In my last post, I told about the Value Code, a book that was published at the worst possible time for its ideas to gain any traction. The majority of the companies the book highlights no longer exist, have been taken over or abandoned the activity for which they were being mentioned.
So much for new ideas.
But on closer reading, the point must be accepted; that value is created as much by the arrangement of resources as anything else. The road to success is a via well though-out plan for execution in the context of a good understanding of the strategic landscape followed by a whole lot of luck…
The trouble with many people’s notions of how to bring business innovation to health care is that they are saddled with assumptions that apply to other aspects of the business world, but do not necessarily apply to health care.
For example, competition in health care frequently leads to increased consumption. Price transparency has the potential to paradoxically lead to rising prices, rather than price competition. (“Have we got a sale on brain surgery this week!”) The fact that a third party pays for the services completely distorts consumer behavior. And yet, health care is an under-estimated contributor to overall economic output.
Before trying to introduce innovation in health care, one must first acknowledge the structural reasons that argue against changing anything. Why adopt EMR? It doesn’t add value to the health of the patient in front of you. Frankly, it only adds work with the hope that someday in the future the collective information derived from such systems may improve something or other.
The real innovations in health care are related to the development of new technologies. Tagamet was a pill that nearly cleared surgical waiting lists (anyone remember how many vagotomies and pyloroplasties filled OR lists in the early 80’s?) Then laparoscopic surgery nearly destroyed the financial viability of half the hospitals in this country by reducing length of stay for surgery that would previously need four or five days in-house. Radiography got killed by CT which is displaced by MRI which will succumb to something else. Chemo has come so far that cancer survival rates have been upticking for the past three or four years. Certainly I have missed an awful lot of revolutionary medical innovations of the past two or three decades, but these are some which come to mind.
EMR will never be on this list.
Shared decision-making is not here.
Evidence-based medicine is of tremendous value but is certainly not a revolution.
Group medical visits for chronic disease will not bring down the walls, nor will disease management, case coordination, Health 2.0, concierge medicine, new insurance paradigms or new models for primary care training.
These items, which have engrossed my attention and dominated my interest for most of my career are not revolutionary technologies that will disrupt everything we now know about health care.
A bitter pill, perhaps, but innovations still make their way into health care delivery… the question is how?
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12 comments:
Dear Zagreus,
I enjoyed your perspective on innovation and agree with you that healthcare has its unique challenges.
Interestingly, I wrote on the power of collaborative innovation, http://healthcarecollaboration.com/blog/, on which I would appreciate your input
I have added you to my blogroll and hope that you will consider adding my blog to your blogroll
I am a practicing general surgeon/ MBA interested in helping physicians and hospital leaders to work more interdependently.
I think your blog is great, and I would like to feature you on the new Wellsphere. We feature only the best health bloggers on our WellPages, which are special pages that our Health Knowledge Engine crafts to give our users answers to their health questions. We would feature you on all the pages on topics that our knowledge engine finds are related to your blog postings. Because we have over 2 million visitors each month (and we are growing rapidly), you would benefit from an expanded audience for your writings. If you would like us to feature you, send me an email to Dr.Rutledge@wellsphere.com
Cheers, Geoff
Well said Zag,
This is right that health care is one he blooming industry now a days.
And the way you described health care as an innovation is suitable term for this.
Hope other will think same as u do.
Regards
Hello. My name is Edgar and I'm an editor at OpposingViews.com, the debate website. Since we both cover health issues, I thought I'd drop you a note. I would've e-mailed you but I couldn't find an address.
See, we're currently having a discussion about whether the U.S. should have universal healthcare. See it here: http://www.opposingviews.com/questions/should-arkansas-pass-the-unmarried-couple-adoption-ban/
Although vetted experts are the ones doing the debating, anyone can contribute by choosing a side and posting comments about the experts' arguments.
Check it out and, if you have the time, let me know what you think at edgar@opposingviews.com
Thanks!
Third party payers can infact distort consumer behavior. In our world of managed care, consumers' decision making is limited and they usually have to align their preferences with what is available and affordable. The economies of scale created by managed care now represent "rate of diminishing returns"
The case for EMR only holds water if physicians are willing to prepare themselves to understand the systems and interfaces. In a cost benefit analysis, the benefit in terms of improved clinical outcomes is negligible unless one wants to equate downstream results of improved processes with better outcomes. In theory, this is arguably correct, in practice only adds to administrative burden.
How can you say that EMR poses no measurable benefit? When I can't read a note or a scan is missing from the day surgery chart, I or others have to track down the paper/person which creates a delay in OR efficiency, a decrease in surgeon/patient satisfaction, and a reduction in cases over any given period.
Or, I can do the case minus the information and cross my fingers, leading to an increased risks in complications, hospital stay, lowered reimbursement.
That is, why have GPS in our cars? We already have maps at every gas station...
FlynnMD - Anesthesiology
Hello,
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Are you allowing advertisers on your site? Or maybe accepting donations for an unbiased interview/review of some kind for Medical Scrubs Mall and/or Uniform Advantage Scrubs?
Let me know if this is something that can work for you.
You can reach me anytime over email at lsherry(at)medicalscrubsmall.com or at 954-626-2145.
Best,
Lee
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Electronic Medical Health Records Compliment Patient-Centered Medical Homes: Innovation In Medicine
Electronic Health Records are progressively being adapted by those involved with the health care profession recently. The criticism of the existing health care system- expressed by others such as the Institute of Medicine, have caused others to consider the benefits of these health care records. Known often as EHRs, there are those who have understandable concerns regarding a patient’s personal information now in a digital format that can be accessed over a network. However, the advantages of this new innovation can potentially reduce medical errors as well as cost. The health care providers and their staff are now allowed to be more efficient as they promote standardization of care due to this new paradigm of accessibility that makes patient information easily obtained by the caregivers. Also, these new EMRs may improve billing accuracy for various medical establishments. In addition, these EHRs may likely decrease the possibility of performing duplicate ancillary services that occur in large part because of other health care providers understandably are unaware of the patient's history relevant to this mistake, perhaps. Needless to say, the handwriting of the well-educated will no longer vex readers who attempt to read what may be unreadable thanks to the advent of EHRs.
Yet still, presently only about 10 percent of medical institutions and health care clinics have a fully integrated system regarding EHRs. However close to half of all health care providers have and use these EHRs. Electronic Medical Health Records have advantages, yet have not been adopted by many involved with patient care for a variety of reasons. EMRs supplement what is known as pay for performance initiatives for health care providers. This relatively new and controversial standard being implemented by payers of reimbursing those in the health care system that rewards those providers who deliver superior health care financially for meeting or exceeding variables established by those who reimburse providers. Some argue that this protocol of reimbursement to health care providers may not be in the best interest of patients- and the variables, some say, are not clearly defined yet. The reimbursement method is based on how providers demonstrate performance and outcomes data regarding patient care. This removes the focus on treating the individual patient- and the P4P initiative does not allow for variables associated with different specialties in medicine that allow for necessary deviations from a structured system such as this. Ultimately, EHRs potentially will effectively manage the health and wellness of patients as well as enhance the quality and continuity of the health care provided to the patient.
Also, those who do have EHRs in their medical clinics utilize only a fraction of what these electronic digital devices are capable of providing. As stated already, this data includes factors that describe performance and outcomes of the care given to patients. So if EHRs are utilized by health care providers, they should perhaps strive to maximize the sharing of data, as this potentially enhances and promotes the quality of health care delivery, according to others. In addition, the interaction between the health care provider and the patient during their encounters potentially be enhanced due to a more complete exchange of health care information.
The functions of electronic health records include the following:
-storage and transmission of health care information and data improved, along with reporting functions
-the management of ordering procedures for patients, and results from diagnostic testing
-enhanced connectivity and communication offered by EHRs
-enhanced support of patients, and the decisions regarding their care
Interoperatibility is the exchange of information due to the ability to access and deliver this data to compile knowledge at the point of care. This is also considered a significant benefit with EHRs that is often mentioned by those who utilize EHRs in their medical facilities. Big words sound impressive, do they not?
One exception to the overall lack of adaption to the concept of EHRs is that this system was implemented with the Veteran's Administration- which consists of over 150 hospitals and nearly 100 medical clinics. Their EHR system, called VistA, is fully functional and beneficial for those who care for others at these facilities. The Army is considering the utilization of EHRs as well at some locations they are giving them a try in the beginning of 2009. One Army location has a protocol called MICare at the Madigan Medical Center in Washington state, and this medical institution not surprisingly is in partnership with both Microsoft Corp. and Google. If successful, maybe further growth will occur with EHRs.
The new administration in the United States appears to support the benefits of EHRs as a prominent factor for health care reform, as well as large managed care organizations, according to reports by others. Others who consider EHRs critical to their concept of patient care models- such as what is known as the patient-centered medical home. This paradigm of patient care is due in large part to shortages of primary care physicians as well as the continued concerns regarding quality medical treatment for those patients who are chronically ill, of which there are many.
Patient- Centered Medical Homes was first suggested as an ideal way to care for those in need of health care by the American Academy of Pediatrics over 40 years ago. The premise behind the medical home is that, if properly implemented, it will result in continual care for patients with a personal physician. This model will result in better health outcomes as well as assuring the health care services needed are provided for certain patients. Components of the medical home model are the following:
-A personal relationship between the health care provider and the patient.
-A multi-talented team approach providing ongoing patient care
-A comprehensive approach that expands the scope and content of health care provided
-Coordination to enhance communication between the doctor and the patient as well as assuring availability of the health care provider, instead of the episodic care that exists.
-Electronic health records is an element of this patient care model as well as a commitment to evidence-based medicine to assure improvements with the quality of care delivered, as well as the safety of the care given to the patient.
Patient-Centered Medical Homes are believed to be a model that provides increased value by maximizing the potential of the health care system, which may result in savings up to 70 billion dollars a year, some have determined.
Presently, primary care physicians care for approximately 2500 citizens in a certain community, which results in about 5000 patient visits lasting 15 minutes each is a doctor’s office. Patient-Centered Medical Homes as well as EHRs should expand the scope as well as the content of health care given to others.
Dan Abshear
Zagreus, please email JClaypool13@gmail.com... I am a healthcare consultant and I would like to correspond with you as soon as possible. Feel free to email me from an anonymous address.
Dear Zagreus,
My name is Barbara O’ Brien and my blogging at The Mahablog, Crooks and Liars, AlterNet, and elsewhere on the progressive political and health blogophere has earned me the notoriety of being a panelist at the Yearly Kos Convention and a featured guest blogger at the Take Back America Conference in Washington, DC.
I’m contacting you because I found your site in a prominent health and medicine blog search and want to tell you about my newest blogging platform —the public concern of health care and its reform. Our shared concerns include health reform, public health, safe workplaces, and asbestos contamination.
To increase awareness on these important issues, my goal is to get a resource link on your site or even allow me to provide a guest posting. Please contact me back, I hope to hear from you soon. Drop by our site in the meantime—www.maacenter.org/blog.
Happy Holidays,
Barbara O’ Brien
barbaraobrien@maacenter.org
Hi,
My name is Annie Smith and I am the assistant editor of Medicalschool.org. I am contacting you today in hopes of developing a relationship with your website; we have seen your site and think your content is great. Medicalschool.org is a purely informational site dedicated to the general Public and Medical Professionals.
I hope you show some interest in building relationship, please contact me at annie.medicalschool.org@gmail.com.
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