Medical Education Evolution - New Social Network on Ning devoted to improving medical education in the 21st Century, thanks to Jen McCabe Gorman for setting this up. Hosted on the Ning platform - if you are interested in reforming medical education please join.

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• Essay - Fed Up With the Frustrations, More Doctors Change Course - NYTimes.com - I am sympathetic, and this is the reason I champion LEAN wherever I go - the processes we use in health care can be changed, and we can involve patients and our families so that everyone works together to be healthy. The challenge for physicians is that we are not trained at all in process improvement, so we usually enter environments with broken processes, and manage these situations with the training we have been given, which doesn’t lend to collaboration. See this blog entry for examples of extreme challenges in our medical education system today. I sometimes say that we’re all actors in a play that has a script we didn’t write. Let’s rewrite the script (patients and their families included).

  If anyone wants to collaborate on a medical student rotation looking at LEAN concepts / process improvement / patient centered care / respect for staff and customer, let me know. This presumes that there’s a medical school either teaching this or interested in this. Is there?

I have been intrigued by EMC’s work in managing an employee personal health record - it seems above and beyond (in a good way) how an human resources function and grow and support talent. Also, time to upgrade Office for Mac. It went OK. I’ll update “my own CIO” tools list in the near future.

• Employers Find Benefits with PHRs - More info about EMC and its employee PHR
• News - - Gainesville.com: Dean admits student without backing - It’s interesting that this is posted in the entertainment section. That aside, this looks concerning. I don’t understand how a student is admitted to medical school on a personal recommendation, and without taking the MCAT. How will we have a diverse medi
• Event Calendar - A way to put upcoming events on a wordpress blog
• TimeDriver - Coming Soon! A revolutionary online personal appointment scheduler - A very high potential meeting scheduling package. Given that Timebridge only allows 5 slots to be determined, this looks very interesting.
• GE Healthcare-Press Release-NCHL and GE’s Institute for Transformational Leadership - I didn’t know about GE’s work in this area. It looks like they are doing work in LEAN as well as Six-Sigma, which they are known for.
• Report cites UA med school crisis | www.azstarnet.com ® - Sad news from my alma mater, related to the difficulties medical schools are having balancing revenue and their mission.
• D.C. Not-for-Profit Offers Model for IT Adoption - iHealthBeat - More progress in DCPCA’s EHR adoption efforts
• Burlington Free Press.com | Fletcher Allen’s new EHR - Fletcher Allen in Vermont gets approval to go ahead. I believe this is an Epic Systems install, bringing with it the possibility for excellent patient engagement with their health system as a result.
• Database Problem with Office 2008 for Mac - Office 2008 Install problems, just in case

Imagine that you are going to launch a new program, like patient access to their medical record online, and a visitor from another institution asks for a tour of the work in progress. Then imagine that it isn’t a member of the staff that does the demo - it is one of your patients. I think this idea would sound foreign to most organizations. It’s pretty normal here, and Christine did a great job, on her own, without any oversight or hand holding. This is the level of trust that exists here.

Images, click any to see larger

I have actually never had a patient demonstrate their own access to the electronic health record to me. This was the first time in my career. I am so used to doing the demos and describing what patients want, and this was so different because it included the things that worked best, but also the hopes and dreams for using this tool to be involved in care. Christine not only did the demonstration for me, but also 3 Medical College of Georgia Students, and part of the research team on a funded project to introduce patient access into hypertension care.

In the hopes and dreams part, Christine talked about uses of the system that we might consider concerning as medical professionals, such as writing messages that conveyed a significant level of concern about her condition (she lives with MS), but when she explained it, it made sense, and it became not so concerning.

This was a theme throughout the visit - the normalcy of patient and family involvement in care. This was very evident in the 3W Neurosciences unit and Ambulatory clinic. Countertops are reduced or eliminated. The layout is open. There is no such thing as “visiting hours.” Signage is welcoming and participation is encouraged. There are alcoves for family conferences, and even computers set up for families to use. There is guest wireless throughout the hospital.

As you watch the Remaking of American Medicine show and look at the data associated with this tranformation, it’s very clear this is not only good for families and patients (and society), it’s good for business. Quality is up, mortality is down, patient satisfaction is up, profits are up - all the right trends for a hospital serving a vital population like this.

This organization of course is part of a health care system with many challenges - physicians and nurses have significant time challenges, and even the physicians in training here are at risk in terms of their future enjoyment of the profession. I casually ran my idea of a 4th year rotation on patient-centered care (which would include elements of LEAN such as process flow, physician leadership, and service and access methods) with our student hosts, and they provided a little balance to the concept and assistance with messaging. Matt, Kim, and Brandi reminded me about the immediate needs of physicians in training and the way that they learn about and commit to new training experiences. I’d therefore like to propose a rotation on success in practice beyond the diagnosis - enjoying work, life, and balancing both successfully. Being patient centered guarantees that this is the outcome for any physician, in my opinion.

The thing I am super interested whenever I meet people who have done exceptional things is, “Why?” I noticed that in the PBS show, Medical College of Georgia was an institution in which their transformation was not set off by a patient tragedy. So I asked Pat about this and here’s what she said:

What started this and kept it going and I may have told you this in a way is that we developed a value around the inclusion of the patients voice in our work from the beginning of the design process for the new childrens hospital. I personally was a senior executive back then and I was utterly transformed by the power of the patient’s (in this case, parents and children) perspective on what mattered most in care and I could see that this was a strength that we were denying ourselves as executive leadership. We also had very good mentors way back then in Bev Johnson and the Institute for Family Centered Care and I think we were just open to learning. Because I became so committed and over time could show the hard results in terms of outcomes so did the rest of our leadership. I think it is really that simple….just persistence over many years, Ted.

I think this is very remarkable - Pat and the Medical College of Georgia did not wait for a patient to be hurt to transform their system. I keep reading and hearing about organizations that transform only after a tragedy. We’re health care, we cannot wait for a tragedy, right?

When we were touring 3West, Pat, Roslyn, and Bernard showed me a plaque, signed by every staff member that represents their commitment to patient and family centered care. The first thing I did was look at the date that it was first signed, and of course wondered if it was up to date. As I did that Roslyn said, “Whenever we get new staff, they add their signatures, too. We haven’t had new staff in a long time, though, because people stay here.”

I can’t wait to see the innovation that will come from Medical College of Georgia in the launch of their patient access system. This will take Patient and Family Centered Care beyond their physical buildings and wherever patients and families live, work, and play.

With thanks again to the patients, families, staff, physician and leadership at MCG for being great teachers, so that every patient and family can be involved in their care, whether or not they are fortunate to be supported by the MCG Health System.

And, I am not going to consider patient access to their medical record successful until a patient does the demo.

• iCal Reply Checker | John Maisey - A little tweak for my own CIO to work with exchange clients
• Five whys - Quick guide to using the Five Why’s technique to get to root cause in strategy deployment
• Fishbone diagrams - Handy guide to using this hoshin kanri tool
• Common Examples of Healthcare IT Failure - Interesting case studies of HIT that didn’t go so well
• Definitions of Medical Informatics - Useful observations on the role of medical and nursing professionals in informatics
• Presentation Zen: FEMA chart becomes brunt of joke. - Jon Stewart brings chartjunk to light in his comments on FEMA
• Cravens Advertising - Ten Things > Disaster Chart - Infamous FEMA Disaster Chart, example of Powerpoint chartjunk

February 18th through February 19th:

• Graffletopia - Nice set of stencils for Mac users of diagramming software
• Lean Manufacturing Blog, Kaizen Articles and Advice | Gemba Panta Rei - Primer on Hoshin and SMART goals
• Life as a Healthcare CIO: Rapid Application Development with Facebook - Looking at innovative consumer technologies as an opportunity in the CIO role is a great thing. I’m a fan.
• Hooked: Ethics, Medicine, and Pharma: Institutional Conflicts of Interest Policies: Some Assembly Required - This tracks back to medical schools’ support of community health…
• Health Care Renewal: Medical Schools to Faculty: “Show Me the Money” - The contribution of medical education to fostering patient centered care is challenged by the current system.

This was a question that was asked of me by a generalist physician colleague at the Robert Wood Johnson Foundation-sponsored workshop that I am attending in Princeton, NJ.

The question is part of a theme of work being undertaken by leaders here, and also in my travels in the last several months now. What about primary care and how should it be supported?

So I thought about this overnight. I am a family practitioner. I went to medical school hoping to be a family practitioner. I left medical school hoping to be a family practitioner. My interest in being a family practitioner is to provide patient and family-centered care, and promote it in my profession and in all of health care, in order to reduce disparities. This is really what’s at the heart of all of my work in health information technology.

I would therefore pursue a different question, which is, “How do I feel about any medical school that doesn’t teach patient and family-centered care?” My answer would be similar to the question, “How do I feel about a health system that doesn’t involve patients and families in their care?”

A family practice department and a transparent health system go hand in hand with a patient centered approach. We should continue to support the thinking about patient-centered approach in every educational institution. A sign on a door doesn’t make that happen. It’s the icing on the cake.

It has been a delight to spend time with fellow alumni of Robert Wood Johnson Foundation fellowship programs this week. We are sharing a diversity of health issues and interests with each other. The thing that our interests have in common, in my opinion, is the desire to support a health system that respects patients, their families, and their communities. The experience has been very affirming of the Foundation’s commitment to health and health care.

• RIAA Unfairly Maligned? Give Me a Break. - More on the RIAA and attempts to manage disruption, from Mashable.
• Characteristics of Recipients of Free Prescription Drug Samples: A Nationally Representative Analysis — Cutrona et al., 10.2105/AJPH.2007.114249 — American Journal of Public Health - Study demonstrating that free drug samples are not a safety net. In my practice career I have never used samples (and I’ve never prescribed celecoxib or rofecoxib, either).
• Health Affairs — eLetters for Walker et al., 0 (2005) 5101 - Comment on interoperable HIT being a net gain/loss for physicians, by Peter Basch, MD, of Medstar Health. I agree that we have to be cautious of theorized benefit in this case.
• Health Affairs — eLetters for Adler-Milstein et al., 0 (2007) 271601 - Comment from Peter Basch, MD, about the sequencing and business case for RHIOs not being ready yet.
• Dupont Circle Citizens Association - Learning more about my community. There has been an uptick in crime, unfortunately.

One of my interests in improving the affordability of health care and process transformation is in the affordability of health information technology. With that in mind, I am starting a link cloud for items concerning Apple, Inc., products in enterprise computing environments. Feel free to subscribe via RSS or comment here with additional resources/information.

December 19th through December 21st:

• YouTube - CNBC’s graphics SAN using Apple XServe - CNBC adopts Apple technology for enterprise storage
• MacDailyNews - U.S. Army enlists Apple Mac for increased security - The Army is making it easier to adopt Macs
• Web 3.0 and medicine — Giustini 335 (7633): 1273 — BMJ - Hope that web 3.0 will return us to “time honoured principles of the (medical library) profession.” I worry about statements like that, without any disrespect to librarians, which I am a huge fan of.
• Pegasystems offers PLM process framework - Computer Business Review - Noted: Group Health as an early adopter
• Johns Hopkins Public Health Magazine | Fix This Mess - More on where we came from, including the history of Insurance.

December 13th through December 14th:

• The Information Technology & Innovation Foundation: Why a dose of IT May be…. - Another discussion of suggested direction for Health Care IT, and where Interoperability fits
• Neil Calman MD: HIT before HIE (and not without my knowing what?s out there about ME) - A blog post that I have read and referenced a few times about HIT and HIE.
• Medicare Spending, The Physician Workforce, and Beneficiarie’ Quality of Care - Impact of physician workforce mix on Medicare beneficiaries’ care.
• The Atlantic Monthly: Overdose - Argument that the physician shortage is really a glut, of specialists
• Vote on Mass. retail medical clinics delayed again - The Boston Globe - MinuteClinics coming to Massachussetts. Reference to data around standardized sore throat care.
• NPR : Washington, D.C. Facing HIV/AIDS Epidemic - Information about HIV/AIDS in Washington, DC