“Understanding events and influencing the future requires mastering four ways of looking at things; as they were, as they are, as they might become and as they ought to be.”
Dee Hock – from book One from Many1
In One to Many, Mr Hock outlines the concept of Chaordic Organization and really a call for a now perhaps over used term”Paradigm Shift.” A synopsis of his concepts is further outlined in his essay - The Chaordic Organization: Out of Control and Into Order. Chaord is reaching a balance between chaos and order that is achieved in complex adaptive systems which is the “zone” of balance and sustainability (health). The human body, communities (both human and natural/animals) and the ecosystem are all dependent upon this fragile balance between chaos and order. In the “business world”, examples of Chaordic are witnessed in examples such as VISA (which Dee Hock was instrumental in creating) and the internet.
It is amazing how the internet has taken on a persona, a “virtual” life of its own. We speak of the internet in various humanistic terms and even suggest that attachment, obsession and even addiction are possible. When looking at Chaordic processes, it is understandable why the internet or “Web” has taken on a life of its own. The web can easy translate to a dynamic “living” system. The infrastructure of wire and fiber optics provides the “neural pathway” to the synapses which one would consider the computer but in actuality the transmission of knowledge to actually “touch” the individual.
Again looking to Dee Hock and his definition 2 of the Information Age
“The so–called Information Age could best be understood as the Age of Mindcrafting, since information is nothing but the raw material of that incredible chaord we call mind and the pseudo mind we call computer. Software, the tool with which we shape and manage that information, is purely a product of the mind.
As we further transition into the Information Age, the current business organizational framework continues to lag behind the explosion and access to information. Information and technology is coming to us faster than business systems and organizations can assimilate. Additionally, we are witnessing increasing failure of Business, Wall Street and ultimately economic turmoil all in respond to organizations continuing to operate based on Newtonian (cause and effect) concepts and Industrial Age (mass produce, uniform and hierarchal ) systems.
Perhaps nowhere else is the limitation and failures of antiquated practices more apparent than in healthcare all this in the face of a great explosion of information and opportunities. What is the future of healthcare and how will the internet play a role in shaping the direction?
The key to the future of healthcare can come from incorporation a Chaordic approach, one which supports a symbiotic and truly collaborative effort. Central to the healthcare shift is system is to fully develop the “Mindcrafting” and leverage the benefits of information to fully expand our knowledge to empower a true dynamic and holistic approach of patient care. The internet represents a model or perhaps the actual connection, the “white matter.”
At least in the immediate future, the internet will continue to serve pathway for connection but I believe that in the future there will eventually be a standalone network by which the healthcare system operates. This network will come through the drive for a National Heath Information Infrastructure NHII. With the NHII comes the opportunity to further the movement for the shift from traditional systems. NHII consist of three components or “dimension” of personal health, healthcare provider and public health. This triad address healthcare as dynamic and interconnected/interrelated system3.
Advantages of a standalone network will provide for elements of connectivity and needs within healthcare that the current systems are lacking. Specifically the issues of proprietary systems, lack of interoperability, privacy and security along with credibility of information leads to challenges with developing a healthcare network under the current system.
Certainly having involvement and endorsement by the Federal Government has been viewed as important and actually requested need within the original objective of the NHII initiative. But for a true Chaordic approach the need for more autonomous collaborative and open exchange must occur. Self interest and proprietary control over processes are creating the friction and resistance to reform. Direct governmental driven programs do not remove and can actually perpetuate the struggles for implementation especially if focus and priorities change due to outside influences (e.g. unemployment, war, pork-belly projects…).
Developing a patient-centric approach is felt to be the most important driver to healthcare reform and the ultimate creating of the NHII and within the patient-centric needs, the Personal Health Records PHR is absolute necessary/required to meet the vision.
Pressure for reform is rapidly approaching a “boiling point.” In California, the issue of rising healthcare cost and increase insurance premiums, 5 have pitted insurance companies against healthcare providers, against patients – everyone is point fingers and blame. The environment is ripe for a “disruptive solution” but will not expect the changes to come from current cast of characters. My sense is that the tipping point will come from a consumer driving demand for change.
PHR hold the greatest promise to healthcare reform and the development of a NHII in that a consumer driven program will “commoditize the data” and “decommoditize” the applications. This will allow for an open market and optimizing competition for service, letting the consumer decide which application makes the most sense based on needs and ability4. The caveat is that a minimum set of feature need to be available in a “basic” program and one that readily accessible to assure universal access to information is possible.
Reason and argument for a separate “internet” for healthcare can be summaries in the need for the following:
1. Access
2. Education
3. Health focus
4. Individualized
With access, it is not simply a matter to have internet connection, the patient need to have a safe and secure means of exchange and protection from unauthorized access. Confidence in a PHR system will require full protection and security for the user. Additionally access and strength of PHR is participation. Bridging the digital divides is an absolute so all “dimension” of a NHII can be realized. Private secured connections with media such as built-in “Healthweb” enable/connected television or handheld (Smartphone) to include video teleconference or store and forward video capabilities will prove valuable for acceptance and compliance.
Education is a challenge! With current internet assurance of high quality and effective education tools prove a struggle given the amount of miss/disinformation that is present. Having a health network has advantage of screening and certifying through “peer-review.” Important to this process is that the material be audience specific and appropriate – which may require a prescriptionThis again will be an effective means of providing consumer confidence.
Personal Health Records allow the individual to become an active participant in the healthcare team. The ability to interact and have access to valuable resources to include secure support groups make PHR and Health network powerful tools.
Individualize care is the ultimate goal of PHR which, in turn provides the integration necessary for the other two dimensions of the NHII Triad. PHR will lead to greater Health provider collaboration and address the overall health of the community, region, nation and perhaps world. We are all linked and the “Healthweb” will provide the conduit for connectivity, collaboration and a Chaordic system .
1Hock, D. (2005) One From Many – VISA and the Rise of Chaordic Organization. San Francisco, CA: Berrett-Koehler Publishers (page 91)
2Hock, D. (1995) The Chaordic Organization: Out of Control and Into Order. World Business Academy Perspectives. Vol. 9, No. 1
3 National Committee on Vital and Health Statistics – United States Department of Health and Human Services (2001) Information for Health: A Strategy for Building the National Health Information Infrastructure Retrieved from http://aspe.hhs.gov/sp/NHII/Documents/NHIIReport2001/report5.htm
4Christensen, C. M., Grossman J. H., & Hwang J. (2009) The Innovator’s Prescription. New York, NY: Mc Graw-Hill (pp 141-143)
5 CaliforniaHealthline (2010, March 8). Anthem Premium Hikes Bolster Democratic Push for Health Care Reform Retrieved from http://www.californiahealthline.org/articles/2010/3/8/anthems-premium-hikes-helping-obama-reignite-push-for-health-reform.aspx
Monday, March 8, 2010
Saturday, February 27, 2010
Social Networks as Marketing Tools
Now it may be a bit of a reach but judging the habits of internet users as it relates to searching and accessing healthcare information, an assumption made is that similar patterns for searching pet health issue would follow. Unfortunately there appears to be no reported studies on internet usage related to pet health care. Despite the lack of direct information as it relates to pet health enquiries, the questions remains are Social Networking Sites (SNS) an effective marketing and management tool for healthcare in general and veterinary medicine specifically?
As background – approximately 62% US Households own a pet (about 71 million households). From the 2008 American Veterinary Medical Association Sourcebook - nearly 50% of owners considered their pet to be a family member and 48% considering pets to be companions. The demographics would indicate that a significant portion of the population and specifically internet user could be leveraging the media as source of healthcare/pet care information. Since we do not have numbers of pet owner utilization of SNS for accessing information on pet health issues, we turn to data available for healthcare in general.
In looking at “e-patients” as defined in Pew Internet to be internet users who research healthcare issues, we see that approximately 61% of internet users fit this category. Of those, 39% (or approximately 23% of all internet user) utilize SNS with Facebook, MySpace being the primary sites. The Pew Internet study1 further indicates that “only a small portion” of “e-patients” utilizes SNS as source for obtaining health related issue, following or posting health related comments.
A recent survey conducted by GreyStone.Net with a panel of (human) hospitals determined that 90% have or are actively monitoring social media sites, of which 60% have a present on Facebook and Twitter sites. The primary motivation for seeking a present was to attract new patients, along with supporting Community Relation, Customer Service, Employee Engagement and Crisis Management but only 12.5% of hospitals realizing some level of success. The article suggests that hospitals with a clear plan and marketing strategy (which is approximately 30% of the participating hospitals) are capable of achieving value in having a Social Media presence2.
Given the relatively few number (no exact figure indicated from Pew Internet), of “e-patients” using SNS for healthcare information, the fact that some hospitals have being successful in recruiting new patients is actually an important finding. The significant is every more impressive give that SNS have just recently achieved momentum and entering into main stream utilization. Significant growth has been demonstrated in just the past year as indicated by studies conducted by comScore3. In the one study it was shown that Facebook in 2009 has double it audience – now close to 112 million and is currently the 4th “ranked property” on the internet, accounting for 7% of all internet use. Additional comScore information indicates that the top three SNS in the United States are Facebook > 100 million; MySpace 70 million and LinkedIn at 30 million users.
What exactly are the effective tools to be a presence on SNS? The studies do not specifically address the success tools used and the caveat is that both GreyStone and comScore happen to be marketing and as well as research organizations (not releasing the tools of success within the studies). Assumption to effectiveness would be same as with other internet media sources (e.g. timely update, relative material, interesting stories and information written to intended audience).
In tracking success, a starting point is to at least establish a presents on the primary sites. Along with setting up the sites is the need to determining measuring tool to be employed.
At Atlantic Street Veterinary Hospital Pet Emergency Center, we began surveying clients in December of 2009 to determine drivers to patient visits. Now with nearly 3 months of data, the results are very telling. In the “How did you hear about us” surveys that we have performed, Internet represents our third highest resource used by clients in coming to our facility. This ranks behind direct referral from our local colleagues and previous visits but ahead of Yellow pages, site location and even “Word of Mouth/Friends and Family” referrals. Not know is the SNS impact as we have only recently created a Facebook connection as well as Twitter. This is certainly an area that we will closely watch and perhaps begin getting even more specific in our questions related to internet resource being utilized, as we see SNS gaining traction.
1 Fox, S and Jones, S: The Social Life of Health Information (June 2009) Pew Internet & American Life Project
2 Roberts A: New Numbers on Social Media [Web blog] (January 20, 2010) GreyStone.Net
3 Lipsman, A: 2009: Another Strong Year for Facebook [Web blog] (January 21, 2010) comScore Voices
As background – approximately 62% US Households own a pet (about 71 million households). From the 2008 American Veterinary Medical Association Sourcebook - nearly 50% of owners considered their pet to be a family member and 48% considering pets to be companions. The demographics would indicate that a significant portion of the population and specifically internet user could be leveraging the media as source of healthcare/pet care information. Since we do not have numbers of pet owner utilization of SNS for accessing information on pet health issues, we turn to data available for healthcare in general.
In looking at “e-patients” as defined in Pew Internet to be internet users who research healthcare issues, we see that approximately 61% of internet users fit this category. Of those, 39% (or approximately 23% of all internet user) utilize SNS with Facebook, MySpace being the primary sites. The Pew Internet study1 further indicates that “only a small portion” of “e-patients” utilizes SNS as source for obtaining health related issue, following or posting health related comments.
A recent survey conducted by GreyStone.Net with a panel of (human) hospitals determined that 90% have or are actively monitoring social media sites, of which 60% have a present on Facebook and Twitter sites. The primary motivation for seeking a present was to attract new patients, along with supporting Community Relation, Customer Service, Employee Engagement and Crisis Management but only 12.5% of hospitals realizing some level of success. The article suggests that hospitals with a clear plan and marketing strategy (which is approximately 30% of the participating hospitals) are capable of achieving value in having a Social Media presence2.
Given the relatively few number (no exact figure indicated from Pew Internet), of “e-patients” using SNS for healthcare information, the fact that some hospitals have being successful in recruiting new patients is actually an important finding. The significant is every more impressive give that SNS have just recently achieved momentum and entering into main stream utilization. Significant growth has been demonstrated in just the past year as indicated by studies conducted by comScore3. In the one study it was shown that Facebook in 2009 has double it audience – now close to 112 million and is currently the 4th “ranked property” on the internet, accounting for 7% of all internet use. Additional comScore information indicates that the top three SNS in the United States are Facebook > 100 million; MySpace 70 million and LinkedIn at 30 million users.
What exactly are the effective tools to be a presence on SNS? The studies do not specifically address the success tools used and the caveat is that both GreyStone and comScore happen to be marketing and as well as research organizations (not releasing the tools of success within the studies). Assumption to effectiveness would be same as with other internet media sources (e.g. timely update, relative material, interesting stories and information written to intended audience).
In tracking success, a starting point is to at least establish a presents on the primary sites. Along with setting up the sites is the need to determining measuring tool to be employed.
At Atlantic Street Veterinary Hospital Pet Emergency Center, we began surveying clients in December of 2009 to determine drivers to patient visits. Now with nearly 3 months of data, the results are very telling. In the “How did you hear about us” surveys that we have performed, Internet represents our third highest resource used by clients in coming to our facility. This ranks behind direct referral from our local colleagues and previous visits but ahead of Yellow pages, site location and even “Word of Mouth/Friends and Family” referrals. Not know is the SNS impact as we have only recently created a Facebook connection as well as Twitter. This is certainly an area that we will closely watch and perhaps begin getting even more specific in our questions related to internet resource being utilized, as we see SNS gaining traction.
1 Fox, S and Jones, S: The Social Life of Health Information (June 2009) Pew Internet & American Life Project
2 Roberts A: New Numbers on Social Media [Web blog] (January 20, 2010) GreyStone.Net
3 Lipsman, A: 2009: Another Strong Year for Facebook [Web blog] (January 21, 2010) comScore Voices
Thursday, February 18, 2010
Virtual Reality as an Educational Tool
As a component of course work with healthcare informatics, our class has been introduced to Second Life™. Briefly, this site is actually a virtual world where you are free to explore, create, experiment and experience life as an “avatar” or character of your choosing. Opportunities are available to “play” and participate in seeming limitless possible scenarios. The advantages and appeal to this outlet are privacy with ability to project a desired persona without inhibitions (my character is Frederick Serendipity). I was finally able to grow the beard, I always wanted, and walk around in sun glasses everywhere. The ability to fly is also very cool!
My original presumption and prejudice was that virtual reality sites represent just an extension or alternative outlet for social networking. For the most part, my experience confirmed this as a channel for expression. Within the public sites, you really do not know who you might encounter and where the conversations might lead – even had a chance to brush up on my German with a couple engaged in a romantic conversation and plenty of folks “dress” in PG-13 clothing. Apparently shopping and social encounters are the popular draw.
Now how does this all pertain to healthcare and specifically to the doctor-patient relationships? We will have to leave Fluffy (direct veterinary applications) out of the discussion but interestingly if you wanted to “morph” into a dog or cat that is possible.
In exploring the several health related sites namely Palomar West Hospital, Second Health London and Davis Island, an appreciation for Second Life™ as a training and education tool were readily apparent.
The ability to interact in a private manner – (you enter as an alias) lends characters the opportunity to explore and/or discuss issues that they might not feel comfortable bring up in the real world. Internet already provides this ability to purse information that might not otherwise be addressed. But Second Life offers the media to be more interactive and perhaps even greater ability for openness. My concern is that this can be a double edge sword in the fact that a trust issue has to be at play. It is difficult to confided in a setting where a person is not who they appear to be. Again this was my experience in dealing in public areas.
Visiting Davis Island provided a situation that I was more comfortable. As this was a private location and I “knew” the group that I was meeting, it was easier to be open to exchange information and ideas. This is significant as a possible resource for training, support groups and counseling (there is a veterinary application). As part of the island is a “hallucination” simulation which takes the avatar through experience of schizophrenia – my first visit was going though the simulation alone and must say was a bit disturbing.
Palomar West site is a sponsored (Cisco) virtual state-of- the art futuristic hospital – which highlights exciting opportunities in systems to improve patient deliver and enhance the overall hospital experience. At this site, I went through a virtual surgery and hospitalization. Again this visit illustrated opportunity to provide information and see application in as patient education as a pre-surgical tour to help reduce anxiety.
Second Health London provides a tour of health related topics. As the avatar walks through the streets of London, on the way to Polyclinic, they encounter various health issues such as stress, smoking, diet, hygiene. Hyperlinks are available on each of the subjects. Unfortunately I visit this site at 3am London time so needless to say, I did not encounter other avatars. One point that was interested is how engaged I was within the site. There was an accident with injured/non responsive characters and I spent 5 minutes trying to figure out if there was any action that I could “perform” to assist. It felt uncomfortable having to walk away without helping.
Overall my I would have to say my experience is mixed but certainly can see the attraction and potential opportunities to educate within this media. The class will continue to spend additional time at Second Life™ and perhaps will gain great understanding and applications.
My original presumption and prejudice was that virtual reality sites represent just an extension or alternative outlet for social networking. For the most part, my experience confirmed this as a channel for expression. Within the public sites, you really do not know who you might encounter and where the conversations might lead – even had a chance to brush up on my German with a couple engaged in a romantic conversation and plenty of folks “dress” in PG-13 clothing. Apparently shopping and social encounters are the popular draw.
Now how does this all pertain to healthcare and specifically to the doctor-patient relationships? We will have to leave Fluffy (direct veterinary applications) out of the discussion but interestingly if you wanted to “morph” into a dog or cat that is possible.
In exploring the several health related sites namely Palomar West Hospital, Second Health London and Davis Island, an appreciation for Second Life™ as a training and education tool were readily apparent.
The ability to interact in a private manner – (you enter as an alias) lends characters the opportunity to explore and/or discuss issues that they might not feel comfortable bring up in the real world. Internet already provides this ability to purse information that might not otherwise be addressed. But Second Life offers the media to be more interactive and perhaps even greater ability for openness. My concern is that this can be a double edge sword in the fact that a trust issue has to be at play. It is difficult to confided in a setting where a person is not who they appear to be. Again this was my experience in dealing in public areas.
Visiting Davis Island provided a situation that I was more comfortable. As this was a private location and I “knew” the group that I was meeting, it was easier to be open to exchange information and ideas. This is significant as a possible resource for training, support groups and counseling (there is a veterinary application). As part of the island is a “hallucination” simulation which takes the avatar through experience of schizophrenia – my first visit was going though the simulation alone and must say was a bit disturbing.
Palomar West site is a sponsored (Cisco) virtual state-of- the art futuristic hospital – which highlights exciting opportunities in systems to improve patient deliver and enhance the overall hospital experience. At this site, I went through a virtual surgery and hospitalization. Again this visit illustrated opportunity to provide information and see application in as patient education as a pre-surgical tour to help reduce anxiety.
Second Health London provides a tour of health related topics. As the avatar walks through the streets of London, on the way to Polyclinic, they encounter various health issues such as stress, smoking, diet, hygiene. Hyperlinks are available on each of the subjects. Unfortunately I visit this site at 3am London time so needless to say, I did not encounter other avatars. One point that was interested is how engaged I was within the site. There was an accident with injured/non responsive characters and I spent 5 minutes trying to figure out if there was any action that I could “perform” to assist. It felt uncomfortable having to walk away without helping.
Overall my I would have to say my experience is mixed but certainly can see the attraction and potential opportunities to educate within this media. The class will continue to spend additional time at Second Life™ and perhaps will gain great understanding and applications.
Tuesday, February 2, 2010
Role of the urgent and emergency care hospital
My background is in both general practice and emergency care. Since the inception, urgent care has been a part of our basic philosophy. A concern, question have you, is whether our business model is in direct conflict of our referring hospitals, which we have look to as not only clients but colleagues? The reality is that a vast majority of the services we provide can be accomplished at a primary care facility. What separates us from general practice is often simply a matter of convenience or need by the client.
Patterns of competition have been defined as progressing with time. As services become “more efficient, functional and reliable” – that is when services are deemed more than adequately covered by all providers, then the measure of QUALITY becomes “defined by convenience, speed and responsiveness.” Further stated, “Every job has functional, emotional and social dimensions.” Client service is centered on the ability to deliver upon the needs and expectations of the client. Companies that success, are ones that can match the needs of these specific “dimension”1.
Are we competing? Or is our role is to meet a demand and expectation for service? Technology and innovations such as in-house diagnostic laboratory tests, assays, improvements in surgical techniques and imaging are all leading to leveling the playing field with management of many disease conditions. This holds true for general practices, emergency care, specialty and tertiary care facilities.
From the emergency hospital perspective: We do not operate as an “emergency only” facility, as this is really not a defined statement. What is an “emergency?” Look to human medicine, a significant portion of what is provide is indigent care, service for people who have no primary care doctor and folks with immediate needs – are all (or any) of these cases emergencies? The services we provide matches our human counter-parts – receiving strays, clients in financial hardship and folks that are seeking immediate care make up a reasonable amount of our caseload (comes with the territory)
As has already been stated, much of what we (emergency hospital) offer is a matter of meeting an immediate need and certainly supporting client concerns (addresses the functional and emotional dimension).
Clients call us because they have a need. Perhaps they have already called their “regular” doctor and have been referred to us because no appointments are available or the referring hospital has determine that we are best equipped to meet that particular need. We have an obligation to supporting the need and accommodation the request to the best of our ability. The benefit that we offer to our colleague is a line of communication back to the referring hospital and support in assisting client when the primary doctor is not available.
1From: Innovator’s Prescription, Christensen, CM et al 2009, McGraw-Hill, New York Chapter 4 on Disrupting the Business Model of the Physician’s Practice
Patterns of competition have been defined as progressing with time. As services become “more efficient, functional and reliable” – that is when services are deemed more than adequately covered by all providers, then the measure of QUALITY becomes “defined by convenience, speed and responsiveness.” Further stated, “Every job has functional, emotional and social dimensions.” Client service is centered on the ability to deliver upon the needs and expectations of the client. Companies that success, are ones that can match the needs of these specific “dimension”1.
Are we competing? Or is our role is to meet a demand and expectation for service? Technology and innovations such as in-house diagnostic laboratory tests, assays, improvements in surgical techniques and imaging are all leading to leveling the playing field with management of many disease conditions. This holds true for general practices, emergency care, specialty and tertiary care facilities.
From the emergency hospital perspective: We do not operate as an “emergency only” facility, as this is really not a defined statement. What is an “emergency?” Look to human medicine, a significant portion of what is provide is indigent care, service for people who have no primary care doctor and folks with immediate needs – are all (or any) of these cases emergencies? The services we provide matches our human counter-parts – receiving strays, clients in financial hardship and folks that are seeking immediate care make up a reasonable amount of our caseload (comes with the territory)
As has already been stated, much of what we (emergency hospital) offer is a matter of meeting an immediate need and certainly supporting client concerns (addresses the functional and emotional dimension).
Clients call us because they have a need. Perhaps they have already called their “regular” doctor and have been referred to us because no appointments are available or the referring hospital has determine that we are best equipped to meet that particular need. We have an obligation to supporting the need and accommodation the request to the best of our ability. The benefit that we offer to our colleague is a line of communication back to the referring hospital and support in assisting client when the primary doctor is not available.
1From: Innovator’s Prescription, Christensen, CM et al 2009, McGraw-Hill, New York Chapter 4 on Disrupting the Business Model of the Physician’s Practice
Thursday, January 28, 2010
Transitioning Healthcare
A recent Sacramento Bee article Medical debate looks at comparing therapies states the over “$700 billion is spent annually on “unproven medicine and procedures, a significant factor in the escalating cost of health care.” The reporter does not quote a source for this figure so I am left with wondering what constitutes “unproven” care. By my rough estimation – that would amount to over ¼ of all healthcare cost, in 2009 (see Trends in Health Care Costs and Spending).
Let’s go back to the Innovator’s Prescription, as I mentioned in the previous blog, Mr Christensen certainly indicates his concerns about current business models used in medicine. “Solution-Shop” model is the primary system by which medicine currently operates. Under this model, care is provided in an intuitive and/or experience based manner. Heuristics or “rules of thumb” is the predominating feature in this manner of care, leading often to trial-and-error case management. It is under this assumption, one certainly could content that much of “intuitive” medical approaches are “unproven” – basically we are guessing or purposing a treatment is going to work. The author and news reporter both makes a valid point that moving to “precision” or predictive medicine will be not only valuable but necessary in order to control healthcare costs.
In the Triad of reform through disruptive innovation – it is the technological enablers which act as a catalysis for change. Processes must become simplified, more accessible and cost reduced in order to be made available to great population of “users”. According to the author the direction of changes are seen as occurring through imaging and molecular diagnostics.
Evidence in veterinary medicine certainly supports the imaging enablers as influential in improving patient care. Parallel radiographic systems (such as CCD) have resulted in simple, easy to use and less expensive digital systems that rival the more expensive “standard technology” flat panel and computed radiographic systems. The result is digital radiographic systems have entered mainstream use and have improved the diagnostic capabilities for the small veterinary practices. Ultrasound is also an excellent example of advantages realized through greater affordability and ease of use. These systems have lead to improvements in diagnosis and therefore a more precise approach to care. My one caveat is that these systems have not lead to point of transfer care away from the doctor and I would contend the need and support of advance training as well as consultation with specialists (ie Radiologist).
Computational bioinformatics as well as studies in genomics will be continuing growth areas in healthcare. Genetic screening has tremendous implication in advancing predictive medicine. Along with genomics, molecular biology and computer modeling will improve safety and efficacy of medications. The implications and advantages in these fields with regards to influence on veterinary care is anticipated to be realized but not predicted to be as rapidly implemented – just not the funding or return on investment that can be achieved compared to human healthcare.
Along with the technologic enablers already mentioned systems such as Clinical Decision Support Systems and Personalized Health Records, our patients (clients) will become better informed and better educated in managing their own medical care. I believe that enablers will result in advancing predictive medicine and safer personalized care. Patients are already seeking information through the internet. For these goals to be fully realized, healthcare needs to play an active role throughout to support and assist patients in the right direction.
The ultimate goal of disruptive innovations – is to move medicine away from its traditional roots of a doctor dependent system to become more personalized, patient-centric. There is supporting opinion that the future of healthcare will/is transitioning to the Information Age of Healthcare. “Individual Self-care” will be the leading driver in the model of information age healthcare. In order to facilitate this transition healthcare must become more predictive and commoditized.
Yes, I am not a big fan of thinking that medicine can be compare to building the Model-T and understand that we “old guard healthcare professionals” have reason to pause and wonder “what does all this mean.” That said the ability to make medicine more precise has profound implications. Will it reduce the cost of care by removing “unproven” care – No not completely, but it will result in our decision having greater impact and ultimately improve quality of life.
A colleague of mine has a crystal ball prop that he occasionally refers to in illustrating to clients the challenges of determining outcomes. If systems can help us put away the crystal ball – I am all for them!
Let’s go back to the Innovator’s Prescription, as I mentioned in the previous blog, Mr Christensen certainly indicates his concerns about current business models used in medicine. “Solution-Shop” model is the primary system by which medicine currently operates. Under this model, care is provided in an intuitive and/or experience based manner. Heuristics or “rules of thumb” is the predominating feature in this manner of care, leading often to trial-and-error case management. It is under this assumption, one certainly could content that much of “intuitive” medical approaches are “unproven” – basically we are guessing or purposing a treatment is going to work. The author and news reporter both makes a valid point that moving to “precision” or predictive medicine will be not only valuable but necessary in order to control healthcare costs.
In the Triad of reform through disruptive innovation – it is the technological enablers which act as a catalysis for change. Processes must become simplified, more accessible and cost reduced in order to be made available to great population of “users”. According to the author the direction of changes are seen as occurring through imaging and molecular diagnostics.
Evidence in veterinary medicine certainly supports the imaging enablers as influential in improving patient care. Parallel radiographic systems (such as CCD) have resulted in simple, easy to use and less expensive digital systems that rival the more expensive “standard technology” flat panel and computed radiographic systems. The result is digital radiographic systems have entered mainstream use and have improved the diagnostic capabilities for the small veterinary practices. Ultrasound is also an excellent example of advantages realized through greater affordability and ease of use. These systems have lead to improvements in diagnosis and therefore a more precise approach to care. My one caveat is that these systems have not lead to point of transfer care away from the doctor and I would contend the need and support of advance training as well as consultation with specialists (ie Radiologist).
Computational bioinformatics as well as studies in genomics will be continuing growth areas in healthcare. Genetic screening has tremendous implication in advancing predictive medicine. Along with genomics, molecular biology and computer modeling will improve safety and efficacy of medications. The implications and advantages in these fields with regards to influence on veterinary care is anticipated to be realized but not predicted to be as rapidly implemented – just not the funding or return on investment that can be achieved compared to human healthcare.
Along with the technologic enablers already mentioned systems such as Clinical Decision Support Systems and Personalized Health Records, our patients (clients) will become better informed and better educated in managing their own medical care. I believe that enablers will result in advancing predictive medicine and safer personalized care. Patients are already seeking information through the internet. For these goals to be fully realized, healthcare needs to play an active role throughout to support and assist patients in the right direction.
The ultimate goal of disruptive innovations – is to move medicine away from its traditional roots of a doctor dependent system to become more personalized, patient-centric. There is supporting opinion that the future of healthcare will/is transitioning to the Information Age of Healthcare. “Individual Self-care” will be the leading driver in the model of information age healthcare. In order to facilitate this transition healthcare must become more predictive and commoditized.
Yes, I am not a big fan of thinking that medicine can be compare to building the Model-T and understand that we “old guard healthcare professionals” have reason to pause and wonder “what does all this mean.” That said the ability to make medicine more precise has profound implications. Will it reduce the cost of care by removing “unproven” care – No not completely, but it will result in our decision having greater impact and ultimately improve quality of life.
A colleague of mine has a crystal ball prop that he occasionally refers to in illustrating to clients the challenges of determining outcomes. If systems can help us put away the crystal ball – I am all for them!
Sunday, January 24, 2010
Disruptive Innovations –introduction to discussion (first in series)
Healthcare reform – what a hot potato! Most everyone agreeing the system is flawed but getting to the essence of where the problems lie and equally import how to “fix” the issues is a challenge which is difficult to fully grasp.
One theory of reform comes in the Innovator’s Prescription – A Disruptive Solution for Health Care by Clayton Christensen et al. The book centers on “Disruptive Innovation Theory”, which according to the author is “the process by which complicated, expensive products and services are transformed into simple, affordable ones.” Cited are illustrations this theory, as a vehicle of reform ranging from Ford with the Model T, Target, Google and Second Life among a great many other examples.
As with previous business books, I find the concepts intriguing but have to remain a bit skeptically in believing that the golden ring is immediately within our rasps (even the author acknowledges this point). That said this book is very provocative in its critical evaluation of healthcare. At the same time, it is powerful in stimulating ideas and thoughts as to the future of healthcare through innovations (technology).
My intention is to present the key concepts through a series of blog (and as I work through the book), with this being the first in a series to follow.
So what is at issue here? – Background
The author’s intent is show how healthcare can become affordable. A message that comes out immediately is that healthcare is stuck in business models that are no longer effective and “screams” for reform.
Briefly disruptive innovation involves:
1. “Technological enablers” – changes in systems and tools that make them simple and easy to use
2. “Business model innovation” – determine and developing the model that is most effective/efficient in delivering service or products to the customer
3. “Value network” - interactive/dynamic “infrastructure” for connecting all the components of the systems
Each of the components is dependent and interrelated but with that said, central to the process is determining the appropriate business model needed to support the particular service or product to be delivered.
The business models are outlined as:
1. “Source-Shop Business” – fee for service “institution structured to diagnose and recommend solutions to unstructured problems.”
2. “Value-Added Process (VAP) Business” – business model which converts resources to “output” with higher value. Payment is for product or service delivered.
3. “Facilitated Network Business” - operating systems that allow customers to exchange product or service. This model is membership based
From the outset there exist a bias and distain for the Source-Shop Business model. Concerns expressed with this model are what the author labels as “intuitive medicine”, isolated care and the difficulties in providing an efficient system due to lack of rules, standards and/or protocols. This is seen as core issue in medicine today – being locked in a model that no longer serves the needs of the profession and in particular the patient.
How will we move away from “intuitive medicine?” Will it be Clinical Decision Support Systems? How will Electronic Health Records play a role in bringing general practitioners and specialist together? Are there other factors that will lead to disruptive innovations? Answers to these questions have relevance to all aspects of delivery of medical care.
Stay tone
One theory of reform comes in the Innovator’s Prescription – A Disruptive Solution for Health Care by Clayton Christensen et al. The book centers on “Disruptive Innovation Theory”, which according to the author is “the process by which complicated, expensive products and services are transformed into simple, affordable ones.” Cited are illustrations this theory, as a vehicle of reform ranging from Ford with the Model T, Target, Google and Second Life among a great many other examples.
As with previous business books, I find the concepts intriguing but have to remain a bit skeptically in believing that the golden ring is immediately within our rasps (even the author acknowledges this point). That said this book is very provocative in its critical evaluation of healthcare. At the same time, it is powerful in stimulating ideas and thoughts as to the future of healthcare through innovations (technology).
My intention is to present the key concepts through a series of blog (and as I work through the book), with this being the first in a series to follow.
So what is at issue here? – Background
The author’s intent is show how healthcare can become affordable. A message that comes out immediately is that healthcare is stuck in business models that are no longer effective and “screams” for reform.
Briefly disruptive innovation involves:
1. “Technological enablers” – changes in systems and tools that make them simple and easy to use
2. “Business model innovation” – determine and developing the model that is most effective/efficient in delivering service or products to the customer
3. “Value network” - interactive/dynamic “infrastructure” for connecting all the components of the systems
Each of the components is dependent and interrelated but with that said, central to the process is determining the appropriate business model needed to support the particular service or product to be delivered.
The business models are outlined as:
1. “Source-Shop Business” – fee for service “institution structured to diagnose and recommend solutions to unstructured problems.”
2. “Value-Added Process (VAP) Business” – business model which converts resources to “output” with higher value. Payment is for product or service delivered.
3. “Facilitated Network Business” - operating systems that allow customers to exchange product or service. This model is membership based
From the outset there exist a bias and distain for the Source-Shop Business model. Concerns expressed with this model are what the author labels as “intuitive medicine”, isolated care and the difficulties in providing an efficient system due to lack of rules, standards and/or protocols. This is seen as core issue in medicine today – being locked in a model that no longer serves the needs of the profession and in particular the patient.
How will we move away from “intuitive medicine?” Will it be Clinical Decision Support Systems? How will Electronic Health Records play a role in bringing general practitioners and specialist together? Are there other factors that will lead to disruptive innovations? Answers to these questions have relevance to all aspects of delivery of medical care.
Stay tone
Sunday, January 17, 2010
Social Networking and Application to Veterinary Medicine
Okay, I have to admit this is one of those topics that I would have never imagined writing about. That said, just three days ago, I would not have imagined writing a blog? What possible could be the root of all this upheaval in my life!
Current I am enrolled in coursework with the Healthcare Informatics Certification Program at the University of California, Davis Extension. For this quarter, I am enrolled in a class titled Internet and the Future of Patient Care. I came to the course with thoughts centered on all the sophisticated and techno-geeky stuff. Cloud-computing, Electronic Health Records, systems integration… visions dancing through my head.
Well right “off the bat” – we are setting up a blog page researching sites on internet usage and topics on Social Networking… – all leading me in a completely different direction. Naturally, I want to take the veterinary spin on things and determine how all this information could possibly have applications to our delivery of care. How can Facebook and Twitter have any impact of healthcare as it relates to veterinary medicine?
With the research I am finding that perhaps there is more to this Social Networking then I was lead to believe – could there actually be some redeeming value here, an application tool?
According to the Pew Internet & Life Project study - The Democratization of Online Social Networks, Social Networking has entered mainstream with use rising from around 10% (2007) to nearly ½ of the US adult population by December 2009. Interesting to note that, the numbers of new users more than doubled in the past year alone. I cannot imagine that ½ the adult population is just sitting around talking about weekend plans, and “poking” each other.
An article for Veterinary Economics Online networking can have clinical value, cites (Telemedicine and e-Health) the benefits of social networks to patient and healthcare organizations. Specifically social networks offer a rapid alerting system on medical warnings, updates even disease surveillance, basically a great client education tool. An additional benefit that was initially lost on me was the power of collaboration and peer discussion.
Recently I admonished an associate for sharing a case on her Facebook site. This of course was short sighted on my part as many of her “friends” happen to be veterinarians. She was excited to share her experience and the case made for a great opportunity to review and discuss care and progress. Ultimately this outlet serves as informal case rounds. Additionally, great success stories and description of care presents an excellent opportunity for the hospital to showcase the quality of care that is provided.
The take home for me is that social network sites (SNS) contains some of the same elements that I feel are essential to the future of healthcare – information exchange and collaboration (colleagues and client/patients).
Of course the SNS are not immune to the needs of protecting the patient (and client) as well as the practice. Instead of admonishing, it is more important to provide clear ground rules. It is important that guidelines surrounding patient privacy and client confidentiality as well as disclaimers of opinion should be written policy in the employee handbook as indicated in article, (When employees get on Facebook). Bottom line is that SNS are going to continue to be a part of our lives. Considering that most of us are just gaining exposure, it will be interesting to watch and see how it morphs...
Current I am enrolled in coursework with the Healthcare Informatics Certification Program at the University of California, Davis Extension. For this quarter, I am enrolled in a class titled Internet and the Future of Patient Care. I came to the course with thoughts centered on all the sophisticated and techno-geeky stuff. Cloud-computing, Electronic Health Records, systems integration… visions dancing through my head.
Well right “off the bat” – we are setting up a blog page researching sites on internet usage and topics on Social Networking… – all leading me in a completely different direction. Naturally, I want to take the veterinary spin on things and determine how all this information could possibly have applications to our delivery of care. How can Facebook and Twitter have any impact of healthcare as it relates to veterinary medicine?
With the research I am finding that perhaps there is more to this Social Networking then I was lead to believe – could there actually be some redeeming value here, an application tool?
According to the Pew Internet & Life Project study - The Democratization of Online Social Networks, Social Networking has entered mainstream with use rising from around 10% (2007) to nearly ½ of the US adult population by December 2009. Interesting to note that, the numbers of new users more than doubled in the past year alone. I cannot imagine that ½ the adult population is just sitting around talking about weekend plans, and “poking” each other.
An article for Veterinary Economics Online networking can have clinical value, cites (Telemedicine and e-Health) the benefits of social networks to patient and healthcare organizations. Specifically social networks offer a rapid alerting system on medical warnings, updates even disease surveillance, basically a great client education tool. An additional benefit that was initially lost on me was the power of collaboration and peer discussion.
Recently I admonished an associate for sharing a case on her Facebook site. This of course was short sighted on my part as many of her “friends” happen to be veterinarians. She was excited to share her experience and the case made for a great opportunity to review and discuss care and progress. Ultimately this outlet serves as informal case rounds. Additionally, great success stories and description of care presents an excellent opportunity for the hospital to showcase the quality of care that is provided.
The take home for me is that social network sites (SNS) contains some of the same elements that I feel are essential to the future of healthcare – information exchange and collaboration (colleagues and client/patients).
Of course the SNS are not immune to the needs of protecting the patient (and client) as well as the practice. Instead of admonishing, it is more important to provide clear ground rules. It is important that guidelines surrounding patient privacy and client confidentiality as well as disclaimers of opinion should be written policy in the employee handbook as indicated in article, (When employees get on Facebook). Bottom line is that SNS are going to continue to be a part of our lives. Considering that most of us are just gaining exposure, it will be interesting to watch and see how it morphs...
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