Sunday, March 4, 2007

HIMSS - HIMSS-07 Hangover

As everybody who is anybody in health care knows, the Health Information and Management Systems Society (HIMSS) supplies unparalleled leadership in health care for managing technology and information through its publications, educational opportunities, and advocacy – but first and foremost, through its annual meeting and exhibition gala.

That said: Hello out there, you health care IT crazies, those of you with a HIMSS-07 gala hangover. A hangover means either suffering from excess or carry-over knowledge from an earlier experience. HIMSS certainly had an excess of IT information, too much for an ordinary mortal like you to absorb.

But you loved it. As Oscar Wilde so famously said, “Nothing succeeds like excess.” This is especially true in health care information technology. And you will, no doubt, retain lessons learned from your week-long, in-depth immersion into IT health care at HIMSS-07. For the geeks, nerds, and technophiles among us, this was an exciting – perhaps over stimulating - event.

Wildly Successful

All reports indicate HIMSS07 was wildly successful, albeit overwhelming. I congratulate its organizers, who, in addition to transmitting the message that IT will go a long way towards saving health care, helped to resuscitate tourism in New Orleans.

More than 25,000 of you gathered in New Orleans the last week of February to hear hundreds of speakers, to meet thousands of contacts, and to view more than 900 exhibits. The advance slogan on the exhibits was,

“Innovations will happen. ‘What if?’ shakes hands with, ‘We can do that.’ And something new is born. Imagine that that happening hundreds of times day all around you.”

Sounds like an Innovator’s Dream to me.

Cyber Uber Alles

By now, in your hangover phase, you might think health care IT has the hardware, software, and brainware to make thousands of health care fixes, to repair and bridge most faults in our health system. and to coordinate it all, seamlessly, of course. Why not? Let’s face it. In many respects, you have just seen and heard the computer glorified as a cure-all of health care.

The Big Dogs

The big dogs – Steve Ballmer, CEO, of Microsoft, now on an acquisition binge to become the number #1 player in the health care space, General Colin Powell, USA (ret), a board member of Revolution Health, Inc., Michael Leavitt, Secretary of HHS, dedicated to the proposition of a national IT structure, Newt Gingrich, everyone’s alternative for President and self-styled IT health care guru, and Dr. Stephen Covey, everyman’s motivational speaker and author of Seven Habits of Highly Effective People – were there.

A Wild Idea --IT More About Cultivation of Ideas Than Technology

What a time you had! Garry Baldwin and Jim Molpus, reporting for immediately after the conference, report the highpoint for them was a crazy idea – that effective health care IT might be more about ideas than technology.

“Thursday morning Harry Lukens, CIO of Lehigh Valley Health Network in Allentown, Pa., described how the community health system reaches out to the staff to develop new ideas. As Lukens pointed out, the session was not about technology, but rather the cultivation of ideas. For the last few years, Lukens has chaired a group called the “Wild Idea Team.” It sports a rotating membership of 18-25 people, representing all areas—and levels—of the organization.”

“Staff members bring ideas about ways to use technology to improve operations. The only rule for the discussion, Lukens said, was ‘no snickering.’ It’s a way to encourage participation. Ideas are vetted through a series of steps including informal evaluation, research, formal evaluation, and test. Most ideas do not make it to actual implementation. Nevertheless, the meetings are a way for the IS staff to stay in touch with their internal customers.”

“Lukens’ punched up his talk by using an interactive audience response system. Using a small handheld device, we were asked to vote on various questions, with the results tabulated and presented on his PowerPoint. Most in the audience had no formal manner of deriving technology ideas from the staff. Lukens uses the same technology at senior staff meetings to solicit feedback on strategic planning proposals. Allowing people to vote anonymously on ideas encourages more honest responses, he pointed out.”

Luken’s "Wild Idea" Team Should Surprise No One

Luken’s “wild idea” is engaging people in the front lines of the organization to submit ideas, and inviting feedback and haggling with them may be just as important, or more so, than deploying technology to improve the system.

That this wild and crazy approach works should surprise no one. After all, it’s just a swing back to Naisbitt’s High Tech/High Touch megatrend prediction – for every technologic advance there’s a counter-balancing human response.

It didn’t surprise me. In my February 25 blog, “Disruptive Innovation at Work: One Solo Doc, One Internet, One Room, One Year Later,” I described how one “Wild and Crazy” family physician, Gordon Moore of Rochester, New York, used the Internet to transform his practice into a highly cost-effective, quality-driven, patient pleasing operation.

Nor would it surprise Tom Peters, the Wild and Crazy management guru of “Ready Fire Aim! “ fame. Ever since Tom Peters and Bob Waterman burst onto the scene with their book Search of Excellence in 1982, Peters has become the guru on innovation.

Focus on People

In the management world, Peters and Waterman are known for setting forth these practices of successful companies – IT and non-IT, all focusing on people.

1. A bias for active decision making –“getting on with it.”
2. Close to the customer – learning from people served by the business.
3. Autonomy and entrepreneurship – fostering innovation and nurturing “champions.”
4. Productivity through people – treating rank and file employees as a source of quality.
5. Hands-on, value-driven – management philosophy that guides everyday practice—management shows its commitment.
6. Stick to the knitting – stay with the business you know
7. Simple lean staff –some of best companies have lean HQ staff.
8. Simultaneous loose-tight – autonomy in shop floor activities plus centralized values.

Peters’ Principles

Here are 26 of Peters’ current health care beliefs on how to fix the health care system. It’s a bit of a rant, but effective.

1. Fully utilize Physician's Assistants to do routine work in a timely fashion. ("Doc in a Kiosk" at Wal*Mart is great!)
2. Maximize Outpatient Services!
3. Short hospital stays work!
4.Support home care to the max. (E.g., "Declaration of Independents"—Beacon Hill/Boston)
5. STOP THE 100K+ NEEDLESS DEATHS—much/most of the "quality stuff" is eminently fixable. (Don Berwick for President! AHA for Hall of Shame!) (Strong, vicious insurer incentives!!!)
6. FLIP HC 177 DEGREES TO EMPHASIZE PREVENTION & WELLNESS. ("Steps" are being taken but not enough. Med schools: Awful! Insurers: Little better. Support for appropriate-proven alternative therapies is an important part.) (HUGE INCENTIVES FOR EFFECTIVE WELLNESS-PREVENTION PROGRAMS-MEASURABLE SUCCESSES.)
7. "Boomers" will determine HC's (very different?) future. (They are from a different & demanding planet compared to yesterday's Oldsters.)
8. "Focus on Women." (It's my generic—and correct—rallying cry, and it applies to HC in spades, women-as-patients-with different-woes-than-men; women-as-HC decision makers at the "consumer"—and commercial—level.)
9. "Patient/Consumer-driven" may be a buzz phrase bandied about all to easily ... but it is true. (And changes the game.)
10. Reduce incentives for unnecessary tests. (Malpractice caps would help, though the issue is complex. Insurers-HMOs doing so-so on this.)
11. OUTCOME-BASED MEDICINE IS A MUST! (There is a long, long way to go!) (Measure until you're blue in the face!)
12. Science-based medicine is a terrific idea!! (Many-most "therapies" unproven scientifically, uneven in application when proven.)
13. Over the next 5-25 years, the Life Sciences Revolution will make the likes of the "info revolution" look like small beer. (Get ready.)
14. Radical increase in "best practices" utilization—inculcate in Med school!
15. Med school "revolution" imperative—outcome-based medicine, abiding emphasis on Wellness & Prevention, etc.
16. Get info to Patients! (HIPAA mostly good.—"I wanna see my records!") (Detailed hospital-by-hospital, disease-by-disease, doc-by-doc success records a must—despite controversy.)
17. Upgrade IS-IT in the entire system, starting with acute-care nstitutions. (Current grade: D-.) (Winners include: Indiana Heart Hospital; Inova Fairfax Heart Institute.)
18. Healtheon WebMD-like (if it had worked) mega-, integrated-info network will-should emerge. (A healthcare Google+?)
20. By hook or by crook, something approximating basic universal care , starting with kids—50 state partial experiments is a help; some are quite far along. ("Market-based" as much as possible—but this is far from a "perfect market.")
21. Deal with the enormous HMO "I want my doc" perception problem. (Fact: MARCUS WELBY, STATISTICALLY, AIN'T THAT GREAT A HEALER IN TODAY'S "HIGH SCIENCE" WORLD! Incidentally, same perception problem re Congress, schools. "My Congressman is great, Congress has 434 other crook-clowns." "My kids' school is good, the system is awful.")
22. Blitzkrieg of Patient/Customer/Citizen education (e.g., re "outcomes-based health care ," "Get the most for your health care dollar"). (Corporate cuts should motivate this.)
23. "Healing-centric"care supported. (E.g., Planetree model—reduces future problems.)
24. Emphasize front-to-back "customer care " practices—cuts waaaaay down on malpractice claims among other things.
25. Specialization in acute care works wonders, regardless of howls! (E.g., Shouldice/hernia repair.)
26. Shorten the FDA approval process. (Tom , age 63, wants the good new stuff and will accept associated risk; so will most boomers-geezers.)
From Peters to Reece to Bullets
As you can plainly see, Peters stresses IT as it applies to people. Here’s my take on what he said.
• Delegate people other than doctors to deliver care.
• Serve patients in decentralized outpatient and home settings.
• Cater to women and baby boomers.
• Measure providers’ performance.
• Use specialists in hospitals.
• Cover people’s every insurance need.
• Engage and educate patients at every level.
• Ease, facilitate, and shorten patient care.

No Reason to Go On

I could go on.

But I don’t need to. You’ve been to HIMSS-07, and you’ve heard it all.

This year HIMSS was wild and crazy.

Just wait until next year!

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