Watch users stumble with Healthcare Technology

I saw this video on HIS Talk, so you may have seen it already, but it is worth sharing.

It's too easy to forget the end-user experience. If what we do doesn't make that experience work for the clinicians, we can't get the data we need.

Making Health Care Better

This article in the New York Times earlier this month is long, but worth reading. If the ads are distracting, try Readability.

David Leonhardt writes about Dr. Brent James of Intermountain Heathcare and how he is using data to improve the practice of medicine. A number of things have to be done to make this useful. And meaningful.

1) You have to have good data which shows concrete improvement in outcomes based on specific changes in health practices.
2) You have to give the practitioners that data as part of their regular workflow, making the preferred action easy to accomplish.
3) You still have to allow doctors to do what they feel is best for a specific patient. Meaning #2 above is not required, but suggested.
4) You have to measure which clinicians are following the suggestions and what the outcomes are in a continuous feedback loop.

It's a lot of work and it's complicated, which is why most medicine is not done this way.

Unfortunately, we also still have a system that doesn't reward some of the quality improvements that can be achieved using data like this; that's a subject for another post. It is easy to see how health care costs keep rising when preventing exacerbations and adverse events can cost a health system money, however.

Forget all the hype about healthcare IT and read this article. The potential we have for improving patient care is tremendous.

Speech by Dr. Robert Kolodner

The recent National Coordinator for Health Information Technology gave an interesting talk at Georgia Tech last Wednesday, 11/4/09. You can watch all 80 minutes here. Thanks to GA Tech and Emory and their Health Systems Institute for sponsoring the discussion.

A lot of the talk was about health as opposed to health care. We tend to forget the accomplishments of public health in the last decade.

Dr. Kolodner spent several years at the VA before his time with the feds. As such, he understands what a good EMR can do for data collection and analysis. Late in the talk, he showed a graph of hypertensives and how well controlled their blood pressure was. With the VA patient population, there were several hundred thousand data points. The fascinating part was the discovery that BPs were better controlled in the fall than in the spring. What you can learn when you have the data...

Dr. K. quotes Peter Drucker as describing health systems. Drucker says they are "very complex". Dr K's un-named mentor always told him that "Beginning are messy". We need to at least be at the messy beginning of beginning to use the data we gather about this complex system which is US healthcare.

Social Media at work

I've been spending more time networking lately, and have been thinking about the use of social media sites. I've written a little about it here before, but the topic is far from exhausted.

One of the blogs I follow, Candid CIO, just posted a piece on Ministry's new policy regarding social media at work. Like everything thing else in the workplace, you'd like to think that a policy isn't necessary if everyone is working with the best interest of the institution at heart. Unfortunately, that isn't always the case. I'm sure Will had to work hard to get the policy they have, and it will certainly need to evolve over time.

A web developer buddy has a pretty strong Twitter presence, but he's paying someone to do it for him. The new UK basketball coach, John Calipari, clearly has a professional web site, tweets, blog, facebook, etc. It's overwhelming, yet an interesting way to access information.

It really is a process of building a persona, whether you're an SEC basketball coach, a healthcare CIO, or just a college student.

Time for me to go update my facebook page...

Low Hanging Fruit

The articles that always get me are ones that focus on getting the software RIGHT. If it works, and you follow up to get the information out of it, it can be a really great thing. If the software looks like programmers thought it up, it won't get the adoption it needs to be useful (or meaningful).

If you subscribe to the Archives of Internal Medicine, you can see the original. Otherwise, enjoy the abstract pointed to above.

With EMR system notifications, just as with email, you can't send a missive to a group and hope that one of them decides to act. All recipients, especially if they are busy doctors, will assume that someone else will do the responding.

The real lesson, post-implementation, be sure to circle back and see what is really being used and how effectively.

P4P in Physician Group Practice

CMS recently published interim findings on the use of Information Technology to achieve measurable improvements in the quality of care for patients with chronic diseases. They have 29 measures for Diabetes, Coronary Artery Disease, CHF and preventative care. The results are very strong; the participating practices consistently achieved improvements. In the first year, all the practices achieved benchmark or target performance on at least 7 out of 10 diabetes clinical quality measures. Similar results are posted for subsequent years.

Other bloggers have written about it as well.

Having the data available really works; the trick is to get people to recognize that the pain of implementation and the challenge of change are worth it.

High Tech and High Touch

Kaiser Permanente recently published an interesting study. They did a two year trial of patients with prior coronary artery disease. Approximately half the patients got their intense follow up program (including regular direct calls to the patient from a specialty pharmacist). The other half got electronically generated reminder letters to schedule the blood checks on their cholesterol.

The fascinating result was that both of these groups showed dramatically better results that patients without any reminder system. The difference between the "high touch" version and the simply "high tech" version was not very high. But the difference between nothing and either reminder system was very high, meaning the cheaper solution was highly effective.

Most institutions are not yet at the point where their EMR could be generating the reminder letters that Kaiser did. But it appears that processes like this may be where the meat of the cost savings promised by Healthcare IT will come from.