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Readers Write 8/19/09

August 19, 2009 Readers Write 10 Comments

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Health 2.0’s Social Networks Get Down to Business!
By Deborah Kohn

deborahkohnForrester predicts that by 2013, social networking will account for nearly half of the $4.6B market it forecasts for all Web 2.0 products (or, as we in healthcare refer to these products, Health 2.0).[1]

Web 2.0 / Health 2.0 products are the suite of online technologies and applications (e.g., blogs, wikis, Really Simple Syndication [RSS], content communities, mashups, podcasts – in addition to social networks) that are used to share information via text, images, audio, video in a participative, communicative environment. They are based on users’ opinions, expertise, insights, interests, or work activities.

Social networks (e.g., Facebook, LinkedIn, Twitter) can be differentiated from the other Web 2.0 / Health 2.0 products because they give users the ability to create individual profiles that foster interaction among many people (“many-to-many” as opposed to “one-to-many”). First made available on the consumer-oriented MySpace site, in general, Web 2.0’s social networks finally are finding a solid niche in the business world, and, in particular, in healthcare. The reasons are that social networks can assist information workers in collaborating and accomplishing work more quickly, productively, and cost-effectively than current collaboration tools.

Information workers spend an inordinate amount of each day collaborating in e-mail. Where e-mail was once considered a “messaging system” — the electronic equivalent of the Post-it note, replacing paper office memos and telephone messages — eMail evolved into a “communication system”, essential for a healthcare organization’s business processes. While soliciting and sharing information via e-mail is effective, relying on an e-mail system for collaboration and compliance is risky. Version tracking becomes nearly impossible, and visibility is limited to those on the “To:” and “cc:” lines. If a worker is hoping to find and re-purpose an e-mail or its content at a future date, it’s not practical. Same for using file shares.

However, Twitter, for example, gives information workers the unprecedented ability to tap into customer-driven feedback loops and turn them into message amplifiers, focus groups, and even goodwill ambassadors! In addition, all workers inside the organization, not just selected groups, can create, edit, and distribute ever-increasing volumes of ad hoc and informal information. Even with limiting posts to 140 characters, many-to-many can still efficiently link to educational podcasts, budget decisions, and quality and safety videos as well as search for the information.

If healthcare organizations have a receptive culture, a clear business strategy, and a clear technology strategy that allow for social networks to be appropriately integrated into established healthcare business processes, I predict that, like e-mail, social networks will become integral to a healthcare organization’s activities and will achieve a level of legitimacy and value that will rate them a secure spot. In other words, instead of sending one-to-many e-mails for certain collaborative activities, the ability to post announcements many-to-many using social networks will become the next generation of e-mail and file shares.

[1] Owyang, JK; The Future of the Social Web, April 27, 2009

Deborah Kohn is the principal of Dak Systems Consulting of San Mateo, CA. 

Survival of the Fittest
By Mark Steele, MD and Jack Callahan

Any highly adaptive species will thrive on its evolutionary journey; any species that is not responsive to its environment will inevitably come to extinction. The EMR and its more adaptive descendent, the hybrid EMR, offer a clear example of this process of natural selection in the digital world.

As the name implies, the hybrid EMR represents a synthesis — in this case, between the traditional EMR and how doctors actually practice medicine in reality. The hybrid EMR is a highly flexible adaptation that has split off from its original species and continued to evolve, while its ancestor, the traditional EMR, still struggles to survive. The incontrovertible success of the hybrid EMR in the marketplace is a perfect illustration of the survival of the fittest.

When the EMR first emerged from the primordial swamp of legacy code, it was poorly adapted to the healthcare IT environment. Its genetic inheritance of hard-to-use, rigid data entry syntax and non-intuitive navigation kept it from thriving, particularly with demanding, high-performance practices. But because it had a few attractive features, along with some colorful-looking plumage and no natural competitors, it did gain a toehold in the market. Still, no matter how many tried to domesticate the primordial EMR, few succeeded.

Later generations of the EMR species made clear the need to regulate its unstable genetics. CCHIT engineering was engaged, with government funding, to control the breed. Yet despite Herculean efforts and even crossbreeding with the PM species to deliver a combined, integrated entity with a single DNA set, maladaptation continued. High-performance practitioners and specialists, who demand a stable, productive, usable species of EMR, were not consulted, and they were not convinced. They did without, waiting for the species to evolve still further.

Finally, it did. The hybrid EMR emerged, with new genetics and usability, and met with huge acceptance and adoption.

This meant that the traditional EMR species had reason to fear for its survival. Its only hope of getting off the endangered species list was a cataclysmic event that might give it a chance to catch up to its competitor. Eventually, the dire state of healthcare led to unprecedented funds being allocated to encourage medical practices to adopt traditional EMRs. This was supposed to benefit the practices, but since EMR genetics remained the same, maladaptation continued, endangering the very practices that adopted them.

The beginning of the end of the traditional EMR species is at hand and the government health IT stimulus program will hasten the demise of the woolly EMR mammoths. As physicians realize that complying with government EMR "meaningful use" protocols requires significant productivity losses, the traditional EMR will be relegated to a minor role for low volume and non-fee-for-service practitioners … or even to extinction.

Natural selection favors species that can evolve and adapt to the demands of a changing environment. Such is the hybrid EMR. Its strength is a fundamentally simple, strong, and very nimble DNA architecture that can accommodate the changing requirements of its users. Unlike traditional EMR systems, which force the user to conform to their structure and syntax, the hybrid EMR thrives because it conforms to the unique needs and productivity requirements of the healthcare provider, even the high-performance healthcare provider. The hybrid EMR is the highest state of EMR evolution; its survival is assured.


The Green Provision to the America’s Affordable Health Choices Act of 2009?
By The Alchemist

In the year 2010, the global economy is on the brink of absolute collapse with overcrowding in the cities, rampant unemployment, and a mandated rationing of healthcare resources because of the increased demand and the sudden swollen health insurance membership. Hospital palaces from around the world are converted to efficient and effective government-run bureaucratic clinics for the delivery of appropriate metered care according to the QARY paradigm.

The United States of North America has implemented a novel solution to scarce healthcare resources by augmentation of the Patient Self Determination Act 1991 (PSDA) within the America’s Affordable Health Choices Act of 2009. The purpose of PSDA is to relieve the burden on the healthcare delivery system by introducing a process that might produce the desired “green” effect by reducing the supply impact to our environment of care.

PSDA is re-crafted and claimed successful within the green movement for scarce resources and has become known as the Solyent Green Movement where tired citizens can “go home” to their favorite government clinic for care. Solyent Green is for people!

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Currently there are "10 comments" on this Article:

  1. Remind me not to hire any of the above…

    All sounds like a lot of blah blah blah…that will get lost in time – shortly.

    The Doc

  2. the hybrid EMR… very interesting article, but please tell me more. I didn’t get enough details to get my head around the “who, what, where, and how?” Would love to hear more about this and who’s using such an animal.
    Thanks!

  3. No, Their web site doesn’t help much either – I can’t figure out what hybrid EMR means. They should have spent less time beating the Darwin metaphor to death.

  4. I didn’t mention their affiliations since there are multiple Mark Steele, MDs when I Googled him, so I didn’t know which one he is (I think he’s probably the NYU ophthalmologist, but I’m not certain, so since the articles are often anonymous anyway, I figured I’d just leave it out since it was getting late). Jack Callahan is EVP of corporate development for SRSsoft.

  5. The Alchemist might garner more authority if he/she spelled “Soylent” correctly. It’s hard to take ignorance seriously.

  6. Health 2.0 sounds nice, but it looks like it’s a rebranded Enterprise 2.0, which is the enterprise version of Web 2.0, which bundled a few unrelated things (applications in the browser a la GMail/Google Maps; online communities AKA social networks; online communities AKA user-created content AKA crowdsourcing; the return of venture capital funding to technology startups). Also I noticed above there seems to be a tint of “online collaboration/information worker” talk which I don’t think has any business in an E2.0 (Health 2.0?) discussion.

    The summary is,
    * YES, there are a lot of benefits to rolling out an online community inside the confines of your corporate network. Connecting people is a good thing.
    * YES, email is inefficient, though the solution to “too much email” will involve more of an organizational (human) solution than technology–moving your emails to a web page isn’t saving anybody time.
    * NO: in and of itself, the technology isn’t a game-changer.
    * NO: the technology is not as important as the community. The Forresters of the world will try to frame the discussion in terms of a magic quadrant. This is a flawed approach.

    Actionable goals:
    * Read up on the good concepts adopted by the Web 2.0 fad. Clay Shirky is remarkably good at explaining a lot of this, you can watch recorded presentations of him if you’re not willing to read a whole book.
    * If you’re tasked with rolling out an “Enterprise 2.0,” focus on building a community and use the technology best suited for that task.

  7. Regarding the extended metaphor on the “Darwinian” article on hybrid EMR. Dr. Steele and I had such an interesting time putting it together, perhaps it was a little over the top. We don’t advertise and do limited promotion, so our passion for hybrid EMR and our 4,000 plus clients comes out in other ways.

    Hybrid EMR takes most of the objections out of anti-EMR sentiments that physicians have. It was designed to do three major things extremely well and non-intrusively.

    First, hybrid EMR focuses on streamlining processes and workflows in the practice. As a result, communications and messaging become the workflow. Document flow and “workflow” are not “modules” or forced sets of processes. Hybrid EMR sees it as seamless, intuitive communication and information sharing across walls, offices and facilities. This often turns out to be client’s favorite aspects of hybrid EMR.

    Second, hybrid EMR does not change the way that busy practitioners conduct their exams. Whether they choose to write and dictate, voice-transcribe, create specific templates or use paper forms and scan, Hybrid EMR allows practitioners to do it “their way”.

    Third, hybrid EMR is not built around templates and detailed data entry. Few things frustrate busy providers more than the need for time-consuming entry in many screens and forms.

    Now this may SOUND similar to claims made by traditional EMR vendors. But seeing is believing. Hybrid EMR was built on a platform of speed, in the office of a high-performance practitioner. While virtually all EMR product descriptions SOUND alike, its in HOW they work that the real differences become quickly apparent. Hybrid EMR is the only one we know of that offers risk-free pilot programs to qualified practices.

    Traditional EMR forces physicians to use nested menus, pull-downs and many click boxes to document each exam. This forces physicians to change the way they conduct exams and interact with patients. The vast majority of physicians have not deployed traditional EMR for one of three reasons: 1) they have no time for all the data entry during exams; 2) they resist being forced to become proficient keyboard/mouse operators; or 3) the benefits are not worth the cost and lost productivity (revenue!).

    Hope that clears up some of the questions left in the earlier article.

  8. Persnickety – Thank you for correcting my dyslexia. However, on 08/23/09 FOX News Sunday morning with Chris Wallace public affairs show, please view the reporting on VA veterans “pulling their own plugs.”

    Soylent green, almost misspelled it again, is an outrageous analogy to some of the occult provisions in HR 3200 and the to-be-numbered Senate Bill. End of Life consultation is an HIT element for measurement possibly under the proposed Meaningful Use of EHR metrics by 2015.

    I’m usually a blah-blah-blah responding type of person but preparing for electronic capture of definable analytics in healthcare is a passion that hopefully will protect my family and friends from subpar medical care and avoid “near miss” medical adventures.

    I am reminded daily, how transcription error, typographical error, or machine error can impact our life – “no one is above the statistical chance for error,” said Sister Mary Margaret.







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Reader Comments

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