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!
Thursday, January 28, 2010
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...
Thursday, January 14, 2010
An Introduction
As the first installment on this blog, the obvious is for me to introduce myself.
I am a 1995 graduate from UC Davis School of Veterinary Medicine. Currently I am the President of Atlantic Street Veterinary Hospital Pet Emergency Center - in Roseville, Ca.
Innovation has been the cornerstone for my practice and professional growth. I have been described as a pioneer and certainly have the arrows in my rear end to attest to the challenges of being an early adopter. I would like to think with age comes wisdom but more importantly learning from mistakes have resulted in some measured success. The rewards lies with being able to survive the mistakes and hopefully share with others so they might learn.
My background in Informatics
The launch into Healthcare Informatics began over six years ago, starting with digital imaging revolution in veterinary medicine. All starting with being the first small animal hospital to impliment flat panel DR (digital radiology). From that point, I quick became educated in PAC, RIS and DICOM. I have had the great opportunity to work some of the brights forward-thinker in the profession. This opened the door to lecturing and writing articles on digital radiology. Along side with the digital imaging experiences, I directed my interest to information exchange tools as well have working with software design teams in enhancements of medical records.
Along with my interest in practice management, my goals are to expand my knowledge and to participate in the development of veterinary medical standards as they relate to data management, information exchange and enhance patient care. Currently I am enrolled in the Healthcare Informatics Program at the University of California Davis, Extension working towards a Certification in Healthcare Informatics.
For the future of veterinary medicine, as it relates to my career direction, my soapbox agenda is centered on collaboration. In informatics (not just in veterinary medicine but healthcare in general), I believe the goal are achieved through the following:
1. Open Source Design - Removing proprietary or "vendor lock", let us pick the best solutions for our practices needs
2. Integration of systems - Our equipment should be able to "talk" with each other
3. Electronic Health Records - allowing for universal sharing of medical information
4. Standards - so that we are all on the same page
My objective with this Blog is to provide an outlet for exchange of ideas and thoughts on issues shaping the future of our profession. I welcome comments and suggestion for topics.
Enjoy
Jim
I am a 1995 graduate from UC Davis School of Veterinary Medicine. Currently I am the President of Atlantic Street Veterinary Hospital Pet Emergency Center - in Roseville, Ca.
Innovation has been the cornerstone for my practice and professional growth. I have been described as a pioneer and certainly have the arrows in my rear end to attest to the challenges of being an early adopter. I would like to think with age comes wisdom but more importantly learning from mistakes have resulted in some measured success. The rewards lies with being able to survive the mistakes and hopefully share with others so they might learn.
My background in Informatics
The launch into Healthcare Informatics began over six years ago, starting with digital imaging revolution in veterinary medicine. All starting with being the first small animal hospital to impliment flat panel DR (digital radiology). From that point, I quick became educated in PAC, RIS and DICOM. I have had the great opportunity to work some of the brights forward-thinker in the profession. This opened the door to lecturing and writing articles on digital radiology. Along side with the digital imaging experiences, I directed my interest to information exchange tools as well have working with software design teams in enhancements of medical records.
Along with my interest in practice management, my goals are to expand my knowledge and to participate in the development of veterinary medical standards as they relate to data management, information exchange and enhance patient care. Currently I am enrolled in the Healthcare Informatics Program at the University of California Davis, Extension working towards a Certification in Healthcare Informatics.
For the future of veterinary medicine, as it relates to my career direction, my soapbox agenda is centered on collaboration. In informatics (not just in veterinary medicine but healthcare in general), I believe the goal are achieved through the following:
1. Open Source Design - Removing proprietary or "vendor lock", let us pick the best solutions for our practices needs
2. Integration of systems - Our equipment should be able to "talk" with each other
3. Electronic Health Records - allowing for universal sharing of medical information
4. Standards - so that we are all on the same page
My objective with this Blog is to provide an outlet for exchange of ideas and thoughts on issues shaping the future of our profession. I welcome comments and suggestion for topics.
Enjoy
Jim
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