What to do when the storm hits

I live to the south and west of Boston and have some "lessons learned" to share as a consequence of our recent experiences with Irene.

1. When you decide that the storm is going to cause a loss of power, go buy ice as soon as you can!     And then buy some more for your neighbors and friends.
2. It's really nice to have a battery operated radio and candles.
3. Plan to use your barbeque to cook up your thawing foods - and you can boil water on it too!
4. Cold showers get old.  Because we have an oil-fired furnace that also heats our water, I learned how to hook the furnace up to an external generator. It's really not too bad.
5. If you want to use your cellphone and other devices after the power goes out, make sure you've charged them!  

Pretty short list.

Good luck!

Social Media in Healthcare - Observations from HIMSS Detroit

This week I attended the HIMSS Michigan Chapter conference, Wiring Michigan for Health Information Exchange. This was a more intimate affair, by far, than the annual HIMSS Conference, but no less productive - and in some ways more so as it was much easier to chat with vendors and colleagues during the breaks.

Among other breakouts, I attended the “Social Media, Healthcare and the Law” presentation conducted by attorneys from Dickinson Wright (Brian Balow, chair of their IT Law Group and Tatiana Melnik, an associate). 

One observation they made was:  Use email to document your decisions – not for internal deliberations!  The reason is that email is discoverable.  Using email for decision deliberations commits to “paper” topics and ideas that may not have had a significant bearing upon the final decisions – but can be used in court to paint a picture that doesn’t reflect what took place.  So, don’t use email to conduct your deliberations.

They also provided a nice justification for “Why to have a Social Media Policy:”

•  To provide a structured framework within which employees can use social media safely
•  To protect patients’ rights
•  To instill professionalism
•  To protect employees and the organization from liability

The core issue with healthcare professionals using social media tools is that of patient privacy.  We are obligated to keep protected health information secure and to specifically prevent disclosure. 

Furthermore, the HITECH act requires that healthcare organizations (known as covered entities), business associates, and subcontractors address breaches:  investigate, give notice to the affected patient(s), reprimand staff, and notify the Secretary of HHS.  I found two points surprising:  first that the HITECH act does NOT preempt state law (so you can face legal action under both Federal and State laws) and second, that State Attorneys General have the “…power to enforce HITECH breach provisions”  And some have, resulting in significant settlements.

Their recommendations for creating a social media policy include:

•          Be transparent and authentic
•          Be responsible for what you write
•          Protect PHI as well as proprietary information
•          Use common sense and common courtesy
•          Think twice before you post!

Additionally, there was a February 24, 2011 settlement in which Mass General agreed to pay a $1M fine as well as implement a monitored, multi-year corrective action plan.  While this particular breach did not involve social media, it does illustrate the costs of breaches.

Observations from HIMSS 2011 - First Up "Social Media"

I attended the annual HIMSS show, which was held in Orlando this year.  I'll post some of my observations from the show.  First up, Social Media!

Mayo Clinic Center for Social Media

 I attended a Mayo session in which the Lee Aase discussed how Mayo has executed their social media strategy.  Here’s a link to his presentation.  Lee is the director of the Mayo Clinic Center for Social Media. 

10-20-30 Rule for Presentations

Guy Kawasaki, who was previously a leader of Apple, recommends the 10 20 30 rule: the 10 represents no more than 10 slides, that 20 represents no more than 20 minutes and the 30 represents no text at less than 30 points shall be presented.  Good recommendations to live by!

Use Flip Video – Not Blogs

Lee also recommended that healthcare should not start in social media with a blog, because blogging is a written skill and requires hard work.  Instead, use what you already have and then use that content across many channels. 

Why Video?

Lee recommended the use of voice and video; specifically conducting 20 minute or so interviews.  He was a big advocate of the use of the Flip phone for capturing both voice and video when conducting an interview of your personality.  Not only is the video produced by the Flip device acceptable, it's tremendously less expensive than professionally produced video.  Additionally, the video that's created tends to have greater value in the eyes of the viewer because it’s not professionally developed.  Lee detailed the following as key reasons for voice / video:

• ·       Nimble alternative to news releases
• ·        TV producers can “try before you buy”
• ·        Sound & motion instead of word pictures
• ·        Lowers the threshold for “news”

Why Social?

Lee also pointed us to his “35 Social Media Theses,” two of which I found particularly compelling:

“Paying for advertising while not taking advantage of free online opportunities isn’t particularly astute.”

“You can save enough using free social tools in your current work to pay for your expanded efforts in social media.” (Aase, 2011)

Unholy Trinity:  Legal, IT, & PR

Lee also had a humorous reference to those that prevent the use of social media tools within an organization and he referred to them as the “Unholy Trinity:” Legal, IT, and PR.  When he was asked about how to address legal concerns, he had several recommendations:

• ·        Provide a standard disclaimer: the purpose of the disclaimer is to point out that the material presented is general in nature and tailored to a condition or disease, but specifically is not addressing an individual patient's situation.
• ·        Provide lots of content:  the purpose of lots of content is to develop credibility and drown out mistakes.  In other words, if you have lots of content, and one particular video has a mistaken it, the mistake is more easily accepted by the public when it is surrounded by a sea of positive content.  If you make a point of acknowledging your mistakes quickly and those mistakes are drowned out by all of the positive content, then the mistakes become much less dangerous.  Perhaps a different way of looking at it is this: If the only content you have presented through social media are mistakes then you’ve got as a crisis;  on the other hand, if you have lots of content, and one mistake, then it's really not a serious problem.
• ·        Faux Paux Fridays: the purpose of the “Faux Paux Fridays” e-mail is to continue educating those that produce content about mistakes that people make.  As an example in a recent Faux Paux Fridays e-mail he sent out a story about a surgical nurse who had taken pictures during surgery and posted them to her Facebook account.  That was obviously a mistake and it was an easy way to reinforce the fundamental restrictions protecting health information, PHI and HIPAA.

Telehealth?

Last night I attended an MIT Enterprise Forum event titled, “What Does Telehealth Say about Technology Adoption?”

Here’s a picture of the panel:  http://www.meetup.com/MITRFID/photos/1216543/20744648/#20744558

The panelists were:

1. Dr. Adam Darkins (Veterans Health Administration) – he was a neurosurgeon then switched to IT in healthcare.  He’s led the implementation of nation’s largest home-based health monitoring system which has improved care for 46000 chronic-condition patients.  They plan to get to 92000 patients next year.
2. Naomi Fried, PhD (Children's Hospital Boston) – she worked at Kaiser focusing on innovation and has recently joined Children’s to accelerate their market expansion into telehealth with the key goal of expanding their market share in tasks unique to pediatrics.
3. Bruce Lehman (LehmanMillet) – totally focused on healthcare marketing.
4. Dr. Steven Locke, (Harvard Medical School, president Veritas Health Solutions) – he’s a practicing psychiatrist bringing to market remote depression treatment.
5.  Edwin Simcox, Jr. (AT&T ForHealth) – he joined ATT to help in the formation of the ForHealth division.

Some of my observations:

Telehealth / remote heatlh / eHealth / etc will take off when a reimbursement technique is accepted.  While these solutions often reduce costs and improve quality (particularly consistency in delivery), they have not been adopted on a widespread basis because payment processes are not globally in place.  

Marketing and selling into healthcare is a long road – healthcare buyers are the most conservative in the market because they have been trained to work within well-defined “guardrails” (first, do no harm) and they perceive that they are “all knowing”.  On the other hand, once you’ve secured a presence in healthcare, you can grow that position in a well defined manner.  Bruce Lehman offered up a new “4P’s” (the classic marketing 4Ps are Product, Price, Placement, Promotion):

1. Protect – Limit exposure to widen opportunity  - once you get your product into healthcare, protect it, protect it, protect it!
2. Promise – Sharpen your vision through the eyes of your users - define the specific capabilities and outcomes delivered by the solution
3. Proselytize – Find followers who will lead - you’ve got to get the word out in a healthcare-acceptable manner
4. Propel – Focus and fire (When the time is right, GO BIG, or go home….) 

Dr. Locke shared that the “motivational interview” technique is proven to be as effective as medication for depression – but medical students don’t learn the technique in large part because they know that the market situation they’re moving into is bound by the “7 minute” patient/doctor window.  And they don’t get reimbursed effectively.  

Because the developing world doesn’t have our brick ‘n mortar investments (if you take the patients out of the hospital, you still need to cover the costs of the beds), developing countries are more likely to adopt telehealth techniques.

Telehealth holds the promise of shifting the healthcare delivery paradigm from today’s doctor-centric to patient-centric.  This refers to the non-acute care scenario (when you schedule an appointment to visit the doctor, travel there, wait, wait some more, get seen for 7 minutes or less etc).

Another way of segmenting the healthcare market is into the patient’s health status:  Well, At-Risk, Chronic, and Acute.  This approach can make it easier to market products in a more appropriate manner.  The offerings of American Well are an illustration of this market segmentation.

"The Direct Project " aka how to connect!

A vexing problem looks to be on a path to being solved!  


The vexing problem?  How to take the paper out of the communications process!




"The Direct Project" is developing specifications for a secure, scalable, standards-based way to enable participants to send encrypted health information directly to known, trusted recipients over the Internet.  In my view, this is the direction necessary to eliminate paper as the communications protocol among healthcare participants - namely providers!


For example, a primary care provided needs to refer a patient to a specialist or to a hospital.  Today, these tasks are accomplished primarily through paper, often with fax.  The Direct Project will enable a purely electronic solution!  Here are other "stories" that have been defined.


And, here are some initial test implementations:


Pilot Project Brief - Rhode Island Quality Institute (shared documents)
Pilot Project Brief - Medical Professional Services (MPS)
Pilot Project Brief - MedAllies (Shared Documents)
Pilot Project Brief - CareSpark 
Pilot Project Brief - Redwood MedNet
Pilot Project Brief - VisionShare and Public Health

Fuel Cell Evaluation

Ever since 60 Minutes profiled Bloom Energy I've been interested in using fuel cells to generate electricity, particularly in commercial use (versus auto, residential, and industrial).  While the buzz around Bloom Energy is compelling and many in the blogsphere trumpet the future of Bloom, I've remained unconvinced - I've had a number of nagging worries.

I came across this analysis for the Seattle WA region public utility that confirmed many of my concerns - without the substantial CA State and Federal subsidies, Bloom isn't viable and it's not clean enough when compared to other renewable energy sources.

At this time, there is no compelling reason for City Light to pursue any interests in solid oxide fuel cell systems. Bloom Energy has the only commercially available system, the ES-5000 Energy Server, and it is available only to facilities located in California with very specific energy requirements. This narrow market focus parallels the structure of major subsidies from state and federal taxpayers and utility ratepayers. (Seattle City Light 2010 Integrated Resource Plan, Appendix I, pg 4)

Generating Personalized Forms / Documents

Have you ever needed to create forms that would be personalized, much as you might with Microsoft Word's mail merge feature, but wanted to do so in an automated fashion?  There's many solutions to that requirement, but here's one I like.

OfficeWriter for Word from SoftArtisans provides that functionality.  OfficeWriter is a Windows server application that starts with your Word Template and then performs variable substitution to create a Word-compliant .doc file (among other formats).  And it does so without installing Office or Word on your Windows server.  Therefor, OfficeWriter can generate 1,000s of Word files precisely to your requirements in a "lights-out" environment.

Here's an example.  Let's say that you need to generate outbound forms that will be filled-in by people who then fax back the documents to you for processing - order forms, registration forms, applications, and the like.  

With OfficeWriter, you can create your template form using Word on your desktop, then give OfficeWriter on your serve the template, configure your datasources and merge criteria, and the let it rip!  OfficeWriter will create individual .doc files  that have been customized with Names, Addresses, Order Quantities, etc. From there, you could hand the .doc files directly to RightFax:

“A new conversion engine converts documents to faxes on the RightFax Server from native applications such as Microsoft Word, PowerPoint, Excel and HTML. The new conversion engine … uses Microsoft .NET APIs to automate Microsoft programs.”

RightFax, in turn, will fax the converted .doc files to the appropriate fax numbers.  After people make their corrections, updates, signatures to the faxed documents, they can then fax them back to the RightFax server.

A pretty slick way to begin automating a paper-based, manual process.  It's a step in the right direction!