by Jeff McKune

Tony posted an entry about HealthVault, and it looks like Microsoft has multiple healthcare irons in the fire. HealthVault appears to be more of a consumer oriented PHR platform, while Azyxxi is a data warehousing and query tool that is directed at healthcare organizations such as hospitals. It should not be any surprise that the healthcare industry has caught the eye of one of the world's largest information technology companies. We hope to see a demonstration of Azyxxi soon, and one of us will provide an update with additional details at that time.

To add to the discussion regarding using generalized networking tools such as Facebook in a healthcare context, we should mention the Joint Commission's most recent efforts. The Joint Commission has started a wiki called WikiHealthCare based on the TWiki enterprise collaboration and knowledge management solution. A wiki is a tool that allows knowledge to be shared and edited by multiple contributors. Wikipedia is good example of a very popular wiki.

It looks like smoking cessation was the sprout from which WikiHealthCare grew, and it now includes the following general discussion categories:

Quality Improvement Discussion & Solutions
Smoking Cessation Counseling Programs
Smoke Free Hospital Campus

Standards Development & Research
The Transfer of Health Information
Pharmacist Review and Use of Protocols for Contrast Agents in Radiology
Microsystems and Patient-Centered Care

WikiHealthCare was announced on September 12 and in less than a month, there are 2,774 registered users of the system.

It would seem that the vision of online collaboration using multiple information technology tools and covering a wide variety of consumer and management healthcare topics is unfolding as we discuss this. So what will the future bring as these systems develop? The key concepts of integration, consumerism, transparency, and quality will no doubt shape these systems. Will there continue to be separate and distinct physician, hospital management, and patient wikis, blogs, and networking tools? These are growing now, but I believe that we are not very far from a time when patients, physicians, and hospital administrators will be sharing information, expectations, challenges, and collaborative solutions using these online tools. You may be seeing some of this already at your hospital.

The technical walls for sharing information are, for all practical purposes, non-existent. The expansive school of hard knocks, coupled with business models that demand trust (HealthVault won't stand a chance if there is a breach), are forcing companies to more stringently address online security issues. It's not technical and security bricks in these walls - it is more likely legal and cultural issues that hinder open communications.

The pieces are falling into place. How will this change health care when we all sit down at the virtual table and talk on a global scale? It sounds sci-fi, but it isn't. It's happening.

by Nick Jacobs

On my hospital blog (Windberblog.typepad.com), my entry this week was about twisted truths, not ours, but others. As the art of spin has become more and more refined, we begin to reach a point in communications where reality is whatever the loudest voiced pundit can emphasis the longest and the most intently. This practice has become true in health care as well. Especially in areas of high competition.

Last year I wrote another blog about an author by the name of S. I. Hayakawa and his book, Language in Thought and Action. As a freshmen college student my impression of the book was that it was about thought and mind control through the use of disinformation.

"The original version of this book, published in 1941, was in many respects a response to the dangers of propaganda, especially as exemplified in Hitler's success in persuading millions to share his maniacal and destructive views. It was the writer's conviction . . . that everyone needs to have a habitually critical attitude towards language — his own as well as that of others — both for the sake of his personal well-being and for his adequate functioning as a citizen.

The reality now, however, is that this art has evolved into a science, and the science has become an accepted part of our world. It is fascinating to observe the use of disinformation as a means to attract patients, to see the truth twisted just enough to confuse the public so as to appeal to their lack of technical and medical knowledge through misrepresentations that lead to business.

A few weeks ago, one of our visiting sub specialists told a patient that they had to be transferred from our facility because we didn't have the necessary equipment for his surgery. As it turned out, the piece of equipment was an orthopedic nail that, had we not had cases of them, could have been delivered almost instantly by a local sales rep. The reality is that a competitor requires each surgeon to do a certain number of surgeries each day that they have scheduled. If they do not, they will have a decreased number of slots to work from in the future that are exclusively designated for their use.

What is the definition of an Open MRI? It is not a larger bore device, it is, indeed, open. Who cares? A facility that has purchased a larger bore device cares. Say that it is OPEN, confuse the public, and take business away from the facilities who purchased the OPEN MRI. A nuance, you say? A tiny twist, you think? Well, if you have a $34,000 a month payment to make, it is just good business, right? Twist to sell.

Finally, we hear, everyday, the little whispers about skill level. Perception is reality, and unless or until total and complete transparency becomes the guiding light of health care, we will be in the same boat that we were in before "Consumer Reports."

Buy our gasoline, "It will put a tiger in your tank!" It wasn't that long ago when we believed that there was a huge difference between the quality of different brands in that business as well, at least we believed that until we were informed that all of the gas was coming from the same refinery or, in some cases, all of the stations were being fed from the same truck!

Bring on open communication, just don't let some of the major, existing evaluators take the lead. They are from a different paradigm, a world where, many times the twisted, interpreted detail is the basis for a pronouncement that has no bearing on the reality of the care.

by Tony Chen

Last week, I posted an entry on the most innovative hospital in the country. Today let's see what we can learn from the most innovative retailer in the world - do you know who it is? What store makes more revenue per square foot than Tiffany & Co, Best Buy, Neuman Marcus, and Saks? You might not intuitively think that the masters of product design are also masters of retail:

Apple is the best retailer in America, making more than $4,000 of annual sales per square foot in 2006. (Tiffany's is 2nd, at a mere $2,666 per sq ft) Read this great article in Fortune on how Apple came to make the controversial decision to go into retail and how they nailed it.

One the most important things Apple did was to build a store in their warehouse for testing. In other words, they approach store concept/design the same way they approach their product design. It has to be human-centric. Among many other insights, here were a few key take-aways for me:

- They designed the store around customer needs, not around product functionality. Their first "test-store-in-a-warehouse" was laid out by product category (i.e. how their company is structured internally). Immediately they knew it wasn't going work - people don't care about the actual machine/hardware, they just care about what they can do with it.
- They learned one of their best insights from outside of retail - hotels. When asked to name the "best service experience", 16 of 18 focus group participants named hotels. So, to inject that Four Seasons flavor of friendliness/service, they added the "Genius Bar" - "let's put a bar in our stores. But instead of dispensing alcohol, we dispense advice."
- They focused only on 20 products, and cut all the other clutter. Computers are complex enough - they keep it visually simple and attractive.
- They paid a premium for the best locations. And by best locations, it is mainly accessibility and visibility. They realized most people won't invest 20 minutes to drop by an Apple store, but they may invest 20 footsteps. Once they're in, the store, the service, and products are pretty compelling.

We all know that hospitals of the future will be drastically more retail than it is now. So, what questions should we be asking as we put together a hospital retail strategy? The main take-away for me is the laser-sharp focus on the consumer. Every little detail about how the store is designed is to add value to the consumer - learning about new products, having an "aha!" moment, getting some small bug fixed. Yes, it costs more to design it, the build it, and to operate it. But their results speak for themselves - their closest competitor has to increase revenue per square foot by 50% to match them.

In some sense, hospitals have been following this advice, except that we've treated the physicians as the end-user, not the patient.

And rightfully so, as thus far, it's really the physician who has more choice and can shop around. Nonetheless, Apple has shown us that everyday consumers notice when things are designed just for them - they vote with feet and will eventually rule (or at least largely influence) the healthcare landscape.

by Nick Jacobs

The book, Change or Die by Alan Deutschman, tells a story of three very different situations that prove that the title can, but rarely does happen. The author quotes the fact that, although we may be faced with the alternative of changing or dying, we are plagued with the reality that only about 10% of us are truly ever able to personally make that change. Mr. Deutschman takes us through three examples of an organization, a leader, and a physician who have helped hundreds of us beat those odds: Heart Patients, Criminals and Workers.

He examines the patients of Dr. Dean Ornish's Coronary Artery Disease Reversal Program (which has been in place at Windber Medical Center since 1999), the criminals who are participating in an effort to rehabilitate themselves under the guiding principles established by Dr. Mimi Silbert at Delancey Street in San Francisco, and the members of the United Auto Workers who were employed at a GMC plant at Fremont that was so hopeless mired in its own controversy that it was closed by GM. It was later re-opened by Toyota as a successful manufacturing plant equipped with the same basic tools and machines and 50% fewer employees, but the vast majority of them were exactly the same union employees who worked in that same failed factory for GM.

It's an interesting journey into human nature, the circle of failure and hopelessness, and the promise of hope that has always been a part of achievement and growth, of success and positive persistence, of debunking old myths and replacing them with empowerment. He embraces the three keys of relate, repeat and re frame to help us make positive changes in our lives.

If, like me, you are a little overweight, have high blood pressure, high cholesterol, a lousy set of genes and are a mouse potato (sit around too much with your computer), you might want to read this book and then, like the journey that I began in 1997 under Dr. Ornish's direction either "Change or DIE."

By Jared Johnson

The latest public hospital data Web site has made it to the Lone Star State, but the jury's still out about just how helpful it will be to consumers. Texas Price Point, sister to Price Point sites in at least 8 other states (IA, NH, NM, OR, UT, VA, WA, WI), is due to go live at the end of February. Most, if not all, are products of those states' hospital associations in an effort to "allow users to view and compare pricing information on common inpatient services."

I was able to take a test drive this week and it felt like I was handed the keys to the car and told to drive wherever my heart pleases. Some call this freedom or empowerment; others might say it's plain intimidating. Price Point includes median hospital charges for over 60 procedures, and they give you turn-by-turn navigation to find the ones you want.

Reaction has been mixed in other states (see Jeff Sturgeon in The Roanoke Times and Heidi Toth in The Provo Daily Herald). The following editorial from the Clinton (IA) Herald on February 1, 2007 is the best assessment I've seen:

In a free market society, it may seem ideal to let patients treat hospitals like a retail store, shopping around for the best price in order to save a buck here and there. However, medical care is much more complicated than that…

…It ought to be clear by now that this isn't the same as knowing how much a gallon of milk costs at Hy-Vee, Jewel and Fareway.

But still, Web site's [sic] like PricePoint are an important step in helping the consumer make educated choices. Health care is something everyone needs and one of the biggest headaches for the state and federal governments. The insurance business is a behemoth that sometimes appears too big for its own good, but it's the only real system we've got and can't be abandoned until a better solution is found.

The topic is confusing, to be sure, but having these conversations and exposing the many factors that boggle the mind are the best way to work toward getting everything cleared up for future generations.

I am rooting for Texas Price Point, and I hope it meets its objectives. My main question is how Joe Consumer will use this information. I can see him deluging the billing office with questions about why his charge is different than what's listed online. It opens more than a can of worms — more like a 50-gallon drum.

Still, the father of Price Point — Wisconsin Hospital Association's Stephen Brenton — pointed out to the House Ways and Means Subcommittee last summer that hospitals are doing their part to make prices available to consumers. That's one reason Price Point doesn't have to be all-inclusive. It is an effectual step toward transparency, not the ultimate answer.

Count me on the bandwagon.