Is HITECH Working? #5: “Gimme my damn data!” The stage is being set to enable patient-driven disruptive innovation. | e-CareManagement

Great guest blog by @epatientdave. There’s a lot to be said about giving patients their raw data… in the right hands you never know what form of disruptive innovation might come about. Strong work Dave… a worthy read

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The Patient as the Platform | Linux Journal

Doc Searls is a bright guy… his take on health care data— and a patient centric approach. He’s been right before… hmmm

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Meaningful Use, non-compliance and un-healthy behavior

In its attempt to get physicians to buy into the MU concept and receive the funds available through ARRA, the gov stipulates that docs will need to demonstrate that they meet certain criteria— the majority of which are pretty much laid out already.   ONC has announced and laid out the initial structure of those criteria.  Unfortunately for physicians, a significant percentage of Stage I criteria will relate to changes in patient behavior, changes in patient patterns of med renewals, adherence to tx protocols, etc.

 Am I the only person who see a significant problem with this???

Lets take a big step back…. computers, technology and computing platforms are enabling mechanisms,  They can accelerate, mechanize, auomate or enhance  current work flows, etc.  What if  we layer technology on top of an inefficient, poorly controlled, nontransparent *sick* health care system—what’s going to happen…. we will make a sick, broken system work faster and probably far less efficiently (most docs report drop in patient load, etc after go live dates).

We as physicians  truly have little data or valuable tools proven to reliably and effectively incent patients to change un-healthy behaviors, convince them to take their medicine or even follow up in the office when their symptoms are not improving.  I will follow Jen McCabe’s work closely since she may have something to address this…. but the answer or solution alludes us right now. 

So we have a system that is  incapable of getting patients to change un-healthy behavior patterns, and we are about to embark on a multi-billion dollar initiative to electronically capture our abysmal results at changing behavior and nothing in those proprietary silos of code or data will help the patient see the error of their ways.  

So, why are we doing this? Or more important, why are we starting here ???

 Will it be possible to meet even the *mild* stage I MU criteria if nearly 40% of those criteria deal directly with patient adherance to protocols, changing un-healthy behavior patterns and improving medication effectiveness (by actually taking the pills).  Since we have no data on how to do this, my guess is the answer is no.  If the physician only needs to demonstrate that they are trying to do this, then what use are these elaborate, complex proprietary electronic platforms we have to spend a ton of money to purchase for ? 

After all… the goal of health care reform, ARRA, etc is to improve our health, improve access to health care and improve the quality of care the system deliver.  Sadly it appears our current gov enabled initiatives will fail at this.    We need to find the proper path… and we all have incentive to do so… after all.  WE ARE ALL PATIENTS !!

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Establishing and Maintaining Leader Behavior – ACPE CareerLink

A leader generates his or her own opportunities. Leaders don’t whine and complain about the lack of opportunities to develop their careers. They CREATE opportunities – regardless of their current situation, regardless of their current boss, regardless of obstacles that may seem to stand in the way of developing their full potential.

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The Technium: The Shirky Principle

The Shirky Principle

“Institutions will try to preserve the problem to which they are the solution.” — Clay Shirky

I think this observation is brilliant. It reminds me of the clarity of the Peter Principle, which says that a person in an organization will be promoted to the level of their incompetence. At which point their past achievements will prevent them from being fired, but their incompetence at this new level will prevent them from being promoted again, so they stagnate in their incompetence.

The Shirky Principle declares that complex solutions (like a company, or an industry) can become so dedicated to the problem they are the solution to, that often they inadvertently perpetuate the problem.

Unions, or example. Unions were a brilliant solution to the problem of capital management which tended to exploit uncapitalized workers. But over time as capital increased in complexity, unions complexified as well, until unions needed management. The two became one system — union/management. So now the problem with unions is that they are locked into the old framework, the old system. They inadvertently perpetuate the continuation of the problem (management) they are the solution to because as long as unions exists, companies feel they need management to offset them, and so the two became co-dependent. In effect problems and solutions tend become a single system.

In his brilliant, classic book The Innovator’s Dilemma, Clay Christensen demonstrates how disruptive technologies almost always arise from the margins of an industry, where they start out as insignificant, or toy, solutions. Honda’s hobbyist electric bicycles were no threat to the big four automobile companies, until electric bikes become motorcycles and motorcycles became small efficient cars. Cheap crumby dot matrix printers were no threat to big offset printing companies until dot matrix became injet printers and injects became the HP Indigo 5000 on-demand printers. In each case, the solutions were marginal, barely working, at first, and therefore ignored. I think what Clay Shirky is pointing out is that many problems, too, are marginal at first, and therefore ignored. Established industries like to focus on established problems.

Shirky made his quote in a recent talk, a bit from his upcoming book Cognitive Surplus. Shirky also referred to a similar idea in a recent blog posting about the ways in which media companies and the media industry are often constitutionally incapable of changing because they are still solving the last problem.


In a strong sense we are defined by the problems we are solving. Yin/Yang, problem/solution, both sides form one unit. Because of the Shirky Principle, which says that every entity tends to prolong the problem it is solving, progress sometimes demands that we let go of problems. We can then look to marginal solutions and ask ourselves, what marginal problem is this solving that might be a more appreciated problem later on?


Couldn’t possibly improve on this… IMHO. Read it, learn, share and enjoy.

Thanks J. Parkinson for pointing me in this direction

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Senate Bill Sets a Plan to Regulate Premiums

Fearing that health insurance premiums may shoot up in the next few years, Senate Democrats laid a foundation on Tuesday for federal regulation of rates, four weeks after President Obama signed a law intended to rein in soaring health costs.

Folks… here we go. Congress has figured out what the response of the insurance industry will be in response to a REFORM package that was supposed to DIMINISH costs…. the insurance companies will raise their rates… significantly. So Congress is already scrambling to put the “fixes” in place. Band aids for a wound that hasn’t even occurred yet 😦

And the insurance industry spokesman is laughable at best… seeking to control costs because the hospitals and doctors demand or command price increases… are you kidding me. I’ve never dictated a rate to an insurance company and would be laughed at if I did.

We start with a program destined to fail, Congress now seems to know it, and they will come up with more legislation to fix the previous legislation initially designed to prevent all of this mess to begin with.

Once again… I was completely in support of meaningful reform… we didn’t get that. My comments do not reflect those of my employers.

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The Collapse of Complex Business Models —> *Simplified Health Care Delivery* Is it possible ? Amended 4/22/2010

When ecosystems change and inflexible institutions collapse, their members disperse, abandoning old beliefs, trying new things, making their living in different ways than they used to. It’s easy to see the ways in which collapse to simplicity wrecks the glories of old. But there is one compensating advantage for the people who escape the old system: when the ecosystem stops rewarding complexity, it is the people who figure out how to work simply in the present, rather than the people who mastered the complexities of the past, who get to say what happens in the future.


Very thought provoking article by Clay Shirky.

The examples given— the illustrated lack of flexibility, borne out of complexity— which will eventually set the stage for significant disorder or even collapse within the biz entities mentioned— is easily transferable to the debate/discussions we are having about our horribly complex and broken health care system. Phew…


When I lived and trained in Japan I was intrigued by the model of the University I was at. Many of the University systems in Japan (as I remember) function as a means of educating the youth from K through graduate school. The university system owns X grade schools spread over a wide area, which feed into a number of more centralized middle schools, then college and eventually graduate schools… why am I am mentioning this ???? Bear with me…
As Jay Parkinson and others always talk about, our current health care model was “invented” in the 19th century. It was primarily designed to isolate the sick from the healthy population. Massive buildings with thick walls and large open spaces inside housed those with (then) incurable diseases. The major killers of those times were TB, diarrhea, etc, etc…. Somehow the model stuck. The buildings are still around, but the spaces inside were turned into rooms. Now these buildings, and the enormous and complex infrastructure to maintain them are only truly necessary to care for the health care needs of perhaps 10-15% of the population. 90% of care in the US is consumed by 10% of the population…. or something close to that. Yet, these large, complex institutions; their ORs, ERs and OB suites are where the majority of us need to seek acute care. What other option do we have?

There has to be a simpler, more efficient way to offer care to the 90% of patients who do not need to go to the centralized, complex, huge, scary hospital… (scary was my son’s description).

Now let’s consider the University system model in Japan… Hospitals become the corporate headquarters (i see you grimmacing already) of a wide reaching “system” designed to efficiently and effectively manage the care of the patients within their catchment area.   Large, centralized institutions would be wise to entertain this or similar concepts. Why?

I agree that a significant part of the current problem with the delivery of health care comes from the fact that hospitals (and many physicians offices for that matter) have taken themselves out of the business of providing the procedures (interventions) that thousands want in favor of those that a few require. CVS’s Minute Clinic is a good example of how hospitals have walked away from revenues. As hospitals continue to build expensive infrastructure and spend millions on technology their per-procedure P&Ls cause them to excise low margin offerings in favor of one-off high margin procedures. What they fail to notice is that each time they do that, someone enters the market and makes much higher margins on the hospital’s low margin offering because they have much lower overhead. Soon those entrants will start moving aggressively upmarket, capturing other service areas, and leaving the hospitals with their high cost procedures. (assist from Paul Roemer)

Back to the concept… Small, wonderfully designed, welcoming acute care facilities for fractures, cuts bruises exist throughout the area around the mother ship (hospital).  Small, specialty specific centers concentraing on Cardiology services, Orthopedics, ENT, Opthomology, etc emerge along the fringe of the system to manage a significant percentage of the needs of the patients in their area.    Slightly more centralized, yet disbursed chronic care centers emerge.  These centers are tasked to actually monitor their patients to prevent deterioration, re-admission, etc to the point where the potential need for hospitalization is intercededThe Cloud, the internet and mobile technology will play a huge role in this space as well, but that is outside the scope of this article and best left to the likes of Jen McCabe, Jay Parkinson and Natalie Hodge… among others.

If patients require *small* or same day procedures they can go to a well designed, aesthetically pleasing, comfortable surgical centers, set up to care for the patient in an efficient, timely and profitable manner. 

The mother ship or central hospital located in the center of the care area in the meantime has been downsized to a realistic number of beds and services, and it has been re-tooled and recalibrated to care solely for those in need of complex tertiary level care. At any time, the centers in the outer rings can send patients to the hospital if the need arises.  The ER functions to care for those truly in need of this level of care.  The ORs manage the critically ill which will require hospitalization following their procedure.   

After the patient has recovered from their acute illness, or if long term chronic (inpatient) care is necessary, the patient is moved a smaller facility which is efficiently set up to manage this level of care and discharged from here or managed as an inpatient for their chronic disease state, where this style of institution has been extensively trained and staffed to deal with end of life care and associated issues. 

Of course there are numerous potential downsides to a centralized model like this, and the potential that it would breed the very complexities and inflexibilty Shirky writes about…. but there are also tremendous potential benefits, especially with regards to managing the supply chain (like Walmart) and perhaps more important, to the IT infra-structure.  All of these centers are inter-connected and function on the same cloud based platform. All physicians within the system are viewing the same data sets.  Exams wouldn’t be replicated, results will be immediately available to the care teams and the patients served by the system will have access to their data.

Sounds easy 🙂   I’ll let Jay focus on the financing mechanisms and “insurance” needs and how the healthy pay for their care. 

Don’t forget… our system is broken.  Layering increasingly more complex rules and regulations on top of  already complex rules and regulations will not fix it… nor will it engender physician support of any meaningful change.  We all need to work together to change the system for the better…. WE ARE  ALL PATIENTS !!!

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