The reason it is so hard to “do the right thing” in health care is that the current environment is a conspiracy of connundrums -
no accountabilty, no transparency, rules/regulations, culture, binding
contracts, third party payments, behavioral choices, lack of evidence,
etc ad nauseaum. A real world example of how this plays out can be seen in the Vicious Cycle of Healthcare Innovation.
This article highlights what happens when health care providers “do the
right thing” but are rewarded with less money, which then kills off not
only their desire but also their capability to do the right thing. Its
a beautiful mechanism to ensure that the status quo never changes. This
“Death to Innovators” concept has been highlighted by Intermountain Healthcare (pneumonia), Virginia Mason (back pain), and health innovators like Rushika Fernandopulle , MD at Reinnassance Health.
These tragedies have to be overcome. Given the grip of the
medico-industrial complex, and their lobbying minions in DC, the only
hope I have is that an entirely new system of health can begin to
develop and emerge “off the grid”
for the current non-consumers of healthcare. From this toehold, and
from early and small efforts of the myriad groups seeking to change the
financing of healthcare, I am hopeful that innovation can emerge that
will align incentives, coordinate care delivery, improve outcomes, and
be rewarded appropriately for these results. That is why I am involved
in the various efforts to not only bring innovation to light but also demonstrate that these models can flourish.
Comments
Excellent article and perspective!
From the HIT arena, we have been very good at providing the features, functions and whizz-bang cool stuff, but have had been very hard-pressed to be able to show practitioners how their businesses and daily activities can change for the better. Many studies are being conducted now to try and pull the patient in as an accountable member of their own health and wellness, but what about doing the same for doctors and practitioners? Dr. Larry Phillips (Emory University) has a great descriptor for this: "clinican inertia".
What can we do to help transition from the current system that "sort of" works, to a more communicative, transparent and connected system that works for all participants every step of the way?
Posted by: Heather Shankwiler | May 31, 2009 8:54:10 AM
Steve,
this "off-the-grid" status is exactly how most of the most active medical online communities were built. ACOR is just one of them, BrainTalk is another one and there are tens of thousand independent communities out on the Internet that exist completely "off-the-grid". The impact of these communities is, I am convinced, vastly underreported and there is much to learn about some of the tools, ideas, methodologies and plain patient advocacy/empowerment in this parallel, mostly under-the-radar world.
And now for an off to the tangent comment:
Where there is a need people will find some solution. Not to become the next bleeding-edge disruptive innovation as most marketers will tell us today but just to come with an easily applicable solution. We all used off-the-shelf applications to build simple and highly stable communication systems. It has always been about the triumph of humanity and not about the triumph of technology. Medicine suffers greatly from the syndrome of complexity. We already know that hundreds of billions are spent annually on new technology, new treatments, new .... with completely unproven clinical benefits, just because it is so easy to sell to patients and clinicians the "newest" because new equals better.
I raised both of my children making constant fun of the "New and Improved" packaging you find everywhere in stores. I never thought this applied equally to medicine!
Posted by: Gilles Frydman | May 31, 2009 9:16:09 AM
Sorry Scott :-) Don't know why I called you Steve...
Posted by: Gilles Frydman | May 31, 2009 9:17:29 AM
Take a look at the HealthCare Innovation Program at http://nursing.asu.edu/mhi its an off the grid program creating leaders that drive change and implement more value added solutions to healthcare problems. There is both a Masters and PhD program spearheaded by Kathy Malloch and Tim Porter-O'Grady two well known innovation leaders!
Posted by: dan weberg | May 31, 2009 10:00:34 AM
Scott, are you a physician?
Gilles, are you a physician?
Dan, are you a physician?
Heather, are you a physician?
If the innovative devices to which you refer were deemed and found to be useful, safe, and efficient after being properly tested, they would be welcomed by health care professionals.
The "CONSPIRACY OF CONUNDRUMS" to which you refer is a problem of the HIT industry and not of medical care. Get real!
Posted by: The Modern Doctor | May 31, 2009 11:53:57 AM
"Modern" Doc,
I'll take the bait.
If anybody calling him/her self "Modern doctor" asks others "are you a physician" as a defense mechanism it is pretty clear that person still adheres to the paternalistic model of medicine and therefore doesn't quite understand "contemporary medicine". A bit like "Modern Art" means art of the early 20th century, in opposition to "Contemporary Art" that is current.
If medical care was not constantly problematic do you think we would spend all our time to fix it? Wait until you or a love one has to deal with the system and then we should talk again!
Posted by: Gilles Frydman | May 31, 2009 1:16:38 PM
Dream on.
Posted by: Perseus | May 31, 2009 9:03:55 PM
Agreed with modern doctor..the adaptation is driven by the awareness of tools and methods in the consumer community and also by the greatness of the product. I fear that HITs are focussing on former while the later bleeds.
rgds
ravi
blogs.biproinc.com/healthcare
www.biproinc.com
Posted by: Healthcare Guru | Jun 1, 2009 4:17:53 AM
Gilles;
In this case I wouldn't be so sensitive with Modern Doctor. I think he/she was only asking if you all were physicians because physicians are being blamed for not implementing IT systems with terms like "apathy" and "inertia", when all the physicians I have ever seen comment on this blog keep beating the same drum: the *&^%**!!! IT systems they produce DON'T WORK FOR US.
Somehow no one at all seems to be listening to this point. Would you spend a lot of money on a television that all your friends and neighbors had bought and it didn't work? No, you wouldn't.
I admire your patient advocacy, but I think if you got on board and helped pressure the IT industry to produce a product that met physicians' AND THEREFORE PATIENTS' NEEDS, your passion would be better placed.
Posted by: bev M.D. | Jun 1, 2009 4:59:04 AM
Bev,
my patient advocacy has been going for long enough for me to disagree with one single word in your comment :-)
I think you misunderstand my advocacy. I am constantly making fun of the many health professionals who have to accept the unfortunate fact that medicine doesn't exist without patients. But I make equal fun of the patients and their advocates who behave like we have medicine without health professionals. Case in point: ACOR was created as a system to provide information IN ADDITION to what people could get otherwise, not IN OPPOSITION. Of course sometimes what they learn from informed patients is in opposition to what their docs have told them, but that's just a side effect of knowledge. I do advocate for better and more open HIT. I even wrote about it this weekend: "David Kibbe & Mark Leavitt : Openness vs. Opacity" at http://e-patients.net/archives/2009/05/david-kibbe-mark-leavitt-openness-vs-opacity.html
It is pretty clear that the famously certified HIT products just don't work for most doctors. It definitely feels like it could have been a good commercial decision to ask the end-users what they would really use in these products before designing them. Unless you and I are mistaken and the real end-users (the insurance companies & hospital adnministrators) are happy with the results.
Now back to that disagreement over a single word. I don't believe that an HIT product that meets physician needs will THEREFORE necessarily meet patient needs. In fact, I am quite sure that the needs of the 2 most important stakeholders are complementary but different.
Maybe in 10-15 years, when we have learned enough about the value of ODL we'll be able to reconcile both sides but we are not there yet.
That's exactly why we should advocate for a revision of the CCR & CCD (I am still confused about these 2) to include information formatted specifically for the patients, in addition to the fields currently coded for billing and clinician communication. That's my take-away from e-Patient Dave's data story.
Posted by: Gilles Frydman | Jun 1, 2009 5:37:43 AM
"Are you a physician?" This question seems to capture much of the condescension historically (and stereotypically?) atttributed to the profession.
People (sometimes but rarely known also as patients) don't like being talked down to by "experts."
So I ask a few Q's:
Is there value in innovation?
Will innovation help people?
Are there lots of broken things to fix?
Will solutions come from one field?
(and most importantly) Am I helping?
Great post, Scott. You don't have to be a doctor to be evidence-based (and training Doctors is in many ways antithetical to creating innovative businesses).
Food for thought?
Was the inventor of Skype from AT&T?
Was the inventor of Quicken an accountant?
Will the inventor of the best prevention delivery process be a physician? A health plan manager? A shepherd?
Posted by: Henry Albrecht | Jun 1, 2009 11:40:22 AM
You can add Thedacare to your list.The redesigned inpatient care unit at Thedacare named Collaborative Care has delivered 0 medication reconciliation errors for two years, dramatically better patient satisfaction, and 25% lower costs but medicare pays 2000 dollars less per case on that unit vs. poorer performing med surg units in the same hospital!
Learn More at www.createhealthcarevalue.com/blog/
Posted by: John Toussaint | Jun 1, 2009 12:37:10 PM
This kind of story is very sad for the conscious people of the society. Even the death of the innocent drug addicted people is also sad for us. So to save the people we needNarconon Vistabay had come across a long way to grant all the preferential solutions to every nook and corners of world of drug complicationsand procured a pivotal role in resonance and undying rehab to the drug wrongdoers.
Posted by: sumit | Jun 12, 2009 6:54:49 AM
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