Another Day, Another App, Another Satisfied Customer

How might health care providers use technology to turn customers' mobile phones into information displays and ordering devices? A few years ago, the NY Times outlined how retailers are doing it...

"(Designer Norma) Kamali is at the forefront of a technological transformation coming to many of the nation’s retailers. They are determined to strengthen the link between their physical stores and the Web, and to use technology to make shopping easier for consumers and more lucrative for themselves.
...

Cisco Systems, the supplier of networking equipment and services for the Internet, is also a leader in the field. The company’s Mobile Concierge system is capable of connecting customers’ smartphones to retailers’ wireless networks — so a shopper could type “Cheez Whiz” into a cellphone, then pinpoint its location in the store."

Ms. Kamali's boutique installed a technology called ScanLife, "allowing people to scan bar codes on merchandise and obtain details about the clothes through video."

Potential health care applications? Let's see. It could go like this...

Perhaps cancellations and other snafus are making it difficult for your CT department to maintain a full schedule. Time is money as the hum of an empty scanner proves. Encourage patients needing a CT scan - those with flexible schedules - to download an app announcing their willingness to respond to a "We've just had a cancellation. Can you be here in 10 minutes?" message.

Now the patient arrives, lost and disoriented from the long trip in from the parking garage. Where am I? Good question. Waving her phone in front of a bar-coded icon on the wall sends a map and location to her phone.

Now the PATIENT knows where she is. You might also benefit from knowing.  And of course your CT department is also interested in smoother workflow and improved customer service, so...

Create an app to give the department a 10-minute "heads-up" prior to the patient's arrival. Patients who sign up and download the app can be detected as soon as they set foot in the hospital. Their paperwork is ready before they walk in the department's door. They're greeted by name.

What if she gets lost on her way to CT? Create an app that recognizes her current location in the facility and delivers turn-by-turn directions on her phone. Sort of a private-label, in-house MapQuest.

Need to deliver just-in-time teaching information or post-procedure instructions? Scan the appropriate procedure or diagnosis bar code and download a short teaching video to her phone.

You know when the patient arrived, now use that same app to track when she leaves, generating "time-in-the-door to time-out-the-door" data as important additions to your productivity and patient satisfaction metrics.

Once the system flags the patient's departure, send an alert to the referring physician saying something like "Thanks for your referral. Your report will be ready in 30 minutes."

As a thank-you to the patient for keeping your schedule full, send her a real-time electronic coupon for a free latte at your in-lobby Starbucks. The bar code allows for instant redemption and tracking.

Your patient needs reminders for follow-up visits, vaccinations, mammograms, cancer screenings? Apps, apps and more apps.

And of course nothing in a hospital would be complete without a committee to discuss it all. Wondering if this conference room is available for an impromptu meeting and for how long? Point your phone at the room number and and the embedded bar code will tell you.

And so ends another day at "Point & Click Hospital."

Developers include Cisco Systems with its Mobile Concierge system and I.B.M with a product called Presence.

The Sam's Club division of Wal-Mart, Crate & Barrel, Kerr Drug and Disney stores are among the retailers deploying mobile technology, with major roll-outs starting as far back as 2011.

11:46 AM

What Tech Trends Do CIOs See As Overrated?

From Chris Murphy, Editor at InformationWeek.com: "7 Tech Trends CIOs Call Overrated."

Trend #4: "Big data over small data."

(Says) Ken Harris, Shaklee CIO: "I'm not convinced that big data for most companies is a promising investment right now. We haven't learned how to handle small data well, let alone throw big data on there. That isn't to say there aren't some companies for whom big data could be a game changer, but most companies don't even effectively handle small data."

Harris is entirely correct, especially regarding healthcare's provider organizations - hospitals and physician groups - who, despite much talk about evidence-based practice, remain too often stuck in patterns of deliberate, consensus-to-a-fault decision-making. 

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Shared on Google+. creativecommons.org.au

Think that's harsh?  One AHRQ study found that "...(t)ranslation of research findings into sustainable improvements in clinical outcomes and patient outcomes remains a substantial obstacle to improving the quality of care. Up to two decades may pass before the findings of original research becomes part of routine clinical practice."

It's not for lack of data, big or otherwise, that this pattern remains.  No, it's culture trumping data. 

What happens when your Chief of Cardiology says "Nah.  I disagree with those research findings.  That's not what I learned in medical school and I'm not gonna do it."  Who wins?  Her or the data?  I think we've all been around hospitals (and cardiologists) long enough to know the answer.

So work on that culture thing first.  In fact, get the culture right and the rest follows.  Otherwise you're just writing big checks to big IT companies, expecting big things and setting youself up for big disappointments.

1:07 PM

NFP Hospitals Hit the Wall

Have nonprofit healthcare providers' improvement efforts hit a wall?  Standard & Poor's Rating Services seems to think so, in this story (via Reuters.)   From the story:

"Adding to pressures, inpatient volumes are dropping.

"With pending budget sequestration at the federal level, health reform implementation, and continuing pressure on state budgets, we believe the next several years will be difficult for most providers," said S&P. "Furthermore, we believe that the improvements of the past several years may be reaching their limit and thus will not be able to keep pace with longer-term revenue pressures, especially in light of weaker volumes."

"S&P says more rating downgrades are possible for not-for-profit healthcare systems over the next two years. It noted that the proportion of systems with positive or stable outlooks is shrinking, which "supports our opinion the multiyear trend of improved financial ratios is unlikely to continue."

Sooner or later providers, notoriously risk adverse, will be forced to admit that cautious incrementalism is little more than death by a thousand cuts - a slow death, but death nevertheless.

Many see salvation in mergers and/or acquisition.  Putting a bunch of soon-to-be-crummy balance sheets together doesn't make the collective any less crummy.  And, usually, the consultants, lawyers and integration costs eat up the first 5 years of savings from any so-called "synergies."

Many see salvation in shiny new buildings with private rooms and in-lobby waterfalls.  Few will find the new business volumes to justify more balance sheet leverage (see "crummy" - above.)

And many see salvation in massive IT investments- Big Data, EMRs, portals, etc.  I hope they're right.  I fear they're not, but it'll take five years to really know how soundly these systems were reviewed, acquired and implemented.  Sitting here it's easy to predict more failures than successes.

In the meantime, under either fee for service or risk-based reimbursement, a "low delivered cost" position looks better and better.  It's the only strategy offering a possibility of success regardless of scenario.  But here providers have been far too timid, scrabbling in the dirt for a few percentage points of margin improvement instead of challenging themselves to find 30%, 40%, even 50% savings on an episode of care.

They're not going to achieve that by cutting the marketing budget (again) or designing buildings offering more of the same.

No, it won't happen until providers finally do hit that wall.  Maybe then they'll realize that the only path to survival requires getting radical about lots of things -  including ditching that leadership box in which they find themselves.

(Photo credit: Magdalena Gmur, Creative Commons)

3:11 PM

Going Rogue: A Fable, But True

Lest you think my last post overstated the case FOR "rogue" employees and AGAINST all you IT traditionalists, let me tell you a story.

Recently, my team and I searched for a way to connect ourselves and a dozen or so vendors - designers, agencies, printers and consultants.  Something like Dropbox or Google Drive.  "No go" said IT.  Not secure enough.
What alternative(s) were we offered?   SharePoint of course, assuming that my modest little corner of the empire would fund the expense (ranging anywhere from a few tens of thousands to the low six figures.)  I countered with a fast "No thanks.  At that price point, I'd have to sell a kidney or something."
But without knowing it at the time, IT's response was a blessing in disguise.

Now I'm (quietly) using iDoneThis (free) to track projects and team and vendor accomplishments,  IdeaScale (free) to generate engagement around innovative ideas and strategies,  Evernote (free) to organize snippets of information, and Delicious (free) to create and share my very own knowledge base about important issues and trends.

Notice anything?  Well, yes, I'm using FREE versions of all four.  I bet that got your attention.  But more than that, none took more than 10 minutes to set up and less time to learn.  I didn't waste months with RFPs, pilot projects or controlled roll-outs.  A short discussion, decide, do it.

Decide this morning, implement this afternoon.  Repeat.

Could someone hack me?  Sure, but I don't traffic in PHI and I doubt my cryptic project summaries, creative work plans and budget discussions would be of much interest to anybody.  Heck, sometimes even MY eyes glaze over!  

Maybe hearing "NO" from IT is the best answer you can get.  Maybe it means, TIME TO THINK DIFFERENT, as the man once said.

12:27 PM

"Enterprise IT has plenty of room for improvement..."

"Rogue IT" is about to wreak havoc at work" is Fortune's headline.  Not a moment too soon, I might add. 
From the article:

"Rogue IT is the name given to the informal, ad hoc software and devices brought by employees into the workplace. If you've ever taken your own iPad to work or used cloud-based software like Evernote or Dropbox in the office, you may well be an offender. And you're not alone. Some 43% of businesses report that their employees are using cloud services independently of the IT department, according to a recent survey of 500 IT decision makers.

"In the past, these enterprise software and hardware decisions were often the exclusive domain of a company's chief information officer or CIO, the senior executive in charge of information technology and computer systems. "Sitting in his high chair in a grey suit barking orders, [the CIO would make] product decisions for big companies with even larger user bases," explains Peter Fenton of tech investors Benchmark Capital. Rogue IT turns that model on its head, effectively crowdsourcing IT choices to employees. So where does this leave the venerable CIO? And what does it mean for the future of IT at the world's largest enterprises?

"The good news is that enterprise IT has plenty of room for improvement. "[Traditional IT] carries connotations of interminable rollouts, bewildering interfaces, obscure functionality and high prices," writes CIO.com's Bernard Golden. Security, compliance and back-end compatibility have traditionally topped CIO wish lists, not usability. As a result, employees have sometimes been left with programs that are anything but intuitive. This exacted a heavy toll in terms of time, money and organizational well-being.

[...]

"Bloated, enterprise software no longer cuts it. Seduced by Facebook (FB) and similarly intuitive platforms at home, millennials balk at staring down monster spreadsheets or decoding web 1.0 UIs at work, writes Fast Company contributor Marcia Conner. Increasingly, they expect their work suites and software to be just as user-friendly as the apps they know and love in their personal lives, a trend known as the consumerization of IT. And they're willing to go outside company walls to find products that work best for them."

So do we still need a CIO?  Apparently we do, but with employees and customers doing the heavy lifting, voting with their feet (to mix a bunch of metaphors,) the CIO will finally have time for the big, important, profitable stuff.  OK.

But if you think it's just your employees (and maybe a few physicians) going rogue, well, your customers went over that wall a long time ago.  You probably didn't notice or care until that first iPad appeared in your waiting room.


Read the whole thing, here.

And, here, from HootSource, HootSuite's blog.

6:58 AM

Healthcare's Biggest Problem Is...

...too much money.  Wait.  What?

Interesting opinion yesterday from the blogosphere, that healthcare's biggest problem is too much money.  Too many resources, leading to too many people, too much time spent deliberating and too few imperatives toward action.

That's why, in our best leisurely fashion, we approve capital budgets just once a year.  Miss the cycle and it's 'wait 'til next year.'  And that's OK; it's not like it's life & death or anything.

Making the cycle, especially in IT, means launching RFP processes lasting another year and pilot projects lasting one more.  And system-wide rollouts lasting two more...assuming everything goes as planned, which it seldom does.  (Can you count to five?)

That's why off-the-shelf solutions costing 'a little' are rejected in favor of customized (yet corporate-approved) offerings costing twice as much and taking thrice as long.

That's why $8.99 iPhone apps are pooh-poohed as "not serious" and "risky" while the entry-level price for "real" software seemingly starts at $250k, rising rapidly after that.  (Ask me sometime about Voxie vs. the IT geeks.)

That's why our systems for cancer care are confusing messes yet our answer is to add yet another layer of staffing and expense - "Nurse Navigators" they're called.  I guess we'll start on that whole cost reduction and process simplification thing sometime tomorrow. 

And so we have armies of bureaucrats and analysts and process sponsors, technicians, project managers, coordinators and specialists.  We need them all to churn the system...and still we think of ourselves as understaffed.

And thus committees proliferate, PowerPoint becomes the organization's lingua franca, and, typically, the "back of the house" systems (Finance, IT, HR) are far more modern than "front of the house," customer-facing offerings.  When did YOU start offering patients an on-line portal and how many revenue cycle systems came and went before the portal's go-live?

Take away that money, most of the people and all of the committees.  Remove the luxury of time.  What's left? A startup mentality where cheap is better than expensive and free is best of all.  Where costs avoided mean making payroll...or not.  Where new customers this afternoon are better than impressive forecasts two years out.  Where a bias to action always trumps endless discussion.

What's Out: big checks to license Microsoft's crappy software (oops, is my bias showing?)  What's In: free Google apps.

What's Out: elaborate performance monitoring and benchmarking systems.  What's in: free daily tracking from iDoneThis.

Money gives you the luxury of time and lessens the pressure of deliberation.  That's not always a good thing.  And it's why a million little, ankle-biting startups are about to eat hospitals for lunch.  I'm just sayin.'

UPDATE:  Don't believe me?  Read "What We Can Learn From Third-World Health Care" by Pauline W. Chen, M.D., writing in the New York Times:

"The key to their success is an unabashed disregard for some of our most cherished assumptions about what constitutes good care. Instead of providing antibiotics, CT scans and high-tech interventions, Partners in Health considers basic necessities like food and housing as critical components of the group’s medical work. Instead of asking patients to travel miles to the only clinic and see only the doctor or nurse, they train cadres of community health workers who can monitor, administer and advise in the heart of local villages and in people’s homes.

"Applied to organizations in the United States, this approach has proved startlingly effective, as the Prevention and Access to Care and Treatment, or PACT, program has demonstrated. PACT targets some of the poorest and sickest patients with H.I.V. and other chronic illnesses in the greater Boston area. Just like Partners in Health, PACT relies extensively on community health workers who are trained in tasks like helping patients take their medications and make it to clinic appointments as well as reviewing their pantries and teaching them to prepare healthy meals. Applying these broad definitions of care, PACT has significantly decreased the number of emergency room visits and life-threatening opportunistic infections, cut hospitalization rates by 60 percent and yielded a 16 percent savings for Medicaid."

8:21 AM

NEJM: Escaping the EHR Trap

From the New England Journal of Medicine:  "Escaping the EHR Trap — The Future of Health IT."

Authors Kenneth D. Mandl, M.D., M.P.H., and Isaac S. Kohane, M.D., Ph.D. offer a devastating critique of health IT's current state:

Even as consumer IT — word-processing programs, search engines, social networks, e-mail systems, mobile phones and apps, music players, gaming platforms — has become deeply integrated into the fabric of modern life, physicians find themselves locked into pre–Internet-era electronic health records (EHRs) that aspire to provide complete and specialized environments for diverse tasks.


We believe that EHR vendors propagate the myth that health IT is qualitatively different from industrial and consumer products in order to protect their prices and market share and block new entrants. In reality, diverse functionality needn't reside within single EHR systems, and there's a clear path toward better, safer, cheaper, and nimbler tools for managing health care's complex tasks.

7:34 AM

5 Reasons Your Healthcare Integration Strategy Is Going To Fail

From Eliot Muir, iNTERFACEWARE, Special to ZDNet:

" I hate being the bearer of bad news, but I can tell you, with 100 percent certainty, that your integration strategy is going to fail. That’s the good news. The bad news is that when your strategy fails, there will be a start-up with only a handful of employees and even less money waiting in the wings to take over your market share. I am not trying to paint a gloomy picture; I am just sharing hardcore facts upfront.
...

" ...healthcare organizations looking to inoculate themselves from integration failure should follow a few common-sense, tried and true rules: develop a clear strategy up front, keep current with technology, leverage the cloud, be flexible about standards and always look at the opportunity costs inherent in custom development."
[Read more...]

3:00 PM

Doctors vs. Algorithms?

Do We Need Doctors or Algorithms, asks Vinod Khosla.  The answer may surprise those of you spending your days worrying about an impending physician shortage.

"Eventually, we won’t need the average doctor and will have much better and cheaper care for 90-99% of our medical needs. We will still need to leverage the top 10 or 20% of doctors (at least for the next two decades) to help that bionic software get better at diagnosis. So a world mostly without doctors (at least average ones) is not only not reasonable, but also more likely than not. There will be exceptions, and plenty of stories around these exceptions, but what I am talking about will most likely be the rule and doctors may be the exception rather than the other way around.

...

"What is important to realize is how medical education and the medical profession will change toward the better as a result of these trends. The vision I am proposing here, though, is one in which those decades of learning and experience are used where they actually matter. We consider doctors some of the most learned people in our society. We should aim to use their time and knowledge in the most efficient manner possible. And everybody should have access to the skills of the very best ones instead of only having access to the average doctor. And the not so “Dr. House’ doctors will help us with better patient skills, bedside manners, empathy, advice and caring, and they will have more time for that too. If computers can drive cars and deal with all the knowledge in jeopardy, surely their next to next to next…generation can do diagnosis, treatment and teaching in these far less uncertain domains and with a lot more data. Further the equalizing impact of both electronic doctors and teaching environments has hugely positive social implications. Besides, who wants to be treated by an “average” doctor? And who does not want to be an empowered patient?"

In just a few paragraphs, Khosla defines healthcare's future. Though I happen to agree, what I find somewhat depressing is that hospitals will sit, wait and have it done TO them, missing out entirely on the future's new, exciting value streams. Missing the opportunity to participate, to benefit and to re-envision the hospital as something beyond a massive, expensive and now-empty acute care cathedral.

Because if algorithms replace doctors, will doctors (and patients) still need hospitals?   Read the whole thing.

7:19 AM

Thomas Goetz: It's time to redesign medical data

11:43 AM

 Randy Lewis writing in the LA Times, discusses a little-known aspect of Steve Jobs' legacy: 

"Stevie Wonder said Thursday that he sought Jobs out late in his life to express his gratitude for matters that went well beyond what he and his company did for music.

"The one thing people aren't talking about is how he has made his technology accessible to the blind and the deaf and people who are quadriplegics and paraplegics," Wonder, 61, said. "He has affected not just my world, but the world of millions of people who without that technology would not be able to discover the world.

"His company was the first to come up with technology that made it accessible without screaming out loud 'This is for the blind; This is for the deaf.' He made it part of the actual unit itself. There was application inside the technology that allowed you to use it or not use it.

"The iPhone, iPad touch, iPod touch, all these things, even now the computer, are accessible to those who are with a physical disability," the 25-time Grammy Award winning singer, songwriter and instrumentalist said."

9:36 AM

Which Is More Important: A Certified EMR or a Productivity-Improving EMR?

Aren't they the same thing?  No, says Paul Roemer, alerting us to this fun fact: "EHR certification inspectors will be dropping in on hospitals like UN inspectors looking for WMDs, only they’ll be slightly less congenial."

2:22 PM

GeekPress: "I am a physician, so I had already been using my iPad for my work, reading PDFs of medical articles, communicating with my colleagues via e-mail, etc. But when I broke my hip in an accident a few days ago, the iPad became my lifeline to the outside world..."

[Read more...]

9:25 AM

Can You Afford To Scrimp On Planning?

From Paul Roemer's blog Healthcare IT: How Good Is Your Strategy?: "It takes a lot of energy to dislike someone, but sometimes it is worth the effort."

"Poor planning often results in a lot of rework. There’s a saying something along the lines of it takes twice as long to do something over as it does to do it right the first time—the DIRT-FIT rule. And costs twice as much. Can you really afford either of those outcomes? Can you really afford to scrimp on the planning part of IT?"

Well, can you?

7:22 PM

JAMA: How to improve patient safety with your EHR? Add natural-language and free-text processing algorithms.  In short, think Google, not billing codes.

[Read more...]

9:57 AM