Well, it got here a whole lot quicker than expected (hmm…).  I’m going to dedicate my usual blogging time (as if I’ve had much of it recently anyway) to standing in line in the early A.M. at the polling location in Battle Ground, USA.  No links to health care plans today, we all have many important issues to consider.  No endorsements either, for in the words of one astute political observer (Hi, Dad), “We’ll have to work with the winners either way.”

Get off your RSS reader, get off this website: Go VOTE!

Carol Diamond and Clay Shirky from Health Information Technology: A Few Years Of Magical Thinking? (via ReadWriteWeb):

The challenge of thinking of IT as a tool to improve quality requires serious attention to transforming the U.S. health care system as a whole, rather than simply computerizing the current setup. Proponents of health IT must resist “magical thinking,” such as the notion that technology will transform our broken system, absent integrated work on policy or incentives.

Optimism abounded throughout the two days in San Francisco—as well it should when a group of pioneers embarks upon new territory.  But whispers of what it could be–bubbly–were heard throughout.  My feeling on what will prevent a bubble pop is the inherent potential in Health 2.0: helping patients muddle through health care and managing their wellness.

There were very cool technologies on display—some completely new, others focused on helping health care catch up to the rest of the internet-dependent world.  There are a few success stories.  Some companies are on the brink of success.  But it’s quite practical to think that there will be some failure, probably even a lot.  That’s the nature of new.

A way to reduce that chance of failure?  Focus on h-e-a-l-t-h (the broad definition).  But the focus of Health 2.0 is health, you may be saying, it’s right there in the title.  Yes, it is/was for many of the companies touting their utilities.  But for a few (maybe more) their focus on profit was completely transparent.  I don’t think that model will work.

So in my (no skin in the game) humble opinion, here are two areas where the people of Health 2.0 need to focus in the coming months:

Integration - I like Scott Shreeve’s definition best: “New concept of health care wherein all the constituents (patients, physicians, providers, and payers) focus on health care value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care.”

Most Health 2.0 companies are working with patients (obviously), physicians (obviously), and a few with payers (by the way, they have the cash, so unless your plan is game changing, it would be best to include them).  But throughout my two days at Health 2.0, I was disappointed to see an almost blatant neglect of working with providers (who I’m going to call hospitals/clinics/points of health care delivery).  The providers have the data (tons of it).  They are the facilities where an astounding amount of care is delivered (even a Hello Health patient may need to visit a hospital).  If Health 2.0 is to realize its true potential, hospitals etc. must be included in the game (Google Health and Microsoft Health Vault have began a few partnerships, but this area remains flush with opportunity).  Which leads to the next point…

Collaboration - The tools available today are astounding.  A patient (sorry, I’m old school on calling health care users patients, the term consumer connotes dirty images in my mind) can price compare services.  A patient can enter labs data into a PHR.  A patient can price shop for insurance coverage.  A patient can participate in communities.  A patient can manage their health care expenses simply.  A patient can find information on physicians.  A patient can compare quality (it’s getting better).  And this is all precisely the problem.  As a patient myself, I have no desire to visit eight different websites to manage my health.  I have trouble enough managing my money with five different institutions.  I want to visit one place.  One site where I can do it all.  The company that is able to bring together the tools that have been created to a single location where patients can easily use/share/create health information will lead the Health 2.0 transformation of health care.

That’s why Health Vault and Keas excite me the most.  Keas has been quiet (understatement) on what they are trying to do.  But their “sneek preview” at Health 2.0 gave me the inkling that they may be creating a platform that brings together a cadre of services in one location.  We wait to find out.  Health Vault could be the killer app in this equation (that’s what we’re all waiting for, isn’t it?).  A talk that took place after Health 2.0 actually provided more insight.  Health Vault is building a platform on which others can build applications to help patients manage their health (think iPhone App Store).  Acquisitions need not happen to make this work, the tools just need to work together.  For this reason, I think acquisitions will be fewer than what has occured in the Web 2.0 world.

Anyway, these are the opinions of a humble observer.  There is reason to be optimistic for what Health 2.0 will do for patients, but first it must become much easier for patients to utilize multiple tools (and include the providers!).

I think the sign of true success for Health 2.0 will be this: when we drop the 2.0 and simply use these tools to manage our Health.

Something different: a collaborative project between Twin Cities hospitals and Portico Healthnet is looking to spend charity care dollars on prevention.  From the Minneapolis Star Tribune:

Now Twin Cities hospitals are going to try an ounce of prevention.

Stung by a sharp increase in charity care, a number of area hospitals are going to fund preventive care at nearby clinics for people with no insurance precisely so they don’t have medical emergencies later.

Starting in January, Abbott Northwestern Hospital, Fairview Southdale Hospital, North Memorial Medical Center, Hennepin County Medical Center and the University of Minnesota Medical Center will contribute a total of $500,000 for the year toward annual physicals, screenings and other primary care at clinics affiliated with the hospitals.

An earlier implemented Portico project has shown results:

Portico says the strategy works: Emergency room visits in the east metro area dropped 33 percent in 2006 for new enrollees. Inpatient hospitalizations dropped 35 percent.

It will be interesting to see how far $500,000 of preventive charity care will go.  Hospitals often bear the burden of the uninsured when they do seek care.  Most hospitals are not-for-profit and are expected to provide this benefit.  We’re getting closer to the breaking point, however.  The demands of the modern hospital industry require management of the charity care benefit.  Spending those dollars wisely to benefit the largest number of patients is becoming increasingly difficult.  Innovative approaches are always applauded.

Another reason that the reality of health care delivery going global should be a consideration in health care transformation thinking (from the Los Angeles Times):

Low cost isn’t the only reason Americans are traveling to foreign countries for healthcare. Timmi Ryerson of Vista, Calif., went abroad looking for expertise she couldn’t find at home.

Her deteriorating hip led her to India two years ago for a procedure known as hip resurfacing. The surgery has been performed for years in Europe and Asia but was still new in the United States.

It’s a simple change, really.

The strategic planning/business development group at our own system is now the Department of Mission and Vision Implementation.  Why?  Because a not-for-profit hospital has one meaning for existence: fulfilling its mission.  Mission and vision statements are easy to craft, much harder to follow.

The stories of hospitals who fail to mission and vision implement are plentiful (ask your family members the next time you get together to tell you about a disappointing health care experience, be wary of the can of worms being opened).

The strains upon our health care system are such that fulfilling the mission and vision have become increasingly difficult, that’s no reason for retreat (in fact, make it a call to arms).  Questions of quality remain as hospitals say they are dedicated to providing the highest quality care.  Charity care is questioned as hospitals promise to provide for the community’s needs.  Treating patients with dignity and respect continues to be a challenge.

It’s akin to the marketing department at a corporation whose lone function remains advertising.  Marketing is their business.  Fulfilling the mission and pursuing the vision is ours.

How often is your hospital’s mission and vision considered in decisions made at meetings?  Not often (ever?)?  Big problem.  If the mission is our purpose then every (every!) decision we make regarding the here-and-now will be guided by the mission.  If the vision is our road map to the future then every (every!) decision we make about the future will be guided by our vision.

Principle 37: If you want to be the best, then make an effort to be.  From here on out, it’s about one thing: mission and vision implementation.  Always.  Simple task with potentially staggering results: read the mission and vision before every meeting.  Every meeting.  And don’t let up until all of the organization’s actions align with these very important words, for words are words apart from action.

I listened to someone speak today while taking advantage of a provided lunch.  The lunch consisted of subs from Jimmy Johns.  The person said “Jimmy Johns is pretty cool, Subs so Fast You’ll Freak.”  Subs so Fast You’ll Freak is a marketing tagline used by the company.  The person continued, “Maybe hospitals should be ‘treatment so fast you’ll freak.’”  It was an off-the-cuff comment, but you know, thinking like this just might be our problem.

It’s Wednesday, a whole week removed from the opening of Health 2.0.  The bad thing about posting a week later: everything has probably already changed.  And so, still relevant or not, this begins a yet-to-be-decided part series on thoughts from Health 2.0.

Clay Shirky had a great keynote.  Here are some selected comments (most likely a mix of my own words and his, with my comments in the parentheses):

• Most valuable thing connected to the internet: people
• Patient-Centric Medicine: internet is implementation layer
• TRUST is the key (recurring theme throughout the conference) for information to flow
• The changes made to the Catholic Church by the Second Vatican Council can be used as a metaphor for the changes going on in health care (very impressive metaphor, IMO); Vatican II shifted the focus of the church from the leaders to the parishioners, Health 2.0 is shifting focus of health care from health care deliverers to patients (I’d even argue it is shifting us from health care to health)
• We’ve always had informal health care conversations, you just couldn’t see them before (innocent conversations around the table…)
• When you give new people access to information things are are going to get weird, and they are

Dear Health Care,

I thought it would be good for you to know that it really is possible to change—even if you’ve been set in your ways for most of your history.  Yes, it seems difficult.  But you’ve have shown a few instances of wanting to do better (indeed you may have been coerced; however, the good faith efforts have been duly noted).  I have confidence in you, even as you continue to make unsustainable business decisions.  If you need further inspiration, read this story about a 100-year-old newspaper that decided to stop actually printing a daily edition and publish in online format only.  Just remember: anything is possible if you put your mind to it.

Sincerely,

Reality

Impassioned plea for action.

The biggest problem with waste in health care: it’s easy to talk about, much harder to get rid of.

And the pertinent question at this point is this: did this problem arise because of government involvement or despite it?  And the even more prescient brainteaser: will this problem be more likely solved with more government intervention or less?

Finally, (and this post is not meant as an endorsement of a particular health care payment philosophy) can a market-based health care economy bring about the needed reform or will it take a czar of American health care?

Oh, and the other thing about waste: that money is someone’s income or an organization’s bottom line.  Expect actions to reduce it to be battle-like.  We’ve definitely got some work to do.

The most powerful presentation of the day at Health 2.0.