Management is a “cancerous growth?”

Biting words about administrators from a National Health System physician in the U.K.:

He calls the administrators the Stasi – nicknamed after the former East Germany police – and the management system a “cancerous growth” which would only be improved by sacking nine out of 10 managers.

He said: ‘Unfortunately I honestly believe that the service I am allowed by the Stasi to provide to my patients is not as good as it was nearly 30 years ago when I came to this hospital.

Dr. John Riddington Young has written a book on his experience.  He continues:

He dismissed suggestions that the rising number of managers have made a positive difference, such as cutting waiting times.

[snip]

‘You could ask almost any working doctor and he would be of the same opinion, that administration is incompetent, top-heavy and unnecessary’, he said.

Anecdotes from foreign countries with universal health care are often used in our health care debate, both pro and con.  Regardless of your position, it’s worth listening to the dissenters.  Our (more so) market driven system probably produces the same feelings in some physicians in this country as well.  Eliminating administration isn’t the answer, but an argument can be made that we’re over-managed.

Notions of privacy are fleeting

Fast Company’s Big Idea on July 29: “CEOs of public companies should be obligated to share their health status with investors.”

The statement is inspired by investors’ concerns about the health of Apple CEO Steve Jobs.

While Fast Company poll respondents resoundingly voted no, the mere fact that the statement was made highlights our culture’s shifting notions of privacy.  Ask anyone on Facebook or MySpace what privacy means to them.

But, medical privacy is a different beast.  Depending upon your health, more important than financial privacy (where lapses can be fixed) and online behavior privacy (where lapses can be blamed on youthful naiveté).  Technological developments have increased those concerns.  While improving patient safety, electronic information also increases accessibility.

The recently passed Medicare bill that prevented fee cuts to physicians also encourages them to adopt e-prescribing. The measure has some groups, including the American Civil Liberties Union, concerned.

The Wall Street Journal Health Blog:

In an interview with USA Today, Tim Sparapani, senior legislative counsel for the American Civil Liberties Union, raised a red flag about electronic prescribing: “Any time you put something in a digital format and standardize it, it becomes much more profitable and easy to move those records.”

Legitimate.

Electronic records and e-prescribing do raise privacy concerns.  Let us not forget the the same concerns of offline medical information, too.

Later in the day the same blog posted this:

In yet another example of the health industry mishandling private patient records, Blue Cross and Blue Shield of Georgia sent some 202,000 explanation of benefits letters to the wrong addresses last week, the Atlanta Journal-Constitution reports.

Medical information isn’t “safe” electronically, nor in hard copy form.  It seems the patient has a choice: pick your poison.

Amazon.com, the over the counter pharmacy

kottke:

Matt Thompson has some advice for you: stop buying cheap-ish pseudo-generic drugs from Walgreens, Rite-Aid, and Duane Reade and start buying really cheap true generics.

As you might know, Benadryl (available at Walgreens.com for $5.29 for a box of 24 capsules) and Wal-dryl ($3.99 / 24 capsules) are otherwise known as “25 mg. of diphenhydramine HCI.” Compare [with the true generic available at Amazon]. Yes, that is 400 tablets containing 25 mg. of diphenhydramine HCI, for about $10 when you factor in shipping.

Heed his words. Here’s 300 tablets of generic Claritin for $11.00, 100 tablets of generic Zyrtec for $6.99, 240 tablets of generic Zantac, 1000 capsules of generic Benadryl for $20.34, 1000 tablets of generic Advil for $11.70, and 1000 caplets of generic Tylenol for $13.91.

Collaboration!

Collaborative networks created to improve care delivery are growing.

Here is the most recent example from Fierce Healthcare (and another example of “getting it“):

A group of nineteen New England hospitals have joined together in a network allowing them to share information about clinical practices and boost their quality improvement efforts. The hospitals are starting by focusing on preventing and reducing the incidence of pressure ulcers. The hospitals will share this information through a “Rapid Adoption Network” sponsored by VHA Inc. The hospitals will be using VHA’s clinical blueprint to mount their pressure ulcer reduction efforts.

Collaboration!

Is there any wonder why our system is dysfunctional?

From Well:

A growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks.

[snip]

About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins study published this year in the journal Medicine. And two recent studies show that whether patients trust a doctor strongly influences whether they take their medication.

From Bloomberg:

Insurers, led by WellPoint Inc. and Magellan Health Services Inc., are increasingly rejecting imaging procedures recommended by U.S. doctors as the companies work to trim $30 billion a year they say is wasted on the tests.

Patients vs. Doctors vs. Insurers vs. Patients

It’s no wonder why we’re increasingly feeling like our health care system isn’t working.

Retail medical facilities?

The Washington Post on a novel approach to tackling the health care access problem:

Under the plan, the county would partner with private retail owners to renovate or build spaces where customers could, for example, buy a pair of shoes in one end of the mall and get a mammogram or a physical in another. The partnership would be paid for with public and private dollars.

That business idea sounds eerily similar to places like this.

For what it’s worth, here is the idea already in action.

New tools to find medical information

MedPedia, a wiki for everything (read: e-v-e-r-y-t-h-i-n-g) medical, launched last week.  From MedGadget:

A group of American medical schools is working on a project to essentially collect and organize all medical knowledge in a Wikipedia-like form. Access to MedPedia will be available to all, but editing rights will be limited to M.D.’s and Ph.D.’s in relevant fields of research. Harvard, Stanford, the University of Michigan, and Berkeley will kick off the site with initial content and work with the rest of the medical community to make it comprehensive. With that in mind, the project organizers are calling on all M.D’s and Ph.D’s to register to become editors of what they believe will be the largest and most complete encyclopedia of medicine in history.

Google Knol, a tool similar to Wikipedia + Squidoo, launched last week, too.  From Knol:

The Knol project is a site that hosts many knols — units of knowledge — written about various subjects. The authors of the knols can take credit for their writing, provide credentials, and elicit peer reviews and comments. Users can provide feedback, comments, and related information. So the Knol project is a platform for sharing information, with multiple cues that help you evaluate the quality and veracity of information.

Common theme: content created, edited, and distributed by experts for the reading pleasure of all.

It seems everything old is new again.

I am a fan of MedPedia.  For physicians, being able to easily search and access information that has long been stored in medical journals is a definite improvement. I’ve witnessed physicians using Wikipedia for a quick once over of a not-often-discussed topic.  Now, not only can they do a quick refresher with MedPedia,  but they are able to make confident clinical decisions based upon the content.

I’m skeptical of Knol, but warming.  It may have its place in medical search as well.  Bob Wachter, a partner in the creation of Knol, explains its usefulness:

So if you search Google for your favorite health care topic (migraine, or MI, or leukemia, for example), you’re likely to see a Knol – at this point, undoubtedly one that I commissioned – in the search results. The Knols are layperson oriented: I asked authors to write the Knol that they’d want their mother or best friend to read if they had just been diagnosed with the illness. There are also a few Knols on broader medical issues; for example, I wrote Knols on patient safety, quality of care, and hospitalists.

Bertalan Meskó raises this contention:

So I will have to find out which Knol is better. In Wikipedia, we merge different “Knols” into one article. So the readers can only see the best version. Doesn’t it sound better?

I believe in the wisdom of crowds (maybe because I’ve been a Wikipedia administrator for years now). You can pay people to create you a database of information; you can let people fight who can come up with the better article. But it can never be as accurate as Wikipedia is.

Don’t we have enough information?  More is always better—as long as the organization of the information is functional.  Finding it, understanding it, and trusting it is what MedPedia and Knol are trying to improve.

On a related note, I’d be willing to offer that many medical information searches start with Google.  Well, a new search engine, Cuil, launched on Sunday specfically taking aim at the search giant.

The launch was laughable.

Seth Godin’s post sums up what many are thinking on Cuil vs. Google:

Once there’s an icon in place, it’s there because it’s working. It serves a purpose, it carries useful information and performs a valuable function.

[snip]

Google, of course, is the Marilyn Monroe of search. I have no doubt that someone will develop a useful tool one day that takes time and attention away from Google, but it won’t be a search engine. Google, after all, isn’t broken, not in terms of solving the iconic “how do I find something online using my web browser” question.

Bringing it all together, Seth provides advice:

The challenge for organizations is this: the easiest projects to start and fund are those that go after existing icons. The search for the “next” is easy to explain and exciting to join because we can visualize the benefits. But success keeps going to people who build new icons, not to those that seek to replace the most successful existing ones.

Are these tools differentiated enough to replace Wikipedia, Squidoo, and Google?  Will they exist in a crowded competitive environment?  Or will they languish in mediocrity?

Collectively, we watch and–maybe–participate.

Health Advisory

We seek tax advice from accountants. We seek financial advice from financial planners. We seek health care advice from…well, doctors.

At least that’s the way it should be. But an overburdened system with underfunding in important high-advice areas like primary care, combined with misplaced financial incentives, make a physician’s time an especially scarce resource.

This usually means short visits with a provider for patients who are passive during appointments.

The internet, of course, is changing all of this through the emergence of Health 2.0.

We now can complete our tax returns online. We can invest using online services. Health care, however, has been slower to adapt. It still lacks the “killer-app” to make the internet truly industry altering.

The complexities of health care delivery are the reason for this slow adaptation—which is good. It allows for the opportunity to do it right, something especially important in this industry.

There are vasts amounts of information available on everything medicine. But it can be daunting for a patient not familiar with the intricacies of the industry. That should be okay, because a patient can search for information, collect and gather, and show up to an appointment armed with questions for a physician.

The breakdown in this Xanadu comes at the appointment. Physicians just don’t have the time to spend 30+ minutes with each patient. Fifteen minutes is pushing it.

But patients want to be informed. Read this post at Health Management Rx for an enlightening example.  Jen has written about the “middle eighty,” the constituency of patients in the middle.  The theory, adapted from sales, goes something like this: ten percent of patients are super-involved in their health care, ten percent of patients are completely passive, and the middle eighty percent is awaiting online tools to help them become more involved, but only after those tools have proved their value.

Targeting the “middle eighty” is where health care online will transform the industry.

The Associated Press wrote last week about a new service cropping up in health care to serve the “middle eighty,” albeit primarily offline.

In the vein of tax and financial advisory, health care advisers are beginning to solve patients’ health care headaches like finding a doctor and negotiating payment.  Organizations have been the primary purchasers of services thus far, mostly in an attempt to lower their health care coverage burden.

The recent trends in health care, including reduced employer support of health insurance and Medicare complexities, have forced the burden of managing health upon the “middle eighty.”  They’re being forced to become proactive in their health decisions.  And they’re looking for help.

The current service offering by these health care advisers is just a start. Once this industry moves to the online world with all that it has to offer–content, community, commerce and advisory to help a patient make sense of it all (coherence)–will it truly be industry altering.  Jen et al. call it Health 4.0. I call it health care transformed.

“Geting It” continued

Maybe defining “getting it” would be easiest through the use of examples.

Here is the first.  From The Washington Post:

Is it ironic that the industry we trust to protect our health is releasing substances that may be tied to cancer, diabetes and other illnesses? Many health-care professionals think so.

In recent years, some have begun to think greener. Most efforts focus on reducing toxic waste from hospitals and medical offices as well as cutting back on water and energy use. But some doctors and health workers are also considering changes in their practices that could enhance environmental and patient health.

Read about Inova Fairfax Hospital is doing to make their operations greener.  Oh yeah, it’s saving money at a time when margins are being squeezed, too.  From the article:

“There are major parts of the building that never shut down,” said Cindy Kilgore, assistant vice president of materials management at Inova Fairfax Hospital. “We have to have a certain airflow, have to stay at a certain temperature, so there are unique things that make [cutting energy use] more complicated.”

Still, Inova has come up with some cost-saving answers. After its five hospitals completed energy audits last month, they turned off the lights in their vending machines. Kilgore said that simple change will save about $15,000 a year. More changes will come once Inova has had a chance to analyze the audit’s findings, she said.

Inova is also exploring the feasibility of a system that would shut down nonessential computers each night. And before the summer landscaping season ends, Kilgore said, Inova Fairfax hopes to use leftover oil from its cafeteria fryers to make biodiesel for its lawn mowers.

28. “Getting It”

Erik Karjaluoto at ideasonideas has a wonderfully entertaining post on a recent back-and-forth he had with a public relations firm.

The moral of the story: the world changes, and yesterday’s way of doing things don’t always continue to work.  Instead of adapting, some people keep trying the old ways over and over and over.  They just don’t get it.  You can imagine the success rate of such a ploy.

The problem happens in every industry.  Think Medicare’s fee for service in health care.  Sure, CMS tries new iterations of the payment system but the meat of the approach continues as it has for years.  What we’re left with is the problems of yesterday, only worse.

This can happen at an organizational level, too.  A favorite notion of health care folk is that change is constant.  A traditional approach to the health care change issue is to ignore it until ignoring the problem manifests into something requiring action.

Wait, wait, wait, wait, wait, wait, wait, wait, wait…hurry up and solve.  Example given: the primary care shortage, er crisis.

It doesn’t have to be like this.

Organizations that “get it” and make proactive attempts to embrace change can be successful in this hectic, ever-evolving world.

“Getting it” is difficult to define.  The problem with a definite definition of “getting it” is that it’s much easier to describe what it’s not.

Eric writes this about those who don’t, “Again, the problem is that they’re completely stuck in an old paradigm.”

There’s a way around not getting it, and that’s to get it.  Prophetic.

Realistically, the solution is diversity.  Diversity of thought, diversity of opinion, diversity of background, diversity of experiences, diversity of race, diversity of age.  Diversity etc.  Having all these people around influencing individual decision making will improve your organization’s chances of not getting stuck in an old paradigm.

Here’s the secret: utilize that diversity.  The dialog created between all this diversity will help an organization “get it.”  Listen to those with dissenting views, they may be right.

Principle #28: It all comes back to this: You either get it or you don’t.  Getting it means incorporating diversity.  It means being proactive toward change, listening to dissenters.  It means learning never stops.  Just because something worked yesterday has no bearing on its effectiveness today.  Organizations must approach each day with this notion in mind.  And we’ll do that at Our Own System.