Friday, May 13, 2011

Fourteen Examples of The Power of Proximity: Why Market-Delivered Care Is Superior to Government-Delivered Care

The American entrepreneurial economy distinctly differs from that of socialistic European economies. American organizations must be able to make decisions based on proximity to performance, the market, technology, society, environment, and demographics. In Europe, on the other hand, distance from the market of centralized systems makes innovation and responsiveness difficult.

R. Reece, Innovation-Driven Health Care: 34 Key Concepts for Transformation, Jones and Bartlett, 2007

To start a blog with a quote from your own book may be the height of egotism, but I will quote myself anyway.

The main flaw of the health reform law is its distance from the problem – care delivered in the office, neighborhood clinics, urgicenters, emergency rooms, retail clinics, the home, and other decentralized settings. For everyday events, you can’t control events top-down from the White House and Congressional environs.

Top-down government cannot innovate quickly enough or relevantly enough to address problems at the level where care is delivered. To put it another way, government is incapable of disruptive, or bottom-up innovations.

These innovations invariably come from individuals or organizations on the ground. Examples are endless. Here are fourteen of them.

One, cardiac defibrillators
- To be of any value, defibrillators must be present near the place where cardiac arrests occur. Dr. Bernard Lown invented the direct current defibrillator in the 1960s, and Dr. Roger Health, invented the pads making automatic defibrillation at remote sites possible. These defibrillators are now widely placed in public and medical places, where nearness to the usually fatal event makes all the difference.

Two, work site clinics - To save money and to address worksite health needs, including preventive measures, corporations and other organizations are now placing worksite clinics, led by primary care physicians, at the work site.

Three, orthopedic clinics offering non-invasive treatments
– The Jewett orthopedic clinics in Orlandom Florida, have established multiple clinics for treating sprains, ligament injuries, and closed fractures at neighborhood locations.

Four, urgiclinics – These are springing up everywhere around the nation as an inexpensive and convenient alternative to emergency rooms. In fact, many are near the ER as a convenient and more sensible alternative.

Five, retail clinics – These clinics, located in retail pharmacies and discount outlets, generally staffed by nurse practitioners, offer care for minor illnesses, and routine vaccinations.

Six, concierge practices - For a retainer fee, charged monthly or annually, and cancellable on short notice, these primary care practices offer same-day appointments and 24 hour availability.

Seven, free standing emergency rooms and neighborhood clinics
- Hospitals are finding these outlets are invaluable for treating injuries or illnesses near where they occur and for establishing brand-name recognition of the hospital and its neighborhood friendliness.

Eight, hospice home care – Given their druthers, most terminally ill-patients would rather die at home surrounded by loved ones, rather than in a hospital. Hospices have recognized this, and are hiring thousands of nurses to fan out to serve patients in their homes.

Nine, telemedicine, telemonitoring, and teledevices for home and remote care. Internet and computer apps, often transmitted through mobile devices, are rapidly changing the health care landscape, by making distance irrelevant and electronic nearness the norm.

Ten, portable hand-held ultrasound, with which physicians in their offices can determine if an abdominal mass or abdominal aneurysm exists.

Eleven, a portable Shape-HF cardiac-pulmonary testing device
, which allows a physician in his office or a trained medical technician in any location to evaluate the cause of shortness of breath and the odds of hospitalization or sudden death.

Twelve, Audio-visual devices developed by American Telecare, Inc.
, at bedsides of home-ridden patients with chronic disease, which permit patients to spot complications on their own and to communicate with doctors and nurses in remote locations, in the process dramatically reducing the need for hospital or ER admissions.

Thirteen, Practice Fusion, Inc, a "free" EMR for physicians
that can be up and running in five minutes and is free to physicians because of its ad-based revenue model and its off-loading to the Internet.

Fourteen, Instant Medical History, Inc, which allows patients to record their chief complaint, medical, social, and family history over the Internet before visiting the doctor and appearing in the exam room.

I am sure there are countless other examples where nearness to care makes all the difference. If you know of them, please email them to me at or comment on them in this blog.