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Evernote Is My EMR And Its Better Than The Rest

EvernoteEMRSpoiler alert: I’m not dying and there doesn’t appear to be anything major wrong with me.

I know, you hate spoilers. But I thought I’d get that one out of there way. It makes the rest of this considerably more pleasant for us both.

I’ve got a new personal electronic medical record. I’m able to store and track my health history. I can add and edit my own notes. I can pull in data from external sources like my quantified self gadgets. I can share data with my provider, or family members. It’s secure, it’s cloud-based, it’s mobile and it’s on all major platforms.

Evernote is my personal EMR.

For the uninitiated, Evernote is a cloud-based, free service with apps on every major desktop and mobile platform. It’s general purpose is to store, sort and help you find anything you throw at it. You can upload a PDF, email a note, clip an image from a website. You name it, and Evernote can probably store it. Take a picture of a wine label, and Evernote will transcribe the text in the image using optical character recognition, so when you search for Zinfendel, you’ll find the image of the wine bottle. But wait there’s more. Since you took the picture with your phone, Evernote also has the gps data, time and date attached to the image. You can add some tags such as “California”, “zin”, and “jammy” to make the note even more specic and personal.

Evernote has a widely supported API (applications programmers’ interface), so many other apps can read and write data into Evernote. For instance, the web-based automation service if this then that, IFTT as it’s known, will, for instance, append a line to an Evernote note every time you get a tweet; creating an effective backup solution.

I personally throw everything I can into Evernote. When I book travel, and the print window pops up over the itenary confirmation, it select PDF to evernote rather than print. When an online store emails me a receipt, I forward the email into Evernote. I have more IFTT rules logging things to Evernote than I can feasibly recount, but a few stand out. When I step on my Withings wifi-enabled scale, IFTT adds a line to an Evernote note with the date, time, my weight and body mass data. I can do the same thing with my Withings blood pressure cuff. And, it turns out, Evernote is pretty much perfect as a personal EMR.

In short, I get a lot of meaningful use out of Evernote.

Recently I was asked to get an MRI (see above re spoiler). I had the MRI done at a health system an hour away from my home. The system uses Epic and has the MyChart patient portal available. My primary care doctor also works for a system which uses Epic and has MyChart. But these two Epic installations might as well be separated by led walls. My PCP ordered some labs, that the other doctor needed and my PCP, in turn, wanted a copy of my MRI results. So one doctor calls me and says can you please print a fax to us the lab results. Mummmm, ok. It’s 2014 and I, the patient, am transmitting my own clinical data between two systems via analogue fax? Then my PCP wants a copy of the MRI results. Same problem. I am again reduced to data mule. I am Jacks health information edchange


So now we have two identical multi-million dollar EMR installations, each with some data about me, but neither having a complete picture or seamless interchange. Again, I’ll point out that this is 2014 and I can FaceTime someone around the world on my phone. And we’re using faxes?!?

But there is one place where I have a complete record of my health and health-related behavior. You guessed it, Evernote. Everytime I have a test done, I get an email from which ever isolated multi-million dollar Epic system at which I’m seen. I log in, and click a button on my web browser tool bar which instantly clips the entire page as both text and image and stores it in an Evernote notebook called Health.

The images from my MRI? They are in Evernote.

Last year, before my annual physical, I decided to eat my own dog food. I started a new note in my Health notebook called health observations. I captured the little things I wanted to remember throughout the year: an ache here, a reminder that I saw a physical therapist, a picture of the vitamin D supplement I started taking… Before my physical, I typed out an agenda in an Evernote note:

  • Review observations note
  • show picture of all supplements and capture into med reconciliation list
  • review journal article on psoriasis and glycerine and why I’m not using prescription steroids anymore
  • ask for opinions on nutritionalists

When I went into the physical, I let my physician do his HPI and med rec and then mentioned my agenda. He knows me well enough to find the humor in my proposal - hey, it’s pretty nerdy - but he graciously went along with it. He did his physical exam and then tuned control of the visit over to me. I asked if I could record the audio and did so using Evernote’s built in audio recording feature.

I also scan, or import PDFs of all my insurance data including EOBs (explanation of benefits). I scan medical receipts and co-pays. So I effective also have a rudimentary revenue cycle system.

I am nearly certain, today, Evernote has a more complete, more personalized view of my health and medical history than any other system on the planet. I can share entire notes, or their contents, via secure links to anyone I chose. I can automate data intake, or enter it manually. I can capture fitness and behavior data. I can trend, search, snapshot, and review my own medical records. I can add to them any time I want, from any device.

Please tell me why a multi-million dollar system is more patient-centered?

The one where I get all soapboxy about the term Obamacare

Tidal Basin

Dear Friends, Pundits, and Politicians,

Can we please stop calling health reform Obamacare?

Opponents began calling the health reform law and its associated components Obamacare as a way to both detract from the law and the President. Those who are not in favor of the PPACA report on Obamacare’s problems and challenges; linking the bill and the President hand in hand with some scary story about how Americans will somehow be less well off if more people have access to healthcare. Let’s defund Obamacare sounds a little to me like taking your toys and going home.

[And, correct me if I’m wrong, I don’t remember calling anything the Bushwar, Clintonbudget or Kennedymoonmission - when did taking liberties with the President’s name become acceptable?]

Those in favor of the the PPACA have co-opted the term; adopting in as a rally cry for the Act’s benefits. Do you like Obamacare, I think it’s a good thing… people will confide in me during meetings and events. Even CMS and policy wonks promoting the Act use the term frequently. Remember the kid in school with an unkind nickname who eventually started referring him-or-herself by the nickname? I bet they didn’t love it, deep down inside.

But here’s the thing…

We’re talking about healthcare. We’re talking about the difference between someone being able to see a doctor or not, to get medications or not, to have better, more fulfilling lives… or not. Making healthcare about politics —and I understand, the two have been an odd couple well before Jack Lemmon and Walter Matthau —does our humanity a disservice.

It’s not Obamacare, it’s the PPACA, health reform, Medicaid expansion, health insurance exchanges, accountable and population health, wellness visits and more.

And besides, spellcheck doesn’t even think Obamacare is a word.

Now, would someone help me down from this soap box, my knees aren’t what they used to be.

When Giants Stumble

When giants stumbleHDR Sunset

Local Cleveland channel News 5 reporter Cassandra Nist posted today:

The Cleveland Clinic announced Wednesday morning that they will be cutting $330 million from their 2014 budget.

“This is a process and the Cleveland Clinic is focused on driving a more efficient healthcare system. The goal is to make healthcare more affordable [and] efficient to patients,” Cleveland Clinic spokeswoman Eileen Sheil said.

The Cleveland Clinic acknowledges that there will be a reduction in the workforce, however the numbers are unknown at this time.

Shiel said this is “not unique to the Cleveland Clinic“ and that it is ”happening to hospitals across the nation.”

Our large healthcare providers —health systems and big hospitals —are in trouble. Public and political concern about hight costs are putting pressure on providers to lean out their organizations. (The true source of much of that cost may be out of their control, by the way). Simultaneously, we are living through a sea change in how care is being delivered. We’re not as far away from the smart phone physical as one may think.

Let’s also not forget population health. Forget concerns about about bridging the gap between the payment models. Do we really know how to take our existing large, complex healthcare ecosystem and turn it 180 degrees towards prevention and wellness?

Recently, while speaking to a group of hospital leaders, I shared an analogy I’ve been kicking around in my brain: these systems are giants and they won’t suddenly fall over. Instead, like Atlas, they will become increasingly unable to bear their the weight and will begin to stumble. Some, from time to time, might even drop to a knee to catch their breath.

Is Cleveland Clinic the first giant to stumble?

I’m all for cutting the fat and being more efficient. But how much of that is spin and how much reflects concerns around constrained reembursement and a changing care model?

Not to be all grey clouds and Andy Rooney here… These giants are giants for a reason. I have great faith in their sophistication, leadership and clinical abilities. Unlike small community hospitals, I doubt we’ll see any of them fall down outright. The smart ones, like Cleveland Clinic, are already thinking about:

  • Population health - Cleveland Clinic’s lauded bundled payment program for Lowes and Walmart is a clever example.
  • Patient engagement - Cleveland Clinic’s highly regarded Empathy video shows a serious commitment to the human side of healthcare.
  • Integrated model - The clinic model, with its employed physicians and team-based care, continues to make a lot of sense. I think we’ll see large health plans follow Lowes and Walmart, with renowned clinics like Cleveland Clinic, Mayo Clinic, Stanford, and Johns Hopkins, become preferred centers of excellence for these plans (further challenging community systems and hospitals).

Patient Designed Care or Doctors 2.0 & You redux

NOTE: This post is intended as a companion post to the session recap from Doctors 2.0 & You here. Untitled

I recently published a recap of Doctors 2.0 2013. I’m no Bob Woodward, but I tried to take a neutral observer role in relating the content of the panel. When I asked for feedback, my friend Liza suggested my personal passion around the topic was missing.

challenge accepted

In early 2013 I wrote to conference organizer Denise Silber and suggested a panel discussion around patient-designed care. It was a nascent idea then, largely still is.

I keep telling this running joke (and it keeps flopping. Note to self…): there’s probably a German word for that concept of once you understand an idea, its hard to imagine a time when you didn’t think that way, and it probably has 7 syllables.

Yeah, not that funny, is it? But the point is still true. The term patient-designed care came out of the first Medicine X IDEO Patient Design Challenge. Through Stanford’s Medicine X program, about 40 conference goers spent a day collaborating with ePatients and IDEO designers. I was lucky enough to observe. As the group was wrapping for the day, one of the designers remarked:

"I think this is the first time we’ve had the people we design for participate in a design challenge. We hear a lot about patient-centered care…” one designer started, “but that’s kind of a hollow phrase. What we discovered today was something new: Patient-designed care”.

The idea has grown, and is still pretty simple. Involve patients in designing anything affecting them. It might be a process, or tool, or space, or service offering, or strategy. Whatever it is, make sure there are patients on the committee.

How could it be any other way?

Regrettably this is still a pretty novel idea to the healthcare industry. I’m as guilty as anyone. I can think of dozens of projects during my time working in hospitals where we set out to do patient-centered things. We had the best intentions. Let’s make this bill more patient friendly… or Let’s add patient-centered training to our new employee orientation.

That kind of work, despite noblest intentions, is inherently based on assumptions. We made assumptions about what patients would want. They’ll love this furniture… and If I got this bill, I’d want it to say….. Don’t get me wrong, that’s not a bad start. It’s still an empathic approach. But why didn’t we involve patients, asking them about their experiences and to share their suggestions?

It’s time to start.

I’ve been using the phrase patient-designed care for almost a year now. I’ve also been trying to put it into practice. For example, In 2012 I was still in an operations administration role in a hospital. When it was time to schedule an off-site team meeting, I invited a former patient to come speak to our group and participate in the meeting. I met the patient when she came to my office to voice a complaint one day. She went on to become a strong proponent of our department.

In my role helping lead a start-up focused on staff and patient experience, we’ve included ePatients in all of our project proposals. We sneak them in as experts consultants, or sometimes directly identified as ePatient experts.

On a personal level, I count many ePatients among my personal board of advisors. (How fun is that term? You should have a personal board of advisors too, if you don’t already.) When I’m stumped and need to bounce ideas around, I call on my friends. When I’m excited and need someone to share with, or poke holes in an idea, I call on my friends.

Here’s the bottom line: I cannot, anymore, imagine doing anything in healthcare which affects patients without involving patients. And that’s the idea I wanted to explore at Doctors 2.0 this year.

My hope for the panel was an honest conversation involving ePatients. I knew some of my Medicine X friends would understand the term. And others, despite doing participatory design work, may not know it yet. I wanted us to get representatives from those groups together.

Largely, I think we pulled that off. The discussion was made richer and more well rounded by our moderator, Michael Seres. Michael is an ePatient - sometimes he prefers iPatient - who takes an active role in designing his care plan. Liza Bernstein, a student of product design, understands the concept inherently. She sees how patients can play an active role in the design of processes and things affecting patients. Kathy Apostilidis is using her patient-acquired expertise to participate in designing European policies.

What’s next?

Maybe we need to find that german word I jokingly alluded to earlier. It’s hard to convey in a talk or panel discussion something so profound (and yet so simple). From my perspective, the next big hurdle is getting healthcare provider organizations (hospital, health systems, clinics, etc) to really embrace this concept. I’m unsure if we need to increase awareness, or reduce fears, or facilitate the formation of formal ePatient hospital advisors.

Hospitals have focus groups and patient advisory boards today. Those are admirable starts. But doesn’t it seem silly to have a meeting about improving the experience of a department or facility without including the people who have been through as patients? It’d be like going to a restaurant where the chef assumes what you want to eat without asking.

Panels like ours help start the conversation. And they broaden it. While I’m focused on integrating patients in hospital process and service design (strategy), others are focused on policy, or research or treatment plans. We need to have these conversations and I’m really glad Doctors 2.0 & You and Medicine X are among the first programs to host these dialogues.

what about employee-centered care?

Yesterday I was lucky enough to hear Chip Conley speak to an intimate group at Experia Health’s Patient Experience Round Table. Conley shared an anecdote about meeting the then CEO of Southwest Airlines. He was handing out peanuts during a flight. This was 2010, before Southwest began advertising their bags fly free campaign, although they were not charging at that time anyway. When Conley asked the executive why they didn’t charge his answer was an interesting one. “We don’t want to put that burden on our employees. First, it’s uncomfortable to collect the fee, people expect their bags to go with them as part of air travel. But what we really don’t want is to ask our staff to deal with having to check bags once the overhead bins are full. Have you seen the flight attendants on those other airlines, they are miserable now.”

(Well, he said something like that, I’m paraphrasing the paraphrase)

I’m concerned about how we work in healthcare. Despite the rewards caregivers get from taking care of patients, largely the work of healthcare has become a lot about things other than clinical work and caregiving. It’s meetings, hand-wringing, politics, wrought processes, data entry, reporting and analysis. Don’t get me wrong, some of those are worthwhile tasks —hey, it’s a large percentage of my job (hopefully not the hand-wringing part). But, there are two problems. First, we’ve built a lot of inefficient, difficult to execute processes under the banner of regulation, reporting needs, and analysis. Secondly, we’ve failed to adapt to modern work environment expectations.

The modern workplace has changed, and how we work has changed. Today, Millennials entering the workforce want to work in jobs which provide smart phones, offer flexible work hours and have cool cultures. Does that sound like many health systems?

Airlines, banks, mobile app developers —they all got hipped to the importance of realtime data years ago. Do you think it takes US Airways two weeks of abstracting and analysis to know the demographics of patients on any given flight? No way. And staff at telecom giant Vodafone don’t even have to be in the office to get data. Realtime dashboards are pushed straight to their phones and tablets via a platform called Roambi.

This may sound like a tech post. It is not. It’s a people post.

When we add layers of complexity on top of an antiquated work environment, well, this is what we get.


Here’s what we know, companies which are great places to work take better care of their customers. At Bon Secours, we measured employee engagemnt with Gallup’s Q12. the Q12 is a remarkably effective and simple way to understand how employees feel about their work. Gallup tells us an indicators of employee engagement include having the tools to do your job and working in a supportive environment. Until we wake up and realize we’ve made the process of working in healthcare less desirable than other industries, how will we ever tackle patient experience in a meaningful way?

I’m not suggesting the key is giving everyone an iPhone. I think we can start with some even easier steps:

1 Take Something Away - This is the first, crucial step to working smarter, not harder. Examine all the work our teams have to do, and take at least one thing away. Remember the lesson of Southwest and the baggage fees. Something which may look like attractive revenue on a spreadsheet can actually push staff past the breaking point. Which would you rather have? It can be the least important thing and you probably won’t have to look far to find it. Maybe it’s a superfluous field in a registration screen, maybe it’s a non-clinical tasks for a nurse. Whatever it is, ask yourselves do we really need this? If not, stop doing it.

2 Practice gratitude Chip Conley speaks about recognition in his TED talk. Taking the time to acknowledge each other is a surprisingly powerful emotional uplifter. Hey Joan, you worked later than expected last night to care for those patients… thank you for doing that! The trick is to make it a ritual. Start huddles or end meetings with moments of gratitude. It works.

3 Think about Employee-centered care too Patient-centered care is a result of engaged employees. Managers, try this: walk into somewhere you have employees and pretend it is your first day at work and you are hired to do their job. How’s the space? Is it clean, is it nice to work in? Do you have the tools do do your job? Do you clearly understand what your job is? Most importantly, ask yourself if this is the job you dreamed of walking into. Just because they didn’t give us dot-com style offices when we started in healthcare, doesn’t mean we can’t be the change we want to see.

Remember, every system is perfectly designed to achieve the result it achieves * . So, reverse engineer the system. If you sense, or worse can measure, staff dissatisfaction or burnout, consider the root cause. If you are focused on patient experience, observe the system in reverse order. What influenced those experiences? Likely it’s interactions with employees. Are those employees loving their job - are they called to it?

*Good luck attributing that often used quote. Most suggest Don Berwick first used it in 1996. Goolge returns several articles and transcripts of talks, each purporting to be the originator.

Together, we can make it better

There’s a former patient outside who needs to see you I’m on a call with my boss when Carol, one of our patient access team members, slips the note onto the desk I’m borrowing. My office is 12 miles away, but I’ve got a meeting in our urgent care center. I’m thinking to myself, ‘doesn’t like their bill….we took too long….whatever it is, I need to put on my mea culpa face…’

Brace for impact. I opened the door.

Do you remember me?

Instantly, I rewind three weeks to a day I hope I never forget.

I was sitting in the waiting room of one of our urgent care clinics; head down, cranking out email. When I need a place to churn through office work, I often like to sit one of our waiting rooms. It is a fantastic way to observe patient flow, the physical space, and general design components of the care environment. It is also a place with remarkably few distractions.

Ma’am, our nurse whispered, I’m sorry to say we think you would be better served by going to the ER. Truthfully, if I were not setting right next to the nurse when she said it, I would not have heard it. The patient’s privacy was, for all practical purposes, in tact. The disappointment, on the other hand, was quite palpable. I simply cannot go there, please don’t make me leave… the patient protested.

Why don’t you come to the back and lets talk about it

I followed them, at some distance. The nurse sat the patient down in a quiet, secluded area. With your history, and the symptoms you have today, we know the doctor is going to want to order tests we cannot do here. Really, you need the next level of care and we think you should consider going to the emergency room. Our physician stood looking on and agreed, the ER was the best bet.

Crestfallen doesn’t fully describe our patient’s reaction. The patient, head in their hands, began to cry softly. Please, I know it will take a long time if I got there and I really need to be seen… She also understood the practical reality of the situation – the doctors needed tests which can only be preformed at the hospital. Her disappointment was much about the situation as anything else. It is not that the ER is a bad place, it was just another stop on a long train ride of misery. Our patient accepted the rationale, but it didn’t mean she had to like it. And I didn’t blame this patient.


When I was in the waiting room at Johns Hopkins, almost a year ago today, I met K (whom I wrote about shortly after). K is a patient care coordinator. One of the things I remember most about K was how she addressed patients and visitors. She always positioned herself at their eye level. If you were sitting, she knelt down. If someone was standing, she stood. It sounds like a simple thing, but it makes a world of difference in how someone perceives your presence.


So I knelt. I crouched down to be on eye level with our sobbing patient. Ma’am, I know this isn’t the best news, let’s see what we can do to make a little better. We are gong to call the ER and let them know you are coming and to be ready for you….


I just want one day off! One day when I don’t have cancer, just one day then I don’t have to think about being sick. It wasn’t an interruption. It was part of the patient’s condition –her emotional needs were in as much distress as her physical concerns. This was a time to listen.


I cannot begin to understand how hard this all is, I offered. Would you be willing to tell me more about you story? She looked up with red, wet eyes and for the next ten minutes told about one of the most remarkable patient journeys I have ever heard of.


Almost two decades ago this new friend was diagnosed with a cancer. Rather than retreat into the world of sickness, she stabbed straight into the gut of their predicament. She started a support group, the first in the area. A call tree was constructed. I’ve been through this, the weepy eyes said, let me help you go through it to. That’s what she told others. Then she lobbied.


This remarkable person went to the state General Assembly and showed the scars from procedures she had and compelled law makers to amend regulations. The support group grew. There were t-shirts made, walks walked, funds funded; lives saved and some lost.

So when I heard this real, passionate, alive human say to me, I just want a day off, I could only understand a wisp of what that must feel like; But, it a wisp of something so pungent and acrid, that was all it took to plunge me into their world, even if only briefly. What do you say, when you hear someone’s story like that? The best lesion I have ever heard is to simply be grateful. Thank you, I started, thank you for sharing your story with me. You’ve reminded me why I come to work every day and the purpose of the work we do, and for that, I cannot thank you enough.


You have a good mother don’t you? We both laughed and I agreed.

You are the expert, you have been through this more times than I have. What should we do? Do you want to try and be seen here, or is the ER a better option?


I think I should go to the ER. But, can you promise me it will be better?


I can only promise you I will do everything I can, and so will every member of this team. Honestly, it was a non-promise. What do you say? Providers know better than to promise an outcome. Surely I, Mr. Beancounter, am the least qualified person in the room to make any guarantees.


When the rescue squad came for the transport, our patient asked me and our nurse for hugs. We exchanged warm embraces and helped see them into the ambulance.

I had a few more meetings that day, but couldn’t shake the sense I may have sent someone out with a promise I wasn’t sure I could keep. I don’t work in the ER, I’m not a doctor. When my last meeting wrapped, I headed over to the ER and asked if she was still in the department. Someone showed me to her exam room.

What are you doing here?


I had to come check in, and besides, you didn’t finish telling me about this support group you started? Would you mind if I sat and visited a while?

We continued to chat for several minutes until a provider came in. I wanted to respect her privacy and left.

I went home that night and told my wife about my experience. I told her how it genuinely reminded me why I work in healthcare. It’s easy to get lost in the daily work of being part of a large team of providers, staff and administrators. For must of us, we never fully lose sight of the mission and underlying human aspects of healthcare. Although we can easily forget how emotionally and spiritually challenge it can be to be a patient.

It’s three weeks later, and this amazing person is back in front of me asking if I remembered them. How could I not? I told her story to anyone who would listen. We borrowed an office and I invited her to have a seat and chat.

Like our previous encounter, eyes began to water. You saved my life, and I needed to come here and tell you that.


Well, people don’t say that to administrators often. For practical starters, we really aren’t involved with direct patient care. I thanked her for the unbelievably kind words and challenged them. I certainly did not, but I’m glad you are feeling so much bet…


No, you did, and so did the nurse here and your amazing staff. I was so sick that day and didn’t even know it. From the ER, I was admitted for ten days. I mean, I was really sick. I’ve just been cleared to drive again and I knew my first stop had to be here to tell you all that you saved my life.

That was all it took, I welled up too. Here we were, sitting in a borrowed office, sharing a box of tissues and connecting over a special moment.

She continued, I told you how I have been fighting for nearly two decades. One of the things I have learned about being a patient is how much control I am allowed to have. You and this team didn’t do anything to me…you asked me what I wanted to do.


I have this expression I used with all of my support group members, it is a reminder that we are a part of our own care…  She went on. Together, we can make it better. It was uttered again, slowly, deliberately. Together, we can make it better…. and that is how you all treated me, you let me decide.


Do you ever have one of those profound moments when you recognize what is happening is bigger than your ability to absorb it, or even react to it? That’s where I was; almost out of body. What a profound thing this visitor just shared.

I asked my guest, and by now I think it is safe to say, friend, if I could borrow her line.

The next week, during our staff meeting I shared the story. I told them about this patient’s experience. And, I shared our new mantra: Together, we can make it better.

Since then, we have ordered t-shirts and buttons with our new raison d’être. We start and close all of our team communications with our co-opted phrase. It reflects how we should treat each other as team members, it tells us how to involve our patients in their care and most importantly it reminds us every patient is on a journey. In listening to their story and seeking to understand them, together, we can make it better. 



Apple iBooks, the future of patient education and shared decision aids

This week, Apple released their latest disruptive innovation, iBooks 2 and iBooks Author. iBooks 2 is a free update to the iBooks app for iPads. iBooks Author is a free mac desktop application which enables anyone with some basic typing and drag-and-drop skills to create pretty amazing eBooks. eBooks can contain pictures, links, audio, video, rotating graphics, self study questions and more. This is the future of patient education, shared decision aids and pre and post visit care.

On the outset, the idea of combining text and video and pictures isn't really that new. It's been around since…well… the start of the web. But in the context of a book, there is something really strangely compelling about seeing a moving video in the middle of static text. I can't quite describe it. After about an hour of tinkering with the app and pasting some images and text in from a keynote presentation, I had a nice little proof of concept. You can download it and see for yourself here.

There is something which draws you in when you see live action video playing within a frame of text. Adult education experts call this blended learning. We absorb more when we engage more of our senses.

So imagine this, your doctor tells you that you are going to need surgery. What's that process going to be like? What do I do before hand to prep? What should I do when I get home, you ask?

"Well, you can just download my free eBook," he says.

The book walks you through the pros and cons of surgery. It plays a video of the doctor outlining the procedure. A moving picture gallery shows you where to arrive, and what to expect the day of surgery. Another video shows you how to use the pre-surgical antimicrobial wash the doctor sent you home with. There are links to online communities from other patients who have been through the same process. There is even an embedded twitter search showing a real time discussion about your condition. Wow!

A few days after the procedure, you fire up chapter two. It shows a diagram of some basic stretching. The next page talks about nutrition. To make sure you understand the concepts, there is a short self test, don't worry, it's open book.

These tools are simple to create. They are easy to publish (for free). And, they are a tremendous value-add to patients. Apple has done it again. By disintermediating author from the publisher, they've given us all the ability to make robust patient aids. For that matter, patients could make them for other patients, and publish them on their blogs, or via the iTunes book store.

What are you waiting for, go publish your first eBook!

You can download my demo/work-in-progress book, Innovation in Healthcare: A Requirement For Success here. I'll continue to update it after this post is live, however the point is not to provide a serious book about health reform and innovation tactics. Rather, the point is to demonstrate how the technology can be used in a healthcare setting (this book is more geared to the administrative types than patients).

The gallery below includes images and descriptions of features in eBooks. 



which way did he go - healthcare, meet the internet

subtitled: foreseeing a day when we will shop for and buy medical services without leaving the house. Which way did he go

Google  - (n.) first stop on the information superhighway. "I went to google to find the answer"

Google - (v.) to look for anything online "He wanted to know more about diphtheria, so he googled it"

Google - (n.) medical instrument used to aid in diagnosis and treatment "Sally wondered about the bump on her arm, so she went to google and googled the symptoms of spider bites"

Sometimes a topic is like a cloud full of metaphors waiting to rain down. The trains coming and you better get onboard. That ship has sailed. Know thy enemy. A few weeks ago I had the privilege to speak (along with a group of infinitely more qualified other folks) at a healthcare conference in Chicago. During one of the panel discussions, someone made a comment which I've been chewing on for a week. "The competition, for attention online, is sites like RatedMd and WebMD."The only thing I could think of was those Loony Tunes where the Abominable Snowman always got confused and said: "Which way did he go George, Which way did he go?". He was cutely befuddled by misdirection as abominable snowman are apparently wont to be. (The catch phrase, by the way, comes from Of Mice and Men.)

The context of that comment was in regards to reputation control and public perception. The concern is healthcare providers are being valued and rated online and without some presence of their own, their "brand" has potential to be devalued. While that point deserves some consideration, it wasn't what got me thinking.

What set the hamster on my mental wheel gasping for breath was the idea of online sites competing for patient attention in general.  This isn't a new idea and likely won't strike you as terribly profound. People go online, they google, and now they talk to each other via social media sites. Now think about this: how does that play out when those searches, sites and conversations reduce the overall need for your system's healthcare services? What happens when a patient goes online and gets a diagnosis and even a treatment rather than coming through your doors?

Think it won't happen?

I've been looking for pickle crocks. I like to pickle things. You probably know that about me. Here's the thing about pickling, when you let natural bacteria do the work, its a delicate process. Two things will kill the bacteria and render salty but unpicked veggies every time: sunlight and chlorine in municipal water. The later is easy, you buy spring water from the store. The best solution against sunlight is an earthenware ceramic pickle crock. You've seen them in your grandmother's kitchen, probably holding the wooden spoons and whisk in the corner near the stove. Once upon a time, they served a real purpose. The problem is that they are increasingly more rare. It seems no one else shares my interest in pickling - shame. So try this: go to google, type in "pickle crock".

If your results are similar to mine (and remember, a google search is in the fingers of the beholder), then the top 5 or 6 results for pickle crock are online stores or sales sites. You may even get some Google Shopping results at the top. Think I even checked a local store first? (I know, I know, its good to shop locally).

Now, google "allergies". This time the top several sites are informational sites: WebMD, MedicineNet, eMedicineHealth, and even a few nationally known hospitals.

I know what you are thinking. Yeah, you can buy a pickle crock online but its not like you can buy an allergy diagnosis on WebMD. …. yet.

Last week CMS, the Center for Medicare Services, announced it is loosening the regulations around telemedince certifications. That is a big step. The process for credentialing practitioners to treat people via Skype just got a lot easier.

Lets talk fee-for-service

This one is simple. The average net reimbursement for a family physician visit is about $60. The average patient co-pay is $25. If a patient can stay in their own home, avoid the hour wait in the waiting room, not to mention the germs and two year old copy of Highlights magazine, and see a doctor or nurse via Skype for $15, which path do you think they'll pick? You're out $60 and the patient saved $10. There is, of course, the huge downstream impact on referrals and patient loyalty as well.

Enter the ACO

With the hullabaloo around Accountable Care Organizations, there is an increased interest in technologies like telemedcine. They can save money. Here's the rundown incase you missed it. In an ACO model, a provider is given a pool of patients, lets say 5,000. They are then allotted a fixed amount of money to keep those patients well for a year. Lets say $1,000,000. If no patients come in the door at all and all of those patients are perfectly healthy you effectively pocket the cool million. However, when they do come in, you need to use your resources wisely. The healthier they are, the more you keep. So you have a mixed bag - don't order expensive tests, thats money out of your pocket. But you do need to ensure they get better. Now what happens when those patients start going online and getting treated by eVisits from other providers? The current CMS regulations do not prevent patients from seeing other doctors. However, you are still on the hook for the outcomes. If that eVisit doesn't work out, or worse, has an adverse outcome, guess who's pocket is being reached into?

Now, I'm the last one to spread FUD and start fear mongering. I'm also a big fan of the interwebz and the potential these technologies hold for patients (after all, we are all patients). What I would suggest is that health systems and providers need to be ahead of this curve, not behind it (that one counts double for buzz word bingo). We need to offer these services to our communities and patients ourselves and not let large, profit driven websites own this space. eVisits, telemedicine, social media, text messages, email, EMR … these are all doable today. There are already patient populations where this makes sense and there are revenue models which work. In a fee for service environment, what does the pro forma look like? Can you staff a nurse in a role to interact with patients and charge them just a little less than an office visit co-pay? What about doctor to doctor telemedince as a start? Lets not be the Abominable Snowman with our arms crossed and fingers pointed in opposite directions asking: "which way did he go George, which way did he go?"

Update: From the "great minds think alike department", Jen Riggle wrote a great post on the same day talking about, of all things, skyping doctors. Her research and links suggest reality is closer than we may think. In particular, take a look at Dr. Brian Goldman's advice. He suggests starting with established patients. If you already know, because you have meaningfully implemented an EMR, that someone has seasonal allergies every spring, that is one more check box in feeling secure about making that diagnosis next April via Skype.


By the way, Leeners sells great stoneware pickling crocks at a good price.

Meaningful Use guidelines for Social Media in Healthcare

I had the privilege recently of being asked to write a short reflection on the use of social media in healthcare. I suggested many of us are moving from our freshman year - getting familiar with campus, determining which is the cooler spot to hang out at, facebook or twitter... you get the idea - towards our sophomore and junior years. For many providers, this year is about figuring out what to do next. What will actually bring value and make using social media in healthcare, well, meaningful. What are the meaningful use guidelines for #HCSM? In late 2010, the federal government released a much anticipated set of guidelines around how healthcare providers should use electronic medical records. The guidelines, know as Meaningful Use, specifically spell out what features an EMR must contain and how doctors must use those features in order to qualify for federal stimulus dollars. For instance, the guidelines suggest providers council every smoker on smoking cessation. The software must be able to prompt doctors when someone has identified as a smoker and it must be able to capture that the physician has spoken to them about quitting.

Meaningful Use says it is not enough to simply have an electronic record. Meaningful Use says the EMR's feature set and how it is put into practice determine the impact it has on care. Today, we can say the same thing about social media in healthcare. With heartfelt thanks to the pioneers who fought the HIPAA and ROI battles, it is no longer enough to simply have a facebook page or twitter account. There are expectations around engagement, user experience, quality and value which users have come to expect through interactions with other individuals and organizations.

The good news is that there is no single correct way to use social media and digital communications as a provider. There are, however, a few basic ideas which I boldly offer as guidelines for using social media as a healthcare provider:

  • Be available - Phil Baumann said it well. You do not need to be famous online, you just need to be available. In fact, the rest breaks down if when this guideline is not followed. It has been said many times by many people, social media is less about pushing and more about pulling. If you are not open to conversations with the public, patients, other providers, etc then social media may not be for you.  As guidelines go, this one may be the most significant for meaningfully using social media. Being available is more than just replying to tweets. Availability means knowing who within the organization can answer the question authoritatively; It means having a team of on call experts. I know at least one healthcare thought leader who envisions call centers giving way to tweeting centers. Have the capacity and expertese to follow up with your tweets, comments and facebook wall.
  • Bring Value - There is an easy litmus test for this one. Think: "why would I follow or fan a company?" Most people get enough spam email and junk mail. Can you honestly say you would want to get the message you are pushing out if you didn't work for the provider pushing it out? If not, then it is probably spam. So what kinds of things bring value? Think about curation, sharing expertise, answering questions, helping someone find what they are looking for. Here is a simple way to bring value: go to and select advanced search. For the search string, enter something like "doctor" and then put your zip code in the location field. Chances are someone in your area is looking for a good doctor. Reply and offer to set them up with a same day appointment. Now that's value! Another example includes hosting diagnosis specific communities and wikis with clinician participation. Imagine an online community of folks who have been and are about to go through an orthopedic joint replacement. What kind of value would they get from connecting with each other and sharing experiences in a forum moderated by a clinical expert?
  • Liberate your expertise - Most physicians go through at least 4 years of medical school and post graduate education. Many pursue fellowships and residencies. There is a significant amount of intellect and scholarship trapped in those brains of theirs. Here is the problem, until there is something wrong with me, I have no way of tapping into that knowledge. We often mistake holding onto our ideas and knowledge as power. The reality is the opposite. Those who are willing to share their expertise often find the rewards to be considerable. If you are a physician, you are a trusted expert in your field (the same can be said of provider organizations). Your use of social media must consist of sharing that expertise. Provide your opinion on the health news of the day. People would much rather get that expertise from someone local and trusted than an etherial disembodied name on the byline of a major news paper. Here are two great examples: Dr. Howard Luks and Piedmont's HealthWatchMD site.
  • Be collaborative - engage publicly with other physicians and experts (and can't patients be experts in their own conditions?). If you are an expert individually, and there is indeed benefit to liberating that expertise, imagine what happens when you team up with other experts? In medicine there is the concept of grand rounds - opportunities for physicians to present complex cases as learning experiences to other providers. Today's social tools are perfect platforms for grand rounds. The more providers are willing to interact and share, the more we all benefit. This collective knowledge becomes searchable, accessible by anyone - patient or provider - who wants to learn more about a condition or treatment. Dr. Gayle Smith does a fantastic job of collaborating with patients and colleagues.
  • Be Innovative - Innovations come in many forms; not everyone has to be the next iPod. Think about how social and digital tools are being used outside of healthcare. What applications might they have in improving health and patient experience? Over 500 million people are using facebook. According to their statistics, 250 million access the site from a mobile platform and mobile users access the site at least two times a day. What does that tell us about the role mobile platforms play in what has become the most significant communication tool of our age? Do you have a way to interact with patients via a mobile device? What about text messaging? There is an innovation which is easy to adopt. Solve problems, don't get hung up on them.

There you have it. How is that for a start? As we start to go beyond simply being online it is time to think about how to have an impact in what we are doing. What other guidelines would you propose? What about from a patient's perspective, what makes social media meaningful?

Elsewhere: Accountable for care, employers supporting healthy food choices

Elsewhere: Remember me? Yeah, me either. This whole graduate school thing is hard - who knew!?! Elsewhere is my series of posts highlighting content from sources I find interesting, inspiring and supportive.

My world got a little bit smaller the other day. When I walk the dog I usually listen to podcasts, downloadable audio and video shows. Think TiVo for your iPhone. You already knew that didn't you?

So I'm listening to American Public Media's The Splendid Table. If you are at all inclined towards the culinary arts, by which I mean eating, then it is well worth a listen. You can dial it in on most NPR stations, although I suggest you download it to you portable gizmo as a podcast, either through iTunes or their website directly.

Anyway. Host Lynne Rossetto Kasper kicks off each week with a mini-monolog about some food trend or observation.

This week, Lynne discussed an employer which is offering to help subsidize community sponsored agriculture (CSA) memberships for employees. CSAs are like gym memberships for famers markets. Usually you pre-pay to "join" a farm and get regular deliveries of fresh veggies, meats, dairy, etc. You help fund the operations and get a share of the lauder in return.

Think about that for a second - an employer that was willing to sponsor a food lifestyle choice for employees.

Some employers, although I anecdotally suspect the number is low, sponsor gym memberships for employees. The idea is when you workout you are healthier and thus avoid disease and illness which, in turn, saves the company money on healthcare costs.

If that logic holds true (and aren't we told we are what we eat?) then doesn't sponsoring healthy food choices also make sense?

There is a lot of talk in the healthcare industry about "accountable care." Without going into details on the pros and cons and esoteric points, suffice it to say it means healthcare provides partner with the people paying for care to reduce the cost and innovate the care model. Most people who get insurance in the US, outside of Medicare, get it through their employers. Many of those employers are self-insured; meaning they pay for care out of the company's coffers, even if administered through a third-party commercial plan. You may have blue cross, but your employer is likely footing most if not all of the bill.

Given that, doesn't it make sense for employers to support employees who make healthy food choices?

Paying for CSA memberships is admittedly not the norm. It is a little on the hippie, 2000s-dot-com-days side of out there. But it may offer similar benefits as paying for gym membership, or perhaps it is even better. Nonetheless, it is as least accountable, forwarding thinking and socially responsible.

Elsewhere: Bar or Hospital - it’s people. You have to get to know people. Relationships. Take care of them

In my growing elsewhere series, I've been highlighting content from other sources online. You know, curating, as the hip social media types say. Last week, the LA Times reported that 'hospitals are looking more like luxury hotels'. The article says that a report found that, to patients, the non clinical experience mattered twice as much as the clinical experience. I call it patient experience. In healthcare, it means how we care for someone's complete needs - emotional, clinical, spiritual, etc. Sometimes it is as simple as spotting the guest who needs directions and walking them to the right place. Sometimes it means giving a hug, or sitting and listening. In the end, it is about people taking care of people.

So what do a bar and a hospital have in common? How you treat people is how people will think of you. I'm proud to call An Bui, "Chief Beer Officer" at Mekong in Richmond a friend. I'm proud to call him a friend because he treats me like a friend. An's special gift is treating everyone he meets like someone special, getting to know them and providing the best service he can, every time. This week, is profiling An -- the quote below typifies An and his approach to service. It also shows his affinity for and success with extending his style of service outside the four walls of Mekong using social media.

It’s people. You have to get to know people. Relationships. Take care of them. We’re not perfect. We know we can always improve. But people who come back to us, we always try to take care of. For me, I’m happy. I like people to be happy. At bar, I do my best to keep people happy. Pour good beer, talk to people like family or at least very good friend.

I’m a beer lover. I say Mekong is for beer lovers. We welcome beer lovers and create new beer lovers by focusing on great beer. That’s why I have a lot of friends on Facebook. I love Facebook. Anyone can friend me who has come into Mekong. I enjoy happy friend. Make good recommendations, too. Also, good customers and friends who tell other people about our food and beer and how we get to know you. We have great customers out there who visit us all the time and tell others and post on Facebook and Twitter.

Its not the platform (subtitled: a note to self)

So, let me get this out in the open. I'm not a social media advocate. I'm not a social media guru, expert, thought leader, or zealot. I am not pro-twitter. I'm not really that into Facebook (please don't unfriend me!). You might be surprised to read that I'm not always looking down at my phone. Maybe I am. But still. I am an advocate for care. I am an aspiring healthcare guru, a wanna be expert, a hopeful thought leader and unabashed zealot for improving the patient experience. I am a pro human. I am really into making someone's care experience a holistic one. You might be surprised to read that I like to spend part of my day greeting people at the door of our ER.

When did social media become about, well, social media? When we we decide that talking about what we are talking on was more important than what we should really be talking about? I'm not an angry blogger, I promise. And I'm not singling out anyone or any post either. In fact, there have been some important online discussions recently about the validity of social media in healthcare.

But, isn't it really about healthcare, about care. I mean, if its not, why are we interested? I'm guilty of getting wrapped up in frenzy; and suspect we all are. This is my call to action, my reminder to myself and my sincere wish - lets keep it about advancing how we care for others. We do that in many unique ways. Doctors do it differently from nurses, who do it differently from patient advocates, who do it differently from mental health professionals who do it differently from us admin types, who …. well, you get it. Still, we are all focused on improving the experiences and outcomes of those we care for. When we start talking about the 1s and 0s that our bully pulpit is made of, we've lost some of our effectiveness.

Be health champions first. Let's be champions of care first. Let's focus on using early adopter, expert, and guru status to champion what it is we are really doing - elevating the art of healthcare.

epilogue: Now, I know what you are thinking. Wasn't my last post on this blog a hubristic, aggrandizing, self-promotional link to an article where I was quoted as being some kind form of thought leader? I see where you are going with that though and I agree. I'm talking to myself in this post. In fact, when I forget about this altruistic nonsense, I expect you (my two readers, hi mom!) to call me out. I'll also add that those kinds of articles and posts are important. They are ammo in our arsenal to promote the use of social media - we just need to remember why we are so keen to promote it in the first place.

Health Progress - Social Media: new tools boost marketing, education and community

The November issue of the Catholic Health Association's Health Progress Magazine includes an article on social media and healthcare. Social Media: New tools boost marketing, education, community, by William Sweetland and Susan Thomson is available on the CHA website as a pdf.

I had the privilege of being interviewed for the piece. I find being asked certain questions prompts me to think about my own work in a different way. That was abolutely the experience I had when Bill Sweetland asked me about the intersection of Catholic healthcare and social media. I am not catholic and have only worked in catholic healthcare for a little over 3 years. When I made my transition from the consulting world back to the provider side, joining a not-for-profit with an emphasis on customer experience and community health was a no-brainer. When we formed our social media program, the same tenants that govern our mission and values went into guiding our social media program. It was a fun exercise to see just how much overlap there is between social media and mission-driven, community focused healthcare.

At Bon Secours Richmond Health System in Richmond, Va., Nick Dawson, administrative director for community engagement, has so far figured out that his goals for social media include “improving the patient’s experience” and “giving away” the hospital’s “vast scientific medical knowledge to promote holistic healing and wellness.”

Wait, give away core expertise? Isn’t that counter-intuitive?

“Isn’t there a saying that tells us that if you give away your riches, your core competence, it will come back to you many times over? It’s a funda- mental truth when you think about it,” Dawson said. “And social media can help us do that” — educate patients and the public, in other words — “in a big way.”

What can healthcare learn from Apple?

Subtitled: in which I offend my tech friends, healthcare friends or both
I synergize, it is what I do. (for those of you playing business jargon bingo, drink!) I am also an unapologetic Apple fanboy (for those playing internet buzz word bingo, drink!) I've long thought that Apple makes bold decisions, and, since Steve's return, calculated long range decisions. Yesterday Apple held their "Back to the Mac" event. They unveiled the next iteration of their OS X operating system along with a new Mac Book Air. To the consternation of technocrats, Apple continues to make moves away from traditional computing paradigms (drink) towards something that is more like an appliance. It occurs to me that healthcare in the United States is undergoing similar changes. If that is the case, what can we learn from watching Apple and its consumers?

First a little watered down techie background. Computers have long been the domain of nerds. Hey, I'm a nerd, I can say that. How many people know that person…scratch that…kid in their family who is the computer person? Put your own memory in? Nope, save it for thanksgiving and they'll do it. (Let the record show that I am that person, and actually quite happy with the mantel). Not everyone knows how to open the command line, clear the cache, defrag the hard drive or replace a motherboard. What happens when that window gets minimized to some new place, or you can't find a file? Today's computer-savvy youth have learned an entire skill set and vernacular that is frankly transitional at best.

Apple is moving computing in a new direction. Will it frustrate those of us nerds who actually enjoy changing our digital motor oil? Of course. There will always be people who want to build a RAID 5 array of hard drives. But most people just want the computer to be like an appliance. Turn it on and it works.

Healthcare is not much different. There are those of us who work in the trenches. We understand what payor mix and covered populations are. Should most people really have the words "explanation of benefits" in their vocabulary? Isn't that the IP Address of the healthcare world? Healthcare reform is a great example of this. Ask ten people what is broken with US healthcare and you will get 10 different answers. Ask that same lot what defragging a hard drive means and I'll bet you get an equally ambiguously and unqualified set of responses. Most people can't articulate much about healthcare because we have a convoluted system that is difficult to unravel.

Where is the Apple of healthcare? Where is the App Store that shows us what apps to buy and automatically installs and updates them? Apple have a much lambasted screening process for apps that make it into the iPhone and iPad store. Some call it closed or a dictatorship. Maybe. But my mother can use her iPhone and never calls me with questions like "how do I get this pop-up window off my phone's screen?" In Apple's world, it just works.

We are moving towards a reimbursement model that is focused on wellness and health. Over the next few years, computers will have a lot more in common with a toaster than the huge beige box from yesterday. Healthcare in ten years may look a lot more like a public utility than the what we have today. There are a lot of us who have been ensconced in the existing healthcare world. We're the nerds who like to drop into the terminal and type cp ~/Desktop/blog.txt ~/Volumes/Server/www/post.txt to copy a file. We're the ones who know how to tweak our reimbursement process to get the most out of medicare for an office visit. Yet there is a huge, increasingly vocal majority of the public who are asking: "where is my healthcare app store?"

Is the answer accountable care? Is it a public plan? Is it a public/private split like our school system (and like the Australian health system)? I don't have that answer. I do know that Apple is on to something when they make their devices more layperson friendly. It may frustrate the old guard, but isn't change always painful for those who can't keep up?

And... for a little light humor regarding accountable care:

In Healthcare, Experience Matters

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.

someone build this: Foursquare for Doctors

The genesis of this idea came out of the Healthcare track of the C2C US/Russia Civil Summit that I participated in in June 2010. During a discussion around the use of social games, Dr. O Marion Burton had a lightbulb moment. He piped up with, "oh wow! how cool would it be to show off that I used a cheaper med and had better results!" I have been taken with the idea since that conversation. Since I am not a coder, here is my plea: someone help build this. 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!

From Russia with Health - the US/Russia 2010 Civil Society Summit

Two weeks ago I was part of an amazing experience. I was privileged to be a part of the C2C Civil Society Summit between Russia and the United States. For two days conversations with thought leaders from both the US and Russia that occurred as a bi-lateral event during President Medvedev's visit to the US. Specifically, I was invited as sort of validator to and contributor of ideas related to healthcare. 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.

Code Lavender - making the patient experience a strategic goal

"Most patients want the high tech and a great quality outcome, but they can't judge the quality of the [treatment] they can judge the quality of the experience..." - Bridget Duffy, MD This inspiring video came to my attention by way of Dr. Howard Luks. Every time I watch it - I have done so several times - I become more inspired. Dr. Bridget Duffy, the Chief Patient Experience Officer for the Cleveland Clinic (how great is that title!) presented this talk at the Gel Conference. Dr. Duffy makes the case for elevating the patient experience to the same level of importance as clinical outcomes.

There are two concepts in particular that resonate with me from this talk. The first occurs around 21:45 when Dr. Duffy talks about "Code Lavender". In her words, TV medical dramas have made us all familiar with a Code Blue, a patient in cardiac and/or respiratory arrest. A Code Lavender is when someone is emotional arrest - a patient, visitor, doctor, nurse, anyone in the hospital. Calling a code Lavender means that "everyone in the hospital stops and sends healing intention or prayer..." It is a powerful concept.

The second point that I find especially apt is an overall theme of the talk: creating a meaningful, positive, healing patient experience is the most important strategic goal a provider can have. "If you focus on that, [hand washing, clinical outcomes, quality, performance improvement] will come."

At the end of her talk, Dr. Duffy slips in a key part of this plan, "listening to their needs." I recently had cause to say to someone "I'm working with a patient to resolve a concern they have, this is the best part of my job, social media is just a way to get there." Using these real time tools to connect with patients and improve their experience is truly what #HCSM is about to me. I am fortunate to work for an organization that has made experience a strategic goal. I get to see every day the impact it has.

Bridget Duffy at Gel Health 2009 from Gel Conference on Vimeo.

Power to the People [Part 2] – Exposure Therapy

Part 2 of a 34-part seriesThe next level of growth for healthcare social media, must come from within the organization and involve all employees in the effort.

The previous post in this series reviewed the first year of healthcare social media and noted the correlation between engaged employees and customer service. I’ve predicted that in the coming year we’ll see progressive organizations extending the use of social tools to their employees; thereby creating a culture of information exchange and online service. Achieving a socially connected employee base at a healthcare provider is not without challenges, although it may be easier than some would suggest.

Action conquers fear

We have no reluctance about hiring someone to register a patient or letting nurses tend to patients. Healthcare providers, as Lee Aase of the Mayo Clinic has quipped, are accustomed to embracing cutting edge advances in medicine but ironically slow to adopt new business practices. And so, it should come as no surprise that many hospital systems balk at the idea of allowing a nurse or registrar represent their brand online. Many concerns can be easily relieved by exposure to social media tools and education about their use.

Compliance and regulatory issues usually top the list of concerns and rightfully so. A well-intentioned caregiver posting a patient’s picture could unwittingly generate serious legal problems for a provider. Similarly, I would not suggest completely dismissing issues relative to branding. Again, a well-intentioned employee could post offensive or misleading information.

But there are also concerns that rest on a much less solid foundation. Here, I’m referring to the red herrings of productivity, viruses (or other technological malfeasance), and inflammatory discourse. I suggest these concerns can be allayed by  what psychologists call exposure therapy.

The tools that organizations are scared to give their employees  can, in fact, be the way to overcome fears – real and imagined. It is time to begin using social media internally, within provider organizations. Doing so will help assuage naysayers and allow organizations to cultivate online ambassadors.

Connecting the dots by connecting employees

Out-of-the-gate it may not make sense to extend Twitter to 5,000 employees. However, a simple forum site, accessible only internally, may be a gentle introduction for both the organization and its employees. Consider augmenting the intranet site with a forum. Make the rules clear and accessible -- no foul language, no insults, and no patient information. This is not a unique idea.

Paul Levy, the widely-read CEO blogger from Beth Israel Deaconess Medical Center in Boston set up forums when facing a difficult financial position last year. He explained that layoffs seemed inevitable, but offered an online, intranet for employees to discuss other options. It worked. Employees collaborated openly and created ways to reduce costs and save jobs. Concerns about inflammatory language proved unfounded, the conversation was civil and professional. Levy is a seasoned leader who knows criticism is often a suggestion in disguise; he’s fearless about letting employees speak freely.

If forums are the first steps, a more feature-rich social platform may follow. Multi-user content management systems like open source Word Press MU or commercial Microsoft SharePoint can be used to build powerful internal social networks. As a colleague puts it: "I can log into Facebook and see what everyone I know is up to in broad strokes, and it only takes minutes a day. Why can't we do that across our organization?"

Imagine logging into an intranet and discovering what’s going on in finance, surgical services, registration, administration, and infection control,-- all from short status updates. Wouldn’t knowing where the company as a team was headed be useful?

These kinds of controlled, internal social efforts also help employees better understand what leadership looks like. Leaders,  coached by those who understand social networks and organizational development, can model leadership by their participation in online communities. Most companies already have online training tools, so including Social Media Communications 101 is an easy drop-in that will lead to an internally connected and engaged workforce.

Next time, a deeper look at the the tools to build an internal social network...

Power to the People [Part 1] - HCSM turns 1

Part 1 of a 3 part series The next level of growth In healthcare’s use of social media, must come from    the within the organization by involving all employees in the effort. Preface

For many healthcare provider organizations, social media has become an extension of external marketing efforts.  And while  big external wins, like viral videos or news coverage of tweets can help create internal momentum, too often these actions are little more than glorified sales pitches. To truly be successful in the use of social media, providers need to begin thinking about engaging their employees in the social conversation and. creating a team of online ambassadors who serve each other and their customers more effectively. In the case of healthcare, it means engaging the  entire staff of caregivers in the conversation about bettering the patient experience.

The story so far If seven human years equal a dog year, how would we calculate an internet year?

Only twelve to sixteen months have passed since early adopters got serious about social media in the healthcare industry. A lot has happened during that short period of time. Just recently the #HCSM twitter chat celebrated its first birthday. According to Ed Bennett’s Found in Cache, over 500 hospitals now have some kind of social web presence.  We’ve seen surgeries tweeted, the Pink Glove Dance go viral, doctors tweeting, and iPhone applications for hospitals. So what does the coming year look like for healthcare social media?

Most, if not all,  healthcare providers  share the collective goal of improving patient experience. Sometimes, this is expressed as clinical excellence; sometimes as increased efficiency. Regardless of wording, having an entire organization discussing this type of improvement can strengthen a provider’s ability to deliver care. Just as there is a correlation between engaged employees and good service, so too is there a connection between connected employees and empowerment.

During the past two years at the hospital where I am employed, we have seen how increased employee engagement has  improved everything from patient satisfaction to clinical outcomes.

Well cared for, happy employees serve customers with an exuberance that comes from a sense of pride that cannot be induced by coaching alone. The exuberance and best in class service I have observed  across multiple service industries is a result of establishing and sustaining a company’ culture of serving customers with pride, anticipating patient needs, and caring about positive outcomes. This type of culture is rooted in engaged employees who believe in the organization’s mission. And just as service emerges from a culture of engaged employees, social media must emerge from engaged participants.

Prediction This next year for healthcare social media will be an opportunity for progressive providers to grow in amazing ways. I say this is the year that organizations that truly embrace openness and transparency will move to the forefront. Social tools have a role inside of organizations. When they’re used to help flatten the org chart and promote discourse, the entire enterprise benefits and convey an important ethic that branding alone cannot match. The path has been paved in this last year. The very social tools that we have been using externally have an immense power when they are applied internally. More on that thought soon...


This post is shared with much gratitude to Meredith Gould for her editorial guidance