After reading my rambling/scattered post from this morning, I’ve found a useful nugget. “Here’s the problem: (constant!) vague and incomplete information.” Enter Google Health, Microsoft Vault, etc. (ETC! because there needs to me more, much more!)

While we as consumers have been inundated with information since the widespread adoption of the internet (and now endure an insatiable thirst for more and more and more), the secret to better health care is more information. Yes more.

More to patients, more to researchers, more to administrators, more to providers. Just more. Relevant more.

This is where Health 2.0 comes in. More is good, but more must be relevant. The tools of Health 2.0 will allow all of us to better organize/ingest/disseminate the “new” limitless information. Get ready for everyone to be more informed. And don’t try to run from it because you won’t have the energy required to keep up the necessary pace to stay ahead of the revolution.

Embrace, Embrace. Embrace! Starting today!

Brian Klepper has typed a guest post at Health Commentary about health information influenced by Sir Muir Gray, the Chief Knowledge Officer of Britain’s National Health Service. A portion of Sir Gray’s comment (you really should go read the rest):

The third [health care] revolution is different - everyone’s involved and it’s everywhere, it’s adaptable, it’s pervasive, it’s inclusive and convergent.

Knowledge is the enemy of disease, the application of what we know will have a bigger impact than any drug or technology likely to be introduced in the next decade. I’m talking about three types of knowledge here Statistics, Evidence and Mistakes - we need to be able to deliver these as simply and abundantly as we deliver clean water.

Knowledge is the enemy of disease. Good stuff.

One of the best aspects of my MHA program (and one of the reasons I chose it) is a clinical rounds class that places MHA students with a hospital service for five weeks to observe medical students, interns, residents, fellows, and attendings do  rounds.  I have often heard that learning on the job is the best way to learn; this experience is no different, a key to understanding others and learning about what they do is to immerse yourself in their situation.

One of the important differences that separates health care from other “business” is that most providers—who are directly responsible for admitting patients into the hospital and thus, relied upon in order for hospitals to make money—are not employees of the hospital.  It is understandable why problems develop.

The age-old health care management problem involves a disconnect between providers and management—most likely to do with a lack of communication.  This class, while admittedly too short, is an effort to help administration students (most with limited clinical experience) gain an understanding of the medical education process (and a general look into the provider’s decision-making process).

I’ve always respected physicians, but my respect has increased dramatically after just a few meetings with my care team.   Decision making can be difficult as there is always some uncertainty in the decision making process.  Limiting that uncertainty is a key to making good decisions.

Here is what I’ve come to understand well: Uncertainty rules the day in medical care.  And patients expect miracles.  While the competent provider (of which I have yet to meet one on the other side) often has a good idea/understanding of a patient’s medical problem, they just never know for sure.  Here’s the problem: (constant!) vague and incomplete information.  Besides a detective, who else deals with so much constant uncertainty?  Or if that isn’t enough, how about dealing with uncertainty and knowing the decisions made could have a negative impact on another human life?

Differences between providers and administrators will always exist.  The two have very different job descriptions with very different expectations.  The differences create a necessary balance.  While only for a short period of time, being exposed to providers doing their job is helping me visualize those differences.  The hope is that this experience will translate to a better understanding of it all.

Recently finished Money-Driven Medicine: The Real Reason Health Care Costs So Much by Maggie Mahar who, as you may know, blogs at the Health Beat.

I recommend the book.  Ms. Mahar does a wonderful job exploring the many different facets of our health care system; each component is responsible for some sort of wasteful spending.  The book also gives good history lessons on a variety of topics including for-profit hospitals (which I found quite interesting).  The many interviews provide a look into how individuals throughout health care feel about current standard operating procedure with some very insightful opinions.

From the jacket:

Why is medical care in the United States so expensive? For decades, Americans have taken it as a matter of faith that we spend more because we have the best health care system in the world. But as costs levitate, that argument becomes more difficult to make. Today, we spend twice as much as Japan on health care—yet few would argue that our health care system is twice as good.

Instead, startling new evidence suggests that one out of every three of our health care dollars is squandered on unnecessary or redundant tests; unproven, sometimes unwanted procedures; and overpriced drugs and devices that, too often, are no better than the less expensive products they have replaced.

How did this happen? In Money-Driven Medicine, Maggie Mahar takes the reader behind the scenes of a $2 trillion industry to witness how billions of dollars are wasted in a Hobbesian marketplace that pits the industry’s players against each other.

An interesting tidbit from the Publishers Weekly review on Amazon, “[Ms. Mahar] wants to show why the most common economic assumptions about health care—especially those that extol the magic power of free markets—are false and stand in the way of real reform.

Despite the light shown upon the non-profit hospital sector by The Wall Street Journal Friday, some hospitals around the country have struggled to keep their doors open.

And after this weekend’s airline fallout (of which you may very well have been affected by) where ATA, Aloha Airlines, Skybus, and Skyway all ceased operations leaving passengers stranded and left to deal with their credit card companies for refunds (yikes!), I’m beginning to see another developing metaphor between the airline industry and health care.

Rising fuel prices and a general economic slowdown are being held responsible for the shutdowns.  We can find similar issues in health care: rising costs of technology and more uninsured patients.

A few months ago, the future of Grady Memorial Hospital in Atlanta, which cares for many uninsured patients, was in doubt.  The Grady situation seems to have taken a better turn, but this editorial about the situation highlights other hospitals that have shut down, “Philadelphia General Hospital in Pennsylvania, the District of Columbia General Hospital in Washington, the Martin Luther King Hospital in Los Angeles.”  

Most recently, SSM St. Francis Hospital and Health Center in Blue Island, Ill., announced it is closing.  Unpaid patient bills seem to be the culprit.

Two of the most regulated U.S. industries have more than a few things in common.  Although the situations may be similar, the solutions are going to be different.  Some sort of insurance reform needs to happen in the near future to prevent more closures.  My fear is that the “solution” will come out of panic and necessity and not make the necessary changes to move us toward sustainable health care.

Medicine is steeped in tradition. Tradition can be good. Other times, not.

The reason providers wear white coats is of some debate. At most academic medical centers the white coat signifies status in the physician hierarchy (i.e., attendings wear long coats, interns wear short coats).

our own system will ban the white coat. All providers involved in patient care, no matter their role, will wear scrubs. We’re not opposed to tradition, we’re just in favor of practicality. However small the risk, if the white coat is worn every day and goes unwashed it can spread infectious disease.

Superbugs have been on the march (technically, since the beginning of time). Stories of MRSA were rampantly covered by the media a few months ago. VRE and LRE are around. Bugs have always been in the hospital. With new patients arriving daily (more like hourly), bugs will always be in the hospital.

It is our job to minimize the patient’s risk and exposure. Don then dump. Don the scrubs when you walk in, dump them in the laundry cart when you leave.

Principle #12: Scrubs for all. No more white coats. Or any other clothing from home for that matter to be worn while seeing patients. The small stuff matters—we must do all we can to ensure patient safety.

I really enjoy when my hours of web cruising pay off (for the record, they almost always do…but what I’m talking about here is when they really pay off).

With that, my most recent discovery is fantastic.  I would encourage you to visit Jen McCabe Gorman’s Health Management Rx. It’s an absolutely fantastic read and she regularly dives into health care issues from completely different perspectives…which, as you know if you have been reading here for awhile, jives with what we’re trying to do.

An example:

I could write a book on the subject of bringing Gen X and Gen Y Directors onto Boards (hmmm), but for now, let’s titrate this future-of-governance thing down to simple solutions.

You. Need. Healthcare. Leaders. And. Thought. Leaders. Under 40 (Under 30). On. Your. Boards. NOW.

Recruiting fresh new voices to join your board is a big component of ‘guitar hero healthcare.’

Guitar Hero Healthcare? Yes, read about it here.

Stuff like this is what gets me out of bed in the morning.  Enjoy.

A widely reported study has shed light on disturbing graduation rates in U.S. metropolitan cities—more than 1 million students drop out of high school each year.

The implications are scary, as Richard Florida writes, “Ponder the implications of this from everything to human development, crime, social cohesion, and economic competitiveness.”

Maybe the key to improving health in the United States is to keep those lost students in school.

Health and income are related.  As one study reports, “A doubling of income is associated with a similar effect on health, regardless of the point at which this occurs.”

Our employer-based health insurance system also makes it highly desirable to have a well-paying job with benefits.  This article reports a large gap between high school dropouts and those who graduated, “Adults who don’t finish high school in the U.S. earn 65 percent of what people who have high school degrees make.”

A healthy (and well-educated) America is a competitive America.

We’re well under the three year mark for when the first Baby Boomers will be eligible for Medicare in 2011.  A short seven years later, in 2018, the trust fund that pays Medicare bills will go broke.  We have some issues, creeping quickly, that we clearly need to deal with.

Maybe it starts with personal responsibility for your own health.  Municipalities in two foreign lands have made that task easier—no gym membership required.

PSFK brings us a trend of Boomers in Hong Kong working out in public parks.  Making this happen in the United States may be another story, “While it seems to be possible to grow older and remain an active lifestyle in China, being elderly in western society at the same time predetermines you to be totally passive.”

They also link to an article (pdf) about the first playground for senior citizens in Berlin.

The good folks at PSFK provide some pictures at Flickr.
Why stop there?  How about work out facilities in parks for all ages.  Now if we could only figure out to get people away from Seinfeld reruns and days-long sessions of Guitar Hero…