March 18th through March 19th:

• The ‘World Wide Computer’?Another HAL? - Businessweek’s Review of “The Big Switch” - I used it for comparison
• NPR: Doctor Blogs Raise Concerns About Patient Privacy - I agree with points raised - a patient should never seek care and then discover that they have been written about on a blog. Instead, they should receive a copy of the medical record that has been created about them. At the same time, physician bloggers are doing something very important - they are testing the boundaries of transparency, to support a more accountable health care system. If anyone saw the 60 minutes story about Dennis Quaid and his family, the rationale for this become very clear.
• What Every Physician Should Know About the RUC - January 2008 - Family Practice Management - The information is useful. As primary care providers I think we need to be careful to include our specialty colleagues in the conversation, not distance themselves from it. As a member of a large multispecialty medical group, I know that there is interest across the physician community in supporting community health and the best experience for patients.
• MindBlizzard blog: Virtual Healthcare 2: Palomar Pomerado Health - All right - More news about the utility of Second Life - testing a hospital before it launches
• What is the ROI on employee suggestion systems? - A nice example from the toothpaste industry. But not necessarily one that supports the evidence, that far less toothpaste than people think is needed to protect teeth…..Maybe a customer suggestion system might be in order.

I had an interesting retail experience last week when I went to find Washington, DC’s Lululemon Store, to buy a piece of workout clothing (healthy for life…).

I had a tough time finding it (hint, don’t rely on Google maps, the address on the Web site is the right one), which seemed odd for a store in a rapidly growing national chain. When I finally found the nondescript signage, I noted a decor that was definitely staff inspired, along with a community feel - free yoga classes on site? This was not what I had encountered in either the Vancouver, BC or just-opened Seattle, Washington store. I asked, what was this all about?

Here’s what I learned (and please forgive me, official Lululemon representatives, if I am not 100% accurate, I was impressed): This is not a store, it’s a “showroom,” designed to build experience operating the business in the community. With success, the showroom will be replaced with a store. However, the showroom is a store also - products can be purchased and staff are available to provide a full level of service. On certain nights of the week, they invite local yoga instructors in, clear the floor, and have a class right in the space, at no additional charge.

As I tried on and purchased my garment, I thought about how this could work in health care. What if an organization set up a health care showroom, where practitioners could work in a lower-overhead space to get to know their community, in anticipation of a full service operation? Just like with this showroom, there would be minimum functionality, such as functioning information technology, appropriate licensing, etc. However, prior to making a big investment, an organization could understand the distinct needs of the community, and maybe involve them in creating a functioning medical center.

I like the concept, especially if we believe that 80 % of all the health care delivered in the United States is done by patients themselves. A health care showroom might introduce the community to itself, in terms of self-management resources or even physical activities. Maybe doctors new to a community could go for walks with patients to talk physical fitness, nutrition, and healthy living where they live and work prior to settling in for a new practice. Why not?

I took the liberty to copy the job description of a Lululemon Showroom Manager and am posting it below. What would the Showroom Manager of a new health care center be responsible for?

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While in New York City this week, I happened to attend the (first?) iPhone Developer Summit, thanks to a free pass and a little wiggle room in my schedule.

I didn’t go because I am planning to learn Objective C and develop for the iPhone. I went because I wanted to see what the developer community is thinking, and I have to say I was impressed with what I saw. I sat in on a session about the new iPhone SDK and the audience looked almost to me like a group of doctors that are sitting in a room to learn about electronic health records and realizing that their lives are going to change.

There was discussion of the iPhone platform, which has far more computing power and graphics capability than any other handheld that has preceded it, coupled with the fact that Apple, Inc., has made it easier than ever for developers to distribute their applications quickly and efficiently through iTunes. Nothing like this has ever existed on other mobile platforms.

I sensed a tone of quiet resignation coupled with excitement that this will be the next revolution in computing. At the same time, the teaching was about the very basics of developing for the iPhone so it’s very early in the journey. I learned a few things, like the fact that the iPhone you use to develop on will need to be disconnected from the AT&T cellular network, so basically you will need to purchase a phone specifically for development. The SDK requires that you have a Mac running Leopard - you cannot develop on a Windows box. And an interesting revelation that was not well covered previously - the iPod Touch is also a platform for this SDK. This means that an enterprise developer could create internal applications that run off of Wi-Fi, decoupled from phone service. That’s a big deal.

After taking in this scene, I wandered with a colleague over to the Apple Store on Fifth Avenue, which provided more evidence of a transformation coming. The store was packed beyond all recognition. There was a long feeder line of customers waiting to buy things. And yet the store made all of the products available to customers and potential customers to enjoy at their leisure.

There’s something going on here. Click on any of the pictures to see them full size, and the video below to get a sense yourself.