" policies in the delivery room, with some going so far as banning all pictures and videos during birth unless - or until - the medical team gives permission.

Hospitals set these policies based on assessments of customer preferences and the attendant risks.  That's not new and neither is it a bad thing.  But inevitably, it means some hospitals will allow things that others don't.  Some hospitals will strive to attract the "I want everything on Facebook" crowd, others won't.

It gives consumers another dimension of choice in hospitals.  Also not a bad thing.

But those same consumers should do themselves, their medical team and their preferred hospital a favor: have the "what is allowed in the delivery room" discussion BEFORE reaching full dilation.

Cancer Commons Taps the Crowd For Treatment Advice

From Springwise: a web app that taps medical crowds for personalized cancer treatment.
" California-based Cancer Commons was founded by a cancer survivor who believes he would not have found the experimental therapies that saved him if not for personal connections at the US National Cancer Institute, according to a CBC News report. Accordingly, the free “open science” initiative hopes to help others succeed as well by creating new ways of finding individually tailored cancer information online. Beginning with melanoma, Cancer Commons is being developed one cancer at a time in partnership with leading professional and patient advocacy organizations, pharmaceutical companies, medical centers, and health informatics companies.

At the core of each resulting “commons” is a curated Molecular Disease Model (MDM) that lists the known molecular subtypes of that cancer and then links to the relevant pathways, diagnostic tests, approved and experimental (targeted) therapies, and clinical tria…

"Your Time Is Limited..."

“Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma - which is living with the results of other people's thinking. Don't let the noise of other's opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.” (Steve Jobs)

Is Your CEO Comfortable With Innovation?

From Blogging Innovation: "Why Innovation Makes Executives Uncomfortable."

"...when you really break it down, innovation requires a different set of skills from those we inculcated in our organizations. Here’s a simple dicotomy:
Innovation requires ART not SCIENCE.Innovation requires QUALITATIVE insights not QUANTITATIVE statistics.Innovation requires HUNCHES not FACTS.Innovation requires RISKS not CERTAINTIES." Overall, more innovation in an organization means less power residing in some walnut-paneled corner office.  Something to keep in mind the next time your latest and greatest innovative idea gets blown up in committee.  Perhaps it was a dumb idea and got what it deserved.  But maybe, just maybe, its only fault was where it originated.

And here are January's Top Ten Innovation and Marketing Articles.  Good list.

Lower Cost Concierge Medicine: Coming To Your City?

From the New York Times"Concierge Medical Care With a Smaller Price Tag."  Dr. Tom X. Lee, co-founder of Epocrates and now founder of One Medical Group, is "...bent on reversing what he calls 'bizarre habits that have been ingrained' in the world of primary care."

One Medical Group offers accessible, personalized care at substantially lower prices than other concierge-type practices, narrowing what Dr. Lee calls "...a growing chasm between the ideals of medicine and what’s actually practiced.”
"One Medical physicians say their jobs are like what they envisioned when they first went into the field — before they got their first job in a typical family practice, with its long waits and blizzards of paperwork."The secrets?  None, really.  Just attention to fundamentals, judicious doses of creativity and (dare I say it?) some modern thinking about customer engagement.  A focus on hotel amenities and process efficiencies.  Automation and patient…