When I listened to the very talented Associate Medical Director of Quality & Informatics, Matt Handley, MD (okay, he’s my boss), speak on a panel about Patient Safety on Seattle’s KUOW, one thing stood out very clearly to me. As the leader accountable for quality and safety activities for the organization, his first comments were about the value of the personal health record to the organization. This is in consideration of the numerous activities that Group Health undertakes every day on behalf of its members. He chose to lead off a discussion of the impact of the online personal health record (PHR).

This says something very significant about the value of a PHR when it is integrated into the workflow of an “ideal” health system, in terms of aligned incentives.

I encourage readers to listen to the broadcast and notice how each system leader addresses the issue of patient safety, and compare their approaches. If you were asked by the media to comment about your organizations’ efforts to promote patient safety, what would you lead off with? How would you conceptualize the value of a PHR in your answer (whether or not you currently operate one)?

As every CIO should do periodically, I have reviewed the technology platform that I use to do what I do. As I posted when I started, I have set up criteria and a stable of technology to help me out.

I reviewed the list again, and it’s been pretty stable. Peter Drucker says that a person should write down their major decisions and revisit them 6 months later as a self-evaluation. So far so good.

The only potential change in what’s there now is Office 2008 from Microsoft, but as I stated previously, that software has been deprecated in my life by the Apple iWork suite. Actually, that has been deprecated by TextEdit for my wordprocessor. Sign of times in the Web2.0 world. Maybe if iWork stored its documents in the cloud in Google docs, that would be compelling?

New Tools, Zotero and del.icio.us

I am adding a few new tools to the mix, Zotero, which is an open source reference management tool that’s a plugin to the Firefox browser, and I have previously added del.icio.us for link storage and tagging. Both compete with tools like Endnote for maintaining and formatting bibliographic references. If you are someone who manages references to things and are asked, “Can I get a link to that article you mentioned yesterday?” you know what I’m talking about.

Zotero offers built in integration to the Web browser, although it stores its data locally on the hard drive. It offers a more versatile storage methodology by adding a button to the Web browser that causes it to scrub the page you are looking at for reference information. It’s fairly accurate. I would be delighted to see a few things added to it, though:

1. A blogging integration tool, to automatically place a zotero-stored reference in a blog post, formatted with hyperlinks, correctly. Right now, all I see is the reverse, plugins to make blog posts visible to Zotero for storage.
2. Integration with deli.ico.us. Del.icio.us stores its info in the cloud, with user tags. It’s hard to maintain two sets of tags. At least, the two platforms could synchronize tags, or Zotero could upload abstract information to a person’s del.icio.us account.

These are not huge considerations. I experimented with embedding metadata in posts that allow references to be picked up by other Zotero users. Try it out by going to this blog post once you’ve installed Zotero. You’ll see the references light up when you hit the Zotero button. Not bad.

It looks like they are working on a Zotero server, to allow enterprise storage and retrieval. This would be great for large medical group organizations, to be able to have access to personal libraries wherever they are practicing. My worry is that institutional IT departments who are still relatively Web2.0-anxious, will not know how to bring this in.

Thinking about Enterprise IT

I always have to relate what I do at the micro level to the macro level (which is what my day job is). From what I’ve learned about what I’m doing, I wonder two things. What if an IT department actually reviewed every tool it has deployed on a regular basis and with honesty assessed the utility of each tool. That’s the first thing. The second thing is if an IT Department sat down and applied the criteria I used in my tool selection and built an enterprise IT from the ground up this way? What would it look like? Has anyone done this?

As a reminder, here are my criteria:

• Open source or public source (avoid proprietary standards)
• Affordable
• Web 2.0 friendly (maybe I’ll create Web 3.0) - incorporating social networking, tagging, interaction
• Easy to maintain (and maybe to tinker with)
• Compatible with Apple, Inc., produced products (which typically means open standards)

The Web2.0 “healing feeling” ecosystem could be leveraged with great benefit in large organizations this way.

Comments are open. Tell me what you think.