Friday, June 22, 2007

Kaiser - George Halvorson Powerpoint on Heath Care Industrial Revolution

With Emphasis on The “Wobbly” Parts of U.S. Health Care

The June 20 Wall Street Journal ran a piece called “The PowerPoint Turns 20, and Its Creators Ponder a Dark Side of Success.”

In 1987, Robert Gaskins and Dennis Austin, working for Microsoft, came out with PowerPoint1 for Macs. Americans now view 3.5 million PowerPoint presentations each year. PowerPoint has become something the world loves to mock but loves to use.

Powerpoint is the perfect match for presentations and graphics. It has the outline and the format to effortlessly deliver talks. Just rare back and let it flow.

For some, PowerPoint has a dark side. Critics say it elevates format over content, smacks of commercialism, reeks of salesmanship, destroys the ability to write and speak independently, impairs intellectual rigor, separates the speaker from the audience, and requires a bullet-point proof vest for bored listeners, who tend to drift off into the blue of the slides.

The Pentagon thought so little of PowerPoint that they disallowed its use. The military establishment now requires officers to speak their mind directly eyeball-to-eyeball – without colored slides, bullet points, and graphics.

I’m not a PowerPoint fan, but I’m often obligated to use it because conferences at which I speak ask for PowerPoint slides in advance, so attendees will have something to have in hand to show and tell when they go home.

But Powrpoint has its powerful points too, if you'll excuse the redundancy. PowerPoint is often just the ticket to reduce a complex subject to its elements.

The Powerpoint I have in mind is a George Halvorson, Kaiser chairman and CEO’s, presentation before the World Bank in September 2005 “It’s Time to Create an Industrial Revolution in Health Care.”

I’m not going to reproduce the Halvorson PowerPoint here. You can google it by going to George Halvorson, World Bank Presentation, clicking on PowerPoint, and view or listen to the presentation. It takes 40 minutes to view.

To give you a feel for Halvorson’s presentation, he starts by saying Kaiser has 8 million members, 142,000 employees, 32 hospitals, 12,000 salaried doctors, and $30 billion in revenues.

He goes on:

•It’s time for health care to stop floundering as a highly localized, unacceptably idiosyncratic cottage – with the exam room functioning as a medical cottage.

•It’s time to bring a significant degree of systems support and systematic thinking to health care.

•It’s time to give health care a whole new set of tools

When he says “tools,” Halvorson is mostly speaking of computer information at doctors’ fingertips at the point of care with accompanying systematic prevention, treatment, and follow-up measures to improve care..

Halvorson describes U.S. health care as:

1.The most expensive in the world

2.with superb high tech

3.with superior technologies for the sick

4.with mediocre outcomes

5.and inconsistent quality

Then comes my favorite part “The Wobbly Parts of U.S. Health Care.”

The most obvious “wobblies”, Halvorson says, are:

1.Inadequate medical records

2.Inconsistent access to current science

3.Poor patient compliance

4.Sketchy patient follow-ups

5.Lack of outcomes tracking

I won’t go on. Suffice it to say, Halvorson talks about how large integrated systems like Kaiser can fix the “wobblies” by bringing a systematic informed approach to health care by focusing on information technologies to give immediate access to science and organizing doctors in to act in teams in a unified system to improve care across the health care spectrum.

Halvorson has a noble concept, and he has facts to back up what he says. His ideas may yet catch fire. Presently, however, only about 12% of doctors are in groups of 50 more.

Maybe someday independent doctors can be “virtually integrated” in some fashion and can act in a more systematic, organized, and purposeful way, but that would require an EMR or its equivalent in every doctor’s office and a personal health record in every patient’s hand – an unlikely development for at least the next decade.

But don’t despair. Worthwhile reform takes time – and money.

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