Health Affairs Blog: Health IT Initiatives: Not Magical, Just Practical

Thoughtful quasi-blogpost* from Mark Leavitt, MD, who is also the Chair of the Certification Commission for Health Information Technology (CCHIT). In the post, Mark very nicely acknolwedges the number of dedicated volunteers in the CCHIT process - I know from experience that this group is working hard and is very talented (way more than I am).

*the quasi part is that I notice that the Health Affairs blog appears (to me anyway) as more of a Web 1.0 publication with comments, than a blog in the spirit of blogs. It might be nice to tweak the HTML title tags a bit for easier embedding into other blogs, and maybe shorter, more personal posts, in the spirit of blogging. I think Health Affairs has been on the leading edge to adopt the blog format in the first place to be sure, now perhaps they could go a little farther to support interaction with the people in health policy in a more behind the curtain way…

I am always delighted to meet other physician bloggers, and such was the case with Bob Wachter, MD, who’s a physician that blogs, and from within academia. That’s rare, and welcomed, by me for sure.

He recently wrote this piece, Will Knols and Blogs Upend the Cozy World of Medical Publishing?, which echoes several ideas I have been having since I started blogging, especially around the idea of, as he calls it, “the democratization of peer review.” (I’m focusing on the comments about medical publishing - the world of Knols appears to be experiencing a rocky ride)

As I occasionally get requests to write for peer reviewed journals or books or I consider writing for them, I have been pausing to ask, “why?”

This is especially when the difference is between instant access and feedback to the people I serve, versus a smaller group of individuals with (potentially) limited experience in the ideas I’m writing about, and the medium I use to write them in. I say this without any predjudice to the publishing community - I am just not sure where physicians in my generation will fit in moving forward, unless the model is changed.

Bob refers to the difference between “Having an article peer reviewed by 3 experts is different than having 17 Joe Six-packs;” however, I’m not sure what the difference is, depending on the issue, between those two constituencies - what’s an expert in if she/he isn’t a person “just like me?” Also, what’s the value of a single (relatively speaking), private, review, that will be locked in time and space, forever? Robert Scoble speaks well to this in the post “Scoble Defends Blogging (Again), and He’s Right (Again).”

I do not work in academia, where people are incentivized/rewarded for the number of peer-reviewed publications with their names on them. I think a deeper question that should be asked, is, “What’s the best way, in this millennium, to produce portable knowledge that can be used by others?” I have talked with innovators in academia who have not shared their knowledge because of the effort required to publish to medical journals. That’s unfortunate.

How could the reward/incentive system in academia be reconfigured to respect the many different ways people can share knowledge, and put them to use to help people? I think it could be, and in turn a lot of great ideas could be unleashed.

Bob mentions in his post that he submitted his piece to two medical journals, who rejected it. However, we still get to read it thanks to Web 2.0.

I’m not even going to try with this one. And I sort of don’t have to.

March 28th through March 29th:

• WordPress ? Search and Replace « WordPress Plugins - Wordpress 2.5 is out. I have a feeling this plugin will be useful to have handy
• JAMA — Preserving Confidentiality in the Peer Review Process, March 24, 2008, DeAngelis and Thornton 0 (2008): 299.16.jed80000 - With tremendous respect for Catherine DeAngelis’ leadership during a tough situation. I am left wondering if the best place to hide is out in the open - if peer review became more Web2.0 like. What would happen in a situation like this?
• Findings From the 2007 EBRI/Commonwealth Fund Consumerism in Health Survey - EBRI - About 2 percent of the population is enrolled in a consumer directed health plans. Significant points for me: (1) almost half of the population with a chronic condition reports not filling medications or skipping doses or delaying care due to cost. Sobering reminder that patients can and do choose to do what we doctors prescribe. (2) “There have been no significant gains int he provision of information on provider cost and quality by any health plan type over the three years of the survey. There has been no increase in the share of CDHP or HDHP enrollees who say their health plans provide them with quality and cost information about their providers, and they remain no more likely to receive such information than enrollees in more comprehensive plans.” Okay, one more point - they did not ask about the impact of involvement in care in choosing a health plan - no mention of medical records access or involvement in information sharing at the level of the encounter.
• My Starbucks Idea - How about doing this for a health care org?
• Bronson Beta - Mail.appetizer - Nice Mail notification tool, Leopard

February 15th through February 16th:

The first few links are from the history of diversity in various industries’ and their impact on quality, affordability, and safety.

• “Fly Me” - TIME - National Airlines pleads innocence in 1971 to the “Fly Me” campaign despite flight attendant protests.
• Classic TV Commercial Jingles: Braniff presents “The Air Strip” - A commercial dubbed “outrageously sexist” for its portrayal of flight attendants.
• Coffee, Tea or Tails? - TIME - Article from 1974 about Continental’s “We Move our Tails For You” ad campaign
• Health Care Renewal: GE: We Bring More Conflicts (of Interest) to Light - An example of a purchaser that struggles with supporting an affordable care system, and supporting an un-affordable care system at the same time.
• No Pharma Funding | When Memorial Sloan-Kettering Cancer Center in New York City stopped accepting commercial support for its continuing medical education activities last January, many at the institution had their doubts that the program would survive - CME without industry support is possible. I would tend to favor events that are less fancy and have less bias.
• apophenia: open-access is the future: boycott locked-down academic journals - A more assertive argument around locked down journals.
• Running a hospital: You can take your $15 fee and … ! - I wonder how relevant peer review is in general. I am going to start a tag cloud on this and keep track.