As we’re working on the patient experience (with their providers) rating system, we got into an interesting “verbal brawl” of what quality means. No clear answer as everyone, and I do mean EVERYONE has differing opinions as to how quality is defined or what is meaningful to them.

So to set the stage internally, here are the “Eleven Dimensions of Quality” (yes, one more than ten):

1. Access: How easily accessible healthcare services are to patients – unrestricted by geographic, economic, social, organizational, or linguistic barriers
2. Technical performance: How well tasks are carried out by health professionals and facilities. Whether they meet expectations of technical quality and adhere to standards
3. Effectiveness of care: How well desired results/outcomes of care are achieved
4. Efficiency/Continuity of services: How well services are performed in relation to cost (do you only have to do an x-ray once or multiple times). Delivery of care by the same healthcare provider throughout the course of an individual’s healthcare needs. Appropriate and timely referral and communication between providers (follow-up by primary physician).
5. Personal relationship/bed-side manner: Trust, respect, confidentiality, courtesy, responsiveness, empathy, effective listening, and communication between providers and clients
6. Safety: The degree to which the risks of injury, infection, or other harmful side effect are minimized
7. Physical space and comfort: The physical appearance of the facility, cleanliness, comfort, privacy…
8. Choice: As appropriate and feasible, client choice of provider, insurance plan, or treatment
9. Peer Considerations: Peer referrals and reputation amongst other providers
10. Timeliness: Capacity to provide health care quickly after a need is recognized, Wait time spent in doctors’ offices and emergency departments, Interval between identifying a need for tests and treatments and receiving them
11. Patient Centeredness: Healthcare that establishes a partnership among practitioners, patients and their families, Ensure decisions respect patient wants and needs as well as preferences, Education and support mechanisms

Now, the REAL challenge is how to enable Consumers to easily, quickly, and simply convey their Provider experiences as well as intertwine meaningful yet “grandma friendly” information that provides consumers with some insight about their providers as it relates to all or most of the eleven quality dimensions.

Now you know why we were in a brawl… sigh.

bbbbrrrrrrrrrr…

Thanks to Matt and Katrina for flying out to WY (in the middle of January) to work with one of our leading client’s employee groups. Sadly, baggage was lost of course on day 1 by United… sigh.

We’re already working on a joint-case study for an HR magazine based on their utilization of MedBillManager for their employees - Yea!!

Get home safe, gang… please!

Let it be known that I am officially “coining” the term Health Graph. Why?  Heck, I don’t know but I figured that I better claim it before Mark Zuckerberg or some other Web2.0 company started to mention it.

Actually, the notion of the term came up today as we met with a large company who we used Facebook as an analogy of change:healthcare’s forthcoming enhancements to our current offering for employers.  We began to construct the following premise - If your friends relationships and the many inferred linkages that you have and maintain via Facebook reflect your “Social Graph”, then change:healthcare enables consumers to self-manage and leverage their own medical expenses, provider and prescription experiences with others and determine one’s own consumer Health Graph.

Nahhhhhh. Sounds too pie-in-the-sky healthcare consumerist.

Or is it?

So as we ratchet down, focus on, and refine our platform — Robert and team threw these questions out that may seem obvious on the surface but actually require some thought. I figured that I’d pass them along. It was interesting to see how I answered some questions vs. others on the team. I’d like to challenge some of the other Health2.0 gang to test these out on their offering. It was a good exercise for us and forced us to stand back and challenge some of our own individual assumptions:

1. What do people want?
2. Who is our audience?
3. Who is our target (is it the same as our audience)?
4. What do we want them to do?
5. How do we want them to do it?
6. How do they get/realize value from that?
7. How do we get/realize value from those willing (not willing) to pay for our service?
8. Where do our customers go (e.g. websites/stores/providers) for information?
9. Why do they want our product?
10. What will they pay for our product(s)?
11. Why won’t they sign-up? Why will they?
12. What draws them in?
13. What makes them stay?
14. What makes them come back?
15. What makes them stay away?
16. Where else do they get (or think they get) our info?
17. Do they want our info?
18. How do they know about us?
19. What do we do for them?
20. How do we make them better?
21. How do we carry thru on the initial wow?
22. Is there an initial wow and what is it (pick “the” main 1 wow)?
23. What do consumers care about?
24. What do consumers not care about?
25. Who pays for our services?
26. Who benefits the most from our service(s)? …Now who pays for our service(s)?
27. What is the ROI to the purchaser?
28. What is the ROI to the User?
29. Why do they want to be a part of us?
30. Why do they want to share info about their expenses/health issues?
31. Can we help them?
32. What matters most?
33. What do people understand about their healthcare? …Not understand?
34. Why do people care?
35. Why SHOULD they care?

Sheesh! Robert just “schooled” me on the 5 basic questions any person should ask themselves as they develop a marketing message. I’m a slow learner:

1. Who is the audience?
   
2. What is your target market?
3. What is the call-to-action?
4. What makes you unique?
5. What is the desired result?

He’s making me write this 500 times so I’ll remember it! jk

I guess MedBillManager is now “mainstream” to the millions of readers of Oprah’s O Magazine. The painful paperwork and confusion resulting from Consumers and Employees accessing the healthcare system has risen to loud roar.

Plus…we’re developing a case study about one of our employer client’s use of MedBillManager to address a significant employee benefit issue they faced [I'm very excited as this employer is a real industry thought-leader and has very progressive-thinking leadership].

As well as Matt and the dev team just showed us screens of the up-coming UI enhancements and new features for prescriptions/ health issues/ and providers – Wow! Nice work gang!

What a way to start 2008!

This just in (errr… for the government, “just in” means insight into data ending 2 years ago) via Theo Francis of the WSJ.com blog: Hospital charges are up 89% since 1997. Yawn.

Oh, wait-a-minute?! You mean the price that the working uninsured and (to some discounted degree) people paying for care out-of-pocket has shot up eighty-nine percent?!

YES.

Now of course there are all kinds of caveats and “buts” to the above statement such as “Nobody pays billed charges.” I would agree that nobody SHOULD pay billed charges (that’s like paying the MSRP when purchasing a car) and yet, the reality is that the majority of consumers use “billed charges minus some sort of discount” as their barometer of fairness since they historically have had NO FREAK’N IDEA what the avg reimbursed rates were for their given Provider for that particular admission. Therefore, when billed charges increase, so does the price paid when based on a discount off charges. Sadly, consumers have never had the right information to reasonably informed decisions [i know, i know, that is what change:healthcare is fixing as well as many other Health2.0 ventures].

Anyway, I thought that Theo did a good job summarizing AHRQ’s December 2007 data review…

The nation’s hospital bill has arrived, and it’s a doozy: $873 billion in 2005, up 89% since 1997, according to work by the Agency for Healthcare Research and Quality.The federal AHRQ study measured charges — the hospital equivalent of a car’s sticker price, which few actually pay in full. Still, the prices show the upward trend for hospital spending. The annual increase in hospital charges was 7% compared with 2004.

But the Health Blog was struck by some of the big-ticket conditions. (See the full report.)

The data from 2005, the most recent year available, show that pregnancy and delivery ranked No. 2 among line items, at $43.9 billion, while newborn infants came next at $35.3 billion. … (Coronary artery disease ranked No. 1, at $46 billion.)

… As a group, the top-20 conditions — which account for about half of all hospital charges — rose 67%.

UPDATED:

ohhhhh man, I just had to come back include these interesting comments made by WSJ readers…

America needs to wake up and realize that heart disease is still its biggest health problem. The country should be very angry that while our system happily pays for nearly each and every hospitalization/procedure, it invests almost nothing in prevention of heart disease and so far has been unwilling to pay for good prevention. Instead, we bitch and moan loudly about the cost of our statin or ACE inhibitor going up a few $$ a month, but we’re silent when the insurer pays a $30,000 bill for the heart attack we just had. The fact remains that drugs account for about 10-12% of overall healthcare costs, and hospitalization accounts for over 60% of total healthcare costs. Time to turn the system on its ear and actually pay more system-wide for prevention so that we can decrease hospitalizations costs in 1-2 years.
Comment by Dr. Remulac - December 14, 2007 at 9:12 am

Ask any hospital administrator why costs are so high and the answer is the same: Bad debt/charity care for the millions of uninsured and underinsured (WHO do you think is taking care of the app 13 MILLION illegal immigrants and their children?) and ever-increasing staffing costs (heaven forbid a union moves into your hospital). And yes, nothing annoys health care providers more than lazy, excuse-making patients that expect the physicians to fix all their problems, all the time and accept no personal responsiblity at all. There is a bill before Congress to improve health care literacy starting in elementary, secondary, high schools, vocational schools, community centers and houses of worship. This would be helpful to getting people to become more efficient users of the health care system and about health insurance generally. At the end of the day, health insurance is insurance like car, home, life, etc. It is there for emergencies only- not prevention.
Comment by First Anonymous - December 14, 2007 at 10:36 am

I’m just getting caught up on emails and i came across the following article that made me ponder the latest health+web efforts here in Nashville. Considering that the majority of for-profit healthcare companies (sans Tenet) are headquartered here in Nashville — is the Country Music City becoming the Silicon Valley of Health2.0 [e.g. Peerclip, connectivhealth, and change:healthcare] Also, do local entrepreneurs have the fortitude to launch their web tools with a “long-view” approach?

Granted, internet phenoms like Twitter are not models that people look to when it comes to healthcare, but i think that many of the same human needs (e.g. Twitter’s notion of instant communication) do align with a person’s healthcare needs and decision-making desires as more and more responsibility gets pushed on to the employee and avg consumer’s shoulders. Think about.

Back to twitter…

What of the business model. I guess in this day and age, put the product out first and go with the flow. I agree that ideas that are not executed are doomed to stay on that ever winding road that leads you back to where you started. I call that “living in square one, round hole optional” syndrome. While popular business thought says to write a business plan, make a half dozen matrix’s, and crunch all those numbers; in today’s world - that just doesn’t work if you plan to succeed. Why? Because as Jason was saying in his post “We all live in Brooklyn (and need to get out) and need to get to the Valley.”

It’s almost like a band. Unless you get out there and just do it, it never gets done. Believe me, all the bands I was in didn’t have a business model. It never prevented us from reaching a level of success. The only thing that stopped us was the personnel factor or personal issues within the band. As far as a business, any of the bands I have been in could have survived and been a successful business. They were all the same, original music done the old fashioned way. Now would a business model have helped much? Yes and no.

Just in the case of twitter, the idea was the foremost item necessary. Just like a band, the players that wanted to play music and write new tunes were needed, so is twitter. An idea that was based on a basic need for instant communication, done in a Web 2.0 way. Nothing really scientific about it. Nothing really ground breaking on what they are doing. They kept it simple, just like rock n’ roll.

Back to twitter again - why do I like twitter? Well of course I use it to help promote my work, as well as keep in touch with people that I like to chat with. It’s almost like that big water cooler of the cubicle days. I think that twitter has a big future in 2008 as it grabs more mainstream recognition. I also believe that now there are local STL news sites on twitter, it has reached that level of acceptance. For me though, it is like the chatter of the cubicle environment where I use to have a job at.

It’s ridiculous! Medicare had attempted to push Providers to adopt a NPI (National Provider Identifier) which is intended to replace the moderately utilized UPIN for Medicare. I can only imagine the complexity, frustration, and inconsistent data pools that exist between federal and state agencies as all parties begin the migration to NPI utilization as well as attempting to spread consistent adoption and broad agency data synchronization.

Unfortunately, as we began aggregating providers there has been a serious lack of consistent and timely data about Providers. From the Provider’s perspective, I often wonder if they’re sick and tired of the continual flood of code and documentation redundant requests and lack of intra-system communication. As a consumer, it seems that the ONLY broad and accurate source of Provider information is the phone book. Why? Because it is a referral mechanism. Providers WANT to maintain correct contact information so patients and other Providers can contact them.

Then it hit me like a ton of bricks. Isn’t the web supposed to support the notion of semantic data exchange? How is it that across a multitude of email and web applications every consumer and Joe Schmoe can easily and simply export or share their contact information in a basic format found in Microsoft Outlook (aka a vCard or .vcf). One entity implemented a standard that became a widely adopted and pseudo-semantic standard.

It’s simple and obvious

I’m sick and tired of everyone building non-open systems and proprietary standards. What a freak’n waste! If consumers use a vCard to exchange contact information, why isn’t there a doctor vCard? A dCard, if you will… What if a web company found several other open and like-minded provider entities who all adopted the same dCard standard so that Providers could easily and simply move, exchange, and maintain their contact and credentialing information seamlessly across the Internet. No. Not via some expensive nor closed system. Just a simple data format/standard.

What if this standard was applied across 900,000+ practicing Providers and included contact and summary credential data as well as obvious consumer-centric data elements like “Office Days and Hours” (Duh?!) and “Accepting New Patients”. That’s right! Not 1,000. Not 10,000. But almost a million Providers.

The dCard

Is it possible that several national and leading organizations could agree upon such a simple standard? Yes they can. Though, there will be some “old school” entities that will desire to perpetuate their own proprietary forms and closed data systems that require Providers to repetitively send/enter/maintain multiple versions of their contact information.

Yes this standard has been established! It will be made an open standard and ANYONE will be able to adopt, share, and implement making it SIGNIFICANTLY less cumbersome for Providers to choose to easily provide and exchange information – as well as web services that support providers and consumers.

Finally, the easiest and most obvious question of “Are we talking about the same Dr. Jones?” can finally be addressed [no pun intended].

More to be announced soon.

Dad passed away Dec 3^rd and Mom a year later on Dec 23^rd. I miss them both. Tremendously.

When asked why i started change:healthcare, why i give a damn about healthcare consumerism, why it is important to make a difference – it’s because i told them and myself that i would do something. Something honest, sincere, and significant.

From my Father I learned the meaning of compassion, honesty, a sense of humor and the value of a warm smile and a firm handshake.

From my Mother I learned that nothing is impossible, loyalty, integrity, hard work always pays off (just sometimes not in the way you thought it might) and that there is good in everyone though sometimes you’ve gotta look really really hard.

Your son and grandchildren miss you. In loving memory.

– christopher