Coordinated Health Care & Evidence Based Medicine, Aided by Social Media

Slate Magazine's recent analysis of the Obama administration's forecasted $2 trillion in health care savings questioned which initiatives would provide true savings.  The highest ranked was "encouraging coordinated care..." and "...adherence to evidence-based best practices and therapies..."  Coordinated care seems to suggest clinical integration and savings derived from better information about what works and what doesn't, would create efficiencies.  

Increased information could increase the benefits of innovation and the ability for federated groups of health plans to use the best ideas for the best results.  Secure Social Media, i.e. the idea of aiding discovery within the enterprise can help.   No World Borders has been advising health care firms on ways to use social media techniques to provide openness, while still providing security and privileges regarding who can access the information within the enterprise.

From Slate:

"3.) Encouraging coordinated care, both in the public and private sectors, and adherence to evidence-based best practices and therapies that reduce hospitalization, manage chronic disease more efficiently and effectively, and implement proven clinical prevention strategies.

"Coordinated care" seems to suggest integration of clinical care by hospitals and doctors. If bundling requires doctors and hospitals to knock heads over submitting a single bill, integration requires doctors and hospitals to knock heads over how the patient will be cared for. "You have to grow both organically side by side," Reinhardt says. A good start, he added, would be getting the pediatrician, obstetrician, and gynecologist to develop a common plan for an individual childbirth; medical procedures don't come much more straightforward than the delivery of babies. "Evidence-based best practices and therapies" refers to compiling national statistics about which clinical approaches work best and then putting some pressure on physicians and hospitals to follow them. It's very difficult to know in advance what the budgetary impact of this information would be. In a recent article in the Annals of Internal Medicine, Theodore Marmor, Jonathan Oberlander, and Joseph White wrote, "Although comparative effectiveness research may provide useful information about the clinical effectiveness and costs of medical treatment options, that information is not guaranteed to lead to significant cost savings." The Congressional Budget Office calculates that between the new money spent on research and the savings derived from better information about what works and what doesn't, the net five-year cost to the federal government would be $490 million over five years. Total health care spending—public and private—the CBO says, would be reduced by $8 billion over 10 years. The CBO doesn't have a five-year number, so we'll slice that one in half."

Healthcare Business Models: Mayo Model Losing to McAllen?

An article in the New Yorker asks: Why does the border town of McAllen, Texas, spend more er person—an average Medicare enrollee there costs $15,000 per year—on health care than any U.S. city besides Miami? The author blames "across-the-board overuse of medicine," which stems from the fact that our health care system "pay[s] doctors for quantity, not quality." This overuse isn't just expensive—it's less effective. "In an odd way, this news is reassuring," the author notes: Providing better health care will also save money. 

This is a disturbing and perhaps surprising diagnosis. Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

Do Schools Kill Creativity? How do we apply creative thought in business and process improvement?

How will education play out in the future given the use of technology and information sharing?  Children starting school in 2006 will be retiring in 2065.  We aren't sure what the world will be like in five years, so how do we educate students to innovate as the world changes?

Creativity is as important in education as literacy, according to this talk at a TED conference.  This creativity, we would like to add, does not stop in the class room.  Regulatory compliance projects such as HIPAA compliance will require re-thinking process.  This is an absolute opportunity to re-design process.  By questioning how things are done we can innovate to make them better, as this video explains. 

Business Process Management Helps Companies Work Smart and Fast

BALTIMORE – The economic decline is continuing to pummel hospitals in the form of reduction of reimbursements, rise of uninsured patients and decrease in number of elective procedures for insured patients.

In this environment of balancing shrinking budgets, staff reductions and patient safety, hospitals are more open to generating efficiencies using IT. Process improvement is a good investment in times when companies need to improve efficiency.

According to an article in Heath Care IT News, "Streamlining administrative processes while continuing to invest in patient care is not mutually exclusive. Business process management, or BPM, can provide a clear view of processes across all systems, including billing, accounting and other legacy systems. "The end goal is to improve business processes running on software, doing things in the smartest and fastest ways, which automates processes, reduces resources and increases accuracy.

An additional benefit of implementing BPM is being able to document and track data in real time, which improves the process for compliance certification and audits."

By using IT to help their businesses fix process issues, C-level hospital executives can "step up and be the champions," especially in this economic environment.

No World Borders' team of BPM experts have cross-industry and cross-technology experience to help your company improve operating efficiencies, reduce cost, and improve process.

http://tinyurl.com/ceehq7

Process Excellence - Cost Savings and ROI in Health Care

According to a new Association for Information and Image Management (“AIIM”) of Silver Spring, MD study, the enterprise is not taking maximum advantage of business process management concepts.

Surprisingly, only 3% of companies felt that they had achieved "process excellence." AIIM Vice President and report co-author, Carl Frappaolo states: “This is disappointing ... Despite decades of market attention on process excellence—from the manufacturing industry, into the world of “knowledge workers”, and across all industries—it’s been a long, slow journey, and many have yet to embark on the journey. The damage lies in the fact that processes are the core of any functioning organization.”

Some of the benefits of process excellence initiatives include:

• Customer retention and satisfaction, as well as better competitive advantage are directly linked to use of business-process management practices.
• ROI via change. According to Tower Group, business that make changes based on Business Process Modeling (BPM), will see visible ROI from improved and faster operations, better employee productivity, and the ability to reach strategic objectives.
• Efficiency gains by mapping and gapping. Simply mapping and closing the process gaps between current practices and those desired can provide 30% of the operational efficiency that a company gains through the BPM initiative.

Important ingredients for operational efficiency include:

• Business and IT Alignment – Business, technology, strategies, and resources must be aligned to achieve results.
• Best-Practices Measurement – Metrics, methods, and frameworks to help you know that change management is helping to achieve business goals.
• Process Change and Innovation – Enabling the transition up the ladder of competency to CMM, ITIL or other measures fundamentally means working with people and helping them see a better way to work..
• Extending Intellectual Capital – Intellectual capital is the real wealth of organizations and this is the bottom line with Business Process Modeling (BPM) - managing people more effectively for Organizational Excellence.
• Management's commitment and leadership are key drivers for successful BPM. Technology can't replace this.

Is your company taking advantage of business process management concepts and reaching toward excellence?

Resources:

• Process excellence in your company
• White paper – The Long Tail of Process Automation

Innovation & Social Media Inside the Enterprise

Recently, the Wall Street Journal noted that Facebook is transforming journalism. This is a great segway into something we've been watching for a while. Social media is not just for social consumers anymore. Journalists can use 'friends' on Facebook as sources without filtering or the usual controlled introductions so common with media firms in the past. A publishing company is therefore using social media to become more efficient.

Similarly, the texting movement where ideas can come from the masses is taking hold in the enterprise, in several intertwined ways. See the video clip below regarding Financial Advisors who "tweet" using Twitter. The Twitter network is helping them connect better with clients. (See our blog, "Twittering in Congress")

New digital imaging products such as Flip video and Canon's new long-recording video / still cameras mean more people can contribute and share ideas among friends on social networks, but also among colleagues in the enterprise.

Finally, 'crowd sourcing' of ideas using open source computer code development, blended with the ideas above means good ideas spread rapidly. (See our blog "...Software Advertising & Innovation). In particular, open source technology is rapidly being adopted in emerging markets. These markets have less to lose by doing things the old way, and much to gain in innovation by being open to free exchanges of ideas. The developed world must embrace these concepts or be left behind. Brazil and South Africa are two examples. This has helped 'lubricate the flow of information,' and save money. Pioneers are often the last to get on the wave. North America is actually the slowest in adopting open source.

The result is an innovation renaissance just waiting to happen outside corporate firewalls. We predict that the companies whose walls do not come down will be left behind, and those enterprises that intelligently embrace social media, open source, imaging of ideas and texting tweets will thrive.

To learn more about how social media can help your organization enhance their customers' experiences, facilitate learning and improve employee productivity contact www.noworldborders.com

Below are for video clips that explain these concepts. They can be blended together powerfully in social media. (See the No World Borders blog entry Innovators in Social Media).

Click the play button below to view "Facebook Transforming Journalism"



Click the play button below to view "When Financial Managers Tweet"




click the play button below to view "Flip Video vs. Canon"




Click the play button below to view "Open Source in Emerging Markets"

Electronic Health Records and Patient Privacy, Medical Identity

Yesterday, an important message titled “Don’t Rush eHRs Without Addressing Medical ID Theft” was posted on ModernHealthcare.com by Martin Ethridgehill, formerly a provider training specialist with Blue Cross and Blue Shield of New Mexico.

Mr. Ethridgehill points out that if a patient’s electronic medical identity is stolen by someone for health insurance benefits, critical information about the patient can be imperceptibly altered, leading to accidental death in an emergency room for any number of reasons. Furthermore, he points out that even if the real patient is aware that his or her record is tainted by a false patient’s data, it is very difficult to get the comingled record cleared up.

I have also read elsewhere that HIPAA actually impedes resolution of the nightmare because the Rule also protects the privacy of the false patient - prohibiting the real patient from examining his or her own health record.

Reasons to Go Slow

Ethridgehill is particularly critical of the EHR industry which lately has downplayed the importance of patient privacy in order to sell dangerous products. He gives these reasons for the need to slow down in the rush for interoperability:

• “Adding safety and records mitigation protocols ensures patient safety as an ongoing concept and practice.”
• “No industry would be allowed to operate, where the officials in charge of it stated that the market or other bodies would be responsible for creating safety procedures. Can you imagine if the auto industry stated, “We make cars, let the market figure out how to regulate safety”? I doubt that Congress or any other body would consider these people as remotely credible, yet I hear time and time again these statements being made in public and private forums by executives, lobbyists, and even so-called healthcare leaders.”
• “For the public and providers to embrace a product that has no regulation, no built-in safeguards and obviously no importance to safety from the makers of these products, why would Congress expect the American public or healthcare providers to embrace a product or concept that involves the unregulated risk of injury, death, or staggering liability opportunities, let alone without any hope of remedy or proper relief?”

One of the keys to improving life for payors as well as providers and patients will be process innovation. This is accomplished by clearly documenting the existing or "as is" process as well as the "to be" of the desired process. That can only be accomplished with combined disciplines of technicians who know business process modeling (BPM), facilitators who are professionals that can interact with all levels of stakeholders in the health care service chain, and "content" experts who understand legal, medical, and workflow implications of making changes to major functions such as provider management or claims adjudication.

No World Borders has been consulting with several health care payors on process improvement, and preparation of the conversion of systems for electronic health records.

Business Process Engineering for Health Care Payers

The Model for Improvement,* developed by Associates in Process Improvement, is a simple yet powerful tool for accelerating improvement. The model is not meant to replace change models that organizations may already be using, but rather to accelerate improvement. This model has been used very successfully by hundreds of health care organizations in many countries to improve many different health care processes and outcomes.

The model has two parts:

• Three fundamental questions, which can be addressed in any order.
• The Plan-Do-Study-Act (PDSA) cycle** to test and implement changes in real work settings. The PDSA cycle guides the test of a change to determine if the change is an improvement.

Including the right people on a process improvement team is critical to a successful improvement effort. Teams vary in size and composition. Each organization builds teams to suit its own needs.
Forming the Team

 

 

Innovators in Social Media

BusinessWeek published one of the first articles we have seen about a trend we commented on last year - social media inside the enterprise.  Social Media will provide a powerful new way to enable organizational development and change management inside companies, particularly those with borders created by siloes.  No World Borders has been following these trends for years and it is gratifying to see main stream media cover them and legitimize them now.

"At Ford, Scott Monty is using social media to remake the automaker's image—and reinvigorate its culture 

It started out with a simple question, on blogs, Facebook, and Twitter: Who should we profile as a Voice of Innovation for social media? Names poured in. Some commenters treated it as a vote, some as an essay contest. Others, including marketing maven Seth Godin, objected to the whole exercise. "Sorry to be a curmudgeon," he wrote. "But I really like BW best when they lead the discussion, not referee it."

Still, this process was bringing in names—lots we'd never heard of—and telling us about people doing all sorts of things with social media. What was wrong with that? Only one thing. As some commenters pointed out, we cast too wide a net. Social media, after all, extends from freewheeling entrepreneurs who build new software applications to consultants laboring inside giant corporations. It includes people who use it to push a product and those who use it to further an idea or just themselves. How could all of these innovators fit into a single category? They couldn't.

So we divided social media into four categories and picked a representative of each. They are:

1) Toolmasters: Imaginative techies whose schemes and applications open new doors and lead to insights. Our toolmaster is Noah Brier, who works days in New York at Barbarian Group, an interactive marketing shop. By night, Brier, 26,pieces together new social-media apps, including Brand Tags, a Web page that shows brand names and invites visitors to describe each with a single word or phrase. The more a word is repeated, the bigger its type, making it simple to see what folks think.

2) Eyes to the World: People innovating with social media to help others. Beth Kanter is our pick. She uses every avenue on the World Wide Web to raise funds for Cambodian childrenthrough her own charity, the Sharing Foundation. And she shares what she learns with nonprofits everywhere. Kanter, 52, is also a Net pioneer. A longtime employee of the Boston Symphony, she plunged into the Internet in the early 1990s. She started tapping friends—and friends of friends—through her blog while adopting two Cambodian children in 2000.

3) Crowdstrappers: Entrepreneurs or consultants who harness new approaches in social media to reposition or invigorate businesses—either their clients' or their own. Here we selectEric Brown, who has turned his apartment business in Royal Oak, Mich., into a social media laboratory. Brown, 49, has no training in social media. But he believes in openness and hopes that the ease of communicating through blogs, Twitter, and Facebook, can turn him into a better landlord.

4) Hidden heroes: These are people working inside old-style enterprises and use social media to change the culture and operations. Our choice is Scott Monty, who heads up social media at Ford Motor (F).

You'll see more on the first three nearby. Meantime, here's a fuller story on Monty.

When Ford came looking last year for a social media maven, Scott Monty had an answer for the auto giant: No. Monty, a consultant in Joseph Jaffe's Crayon consulting company, had been living in Boston for 20 years. He got to work with lots of blue-chip clients, from Coca-Cola (KO) to American Airlines (AMR). Why move to work inside an auto company—in Detroit?

Then he started thinking. "Here was one of the most storied brands in American culture asking me to do what I liked doing specifically for them, and I said no. I'm still shaking my head about that." When he reconnected with Ford, he said yes—and since July, Monty has been busy on blogs, on Twitter, and in the hallways of Ford trying to revive the culture of a suffering industrial giant. His boss, Chief Executive Alan Mullaly, compares the transformation of Ford to "changing the tires on a car going 60 miles per hour."

Monty's challenge, as he sees it, is to communicate to the rest of the world the same lesson that he learned himself: that Ford is not a stodgy company tied to the past. "I realized that I'd fallen victim to the very thing that Ford was trying to combat," he says. "There were assumptions I'd made that just weren't true anymore. These are the things I struggle with every day. We've got a big perception problem to overcome."

His first goal is to "humanize the brand, giving Ford as many faces as possible." The most prominent face, of course, is Mulally himself, who appears to be a willing experimenter. Last month at the Detroit auto show, Monty says, he collared the CEO coming out of a meeting and asked if he would answer some questions on Twitter.

"What's Twitter?" Mulally asked.

After Monty explained, he asked his followers on Twitter for questions for the Ford CEO. Mulally stayed with him and gamely answered a few. (True, there's no sign of him yet on Twitter, but that could be a good thing: The guy is dealing with 2008 annual losses of $14.6 billion, and sales that fell 40% in January.)

Monty says he wants to "democratize social media" within Ford, deputizing tens of thousands of employees to represent the company. They have blogs, of course, and have reached out to all tech and green bloggers. But the challenge is less about technology, Monty says, than changing the culture of an organization, making it so that people aren't afraid to speak up. "It's like being at a dinner party," Monty says. "If someone says something derogatory about Ford, do you just sit there? No, you respond."