Friday Fantastic Kate Davis tune
Friday Fantastic Kate Davis tune
Update 11/18/2016 Why interoperability is crucial in radiology http://www.healthdatamanagement.com/opinion/why-interoperability-is-becoming-more-important-in-radiology
It’s not just the intellectual capital of vendor products or the need to ensure the security of PHI, or to maintain patient confidentiality; there are very real needs to share data securely among systems (and providers) for the benefit of decisions made on behalf of patients. Clearly, there is no single standard in healthcare, nor does semantic interoperability exist. What does the Security Rule say about flexibility in its implementation? HIPAA regulations for security of PHI is required. Is flexibility in the rule to enable the flow of information between providers, or integration, that can be enabled to provide improved quality of care for patients? Take a listen to Carlos on the Security Rule Flexibility Principle (and visit HIPAA Survival Guide on YouTube for other short videos).
An a recent article in Health Data Management, it stated “IT vendors are not helpful when it comes to integrating.” They either require complex Application Programming Interfaces (APIs), “flatly refuse to transmit the data,” or require additional fees for exchanging data. Also, in my experience, providers were required to purchase additional software for secure transmission of health data. Why are there so many ways to get from point A to point B? It’s expensive, time consuming and an uphill battle at best.
The Centers for Medicare and Medicaid Services (CMS) is promoting full interoperability even though it was NOT part of the attestation of certified EHRs at the onset of Meaningful Use nor its subsequent updates. CMS has sponsored “a major PR effort to get vendors to sign the toothless Interoperability Pledge” plus the MACRA rule now requires that providers attest to “not blocking information.” Providers have previously complained that EHR vendors were unwilling to share data or they charged cost prohibitive fees to make sharing possible. [i]
There are situations where the need for claims information is necessary for patient conditions, and a vendor has required significant programming efforts before enabling integration. Why continue these practices? Not only are they difficult to address, but in many cases (and in this example) may negatively impact decisions by practitioners due to lack of a complete medical history.
Moreover, lack of common semantics is a key inhibitor to interoperability. Without a single standard at the granular level of patient data, too much time is spent assimilating data from various formats into a single standard. Health Data Management says “we’re not talking about producing breakfast cereal.[ii] HIMSS Electronic Record Association reported that “Value-based payment and delivery system reform remains the biggest driver of interoperability.”[iii] Let’s hope that is the case.
Lack of interoperability and its resolution is long overdue. Fortunately, ONC Health IT Certification Program recently passed Enhanced Oversight and Accountability and amended the Public Health Service Act (PHSA) to create “Title XXX – Health Information Technology and Quality” (Title XXX) to improve health care quality, safety, and efficiency through the promotion of health IT and electronic health information exchange.[iv] It’s like Mother telling Child. You must do what I say or there will be consequences. Yes, the ONC can take certification away from those who do not comply. Is this what we need to exchange or share healthcare information – a big stick approach? Seems that way.
[i] Gue, D’Arcy Guerin. "HIT Think Is Information Blocking Finally on Its Last Leg?" Health Data Management (2016): n. Web. 17 Nov. 2016.
[iii] "Interoperability in Healthcare FACT SHEET June 2016." HIMSS. HIMSS Electronic Record Association, June 2016. Web. 17 Nov. 2016.
[iv] "ONC Health IT Certification Program: Enhanced Oversight and Accountability." Federal Register. Office of the National Coordinator for Health Information Technology, Department of Health and Human Services., 19 Oct. 2016. Web. 17 Nov. 2016.
As mentioned in Health Data Management article “How to keep the top exec up to speed on security issues,” there are three aspects of the Security Rule that should be distilled into meaningful executive reports: Administrative, Physical, and Technical Safeguards.[i] The security rule regulations provide standards for the protection of electronic (and paper) protected health information (“PHI”). An executive summary should identify not only compliance with the regulations but also gaps where additional attention should be focused. Where are the gaps in your protection of PHI? Is your organization in a state of possible WILLFUL NEGLECT?
The Security Rule's Administrative safeguards describe an organization’s actions, policies and procedures to manage development, implementation and management of security measures that protect PHI. They also describe required actions of the organization’s workforce related to protection of PHI. Physical safeguards are the procedures and policies related to buildings and equipment that protect PHI from natural and environmental hazards as well as unauthorized intrusion. Finally, Technical safeguards are the policy and procedures for use of technology and its protection with controls that prevent unauthorized access.[ii]
An assessment is required prior to developing an executive status report on the security of PHI. Identifying and understanding risks is the first step. Eliminating or mitigating risks closely follow.
Simply put, executives want to know two things… First, they want to know if there are risks that have not been mitigated. What are they? How can they be exploited? What is being done to “plug the hole.” Second, they want to know the status of mitigation efforts. Have these efforts been tested? Are they sufficient? Do they require improvement? What plans have been enacted to verify, test, and ensure operational success in the event of an exploited vulnerability and threat?
Finally, what is the status of your compliance with the regulations? I like the example in the article of the threat and vulnerability of PHI due to a natural event such as a Hurricane. Living in Florida I have experienced several. The Compliance Officer and supporting technical staff are likely the individuals preparing the executive summary report and that should focus on the most important items, not an enormous list of issues. As mentioned earlier, this executive (one-page) summary should be brief and to the point. What is the status of compliance? What tasks are in-progress? What is the date at which known risks will have required policies, procedures and mitigation available? Who are the individuals responsible for its execution?
Reporting on the status of PHI protection is not a once-and-done event; it is an activity that should occur at intervals and updated as necessary. Key factors reported by KLAS for 2016 include Secure Communication (Secure Communication 2016: Vendors Transitioning to Secure Communication Platforms) and Interoperability (Interoperability 2016: From a Clinician View - Frustrating Reality or Hopeful Future?)[iii]. Not only are changes in technology evergreen, but so is the data associated with PHI.
[i] Bowen, Chris. "How to Keep the Top Exec up to Speed on Security Issues." Health Data Management. Source Media, 15 Nov. 2016. Web. 16 Nov. 2016.
[ii] "CFR 45 Part 164." HIPAA SURVIVAL GUIDE CFR 45 Part 164. 3Lions Publishing, Inc., n.d. Web. 16 Nov. 2016.
[iii] KLAS Tech. "KLASresearch." KLAS Research. KLAS ENTERPRISES LLC, n.d. Web. 16 Nov. 2016.
It's tough to say what will happen in healthcare under the new President; although, he delivered a 310 word Health Plan. Three hundred and ten words in a document called a Presidential "Health Plan" does not bode well for improved health policy. In fact, its impact is more likely to cause negative impacts to healthcare in the form of decisions made or not made in the process of providing care. "In this 'Health Plan,' the President-Elect damns the Affordable Care Act and promises to repeal it - one of his largest campaign promises." Healthcare, as an industry, is way too complex to be addressed in such short prose.
It's no surprise that we're in a state of perpetual disruption. We have been for quite some time and healthcare leaders continue to seek methods to improve the quality of care for their patients at the same time hoping that costs move in a downward trajectory. Unfortunately, baby-boomers and potential new legislation could hit the industry like a bomb. On a more positive side, if new legislation supports it, Fee-for-Service will continue to die a slow death to the benefit of Value-Based Payment models. I believe that patients, providers, and payers seek to improve our unsustainable aging health system.
But even though many have been hopeful for improved care, many health care executives fear that drastic changes will further disrupt and decompose progress. Others believe that more competitive markets will lead the way toward price reductions. Essentially, we all know there will be changes forthcoming - but to what degree and what impact will become of these changes? We don't yet know. "“Massive disruption in the health insurance markets,” one senior director not happy with Trump’s victory said. “Many individual consumers will be priced out of coverage due to the reinstatement of individual underwriting and young healthy consumers will exit the risk pool.” 
We're in for a rocky road ahead. Stay tuned.
 Davis, Jessica. "Donald Trump Posts New 310-word Plan for Health Reform." Healthcare IT News (2016): n. pag. Web. 11 Nov. 2016.
 Sullivan, Tom. "What C-suite Execs Expect to Happen in Healthcare When Trump Takes over as President." Healthcare IT News (2016): n. pag. Web. 11 Nov. 2016.
ExpressoTM is a new edition to the HIPAA Survival Guide's suite of products. This SAAS-based software provides healthcare organizations and their business associates with the tools to produce a mandatory Risk Assessment within 3 hours or less. It contains Risks associated with Threats and Vulnerabilities, which are directly linked to the Security Rule regulations. As a founding shareholder of 3Lions Publishing, Inc. I suppose I should claim some bias, but the truth of the matter is that I had no input for any of the features of this product until after it was developed and I began consulting with 3Lions.
Now that I have performed Quality Assurance for each of its features, and provided support to 3Lions customers, I must say that Expresso provides a rapid path to HIPAA compliance and the HIPAA Survival Guide's other products engage customers with the policies, procedures, and processes needed to perform the necessary Risk Mitigation. I haven't seen anything like it at its price-point.
As a Registered Nurse and Clinical Informaticist who has worked not only in hospitals (Covered Entities) but also for clinical software vendors (Business Associates) I have taken the mandatory HIPAA education required, but was not exposed to the detailed processes and procedures that are required for compliance with regulations of the Health Insurance Portability and Privacy Act (HIPAA) Security Rule. I learned that Expresso's origins came from NIST Special Publication (SP) 800-30 Rev. 1 that ensures the confidentiality, integrity, and availability of electronic protected health information (e-PHI) that is created, received, maintained, or transmitted in the course of business.
So let's get to the heart of the matter...
#1 Risk Analysis is REQUIRED by the HIPAA Security Rule to assess potential risks and vulnerabilities to protected health information (PHI).
#1.1 Outcomes of Risk Analyses are critical factors in assessing whether an implementation specification or an equivalent measure is reasonable and appropriate.
#2 Vulnerabilities can be thought of as "holes" in your defenses that Threats may exploit.
#3 Threats may be natural, environmental or man-made. Threats exploit vulnerabilities and become Risks to PHI.
#4 According to NIST 800-30 Risk is defined as "(1) the probability that a particular [threat] will exercise (accidentally trigger or intentionally exploit) a particular [vulnerability] and (2) the resulting impact if this should occur.
Expresso captures Security Rule specifications as well as threats, vulnerabilities and the potential impact to an organization if the Risk were to occur. To explain this a bit further, I like to use the example of a Hurricane as a Threat. If your organization is subject to Hurricanes, you would implement policies, procedures, and protection of e-PHI that could not be impacted by a Hurricane. Examples of what may be implemented are cloud-based backups or redundant sites with real-time updates. The organization would also implement a Disaster Recovery Plan that contained (at a minimum) the following components: Purpose & Scope, the Team: Roles and Responsibilities, Incident Response Steps, Plan Activation, and Procedures.
If you want more information or would like to see a demonstration of Expresso, I invite you to visit the HIPAA Survival Guide website.
The Office of Civil Rights (OCR) has launched Phase 2 of their HIPAA Audit Program, seeking to expand its scrutiny to a much broader array of HIPAA-covered entities and business associates. In Phase 2, OCR will contact Covered Entities (“CE”) and Business Associates (“BA”) to perform desk or onsite audits that comprehensively examine data security practices and compliance with HIPAA privacy and security rules.
Until recently, smaller CE’s have not been a primary focus of OCR attention but now, with this “across-the-board auditing,” CEs and BAs of all sizes will undergo the possibility of HIPAA Audits. This changes the game for those who have ignored the possibility of HIPAA audits in the past. Now, organizations must get their “house in order” to ensure that a Risk Assessment has been performed, Risks are identified, and mitigation policies and procedures, put in place to avoid enforcement actions – many of which can be significant. “HIPAA fines are on the rise and getting larger.” In addition, CEs are required to obtain satisfactory assurances that their BAs are complying with the Security Rule.
Implementing HIPAA compliance begins with a Baseline Risk Assessment that identifies areas in which CEs and BAs have high Risk exposure due to lack of policies, procedures and Security and Privacy Rule compliance. A Risk Assessment is one of the implementation specifications of HIPAA Security Rule—but by far, arguably the most important.
In addition, subsequent Risk Mitigation includes review and implementation of security controls that mitigate identified risks. Possible items may include encryption, employee training, governance of login credentials and security. Moreover, the Security Rule requires documentation for each implementation specification and a written sanction policy. The Privacy Rule requires a log of restriction requests made by patients as well as a log of PHI, access, amendment, and disclosure requests. The Breach Notification Rule requires documentation regarding how the HHS Secretary should be notified in case of a breach. The Omnibus Rule mandated changes to notice of privacy practices and introduced other modifications to the HIPAA Rules. Suffice it to say these regulations are non-trivial. Management must make compliance, their risk assessment and its mitigation efforts, a high priority in addition to ensuring that the right solutions are implemented.
OCR is committed to transparency about the process by posting the updated audit protocols on their website. “The audit protocol will be updated to reflect the HIPAA Omnibus Rulemaking and can be used as a tool by organizations to conduct their own internal self-audits as part of their HIPAA compliance activities.” Gathering an inventory of security objects (i.e. operations, assets, and workforce members) that create, access, maintain and/or transmit PHI, is foundational to Security Rule audit preparation.
Commercial off the shelf products may be helpful to the implementation of the Security Rule’s Safeguards. If a CE or BA is out in the Risk Assessment wilderness with manual reviews or only paper documents and spreadsheets, or no documentation at all, take a look at Expresso’s Risk Assessment software and all of the Risk Mitigation products available at The HIPAA Survival Guide. “Now that the stakes have changed, those who are unwilling or unable to adhere to HIPAA data security rules threaten not just their own businesses, but those of the public, including yours.”
 Robertson, Cam. "Why HIPAA Audits Raise the Stakes for MSPs as Well as Providers." Health Data Management. N.p., 06 Oct. 2016. Web. 06 Oct. 2016.
 "OCR Launches Phase 2 of HIPAA Audit Program." HHS.gov. HHS Office of the Secretary of Civil Rights, 2016. Web. 06 Oct. 2016.
 Robertson, Cam. "Why HIPAA Audits Raise the Stakes for MSPs as Well as Providers." Health Data Management. N.p., 06 Oct. 2016. Web. 06 Oct. 2016.
Where do nurses and doctors find the time to provide care beyond the office walls? Given the fragmented nature of the U.S. healthcare system, healthcare providers have increasingly implemented Care Management programs aimed at coordinating the care patients receive to improve quality, reduce per capita cost and improve access to care. Traditionally, coordination interventions follow from several perspectives: medical versus social; short-term episodic or acute care versus chronic and long-term care; and various points of access to the patient (e.g., patient targeting to find those in need of high-intensity services, managed care organization, or physician office practice).[i]
Care Coordinators (a.k.a. Care Managers) provide outreach to at-risk patients to ensure they receive specialized attention related to needed services. They are a key liaison between the patients and their primary care providers. The general intent is to facilitate delivery of the right health care services in the right order, at the right time, and in the right setting.[ii] Recently, care coordination programs have gained a stronghold where managed care organizations, commercial vendors, academic medical centers, and private health insurers sought to implement mechanisms aimed at controlling costs, improving disease outcomes, quality of care, and patient satisfaction.[iii]
At a high level, a 2000 report, entitled, “Best Practices in Coordinated Care,”[iv] made the following five recommendations for Care Management programs:
Care Management software comes in various shapes and sizes. Many fill the needs of Clinically Integrated Networks of Hospitals, Clinics, and practices; others come in smaller sizes to meet the needs of small practices. One such package is Stone Health Innovation’s Idea Care. Regardless of the size, certain capabilities should be part of the care management software solution as described below.
Care Coordination Components[vi] should include:
Information provided herein serves as development for a working definition that may be a helpful step for others attempting standardization in the area of Care Coordination. Interventions can be demarcated by type that includes not only use of software, but also educational brochures, mailings and member letters, telephonic care management, in-person care management, call centers and self-monitoring devices. Providers may find patient profiling and reports that originate from registries and clinical information systems, electronic medical records, decision support and other electronic communication systems useful. The Agency for Healthcare Quality and Research (AHRQ) published research on care management entitled “Measuring Value in a Care Management Program.“[vii] AHRQ claims that a measurement strategy is critical for determining the value of a Care Management program and to ensure effectiveness in reaching its goals.
[i] McDonald KM, Sundaram V, Bravata DM, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 7: Care Coordination). Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jun. (Technical Reviews, No. 9.7.) 2, Background: Ongoing Efforts in Care Coordination and Gaps in the Evidence. Available from: http://www.ncbi.nlm.nih.gov/books/NBK44011/
[iv] Chen A, Brown R, Archibald N, Aliotta S, Fox PD. Best practices in coordinated care. March 22, 2000 [Accessed: January 30, 2006]; Available from: http://www .cms.hhs.gov /DemoProjectsEvalRpts /downloads/CC_Full_Report.pdf. [Reference list]
[vi] McDonald KM, Sundaram V, Bravata DM, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 7: Care Coordination). Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jun. (Technical Reviews, No. 9.7.) 3, Table 6: Components of Care Coordination. Available from: http://www.ncbi.nlm.nih.gov/books/NBK44012/
[vii] By Using Structure, Process, and Outcome Measures, a State Can Ensure That It Is Receiving a Complete Picture of Its Program's Value., AHRQ. "Section 7: Measuring Value in a Care Management Program." Agency for Healthcare Research & Quality. U.S. HHS: Agency for Healthcare Research and Quality, 2014. Web. 13 Sept. 2016.
In my first post in this series on Population Health, I stated that EFFECTIVE PATIENT ENGAGEMENT IS ALL THAT MATTERS. There is simply nothing more important than the patient if you are trying to deliver higher quality of care at a lower cost for a population of patients. When clinicians are dealing with many patients they generally do not have the time to effectively educate each individual patient in a manner that may help improve their wellness.
For example, patients with Diabetes require education about exercise and the kinds of foods that are suitable for someone with their condition. Likewise,there is a need to teach all patients, but especially those with comorbidities the importance of staying in compliance with their medications. The list can go on and on. 5-10 minutes with your doctor every three months will never suffice vis-à-vis the kind of information needed to support wellness.
Almost everyone is using the Internet to search for articles on their conditions, however; often they may encounter information that is inaccurate for their specific circumstances. Nurse note here... “It is always best to check with your Doctor or Nurse” – but they may not be available when the patient needs a question answered. Now we have the role of the “care manager” in population health. The healthcare industry recognizes this obvious need but is struggling how to fulfill it.
One thing is certain as we have discussed before, conversations with the patient cannot take place in a multiplicity of places (e.g. patient portals for every specialist). It has to take place in one virtual space or it won’t take place at all. But, how is this possible if every doctor wants to use their own distinct virtual space to communicate? Enter a visionary startup Docola, whose platform allows the conversations to take place in a single virtual space no matter how many clinicians are treating the patient.
Using Docola’s Platform (or something akin to it) the conversation becomes centralized across all care providers. Care coordinators are able to pull the requisite patient information from multiple EHRs and other data sources to effectively educate the patient. In fact, Docola’s Platform is, among other things, a patient education platform. Now clinicians can choose from world-class clinical content publishers the educational courses that have the potential to make an enormous contribution to patient education, while at the same time ensuring that the patient conversation takes place.
The certainty of this approach for patient education is self-evident. The reason that we have not seen this type of system receive widespread success is that the healthcare industry, despite recognizing the need and potential of this type of Platform, is struggling to develop the business model(s) that would make it work. In short, the industry is struggling mightily to remove the shackles placed upon it by Fee-For-Service. However, disruption is coming.
In my last post, using Atul Gawande's TED Talk as an example, I discussed the need for healthcare training to transform itself from educating cowboys and cowgirls (i.e. fiercely independent and self-reliant clinicians) to coaching “pit crew” members.[i] Don’t hold your breath - this transformation will not happen anytime soon; clinicians were trained in a particular way for well over 100 years. Moreover, academia is the last industry in the world from which you should expect innovation. It’s not going to happen. That leads us to the question of knowing what type of professionals and skills are required to deliver on the promises of population health.
Healthcare workforce education has traditionally focused on a siloed approach and rarely offered students of diverse disciplines the opportunity to learn together in the classroom or through experience. This siloed approach has contributed to the constant problems faced in health care. What healthcare needs is a learning organization. A learning organization uses systems thinking to see the surrounding parts as a whole. It is an antidote for complexity and with the scale of complexity at its highest in Population Health initiatives, systems thinking can provide the discipline for “seeing the structures that underlie complex situations.[ii]” Interprofessional education and practice has shown to improve healthcare’s ability to provide high-quality patient-centered care.[iii]
As software and hardware continue their downward spiral toward more and more commoditization, services become the key differentiator. The professional services sector is becoming increasingly critical to the success of population health projects. That is why the main commercial population health vendors have ongoing initiatives to strengthen this part of their value propositions. Even the uninitiated quickly discover the myriad of complex skillsets required for the recipe that delivers on the promise—from HIT professionals to top notch clinicians—spiced of course with professionals who can bridge the gap between the two.
All growth will come from intellectually based services.
—James Brian Quinn
My primary complaint against a professional services led model is not that talented consultants do not bring significant value to the table, but that their business models often work to the detriment of providers, especially in the population health space. Here’s why. Maximizing billable hours is their principal mechanism for increasing revenues. They develop sophisticated techniques for achieving this end, including a never-ending obsession with account control. The goal from a provider’s perspective is to minimize the amount of time and risk it takes to develop and implement population health solutions. These two goals are diametrically opposed. In turn, when revenues begin to fall, they cut corners to compensate and as they push harder they begin to realize that the easy way out usually doesn’t work.[iv]
Consider the fact that for professional services, maximizing revenues for a given project requires providing more warm bodies and billable time instead of fewer. The key for providers is to hire a professional services organization that is thoroughly focused on doing more with less and transferring knowledge as fast as providers have the bandwidth to absorb it.
Although professional services continue to increase in importance, not all service providers have the best interest of their customers in mind, caveat emptor! The question you should ask any service provider is “How do you intend to reduce the number of project hours required for closure?” Enough said.
During the dot.com craze, companies thought they could instantly manufacture a corporate culture of creativity by having a fully stocked kitchen, game rooms, casual dress code, and mandatory corporate fun activities. All of these culture creation props, for most of these companies, were as empty as their bank accounts. These perks are obviously nice to have, including a physical work environment that is conducive to creativity and personal productivity, but they are no substitute for a sincere corporate culture. The burden of consistently working 60-80 hour weeks for months at a time, and spending precious little time with those you love, will not be lessened by ten free diet cokes a day.
It is clear that a sustainable corporate culture must be built on a foundation of open communications and a shared set of core values, which include: honesty, integrity, respect, diversity, and profitability. Your shared belief system must permeate the entire organization and manifest itself in the day-to-day operations of the business. This common belief system should be self-evident.
The business press quickly killed a good-sized forest with all the print space that has been dedicated to the importance of cross-functional teams and communications. Despite this, organizational silos exist everywhere you look. Why do these walls remain when there is universal agreement that they significantly contribute to organizational dysfunction? Apparently, as previously mentioned, the walls remain because individual stakeholders often have a perceived vested interest in maintaining them. Nowhere are silos more insidious than in population health projects given the enormous amount of cross-functional support required for success.
One way to begin tearing down the walls is to eliminate physical barriers that exist between various departments. Have Nurses and Therapists intermixed in adjacent cubes or offices. While you are at it, throw in a Doctor as well. The daily communal contact will enhance cross-functional communications. Without encouragement from anyone, neighbors will begin to break bread, and perhaps have a drink together after work.
Another, perhaps better, way to improve cross-functional communications is to encourage Natural Leaders and individual team members to open dialogs with all business functions required to accomplish the mission. Frequently line executives prevent cross-functional communication because of their prejudices, fears, and insecurities. Learn to maneuver around these obstacles and watch as the communications process improves dramatically.
Our people are our greatest asset. We should all agree to abolish this statement from the business lexicon because at 99.9% of the companies that I have worked or consulted with (unfortunately) this statement is empty rhetoric and corporate propaganda of the worst kind. Most companies do not treat their employees as if they were the business crown jewels, and everybody knows it. Cut the baloney unless you can deliver the goods.
Everything else being equal (and of course they never are), the companies with the best teams will win more often than not. It follows that you will require excellent coaches and talent scouts to sustain an advantage. You better pay these folks well because they will be (and are) in high demand. Recognizing quality talent is a tricky business, and if you rely on Ivy League pedigree nonsense as your principal criteria, one of your competitors is likely to wind up with all the golden needles in the haystack.
When I am brought in to help an organization build a team, the first question I ask is “What is your recruiting buzz?” Of course, I always get the expected response, blank stares followed by “What are you talking about?” In a labor market where quality talent is scarce, they are in the driver’s seat and are usually very selective when choosing new assignments—not unlike the best actors and directors in Hollywood.
Why would the best talent want to work for your company, and on this particular population health project? Your recruiting buzz answers this question. It is the story told to candidates to get them excited about your mission. Companies are often engaged in very cool and exciting projects, yet they do not know how to milk it for all it’s worth during the recruitment process. Don’t get me wrong; this is definitely not about selling a story that will vaporize as soon as the newly signed up candidate walks through the door. It is about presenting what your project has to offer in the best possible light. Without a great recruiting buzz you are unlikely to win your fair share of the best candidates. Build it. Practice it. And use it often.
[i] Gawande, Atul, MD. "Transcript of "How Do We Heal Medicine?"" Atul Gawande: How Do We Heal Medicine? TED Talks, Apr. 2012. Web. 28 Aug. 2016.
[ii] Senge, Peter M. The Fifth Discipline: The Art and Practice of the Learning Organization. Revised ed. New York: Crown Business, n.d. Print.
[iii] Knickman, James, Anthony R. Kovner, and Steven Jonas. Jonas and Kovner's Health Care Delivery in the United States. 11th ed. New York: Springer Publishing, n.d. Print.
[iv] Senge, Peter M. The Fifth Discipline: The Art and Practice of the Learning Organization. Revised ed. New York: Crown Business, n.d. Print.
It is not the Internet, or the Internet of Things, or Big Data, or analytics, or a host of other technologies that are foundational to population health that will eventually transform healthcare. These technologies may be necessary, but they are certainly not sufficient. No, what will drive transformation is the way in which the medium will improve conversations that take place between human beings (i.e. between providers and patients). The improved human dialog is the change agent.
We need to insert the patient into the equation. Although this may seem obvious, it is one that the FFS model has ignored for well over 100 years. Everything else was a distant secondary consideration. Why has the patient been left out of the equation? Because unlike almost every other market you can imagine, in healthcare the patient historically was not the entity that paid for the services. Hence, from an economic perspective, the healthcare industry was free to ignore the very people they purportedly served.
Atul Gawande spoke about the need for communication and systems thinking in healthcare. In a TED Talk, he summed it up by saying “We’re all specialists now, even the primary care physicians. Everyone just has a piece of the care. But holding onto that structure, we built around the daring, independence, self-sufficiency of each of those people has become a disaster. We have trained, hired and rewarded physicians to be cowboys. But it’s pit crews that we need, pit crews for patients.”[i]
The very reason that population health is in a state of crisis is that the focus formerly has been on a million and one potential distractions with very little attention paid to how we were going to engage with the patient, and moreover exactly where was this engagement going to take place. A premise of the population health “movement” is that healthcare has to transform its view of the patient from a “clinical thing” to be examined and studied, to a natural person with whom we want to engage in a mutually beneficial dialog.
A few thousand years ago there was a marketplace. Never mind where. Traders returned from far seas with spices, silks, and precious, magical stones. Caravans arrived across burning deserts bringing dates and figs, snakes, parrots, monkeys, strange music, stranger tales. The marketplace was the heart of the city, the kernel, the hub, the omphalos. Like past and future, it stood at the crossroads. People woke early and went there for coffee and vegetables, eggs and wine, for pots and carpets, rings and necklaces, for toys and sweets, for love, for rope, for soap, for wagons and carts, for bleating goats and evil-tempered camels. They went there to look and listen and to marvel, to buy and be amused. But mostly they went to meet each other. And to talk.
Yes, markets contain prominent conversations. The Cluetrain Manifesto[ii] propelled this meme on the world’s stage over fifteen years ago. However, very few people intuitively understand the implications, and fewer still are leveraging the idea, as a way of doing business in healthcare. Enormous opportunities await any organization that finds its voice, and through it learns to have an ongoing conversation with its patients.
Further, patients are eager to have this conversation, as long as it is no more demanding of them then their use of Facebook, or WhatsApp, or Snapchat or whatever social media platform they choose to engage with. Moreover, it is clear that the conversation needs to take place in one virtual space, not hundreds. The idea of patient portals is DOA. Why? Because a patient is not going to visit twenty different portals to engage with all the clinicians (i.e. specialists) that our currently fragmented delivery system mandates.
[i] Gawande, Atul, MD. "Transcript of "How Do We Heal Medicine?"" Atul Gawande: How Do We Heal Medicine? TED Talks, Apr. 2012. Web. 28 Aug. 2016.
[ii] Rick Levine et al., The Cluetrain Manifesto: the end of business as usual (Cambridge: Perseus Publishing, 2000).