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Wednesday, May 8, 2013

"Transforming" Health Care?

I saw mention of this book this morning amid the Health IT news I scour every day. Into my Kindle Cognitive Crack Pipe it goes, at a pricey $43.53. Let's hope it turns out to be worth it.

"Transforming health care" has become one of those noble cliches regarding which we all tend to nod in unreflective agreement. But, what constitutes "transformed"? Is that semantically and materially different from "reformed"? "improved"? "re-engineered"?

I immediately went searching for Mr. Fasano's definition of "transformed." Haven't found much yet (though, in fairness, I've only begun to read the book in depth).

Definitions matter. To a scientist, operational definitions matter centrally (i.e., outset metrics via which to determine attainment of significant improvement or, more broadly -- "transformation").

  • ...George Halvorson, who I have always said is really the CIO of Kaiser Permanente. His vision, mentorship, and partnership are inextricably linked to my own passion for transforming health care through technology...
  • As you read what I hope will be some inspiring predictions and heartening examples of how health information technology is already transforming health care, ask yourself how in your position— whether you are a technologist, a healthcare provider, or another player in the healthcare and technology industries— you can accelerate the change that we know must come to health care.
  • ...smartphones will play a big role in transforming health care. Mobile devices mean that any place can be the right place to deliver healthcare information. Mobile technology has already changed how we connect with families and work, with our finances and friends. It is about to change our relationships with our physicians and personal health information as well.
Useful detail only emerges at the conclusion.

If you take away only one thing from this book, I hope it is the conviction that transforming health care through the use of health IT is essential to building the healthcare system we need; a system that is:
  •  Connected, beginning with EMRs that are part of an HIE that follows a patient throughout her life.
  • Consistent, so it can be shared through HIEs and added to care registries and databases where it can advance our understanding of disease, treatment, and prevention, leading to better health for all.
  • Mobile, allowing patients, physicians, and other caregivers to meet, converse, and exchange information of all sorts from anywhere.
  • Personal, achieved by giving individuals more transparent and secure access to their own data (including their own genetic makeup) and by tapping into the masses of data that will be generated by the technologies described in this book, and others that have yet to be dreamed of. 
No one can deny that the stakes are high. The amount spent on health care in the United States is unsustainable. The United States spends the highest percentage of its GDP on health care in the world (18 percent in 2010; 19 percent projected in 2020). 37 Yet, we do not see the kind of health outcomes that one would expect that level of expenditure to buy. Indeed, most doctors and healthcare providers in this country are paid to treat illness, order tests, and deliver treatment, not to ensure health. Too many hospitals put an empty bed on the debit side of the ledger. Instead, we should see empty hospital beds as a credit to the quality of preventive care being delivered.
But the rewards we stand to gain are even higher. Some rewards are financial; reducing our overall healthcare expenditures would strengthen our economy overall and ease the financial burden on individuals and families. Private sector companies, large and small, that participate in the healthcare IT transformation will deserve to prosper from their contributions. Even healthcare plans and payers stand to reap financial benefits for the effort they put into change. Better health outcomes also have financial implications: People will be more productive on the job and have more discretionary income without big pharmacy bills to pay each month.
And of course, the biggest rewards are intangible: a better start in life for babies born to women who get good prenatal care; active, happy children who never know the clutching terror of an asthma attack; the peace of mind of women who don’t have to fear breast cancer and men relieved of the specter of prostate cancer; more years to spend with the grandkids. Not to mention the satisfaction of a doctor or nurse over a job well done, another patient well cared for. We hold the key to all of this in our hands: information leveraged through technology. I hope you will be motivated to join me in using that key to open the door and step into the transformed future of health care...
  • The real reason I joined Kaiser Permanente was to contribute to an industry where the results of my efforts might have a small part in creating better health for all Americans. I knew that the healthcare system was in desperate need of transformation, and I thought I might be able to transfer my experiences in industry-transforming technology to what I saw as a more worthy cause.
  • The coming transformation of healthcare IT presents significant opportunities for entrepreneurs and established technology firms, venture and angel capitalists to invest and reap the benefits of their investments. The options for the kinds of technology investments that will be needed are almost limitless. They range from mobile platforms, software, and apps to the software and hardware needed to enable virtual consultations through telehealth technologies.
  • How can we be sure this transformation will work? There are no guarantees, but we have examples in other countries. This book presents three case studies from countries with high levels of EHR adoption and well-connected systems. They paint pictures of how we might proceed and what health care will look like when we arrive.
  • Done thoughtfully and methodically, the transformation of health care can help my colleague achieve his goal of helping as many people as he can. I want to help him do just that in the way I know best: with technology. So do the other players in the transformation of healthcare IT: the health plans and insurers who help pay for health care, the government that regulates and mandates care, and most importantly, the private sector, whose proven ability to fill unmet needs with innovation will deliver.
We shall see. Stay tuned. I hope this e-book turns out to have been worth 44 bucks (unlike the $40 Kindle edition "Perfecting Patient Journeys" I could have done without).

The word "transform" is itself value-neutral, ja? My own value system calls for the necessary goring of a number of egregiously bloated oxen in pursuit of systemic "transformation" resulting in significantly improved, significantly less expensive health care for all people. I've been thinking about this stuff for a long time.

apropos, see
How Kaiser bet $4 billion on electronic health records -- and won
Kaiser Permanente CIO Philip Fasano explains how electronic records have paid off and the health care giant's embrace of mobile technology

In July 1907, the first great breakthrough in medical IT took place at the Mayo Clinic in Rochester, Minn.: the paper medical record, dropped into a paper folder and stored in a file cabinet. Until then, information on patients was kept in a ledger that recorded all of a day's patient visits, one after the other. Different departments kept separate ledgers, making it extremely difficult to track down patient information in a timely manner.

But 106 years later, the paper record remains the state of the practice in medicine. In 2009, only 9 percent of America's hospitals were using even a basic form of electronic health records...
This is the article that put me onto Mr. Fasano.

Attention stressed-out docs: Can the consumer be the "cavalry" that rescues you? "Transformative"?



From "
Why EHRs fail" at

I'd love to be challenged on this assertion. Let me illustrate (anyone can go into Open EMR, log in, and look at these structures -- unlike those of the for-profit proprietary EMR vendors):
  1. Username "admin" password "pass"
  2. Left vertical panel "administration" / "other" / "database.

 Pick a table. Say, "patient_data"

See also my July 8th, 2012 post:

Analytics - SAS, R, SQL, EHR database schema. An old school data miner's ramble involving the intersections of workflow, audit logging, and CER, etc.

Wherein I discuss things such as "schema" (the manner in which an application links and governs its RDBMS tables consistent with "relational integrity enforcement at the data dictionary level" -- the very definition of true RDBMS).

  • We know the number of licensed medical specialties and subspecialties;
  • We know the number and types of data structures essential to their practices (many of which overlap and some of which are unique to each specialty);
  • We absolutely can construct, deploy, and enforce one certification standard master data dictionary encompassing the foregoing.
You would think that the 363 kg. Payor Gorilla -- HHS -- would mandate this as a priority. It would be the only HIT architectural mandate they would need issue. Their beloved "innovative private sector" could build whatever they wished out of it.

Absent this, Meaningful Use EHR "Certification" continues to be crippled out of the gate with respect to the seamless "interoperability" end -- and all of the ends flowing from that goal, e.g., data mining for CER, financial metrics for resource utilization analytics, event audit logging for fraud and HIPAA violation detection, etc...

What am I missing? (Beyond profit margin Vendor Lock Data Silo opacity.)

More to come...

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