First the good, my tacos took week 1! Thanks to everyone who voted!

Now the bad, it has become apparent that no one really likes the idea of confit of lambs tongue… although it’s not too late. Come on people, it’s just a muscle like any other cut of meat. Did we give up when the German’s bombed Pearl Harbor? “Over, did you say over? Nothing is over until we say it is!” So get over to RVA News and VOTE DAWSON!

From my entry for this week:

Ok, I’ll admit it. There is a certain stigma with offal. The problem with the 5th quarter, as our Italian friends often refer to organ meats, is they remind us so much of…well… us. But before you go sticking your tongue out in disgust, I implore you to try an experiment with me. Every time I use “tongues” below, substitute “duck leg”. Then, ask yourself, what is really different about eating the equivalent of a quadricep vs. any other muscle?

After the silence of these Virginia lambs, the tongues spent what can only be likened to a weekend at the spa: 24 hours in a salt water bath before being blanketed in a liberal snowfall of coarse kosher salt, thyme, and garlic over night. Next they went into a vacuum bag with some black tea leaves, juniper, and bacon fat, and took a plunge in the sous vide hot tub for 10 hours at 162 F. While they rested, some par-boiled potatoes, straight from my dad’s garden in Bedford county, were glazed in the cooking liquid from the tongues. The dish came together with some garlicky, sticky, slow cooked brussels sprouts. Some fennel was warmed in the separated bacon fat. The tongues got a final quick fry in some butter and were plated with a reduction of the cooking liquid and a whole grain mustard vinaigrette.

If I could have, I would have cooked the tongues longer. You’ll be surprised to find out there are not a lot of guides for sous vide of lambs tongue online. I think 18 hours would have made them meltingly tender. As it was, they had the texture of a medium rare steak, not unpleasant at all.

I’ve posted more pictures over on flickr

Lately, I have been inspired by the Ritz Carlton’s use of “guest tweeters;” ladies and gentleman outside of their core communications team who take over the reigns on behalf of the organization. Having different members of the organization represent the company gives a chance to highlight regions and specific properties. Hospitals, even single facility systems, are not much different. Using guest tweeters, or “social media ambassadors” is a great way to add some dynamic range to what you are sharing online. Recently we tried something similar in our Richmond market. If success can be measured in sentiment, we felt energized by the pilot.

There are many reasons to consider cultivating social media ambassadors. For starters, no [person] is an island. Even with best efforts, it is difficult for any one person to represent an entire healthcare organization. The most seasoned healthcare communicators may still be clinically novice; having a nurse tweet for a day could be a detailed look at a clinical topic. Interviews and quotes from various departments or experts give a sense of a topic. Allowing those same groups to run the show for a few hours or days lets them to take a much deeper dive. Showcasing someone else’s voice in the mix also keeps things fresh and interesting. The way someone talks passionately about their own work is always more stimulating that listening to someone else try and represent it for them. Finally, cultivating a group of ambassadors helps organizations develop a base of pitch hitters and trusted spokes people. (I’ve written before about empowering employees to speak for the organization.)

The logistics and mechanics of a social media ambassador program is fairly straight forward. Just like any successful project, coaching and a partnership will go a long way. Start with a simple, one page document. It should include an overview of the tools (twitter, Facebook, etc) and terms (retweets, direct messages, likes, etc). It should also spell out, in lay terms, the organizations communications guidelines. For example, thank everyone, even those with negative feedback, or don’t engage in political banter. Finally, it should define expectations of what is on and what is off limits. For instance, you may want your ambassadors responding to general comments and you may ask them to avoid replying to anything negative. Perhaps you stay “on call” and formulate any replies together, ensuring that the organization is well represented along with the guest’s voice. Regardless of the plan, spell out out.

In addition to coaching the experience for online ambassadors, it is important to make sure they understand the tools they are using. Many will already be familiar with Facebook, making it easy to turn “Wellness Wednesday” over to your wellness team. They may not have administrated a page, something that is easy to walk through in a 30 minute coaching session. The same goes for Twitter. Tools like Hootsuite can help and give some control. They can also be tedious for new users to pick up quickly.

A good policy and agreement of expectations will help the governance process. That said, turning over the controls should not mean abdicating responsibility. It is important for those responsible for social media to watch the flow of the posts and conversation. Maintain close contact with your guest posters and make yourself available to answer any questions they have along the way.

Take a page from the Ritz Carlton’s play book and find some social media ambassadors. Hold their hands through the process and you’ll be well rewarded. Your social media stream will get a fresh voice, some deeper perspectives and you’ll be training a whole team of spokespeople in the process.

Note: I’ve been working on a mind map of the ideal mobile application for healthcare providers. Ideal of course being a subject measure. Part of ideal in my mind is not duplicating what already exists. For intense, UMMC has a wonderful medical encyclopedia and the iTriage app is a popular symptom checker. But what is missing? This is part of a series of posts that will explore this mind map as it develops. Specifically, this post will focus on the right side of the image below.

You know the Staples easy button? It looks something like a cartoonish giant red button that, when pressed, is supposed to solve all of your office supply problems. Well, where is our easy button in healthcare? I mean, within the laws of physics, can we at least have a way to do what other industries have been taking for granted for a decade? Even in 1999, I could use a computer and find a flight to Reykjavík, Iceland. Fast forward to today and the Open Table application. OpenTable.com is a great restaurant reservation site, and their mobile app takes things a step further. Using your phone’s GPS, it is able to show you which restaurants near you have, well, open tables in the near future. Who hasn’t had the “where do you want to eat tonight?” fight…er…lovely conversation?

So if I can book a flight to Iceland and find the first available restaurant table near my hotel, all with my iPhone, why can’t I do the same for a doctor’s appointment? As another in my series of “someone please build this”, I’m asking: Someone please build an easy button for healthcare.

When you, or someone you care about is unwell, it is all about access.

We in the healthcare community often balk at the idea of consumerism in healthcare. Patients are people, consumers are shoppers. People need high touch, along with physical and emotional care. However, we can take a few lessons from the retail side of the world. In retail, it is all about “conversion”, getting people to go from browsing to buying. One of the easiest ways to do that is to remove barriers. Don’t make it hard for people to purchase what they want (thank you Amazon Prime). In healthcare we call this “access”; how do we make it easy for patients to use health services.  When you have a sick child, picking up the phone and being told the next appointment is two days away is not access. The same applies to new patients looking for a doctor. (The average wait to see a dermatologist in the US is between six months to a year!)

For a while, I have been pondering what I call the “virtualization of urgent care”. Urgent care, at least in this example, is defined as important but not emergency: waking up with a bad cold or sinus infection, a rash is worse than yesterday, a sick child. In those cases, the normal course of action is to call the doctor’s office, and if you are lucky you might get an appointment in the next few days. By that time you might be well, or you might decide to go somewhere else, like a doc-in-a-box walk in urgent care center, or the emergency room.

Enter the healthcare easy button. Whip out your mobile phone, launch an application and press the button. The GPS fires up and determines your location and the nearest open appointments. You pick the one that best suits your needs and press “reserve”. It is that easy. When you arrive, all the paper work is done and you simply check in.

Those well versed in the healthcare IT world have already started punching holes in this plan. How will you ever retrieve open appointment data? How will you get a new patient scheduled? What are the security and privacy risks? Truthfully, those were valid concerns….a decade ago. To be blunt, there is no excuse for the lack of consumer technological advancement in healthcare. (Getting nerdy in 3…2…1) There are health information standards like HL7 that allow for the creation of and update of patient visit records in the A segments with additional information in customizable Z segments. Bottom line, it can be built easier than one might think.

From a business prospective, this is a model that probably makes more sense for integrated health systems with wide offerings of primary and urgent care. However, savvy communities might also realize that independent physicians could bond together in a sort of co-op, offering to accept each other’s patients in an urgent care scenario. Every walked into a restaurant with no tables and have the host suggest someplace else down the street?

As my mind map above suggests, there are a lot of other features that can make for a rich mobile experience. I’m looking forward to exploring some of those ideas in future posts. Almost all of them have something in common: looking at the retail and consumer experience and applying to the healthcare model. That doesn’t mean we have to lose anything about the patient experience. On the contrary, I would suggest that helping people find access to care is a form of emotional support and am improvement in the patient experience. So, someone please build us a healthcare easy button!

This is all in good fun (seriously, vote Dawson) and I’m very much looking forward to seeing what everyone comes up with for the next 9 weeks. I’m joined by Sarah Bonkovsky, Jennifer Carnam and RVA News’s own Ross Catrow. Don’t let the cavalier attitude fool you – these are some serious contenders.

If this first week is any indication, the competition is going to be on like a pile of neck bones.

More than anything, I’ve loved having the impetus to get back into the kitchen. I’ve let my work-life balance pull me closer to the office desk than the stove lately; nothing like a friendly competition to turn up the heat.

This week I made an homage to Richmond’s own Nate’s Taco Truck. Self-dubbed “a mouth full of awesome”, I cranked out some home cured chorizo and potato tacos with a pickled tomato salsa and cilantro slaw. I know what you are thinking, and yes, you can vote for me.

Read more (and vote Dawson) on RVA News

Via RVA News:

First, there was Garden Wars where three gentlemen engaged in an epic battle for agricultural supremacy. Now, there’s Supper Punch, an equally epic battle, but this time between four local food enthusiasts and the cuisine they lovingly put forth for consumption.

Each week, our competitors will submit two photos and a brief commentary (including ingredients and prep time) on a recently-completed dish of their choosing. You, our readers, will then declare a winner for the week by voting in the comments. Your vote can be based on whatever you like: creativity, good use of local products, what you want to put in your belly at that exact moment, whatever.

The competition will go on for a total of nine weeks. The winner will be awarded with glory and honor. And hopefully our readers will walk away with a little culinary inspiration.

More pictures here on my flickr page

A few weeks ago I had the privilege of being asked to write a guest blog post for Odom Lewis, a healthcare communications staffing and recruiting firm. Angelia from Odom asked me to comment on Dr. Bridget Duffy’s ever-inspiring presentation from the 2009 Gel Conference. Some may recall that I wrote about Dr. Duffy’s talk here on this blog in June 2010.

In short, since most of us are not doctors, or may not even be conscious while we are being attended to, it is very hard to gauge the quality of the clinical attention we are receiving. However, every person has the ability to gauge their healthcare experience. When providers make the patient experience a strategic goal, everything else will follow: clinical outcomes, revenue, market share, etc.

For most of us, auto mechanics are a bit of a mystery. The oil light comes on, we drive to the dealership, they work some voodoo and we drive away under the impression that things are running smoothly under the hood. Unless you have the know-how, there isn’t a way to verify the quality of the work that is done. That is probably why savvy dealerships started offering fancy waiting areas – coffee, danishes, flat screen TVs and high speed Internet. If we can’t judge the craftsmanship, maybe we’ll make our service decisions based on the waiting experience. The interesting thing is that medicine is not much different.

Want to read the rest? Head over to the Odom Lewis blog.

Enter the idea of accountable care. Many industry experts are already envisioning a near future when providers will move from reaction to proaction. Rather than being paid to treat the symptoms that walk in the door, doctors may get paid for keeping you out of the office. A practical example is obesity. Instead of being reimbursed to treat the side effects of obesity (asthma, diabetes, joint pain, etc), a doctor may get paid for helping a patient achieve a healthy lifestyle and losing weight.

There is still something missing from this equation. And that is where your social graph comes in. A lot of us do healthy things all the time. According to Foursquare, the geolocation based social network, I have “checked in” to my gym 57 times since early March. I have gone to the farmer’s market 15 times this year. I have attended four medical education seminars (ok, those were work-related, but I still learned something). Here’s the rub, my doctor doesn’t know any of that. If he is going to be responsible for my complete health, shouldn’t those things factor in?

So, continuing my “someone please build this” series of blog posts, here is my latest plea: someone please build a conduit between my social graph and my health record. Let me opt in and chose which things I share online which should also go into my EMR to become available for anyone treating me. Tools like Foursquare come to mind as an obvious choice. Since it is based on location, it takes some of the effort out of participating; it just knows where you are. So when I check in to the gym, wouldn’t it be great if my health record was updated too?

My good friend and HCSM guru, Dana Lewis pointed out the power of twitter hashtags. What if we were able to define a specific, personal tag, say #NicksHealth. Every time I want to include a twitter update in my health record, I tag it with #NicksHealth. Last week, I had surgery on my knee to repair an ACL injury. Every day for the first week, I took a picture and loaded it into Flickr, the social photo sharing site and posted a link to the picture to Twitter. If I were able to tag it with #NicksHealth then my doctor would have a series of images showing the progression of my range of motion, wound healing, etc. When I update my Facebook page with details from physical therapy, that information could populate my medical record, along with my Foursquare checkins – my doctor would see just how compliant I have been with his rehab orders.

It doesn’t all have to be healthy. Providers need a complete snapshot of our lifestyles if they are going to suggest a course of care. Perhaps through incentives, competition or other means, patients may be encouraged to also share things that are less healthy. “I ate a burger tonight, with fries…and bacon…lots of it. #NicksHealth” – My doctor should probably know how often that happens in relation to my trips to the gym.

There are, of course, some challenges to this idea; including the burden of combing through all the data. Physicians may already feel like they have information overload. Without an accountable care model in place today, there is not much to entice them to pour over patients’ social graphs. In time, we will also need software that can automatically sift through the updates and present them in a meaningful way to physicians. However, the first step remains building the connection.

Every major social network has an API, or Application Programer’s Interface. APIs are a way to move data into and out of systems. If you use a twitter client like Tweetdeck or Twitter on your iPhone, you are using the Twitter API. Health providers, when considering their online offerings, would be wise to build in API functionality to online health portals.

Let people chose which data they want to share with their medical record. Providers can incentivize participation through reduced co-pays, social competition, etc. In return they get a rich flow of lifestyle information. When accountable care, meaningful use, EMRs and social graphs come together it will be a win for us all.

When I saw this post on the great Bad Banana Blog- a site who’s fantastically witty Twitter profile beguiles the design and art oriented site and makes one wonder if they are even connected – I was struck by a thought:

Give me the means to build my dream and I will

Looking at these images, there is not much practical value to the design of the Hergé Museme. I mean that in the truest definition of practicality, a crooked staircase is not the easiest to climb. Although, even given my green interest in design and architecture, I appreciate the art involved. There is something to Christian de Portzamparc who designed Hergé. Someone, maybe many people, gave de Portzamparc enough latitude, trust, money and faith to build his vision (and honor Hergé).

What would you do with enough latitude, trust, money and faith to build your vision? Do you have a dream that you could articulate and bring to fruition?

In the traditional sense most of us, and the same was probably true for Christian de Portzamparc, will need to prove ourselves over a series of small, incremental steps. To propose a radical idea, no matter how committed you are to it, is a risky thing. I love imagining both the confident creative “ah-ha” that de Portzamparc must have experienced juxtaposed against the frightful, risk that came with presenting this design.

I’m inspired by this building, its impracticality and its existence. It is someone’s vision and to bring a vision this unique to reality deserves applause in itself. What great ideas go unfulfilled because someone doesn’t present them, or worse, someone else is unreceptive? How many great things are built as the result of taking a chance on something seemingly risky?

See the rest on Bad Banana

Imagine a social site, a game of sorts, that rewards doctors and clinicians for improving outcomes, reducing costs and improving a patient’s experience. Docs are a competitive lot, they worked hard to get where they are and that kind of drive doesn’t end at graduation from medical school. “Dr. Smith just prescribed a less expensive alternative.” Oh yeah? “Well, my patient just got out of the hospital a day under the national average length of stay.” Can you see the peer pressure building?

Unfortunately this site doesn’t exist…yet. Imitation is the sincerest form of flattery right?

Have you checked out the Foursquare social network? It is a social game, you (or rather your GPS equipped mobile phone) tells Foursquare where you are and Foursquare tells your friends. If you are out on the town and want everyone to get together at your favorite watering hole, you log into Foursquare, update your location and blast a note to your friends.

The game part comes into play in two ways. First, if you check into a place multiple times you may become its “Mayor”. Savvy restaurants and businesses are rewarding mayors. In early 2010, Starbucks began offering Mayors a $1 discount off Frappuchinos. The second part of the game are the badges. You get badges for anything from checking in after 3:00AM (School Night) to checking in near the water (On a Boat). Think of them like Girl or Boy Scout merit badges, only, well, internetier.

Back to our medical example

Patient care is not a game and to create a social site that does not trivialize it takes tact. However, there is nothing wrong with a little healthy competition. The Federal Government’s CMS website offers good data on how one hospital stacks up against another; and it is fairly easy to read….if you work in healthcare and spend your time digesting these kinds of things. I am not convinced that the average consumer wants to suss out the percentage difference between two providers (although the site does a nice job of using plain language).

What I am suggesting – no – begging someone to build is a site that is relevant to both clinicians and the public. Think: Foursquare for doctors. Write a script for a generic med three times, get a badge. Have a better than average outcome, get a badge. Become the mayor of wherever you attend CME courses. Doctors could follow each other and would see what their peers are up to. When Dr. Jones writes a generic script three times, Dr. Smith might ask him which med it was, what the differences are, why Dr. Jones prefers it, etc. The professional interaction does not have to happen on the site. The site is simply a way for docs to encourage each other to improve care. Patients can follow along too. You could visit your doctor’s page and see what badges they have. Looking for the best surgeon? Find the one with the “10 complication free surgeries” badge.

I’m not much of a coder and don’t have an ability to produce great design (although I did the fancy syringe badge for this post, pretty good huh?). So please… someone build this!

The VA pretty much invented travel medicine

The VA system is divided into “21 regions called Veterans Integrated Services Networks (VISN). Each VISN is responsible for coordination and oversight of all administrative and clinical activities within its specified region of the country.” –Va.gov

Put practically, each region features clinics and hospitals that do different things. For instance, here in Richmond Virginia the McGuire VA Hospital is a center of excellence for brain trauma and ploytrauma. The Minneapolis VA Medical Center specializes in orthopedics and women’s care. There is overlap, many VA medical centers all do the same common procedures. However, it comes to something major the VA has found it more advantageous to move patients to specific places. If a center on the west coast has the best oncology treatment program with the best outcomes, why not send patients there?

Here in the US we have begun to explore travel medicine more in the last few years. In June 2010, the Lowes hardware stores announced a partnership with the Cleveland Clinic for heart surgery.

There are clear benefits to patients as well. When providers specialize it is often around a cutting edge procedure or technique. For example, a mitral valve repair done with a surgical robot often has the patient out of the hospital in two days rather than the nine that most open heart patients spend. That same mitral valve patient is also back at work in a fraction of the time as someone who had their chest cracked open.

As medical technology and the skill set of providers advance, it may become increasingly challenging for every hospital to be all things to all people. And thats ok. Sure, every hospital should probably continue to deliver babies, set broken arms and remove a burst appendix. But does every hospital need to do knee replacements? It is a challenging question to ask ourselves, particularly in a time when reimbursement has more challenges than ever before. However, integrated systems are on the rise; multi-hospital systems may already starting to figure out what procedures work best at which facilities. Travel medicine could be a real boon for both outcomes and cost savings.

Employee Driven Innovation

In early 2010 the VA system launched a system-wide innovation campaign dubbed the Innovation Initiative. The Veterans Affairs team built a Digg-like website which allowed any employee to submit an idea for improving patient care. Other employees voted on the the idea by clicking a thumbs up icon. The more votes, the higher up the list the idea was placed.

The top 100 ideas were presented to senior leadership who are selecting the top 25 to enact.

It is a simple thing really – let the people who are caring for patients every day tell us how to do it better.

note: unfortunately the site is no longer available to the pubic

Now, if you are asking why I was picked, you are not alone. I’m still in awe of that myself. Setting aside that certainly unanswerable question, it was without doubt one of the most honorable and proud experiences I have had.

Some detail:

The Civil Summit, the second of these to occur, was conceived as a way to identify socially beneficial solutions to human rights concerns in parallel to the US/Russian presidential summits. To accomplish the goal, key areas were identified – education, anti-conspiracy, healthcare, and others – as working groups. Each working group consisted of three to four US and an equal number of Russian delegates. Those delegates spent the first day identifying challenges in their respective areas and brainstorming solutions; typically involving private industry. On the second day the various groups came together in the plenary session to present their challenges and solutions.

The audience of the plenary session included most of the delegates. In addition representatives from President Obama’s cabinet, including Hilary Clinton, Russian ministers, US AID, various NGOs and industry innovators were present to form a group of about 200 large.

In search of solutions:

When I opened this post with “amazing experience”, it is not the company I kept that led to that statement but rather the intense intellectual discourse that left me inspired. In particular, the ideas around healthcare challenges and solutions were quite impressive.

Both Russian and US delegates identified the following as challenges:

• Lack of healthy behaviors
• Pediatric health
• Infant mortality
• the health of the elderly
• lack of MDs and RNs
• substance abuse
• disaster preparedness
• communication challenges between clinicians and communities they serve

To my fellow HCSM (healthcare communications and social media) compatriots those issues will undoubtedly sound familiar. Many are the same concerns we have been discussing in online chats and conferences for two years.

What may also come as no surprise are some of the proposed solutions (may of which are in fact tools to reach solutions):

• Web platforms
• Mobile applications
• Anonymous feedback mechanisms
• System to verify product authenticity (eg: pharma products)
• Online health professional groups and forums
• Health based online games
• Internet communities to combat isolated groups
• Applications for chronic disease management and wellness promotion

Some stand out points of the conversation came when we were able to dig deep into the real cause of an issue. One pediatric physician discussed the importance of using data to drive outcomes. His example was focused on using APGAR scores to better understand the performance of labor and delivery teams at various times of day. Another physician keyed into a conversation about the Foursquare social networking site and suggested a twist – doctors getting badges for reducing costs or improving outcomes. Imagine the positive peer pressure from docs “one upping” peers by getting the “no unnecessary tests” badge.

As the conversation progressed, three main challenges emerged:

• Who would provide the health information  -  it may be relatively easy to build a web, or SMS platform to deliver wellness information. However, finding an authoritative source to produce that content may be difficult.
• How to keep people engaged – just because you build it does not mean they will come
• How to increase interactivity and social proliferation – how do I get my friends to sign up too?

Power to the people:

In the end, one of the most solidifying concepts proved to be “the wisdom of crowds” (a phrase I contributed, although in consideration of the book of the same name, may have misused). We rallied around the importance for communities to help drive the content, the engagement and the feedback. Health providers can take the role of curators who help cultivate the expertise that comes from actual patients. It was a powerful breakthrough and something that resonated with the plenary group.

I’m still processing the the event, the thoughts and their impact. The proceeding “brain dump” represents only a faction of the big ideas and valuable relationships that came out of the 2010 Civil Society Summit. It is something that, as I continue to reflect, will provide much fodder for pontification… and of course more blog posts.