Tuesday, April 17, 2012

Personal Honesty: Is Facebook the Real You?

Social media, especially Facebook, is among other things, a life experiment for me as an IT professional and "corporate executive". In particular, I'm insatiably curious about the role that social media technology plays in transparency-- breaking down the barriers and often hypocritical behaviors between personal and professional lives that allow for things such as university football coaches to lead double lives as pedophiles; Secret Service agents with the trust of Top Secret clearances to cheat on their spouses with prostitutes; and Board members and executives to conspire and misappropriate money from non-profit healthcare organizations-- i.e., how truthful is the complete circle of our lives? The recent flap over employers asking for Facebook passwords is an interesting twist on personal honesty vs. personal privacy-- should we care if we have no secrets? Does social media reveal the truth and real person in us or not? This study from the University of Texas seems to think so...  Manifestations of Personality in On-Line Social Networks.

None of us hold perfect behavior.  Accepting that, if you are going to make a mistake in personal behavior and organizational leadership, err towards transparency, not secrecy.  Open up your life.  If the worst thing they accuse you of is "too much honesty... too much information", I suspect you'll still get a clear pass through the Pearly Gates.  :-)

Saturday, April 7, 2012

Healthcare Change is Here to Stay, Regardless of Supreme Court?

"Do you agree that Change is Here Regardless of Supreme Court's Decision?"

This question was recently posed by Jay Warden of the Camden Group to members of HIMSS.  Copied below was my response.

I believe SCOTUS is going to overturn the individual mandate, but leave the rest of ACA alone for Congress to fix. But, to the question, yes, I believe we finally reached a tipping point in the industry towards what I'm calling Healthcare 2.0, which boils down to bundled payments that put the economic burden of quality and cost control on the provider, neither of which exist under the current fee-for-service model. In the absence of federal pressure to change healthcare if the Affordable Care Act (ACA) is repealed-- partially or completely-- the employers now have the momentum and there's no turning back.

We are seeing a growing trend of direct contracting with providers by self-insured employers, which is disintermediating the insurance companies and their profits from the economic model. The federal individual mandate under ACA was foolish and naive-- and pushed by the insurance companies to line their pockets. We simply aren't the type of society that legislates that sort of thing from the federal level, and trying to do so was like poking a stick in a hornet's nest. But, the ACA is not all bad and I will give the ACA credit for getting the ball rolling. Employers like IBM, Cisco, Intel, Google, Facebook, Apple, WalMart, Ford, et al, are not going to allow the momentum stop. They are taking control of healthcare by squeezing traditional insurance companies like Aetna, BCBS, and United out of the picture and direct contracting for fixed-fee coverage-- or in some cases, hiring and building their own healthcare delivery organizations.

I'm a CIO in a national health system that allows for private and federally insured options and thus provides 98% insurance coverage without an individual mandate. In this model, if you want insurance for broader coverage, you can buy that in the private market. If you want very affordable, basic coverage, you can access that through the federal government or similar products that are legislated upon the private insurance companies. It strikes a very good balance between private market and federal involvement to ensure access and affordability. I'm also a part-owner of a small business that is leveraging new models for self-funded coverage; it's not easy but it is possible. Obama and Congress could have made it easier for all employers by repealing the McCarran-Ferguson Act (MFA) and opening the doors to interstate competition between insurance companies. Legislating insurance that's not affordable is like creating 30 million new criminals. You need to lower the costs of insurance, first, and you can do that by removing the federal laws that protect the insurance companies from open competition. The Obama Administration caved to the insurance lobby by allowing MFA to stand...since the 1940s.

Despite a less-than-perfect federal attempt, the ACA got things rolling and the momentum for healthcare change is hear to stay, thanks to employers who are no longer willing to accept the status quo.

Thursday, April 5, 2012

EMR User Interfaces: Embedding Team-Based Care and Knowledge

There's a great new article in the March 2012 issue of The American Journal for Managed Care, "IT-Enabled Systems Engineering Approach to Monitoring and Reducing ADEs".  You can find it here.  The point I'm trying to make in this blog, by drawing attention to this article, is this:   It's time for EMR vendors to rethink the fundamental design and user interface of of their products.  They've been basically unchanged for 10 years, at least, supporting the same concept of encounter-based care that itself goes back at least 50 years.  EMR vendors need to stop thinking of patient care as short term encounters with a clinician and start thinking of patient care as long term project management with a team of care providers.  EMRs user interfaces need to look more like a project management tool that enables social collaboration, task assignment and follow-up, and the collective wisdom of the care team, including the patient's wisdom, more effectively.

In summary, the AJMC article concludes that, by using web-enable team resource management (TRM) tools, clinical work teams can significantly reduce the rate of adverse drug events in patient care.  According to the article, "the rate of ADEs decreased from 25.8 to 18.3 per 100 patients per year in the intervention group. The rate was virtually unchanged in the control group (24.3 vs 24.8)."  That's a major impact.

The study described in the article is particularly impressive in that, the TRM tool leveraged the collective wisdom of the care team in identifying, tracking, and measuring the causes and interventions associated with ADEs.  It's a prospective model for preventing ADEs versus a retrospective root cause and failure modes analysis of what caused the ADE.  Very, very impressive approach.  The team at  the Department of Family Medicine and UB School of Management, State University of New York, should be widely acknowledged for this innovative yet common-sense approach to patient care.

EMR vendors, please take note.  :-)

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