Christina's Considerations

States vs Regions

Mark at Health Informatics Response asks a great question, which has been asked before.  However, now we have the economic stimulus money and I say we need to have everyone contribute their thoughts.  So, please do so here or on Mark's post at:  http://informaticsresponse.blogspot.com/2009/03/states-or-regions.html.

I'd like to comment about why I don't think a one statewide RHIO (or HIE) it will work at this point here in California.  First, I don't really see the State of CA sitting at the table and by far, they are our biggest stakeholder.  They are there in the room (representing different agencies who are stakeholders), but hovering and waiting for someone (maybe the Governor) to give the OK for them to be engaged in strategic and thoughtful way as a partner.

Second, the State has competing priorities at the moment.  Yes, the stimulus funds and improvements in healthcare will help reduce costs for the State, but there are more immediate issues that need to be attended to... right now!

Third, the grand State of California is made up of small towns across the north, central and south portions of the state.  We have small counties and large counties -- some with heavy population centers and others without great concentrations of healthcare consumers and providers.  We also have two, maybe three cities that have economies that are bigger than some States and countries.  What works for Modoc County just won't cut it for LA and vice versa.

Now, I'm sometimes way too optimistic (and rather proud of my leanings), but I just can't see it actually happening anytime real soon for all of California.  Heck, we can't even get North Santa Barbara County and Santa Barbara to agree on most things and our little RHIO experiment may be a good example -- a little too close to home. 

One more thing.... I really don't like bullies.  I'm not saying that there are any bullies here in CA, but I do know that nothing will turn people off faster and create more mistrust than one big RHIO stepping in to take the lead (again at this point).  Maybe it is a Western thing, maybe an American thing, or maybe its because there are just too many unknowns and we need time to sort through everything to get to a point when everyone can buy into that golden "shared vision."

Thanks for listening!  Now, I need to get back to unpacking from my weekend trip to beautiful San Simeon (one of those really little towns) where I relaxed while searching for moonstones on the beach!

The Future of RHIOs in California

In reference to my post on Monday I'm sharing one perspective and additional information with my readers. The dialog we see here in California will certainly be a key determinant in our ultimate success -- or failure!

HIT Stimulus Package: Looking at the money!

The guys over at HIT Transition are looking at the money down to the individual physician/practitioner and RHIO level and what they present looks pretty good.  Let me know if you need help getting started and I'll see what I can do. 

Communication, Communication, Communication!!!

Before the HIMSS published guide to establishing a RHIO, I wrote Forming a RHIO?....  In this first version I listed those things that would be important to building a strong foundation for sustainability and success.  The last item was "communicate, communicate, communicate". 

Well, I have an example of what happens when sufficient ongoing communication and engagement with all stakeholders doesn't occur.  It leads to misunderstandings, mistrust, and a diversion of  interests.  This all threatens further collaboration and the vitally important shared vision.

On one side we have a RHIO effort with the desire to move state-wide HIE forward. They are committed to working with local and regional projects around the state and helping other communities in the state to implement health information exchange.  Over the years their attention is drawn to other directions and the amount of communication they have with the local and regional RHIO leadership lessens in frequency and in significance.

On the other side, we have multiple local and RHIO efforts who are making significant progress and exchanging data.   The lessening of communication is noticed which naturally leads to a questioning of intentions and soon the belief that the state-wide RHIO has another agenda.  Because the state is big they begin to formalize their need to associate by creating a new and separate state-wide organization.

It is time they all sit back down around the table and discuss openly the important issues to rebuild trust and a shared vision.  Communication, when it is most effective, is two-way, open and honest.  Knowing many of these pioneering leaders, I'm confident that each will step forward and put their individual interests aside to overcome this challenge and re-establish mutual support, collaboration and a new shared vision.

The times are changing and there are many challenges, but also some opportunities.  Now more than ever, we need to come together and find ways to support each other in overcoming the challenges so we are prepared to take advantage of the opportunities that will help us grow and reach our common goals. 

HIT: One Step at a Time

I'll end my review of the Health Affairs Perspectives with Dr. Mark Frisse's urging that we take one step at a time and focus on a limited set of near-term objectives and a foundation that will be essential for reaping long-term benefits.  He points out that the cost of technology is often the focal point, however, the real determinants of success include the local culture, regional policies, organizational commitment, caretransformation objectives and the availability of skilled personnel. 

And, as stated previously, technologies poorly applied will simply render our current delivery system "inefficient, faster".  Technology is a tool that should be applied to transform care to meet the needs of people.  For example, making available laboratory and prescription drug history data at the point of care is an urgent priority, but the clinical labs and coalitions of pharmacies and pharmacy benefit managers have not made much progress toward making this information available.  An affordable means of obtaining this data consistently must be found.

I like the idea of shifting incentive strategies away from third-party case managers to physicians and pharmacists.  I also agree that funding should be a allocated to support interstate collaboration, simplification and substantive change using real-time systems.

"Public reflection is not a retreat from improved heatlh; rather, it assures cautious and deliberate progress toward a more promising future."  I'm a believer in the power of reflection as a way of moving forward in a much more confident way.  Dr. Frisse is just reminding us of the power of this tool on a national level.

Lets not automate systems for the sake of automation!  Lets really transform care for the patient and society as a whole!

Note:  I hope you noticed that the three gentlemen I've highlighted are physicians - the other person at the point of care with the patient.  We are fortunate to have so many committed physicians (these and many others) involved in health information exchange.  Their insight and partnership with the rest of the disciplines (information technologists, nurses, pharmacists, administrators and many others) only makes us stronger.

Core principles of making smart investments in HIT

Dr. John Halmaka offers five principles in his Health Affairs Perspective:

• Establish regional implementation organizations

• Establish technology service organizations

• Establish minimum federal requirements, but allow for local variation

• Establish funding sources and priorities

• Protect Privacy

He points out that the stimulus/recovery package is a huge expansion of the HIT industry revenues and as a result, the risk of misspending this money and having little to show for it is immense.  I agree because the money has to be spent on well planned and implemented projects .  Too often, technology is thrown at a problem and we end up with an electronic problem and ultimately, an abandonment of the system and waste of that money.

I agree that we need to expand on the work already in progress and accepted principles and a common vision will help ensure our collaborative success.  I especially appreciate Dr. Halamka's idea of using regional implementation teams that engage stakeholders at the local level and ensure that their buy-in via education, training, and support.  Think of it as the each community's HIE general contractor to ensure that (like building a house) that all of the supplies, materials, equipment and contractors deliver results when due and that everything in the system (house) works together and is ready to go live (move in) for all stakeholders.

He, too, is a proponent for establishing minimum national requirements, but allowing for local variation based upon policy, needs and resources.  And, like Dr. Brailer he believes public monies should be allocated to those organizations that do not have the resources to implement technology on their own.  However, I caution that monies should not be given to those organizations who cannot afford the technology because of their ineffective and inefficient management and leadership. 

Dr. Halmaka also mentions the need to support "public good" efforts that don't attract investment, such as, coordination of care and population health.  In these cases, everyone benefits, but no one party benefits so much that they are willing to foot the bill.

He ends with a reference to his idea that this may be the greatest health IT generation -- if we do it right!  Please work with us to do it right!

Health Affairs on HIT

Health Affairs does a really great job addressing policy issues in healthcare and their latest issue once again focuses on HIT.  I will review a few of the web-exclusive perspectives presented over the next week and will comment on each separately.  

Since Dr. Brailer taught me the foundation that is the basis for my opinions about health information technology and exchange, I will start with his thoughts on presidential leadership and health information technology.  At this point, it is important that I remind readers that I come from the perspective of a hospital administrator who has worked closely with physician providers (many small business men and women) throughout my long career.

Dr. Brailer does a really nice job reinforcing the fact that it doesn't matter if you are a democrat or a republican, what is important is that we apply health information tools to improve healthcare.  He describes our current goal for widespread adoption of EHRs within the decade as a torrential rate in a glacial industry and his assessment is so accurate.  That is why we should take seriously his cautions and advice unless we want to really jeopardize the tremendous progress that has been made over the last several years.

Dr. Brailer highlights the importance of portable health information, not just throwing technology at broken processes.  Previously, Congress didn't get it and Bush had to ensure that we stay on the right path.  Today, it looks like Congress still hasn't gotten it and our prayer is that Obama will get us back on track.  Investment in interoperability using the technology tools will stimulate the economy, but investment solely in the technology will only lead to more of the same inefficient and ineffective silos of electronic of health information that don't always bring that information to the point of a patient's care.

If you read the chapter I wrote for the  HIMSS RHIO Guide titled "Stakeholders, Collaboration and Driving RHIO Formation" you will understand the importance of balancing private and public leadership.  Interoperable health information exchange isn't something the government nor the private sector can do alone.  We will be most successful if we truly collaborate for the good our healthcare consumers and put aside our individual interests (ie. the people who elected us to office or our company's product.)

"Fear of government prosecution and liability" are words Dr. Brailer wrote about what providers feel about sharing health information.  I don't know if Congress doesn't understand, but I do know that this fear sometimes paralyzes a healthcare organization and causes delays in needed change because administrators just don't want to go to jail.  We all know that you have to take risks (with some amount of calculation) to grow and dramatically improve an organization's efficiency and effectiveness.  However, healthcare is the most overly regulated industry and the barrage of unfunded mandates with stiff penalties causes delays while expensive legal council and hospitals tip toe through the often confusing and conflicting legislation.  Patient information must be shared to improve healthcare.  Portability with privacy is a slippery slope, but balance must be found if we are truly to improve healthcare and lower costs.

Dr. Brailer is correct that many of the larger healthcare organizations, especially if they are both a payor and provider, are implementing HIT tools because it is quickly becoming a cost of doing business.  They have a value proposition.  However, a small rural hospital struggling to breakeven or realize modest profits so they can afford to replace old outdated equipment or add services to address growing patient needs is going to have a much tougher time affording a new EHR.  More does have to be done to reach out and bring these organizations along.  I suggest a component that provides additional assistance to the hospitals treating the 20% of their community's population that account for 80% of the costs and a reward for those operating efficiently but who still have thin margins because of uncontrollable reimbursement issues.

Lastly, real healthcare reform will stimulate the economy because the cost savings realized will allow businesses to invest in growth, the government to expand important programs, and consumers to have a little more money to spend on their daily living.  Lets reform healthcare using the interoperable information technology tools that are available today and in the future!

Health Tech Investment Forum

Next week investors and healthcare leaders will meet in San Francisco at the CCS Health Tech Investment Forum to discover and discuss the latest trends and investment opportunities in health information technology (HIT).  Both public and private high growth companies will share their investment insight and the forum will open with a keynote by Dr. David Brailer of Health Evolution Partners . 

Now more than ever our HIT investment choices may mean the difference between reaching our goals or stagnation due to wasteful spending.  I urge you to join me on Tuesday, March 24th at the Le Meridien San Francisco to take part in the Health Tech Investment Forum.

Organ Donation

Organ donation is important to saving the lives of otherwise healthy adults and children.  If you have not already completed an organ donor card, please visit and print one or order 10 free paper copies.  To learn more about organ donation and the prevention of organ failure go to OrganDonor.gov.  

Social Media Sites for Job Searching

The times are challenging and economic stimulation will take some time to produce real results, so it is up to each of us individually (with the support of our family and friends) to successfully navigate through the turbulence.

The people at Mashable have a great post on the top 10 social sites for finding a job.  Luckily, I'm already set for their #1 pick LinkedIn.  It will be interesting to see how my job search turns out and whether I find my next position using traditional methods or from the exciting world of social networking.

Visit my profile  and consider setting up your LinkedIn page.  It takes time to do it right, so don't wait until you actually have to conduct a job search.

Oh, and if you need an exceptional hospital administrator for interim assignments, consulting/special projects or you have a great job working with wonderful people, let me know!

Kick Butts Day

One of my favorite days of the year is Kick Butts Day, a campaign for tobacco-free kids, which will be held this year on Wednesday, March 25th .  

Visit their site and download some of the promotional materials and activity sheets if you work with kids or their parents.  If you really want to makean impact, coordinate an event for the kids so we can prevent them from starting to smoke, or help motivate them to quit.   It is as easy as including a flyer (ready for printing) into the next paychecks.

Compassion and Healthcare

Yesterday I helped celebrate 25 years of promoting compassion and listening in healthcare by Adventures in Caring.  Twenty five years ago Karen Fox began visiting patients at Cottage Hospital and soon expanded her scope from touching the lives of  individuals to many by ensuring that the medicine of compassion is delivered to the sick and injured by all care providers.

One of their most important investments in the future is made by teaching college students who are considering medical professions the art of connecting with their patients at the start of their careers.

This nonprofit organization offers training (on-site and award-winning DVDs) to healthcare professionals and volunteer and family care providers.  I encourage you to learn more about their work and use their tools to help your facility improve the care being provided and the satisfaction of your patients.

 

Engaging Healthcare Consumers using Social Media Tools

Last week I attended the World Congress Consumer Connectivity Summit and want to share a few take-aways with my readers.

• In the Pyramid of Trust, healthcare is currently working to establish trust with customers.  Social media can help personalize information to address generational issues and the technology people prefer so it is more naturally absorbed.

• There are many opportunities for Public Health to apply social media tools to their outreach, education and prevention campaigns.  The Centers for Disease Control (CDC) seems to be leading the way and should be commended for their ability to conceptualize the changing learning opportunities.  My favorite is their partnership with Whyville to educate kids (and many grandparents) on seasonal flu and prevention. 

• Learning is social.  Acting on learning comes from context.  Context comes from the groups of like meaning or microcultures of meaning.

• Engagement is key and built on relationships. (Amen!)

• Hospitals and other providers need to be concerned about and prevent "domain squatting" by establishing their organization on Facebook, YouTube, Twitter, etc.  or at least check to see if someone else is already using your same name.

• Hospital and employee newsletters with video "articles" is bigger and better than words on the paper.  Seeing makes a bigger impact.  Mayo Clinic is a leader in this area.

• Keeping people healthy is local.  Social media can benefit those who already have a condition.

• Scheduling appointments is taking over renewing medications for top use of online services at Kaiser.

• Social media strategy -  add to and compliment what is already being offered.

• Use of patient advisory committees to confirm intended message is what is being received.

• Free iPhone applications include one developed by Community Health Network  for their patients and being shared now with all.  Pillbox.app is an electronic "pillbox" used to help patients or caregivers manage and keep track of medication schedules, especially when there are many.  CHN is now working on establishing a connection between Pillbox.app and their PHR.

The ROI of Social Media Tools is the risk of ignoring. Invest in keeping customers!

It was a stimulating two days of how we in healthcare can better engage and communicate with customers and consumers.  I'm glad I attended!