hospital impact

by Christopher Cornue

A few weeks ago, I wrote about a national effort by the Robert Wood Johnson Foundation that was formally launching in June, and I promised to offer a website when it became available. Well, the "Aligning Forces for Quality" project has been launched and you can learn more about it at the following link: http://www.rwjf.org/qualityequality/af4q/. Much of this work is borne from the RWJF sponsored "Expecting Success: Excellence in Cardiac Care" project that focused on disparities and cardiovascular disease (among others RWJF projects). I was involved in the Expecting Success project, led by the George Washington University as the National Program Office. They are again leading these more far-reaching efforts. It promises to be both a challenging and an impactful endeavor -- to change the care of 14 communities (currently, expanding further in the near future). Go to the link and learn more about this important project and see another step forward in changing healthcare across our nation!

by Nick Jacobs

In the July 3, 2008, Nature, a brief article titled “In rude health” explains the process that has evolved in the National Health Service of the United Kingdom that will result in “A treasure-trove of data in the UK National Health Service . . .that . . .is set to energize biomedical research.” Although the NHS takes a verbal beating from all of the criticism generated by its reported shortcomings, a recent survey showed 91% of 17 M hospital inpatients rated their care good, very good or excellent. More importantly, the NHS was rated above the systems of health-care in Australia, Canada, Germany, New Zealand, and the United States.

If that isn't enough good information, it turns out that the goal of the NHS has been, since its inception 60 years ago, to promote research. Sally Davies, NHS’s Director General of Research and Development has created the National Institute for Health Research which already has plans for virtual organizations to link universities, hospitals and industry, through which researchers will be able to conduct studies on patients more easily.

According to the article, the most important aspect of this plan is that it will open the myriad details of the patient data that has been collected over the past 60 years. This data will allow researchers to readily identify appropriate patients for clinical studies, an internationally unique resource that will swiftly move the concept of translational medicine into the current decade.

The article ended with this quote, “ . . . the NHS’s golden period may be yet to come.”

by Nick Jacobs

False security is something that typically comes from a lack of information or, conversely, an abundance of misinformation. As a young college student, we were taught about semantics, the study of the relationship between words and meanings. If you ever doubt that various national media outlets present things differently, watch the contrasts between the same news stories as presented on the numerous cable news networks and then watch the same story on the international news network. It is sometimes amazing how convoluted the actual facts can become from the interpretation of the stories by the different media sources.

Sometimes we just need to determine what the connection is behind the scenes. For example, I recently saw a newsletter called Environment & Climate News that was published by the Heartland Institute. The first article that caught my eye was entitled, Hybrid Vehicle Owners Report Adverse Health Effects. Because my family has two hybrid vehicles, I immediately immersed myself in this article. After paragraphs of fear mongering (my use of semantics to make a somewhat opinionated and prejudiced point), it quoted H. Sterling Burnett, senior fellow at the National Center for Policy Analysis who said, “There is no research definitively linking hybrid batteries to adverse human health effects.” When I googled the Heartland Institute, this is what I found, “The database contains 22,000 documents from 350 U.S. right-wing think tanks and advocacy groups.” Title vs. facts? Your call.

This article, however, is about at risk women and the various modalities that should be considered for ascertaining their risk levels. As a disclaimer, both local hospitals have MRI’s and will be performing MRI breast exams at centers near you. With that knowledge in mind, read this and decide for yourself.

Anne Wilde Mathews in the Personal Journal Section of the Wall Street Journal wrote a persuasive article that should be required reading for any woman at risk for breast cancer. The basic thrust of the article is a very clear revelation that mammography alone is absolutely not foolproof. Not unlike the accuracy or lack thereof of cardiac stress tests, mammograms can miss as high as 30 percent of malignancies, and, if you happen to be one of those unlucky, high risk patients, a clean bill of health after a mammogram is not always a reason for celebration.

As new and more refined modalities come to the forefront, the efficacy of these diagnostic tests is also continuously being substantiated. Ms. Matthews writes, “For those women whose family background, genetic, or other factors signal a high level of concern, a growing number of physicians are suggesting that MRI breast screening be recommended as the most sensitive form of screening.”

Some physicians regularly recommend ultrasound as well. Although ultrasound is much less sensitive; it still helps to identify sometimes missed lesions. According to the article, “MRI could detect cancers missed by mammography.” In higher risk patients, MRI’s detected over 70 percent of breast cancers while mammograms detect only about 40 percent.” The combination of mammography, physician examinations, and MRI resulted in a 90+ percent find rate.

One of the cautions expressed in the article from a study that appeared in the Journal of the American Medical Association, JAMA, was that both ultrasound and MRI’s can lead to false positive findings which, although disconcerting, are far better than false negatives which can be lethal.

One physician quoted in the article, Wendie Berg, a radiologist, said, “It’s a judgment call. The denser the breast, the more difficult the mammogram is to read, the more likely I am to recommend ultrasound.” Another physician, Constance Lehman, said that she never advises ultrasound for patients. “It’s not even in the same ballpark” as MRI.

My objective take on this one is, if you or your family member is an at risk patient from either family history or genetic propensity, seek further diagnostics. What you don’t know can kill you.

(Mr. Jacobs is not a medical profession - this blog is for educational purposes only and should not be construed as medical advice in any way. Please consult your medical professional)

by Tony Chen

I don't know about you, but I'm drooling over the new iPhone. I'm not a big gadget guy, nor am I one of those Mac enthusiasts. But I am someone that loves great functionality packed into great design, and this thing is the one gadget that I feel like is made "just for me."

This also got me thinking. What applications will the iPhone have for healthcare? Especially now since Apple opened up the floodgates for developers to create new apps. Here's 10 being talked about right now.

For Physicians
- Integrate all your other beepers/phones/PDAs, etc?
- Access medical files, charts, and mini-versions of clinical decision support systems?
- Download comprehensive drug information from drugs.com
- Use the camera to take pictures to send to specialists?
- See heart imaging with this software.
- refresh your CMEs or pick up medically-related videos/media? Read MEDLINE journals.
- Make the X-ray light box obselete?

For Consumers
- People with diabetes, Download your blood glucose levels right from the attachment.
- Track fitness? I've previously written about a wellness phone being tested in Japan
- Interface with your medical record. Looks like Life Record does this already. And I'd be surprised if someone isn't working on an interface between Google Health and the iPhone.
- Reduce anxiety/pain for kids during hospital stays?

Honestly, I probably could have made the same statements about many of the smartphones on the market today. But the iPhone just looks so darn nice, too. And the processing power is a plus.

What do you think will be the greatest healthcare use of the iPhone?

by Tony Chen

Now you can get your local map with color-coded hospital ratings. See below for an example.

Go to NetDoc to draw up your own. This is a nice little tool for patients, but as always, it's only as good as the underlying data.

(HT: Warren Johnson)

by Tony Chen

This just goes to prove again my conspiracy theory about Minnesota being the undiscovered hotbed of health care innovation. Check out this press release from Allina Hospitals & Clinics - a $100MM "living laboratory" to innovate new care models & treatments.

by Tony Chen

Remember's Google's big announcement when they launched Google Health? Their partners included the likes of Cleveland Clinic, Quest, CVS, among others? These were the partners that had built interfaces to the Google Health platform, and patients could choose to import data from those sources into (and out of) their Google Health record.

Got this in my email today:

Today Microsoft and Kaiser Permanente announced a pilot program between Kaiser Permanente’s My Health Manager personal health record and the HealthVault consumer health platform at the Microsoft HealthVault Solutions Conference. Connecting My Health Manager to the HealthVault platform will allow users to combine personal health information from Kaiser Permanente and a wide range of health and wellness management applications and devices, such as blood pressure monitors. Also at the conference, a wide range of health technology companies introduced more than 40 new online health applications and devices.

While Microsoft is probably nobody's favorite company, you have to commend them for landing such a strategic partnership covering xx millions of lives right off the bat?

by Nick Jacobs

Last month, I was invited to speak for the American Hospital Association in Phoenix, Arizona. One of the speakers who preceded me, Ian Coulter, PhD of the Samueli Institute and RAND Corporation provided a compelling analysis of healthcare around the world. He described his countrymen from Scotland as “Unarmed Americans with health insurance.”

Even more chilling was the fact that, “America is the only major economic power where, if you lose your job, you literally can fall into medical oblivion without health insurance until the age of sixty five.”

Another major problem identified by Dr. Coulter is that the food producers of America provide enough food products for every adult to consume 4000 calories each and every day. Unfortunately, we only need about 2000 calories per day. The more is not better theory works here as well as we overeat, become morbidly obese, develop diabetes, high blood pressure and high cholesterol.

Interestingly, in the rest of the industrialized world, the ratio of specialists to primary care physicians is approximately 40 percent specialists to 60 percent primary care. In the United States, that ratio is exactly the opposite; 60 percent specialists to 40 percent primary care physicians. This fact was very interesting as well. In the United Kingdom, primary care physicians earn approximately 130,000 pounds a year or nearly $260,000, significantly more than primary care physicians in the U.S. There is also a 30 percent pay for performance opportunity in the U.K. compared to a 6 percent pay for performance opportunity in the United States. Our primary care physicians are under incentivized while we may have too many specialists in some areas of the country.

Dr Coulter also corrected a previous set of facts that we have all read numerous times; 30 percent of all healthcare dollars are not spent on the last thirty days of life. Thirty percent of all Medicare dollars are spent on the last thirty days of life. What is not stated is that these expenditures typically do not improve the quality of those last thirty days of life.

If you aren’t too tired of facts and figures yet, how about this one from his presentation? Two thirds of Republicans and only one third of Democrats think that we have the best health system in the world, and 58 percent of Republicans and only 20 percent of Democrats are satisfied with the quality of our health care. These statistics may indicate that money does influence your perception of what you can buy in the health care system.

Finally, 20 percent of all American are consumers of complimentary and alternative medicines. On the other hand, 40 percent of the population or nearly 120,000,000 people are fully open to trying integrative medicine alternatives. Unfortunately, only about 30 percent of physicians embrace the various modalities offered through these alternative medicine approaches.

In closing, maybe we should consider this very broad interpretation of health as stated by the World Health Organization’s, "Health is relatively simple; if you feel better, that is health.”

by Christopher Cornue

Through an email distribution I receive from the RWJF, I was led to this article in the Washington Post from last week. It's an interesting read and a positive spin on what has been a difficult challenge for US Health Care - a total reform of our health care system and politics. If you get a chance, take a gander ... and feel optimistic about the future of healthcare!!

by Christopher Cornue

Allow me to be bold and perhaps even controversial for a few moments (er, paragraphs), please. During a recent collaborative visit with some healthcare organizations in England this month (of which I'll be writing future postings in the next several weeks), I was hit by a revelation during one of my presentations. I was talking about some of the innovative strategies for total access in some of our states ... specifically, Massachusetts, Illinois, California and Oregon and thought about the unique opportunity that each state has in the US. Also, each state focuses on specific metrics (as part of a state-run group, Joint Commission or other national body). As most folks know, each of these states (and others) have developed different versions of plans to ensure there is access to healthcare for kids, women, or everyone, depending upon the respective state. It was then that I realized the United States is a huge laboratory for health care reform ... with 50 separate labs working on solutions to health care. This is exciting!

So, what if we take this to the next level (here comes the controversial bit, and I admit I don't know all the dynamics regarding the plausibility of what I'm suggesting - so don't kill me!). What if the Federal Government were to identify a block of funding for each state... and each state would be overall responsible for the delivery of healthcare in that state with: 1) everyone having access to healthcare; 2) quality metrics are established and trended; 3) patient's satisfaction with their care is tracked, trended, addressed; and 4) poor performers (hospitals, clinics, physicians, etc.) are improved. Each state can do something different, depending upon their unique challenges, population, resources, etc. -- but they would have the ability to create programs providing healthcare to their respective groups.

I know there are other options too (i.e., federal funding could be provided to each state to develop a program that could then be potentially rolled out nationally, etc.), and that's the exciting part - that there are 50 test tubes for what could end up being a solution to our healthcare issues nationally. So, is this "out there," are there efforts like this already in place, etc.? OK, I'm finished - thanks for allowing the moment of boldness!

by Tony Chen

Okay, this post has nothing to do with retail clinics, except that like these clinics, I'm purposely only offering limited services on a limited scope. Okay, I apologize for the weak analogy. Anyway, here's a few quick links on what's happening in the healthcare blogosphere:

- The Health Care Blog: An insider look at Google Health

- Health Affairs: Kaiser has started a blog watch

- The World Health Care Blog: Privacy 2.0

- Foresight.org: Nanotech could revolutionize diagnostics with nano-sized barcodes.

- FierceHealthcare: NEJM's study on social network's impact on health decisions

- Forbes: Stem Cells Get Real

- Health Management Rx: Why I Believe in Consumer-Centric Care, Part II (may be the longest blog post I've ever seen, but still worth the read)

- Dr. Wes: Criticisms of "Consumer-Driven Healthcare"

- USAToday: America's Fittest Cities

- FierceHealthcare: Consumer Reports to rate hospitals

and finally, the new EMR that will rock your world. Brilliant.

by Tony Chen

This past week, I was at the Front End of Innovation Conference in Boston. Overall, it was a great time to reflect on my own mindset about how to bring innovation to hospitals & healthcare.

Here are a few things & quotes I'm still mulling over:

On Being Customer-Focused
- A.G. Lafley (P&G CEO) had a ton of great insight. When asked about how P&G became so customer-centric, he recalled his first days on the job as CEO. "We were all so busy every day, so much so that our heads were in our phones/computers and our behinds were facing our customers." First thing he did was to get people out of their offices and into customer's lives and watch them.
- Google does this as well. One "problem" they deal with is that they work pretty hard, have a great campus that almost allows employees not to leave. Employees start living in a "google bubble" and "googlers are not necessarily representative of the general population." Google continuously sends teams out to watch people do searches and use their products in their "natural" environments.

On Humans
- I know this sounds cliche or stupid, but we're human. And humans are emotional and experiential. The most beloved products/services in the world just happen to treat us that way.
- Apple isn't selling a high-tech device, Apple is selling a human experience
- A.G. Lafley: "we have to understand what customers can't articulate." Customers might be able to express what they dislike, but they won't necessarily be able to tell you why or how to fix it.
- Peter Guber (Mandalay) - storytelling has been the key to his success, and the key to the success of just about everyone he knows (in entertainment or not). When you can tell a good story (about yourself, your product, your cause, your goal), it resonates with people emotionally and memorably. Good storytelling is not informational, it's emotional - it engages the heart and the mind.

On the Future
- Ray Kurzweil (Ridiculously accurate futurist on all things tech and IT) believes in the theory of the "law of the accelerating returns." The reality of innovation and of human history is that things don't progress linearly, things progress exponentially. That's because every new innovation we come up with accelerates the next innovation. Just think about "Moore's Law" - a "doubling every two years." Check out his work here and here
- Exponential growth and linear growth are hard to distinguish in the early years (because the numbers are so small). But the turning point (the bend on the hockey stick) is hitting us now in the areas such as solar energy (within 5 years, solar energy will be cheaper than fossil-fuel energy) and reverse engineering the human brain (15 years, we'll have ridiculously real AI)
- Devices won't be laptops or PDAs - devices will be in our clothes, in our heads, in our bodies. Sound crazy? There are 50 studies being done right now in animals on implantable devices. One has cured diabetes in rats. One is an in-blood device that finds and destroys cancer cells.
- We can learn about innovation from the one obvious place no one really looks: nature. Why? Because every single organism has been an innovator for billions of years in order to survive (99% of all species are extinct) We can take advantage of those billions of years of "market testing" by reverse engineering nature. Check out some examples here.

As I said, I'm still mulling over what this all means. In general, I think I tend to overestimate what innovation will bring in the short-term, but greatly underestimate what innovation will bring in the long-term. New innovations are accelerating and will vastly change the landscape of healthcare as we know it. Hospitals that go out on a limb and catch the wave will have to take big risks but also stand to reap tremendous rewards.

by Christopher Cornue

I've written in this space before about a national collaborative, funded by the Robert Wood Johnson Foundation (RWJF), called Expecting Success: Excellence in Cardiac Care. This was a 29-month collaborative project, led by the George Washington University and comprised of 10 hospitals from varying communities in the United States. Detailed information is available at the website and further tools developed during this process will be available at a new website in June (I'll post an update when that becomes available). Briefly, though, I want to call out some significant successes from this project that "formally" concluded a few weeks ago and were shared at a national meeting in Washington, D.C on 8-9 May 2008.

* Each hospital implemented a consistent way of collecting Race, Ethnicity and Language, based upon OMB classifications - this is expected to become a Joint Commission requirement in 2009. These data allow hospitals to identify potential disparities, and then implement changes to address any that may exist;
* Through the project, 61 statistically significant changes in quality occurred (58 of which were improvements; while 3 were declines);
* Evidence-based "Measures of Ideal Care" for AMI improved significantly across the hospitals since the project began in Q4 CY2005 through Q4 CY 2007: mediancompliance increased from mid-70% to upper 80%; additionally, the spread of compliance across hospitals (which in the beginning was a large gap between approx. 17% to 93% to a much smaller gap of approx. 77% to 100%);
* The gap for "Measures of Ideal Care" for Heart Failure were even wider than AMI when the project began (approx. 5% to 88% compliance in Q4 CY 2005) and ended with a narrower gap of approx. 59% to 98%);
* Some hospitals demonstrated a significant reduction in the gap of care provided by race and ethnicity - with one example focusing on percentage of AMI patients receiving ACE/ARB for LVSD where in early 2006, whites received ACE/ARB 90% of the time while blacks received it approximately 76% of the time. By the end of the project, the gap had closed to such a significant degree that both received ACE/ARB 100% of the time.

There were many other noteworthy examples demonstrating the significant improvements. Suffice to say, quality has improved significantly at these 10 hospitals over the past 29 months, with the gap in race and ethnicity closing. While more specific info about next steps will be shared in June and July this year, RWJF plans to implement this project on a broader scale nationally, using lessons learned from these 10 collaborative hospitals. Their focus will be on dozens of communities across the country in an effort to spread the successes and ultimately improve the quality of care in cardiac care, while reducing disparities where they may exist. More detail to come ...

by Tony Chen

Google Health launched today. Check it out here

As you can see,, there's 4 calls to action:
- I can add info to my profile (stuff like conditions, medications, allergies, procedures)
- I can import my medical record into Google Health (right now, the only options for this are info from Cleveland Clinic, Beth Israel Deaconess, Walgreens, CVS, Quest, and a few others - so I'm out of luck here)
- I can explore online health services. The first 3 services listed? Cleveland Clinic's eConsult service, ePillBox.info (free med mgmt tool), and AHA's heart attack risk calculator.
- I can look for physicians using a drop-down specialty box and typing in key words/locations.

There has been a lot of hype about how Google and Microsoft will "change healthcare" because of their new services, so today we can get a sense for whether they're going to live up to all the hype.

What I liked
- I give Google high marks for what they do best - taking complex information architecture and making it simple and easy to navigate. The navigation for the site was very intuitive for me. I added to my profile the items I wanted pretty easily (I wish I can see how the import works - if anyone did this, please comment!). I searched for my primary care physician and clicked "add to my medical contacts", and boom, his info was stored there for me for future reference. It's pretty easy to add immunizations/procedures/meds - I could pick it from the list. Or I could start typing in the open text box, and the more letters I type, the likely field appear (just like we do now with email addresses)
- I liked the fact that there's a drug interaction area. As I added meds, it showed exactly which interactions to watch out for.
- I liked being able to create a new profile (which I did for my 2-year-old).

What I didn't like
- They still need to fix the "find a doctor" function. I typed in some docs I knew and for some reason, their practice partner's names come up, not theirs. So, it was pretty confusing.
- It's still unclear how to "use" the record besides just having it all in one place. I've heard that patients will be able to choose what part of the record to share and with you, but didn't see that in this release. There's no option to download the data, either. What else can I do with it?
- I wish they added some sort of HRA & fitness/wellness area. Now that would drive usage - if I could traffic my weight, workouts, bp, whatever. After all, it is launched as Google Health, not Google Health Care. Nonetheless, maybe they've decided to give that piece of the pie to others.

Where hospitals have opportunities
- Tech-savvy hospitals should be able to start looking at linking their EMR's into Google Health. Of course, there's some tension with this as many hospitals are trying to drive stickiness/traffic to their EMR portals. This would stand to compete with that. Why would a patient log into their hospital's EMR system when Google's system is probably easier to use and more visually appealing. On the other hand, hospitals that do have the link the Google Health provide their patients will this added benefit. Maybe patients will increasingly ask their physicians who will increasingly ask their administrators?
- Tech-savvy hospitals and others can try to have their online services added to Google's list of online services. This is essentially another channel to drive traffic/utilization.
- Hospitals who are savvy in the ways of 2.0 will have their physicians appear higher in search results. Yup, this is yet another way to search for physicians, but honestly, I doubt people will use this tool to make physician decisions. More so, they'll go onto HealthGrades or other Physician rating sites. The "Find a Doctor" option on Google is more so that we can automatically add our physician's info into our profile quickly.

Here are a few other notable mentions of Google Health:
Blogscoped
news.com
GeekDoctor (CIO BIDMC)
TechCrunch
ScienceRoll
Healthcare IT Blog

More on this soon, as they unveil more details in today's press conference.

by Tony Chen

I'll be at PDMA's "Front End of Innovation" Conference in Boston next week. If anyone is around and up for drinks, let me know.

Last time I checked, I couldn't find any other hospital members of the PDMA (Product Development and Management Association). Think of them as the ACHE for innovation & product development people. As I interact with this group, I'm definitely stretched by their progressive thinking about how to bring innovation into any culture/organization (apparently, the Russians did a lot of innovation theory work back in the day that are still being utilized widely today).

What can hospitals learn from the likes of Dow, Staples, Google, Starbucks, IBM, Kraft? I'll let you know.