Still it was hard not to be excited to hear Capt. Chesley Bernett “Sully” Sullenberger III present the final remarks at HIMSS last week.  Capt. Sullenberger was the face of the “Miracle on the Hudson” event in January last year. The Airbus A320 he was piloting struck a flock of birds, lost two engines and he and his crew successfully landed the aircraft in the Hudson river, saving all aboard.

From everything I’ve seen and read about Capt. Sully, he’s a very smart, articulate, accomplished individual.  And that’s just what I expected to see when he took the stage.

What I didn’t expect to hear was a finely crafted assessment of the state of patient safety in the U.S. healthcare system.

Specifically, Capt. Sully talked about the use of checklists in healthcare to reduce infections and surgical outcomes.  This isn’t a new idea of course.  It’s been getting increased attention including Atul Gawande’s book The Checklist Manifesto published in December. 

Yet adoption of checklists by the medical establishment continues to be low.  Doctors feel the checklists somehow demeans their capabilities or removes their latitude in creative problem solving.

Gawande’s fundamental argument is that checklists are a simple solution and they work astoundingly well.  Capt. Sully adds the human element to that argument by explaining why they work and, more importantly, that checklists empower physicians rather than holding them back.

By way of example, Capt. Sully, who has a long record of working on airline safety issues, explains that in a crisis, the pilot will routinely allow the co-pilot to fly the plane.  Freed of these burdens, the pilot has the freedom to develop a strategy for how to proceed.

Pilots cannot believe checklists aren’t standard practice in medicine – “you can’t do anything that complicated without a checklist.”  No one is infallible. However, by using checklists, you can at least be sure that your crises happen over the hard things, and not the easy things.

Checklists need to be combined with a few other fundamental shifts in the way healthcare teams work.  First, the entire care team needs to work together in an atmosphere of professional respect.  Anyone involved in the care of the patient should be able to raise a red flag and force the entire team to stop and take a look at what’s going on with the patient.

Finally, eliminating errors comes from examining the system and finding process solutions to prevent future errors.  Healthcare today uses an individually punitive system.  When something goes wrong, the energy is invested in finding individual fault and then punishing that individual.  The result is that the people involved try to hide errors or impede their investigation.  The airline industry wasn’t able to eliminate errors to the extent that it has until this aspect of the system changed.

It was easily the best closing remarks I’ve heard at a conference, and yet, we were really the wrong audience to hear it.  HIMSS is a great group of IT professionals representing all aspects of the field.  The people who needed to hear this presentation are the Chief Medical Officers and other physicians.  I certainly hope Capt. Sully’s speaking career continues strongly and that he gets the opportunity to present this topic to lots of docs in the future.

One of the key changes undertaken by the HIMSS social media crew was to move from a proprietary social networking tool used in years past to the places where attendees are already engaging:  Facebook, LinkedIN and Twitter.

In addition to several educational sessions on Social Networking and Health 2.0, HIMSS held several “meet the blogger” sessions, allowing people to hear and interact with high profile healthcare IT bloggers/tweeters.  Needless to say, these sessions received some of the most intensive social media interaction between attendees. 

Some of the “meet the blogger” participants are people I’ve known for awhile, such as John Sharp (Blog: http://ehealth.johnwsharp.com/ Twitter:www.twitter.com/johnsharp) and Brian Ahier (blog:  http://ahier.blogspot.com/ Twitter: www.twitter.com/ahier). And there were some great folks who I’ve followed for some time and interacted with, but never met in person, such as TheEHRGuy www.twitter.com/TheEHRGuy and ePatientDave www.twitter.com/epatientdave.  It was an odd feeling to realize that I haven’t met some of these people, but I feel a personal connection with them after months of interacting with them online.  I was happily able to remedy that situation with several of my favorite bloggers.

Social media has certainly been an active topic at conferences over the past year.  At shows like SHSMD or PRSA Health Academy, the focus of social media discussion is primarily on how this can be used as a tool for communication by the organization.  Being that this is HIMSS, the discussion centered more heavily around possible applications for patient care, policy development, what services facilities are allowing or blocking on their internal networks, and managing risks. 

A few key takeaways:

• You are on social media. You may choose not to listen.  You may choose not to participate in the conversation.  Still, others are talking about you.
• Better to be proactive. Listen, monitor, set policies, train and communicate.
• Despite growth in adoption, social media channels still only used by a small number of hospitals routinely.
• Blocking social networking sites is dissatisfying for patient families.

Several facilities were kind enough to share many details about their social media policies

• Mayo Clinic Social media policy http://tinyurl.com/bra56t
• Kaiser-Permanente social media policy http://tinyurl.com/p66cwu
• Cleveland Clinic social media policy http://bit.ly/c9btwV
• Cleveland Clinic also allows access to social media from within their organization with the exception of streaming video.  The concern with video is strictly one of the bandwidth needs of their EMR.
• In contrast to these relatively open organizations, many are not.  For an example see this announcement from the University of Iowa Health Care two weeks ago: http://www.press-citizen.com/article/20100226/NEWS01/100226015/UIHC-to-block-Facebook-access

Think back to when banks decided to move to ATMs.  (I wonder how many kids today even know that stands for Automated Teller Machine?) Think of the overwhelming, logistical nightmare it must have looked like to banking executives in the 70s. Developing the technology. Implementing the telecommunications infrastructure. Setting up the machines. Setting up the ATM cards. The authentication process.  The possibility of fraud and other security issues. 

I mean this is peoples’ bank accounts we’re talking about. Their money. 

But banks knew the benefits outweighed the risks. The convenience it gave their customers. The savings they realized by having fewer tellers to train and employ to do the same work. The profit they eventually received from charging fees. Just as importantly, banks such as First National City Bank (now known as Citibank), as early adopters of ATMs , were able to use these convenient tools as a competitive differentiator driving the dramatic growth of their consumer banking for many years.

But banks didn’t stop with ATMs. They quickly moved to online banking.

In online banking’s humble beginnings, customers were only allowed to view account balances and transactions through the use of a terminal and a phone line. And look what we can do today from the comfort of our homes (or even our phones!) – pay bills, apply for loans, transfer money – essentially manage our financial health.  Online banking is so important that today financial institutions worry that if they don’t offer online banking, customers will go to competitors.

Healthcare is where the banking industry was a quarter century ago and health systems implementing patient portals have a lot to learn from their financial counterparts. 

Success wasn’t realized overnight. Look at ATMs – they started small – those first few disconnected ATMs that sat in bank lobbies eventually grew to be a part of huge inter-bank financial networks. 

Everyone has obstacles to overcome. Health systems have geographically-disperse hospitals or clinics, banks had branches. And banks weren’t without regulations to adhere to, either.  Yes, healthcare has HIPAA but banks had the Electronic Fund Transfer Act.

It’s ok to start small. It’s ok to start disconnected from other systems. Taking small steps eventually covers a lot of ground.  

Let’s learn from the financial industry and celebrate the progress we’re making. Yes, we have a long way to go as an industry. But we don’t have to get there in one giant step. Just start, engage health consumers, and keep moving forward. I’m confident we’ll eventually get there!

It’s a great video from a marketing perspective – engaging, thought-provoking, and memorable. Plus there’s a chuckle at the end.

But it’s also indicative of what I see is the problem in healthcare. I know the GE commercial is meant to be an illustration. And there’s nothing wrong with making sure the primary care provider has all the relevant data at his fingertips to better inform his diagnosis and improve his care of the patient. But the ad focuses only on the doctor and ignores an equally important part of the equation.

The commercial shows a bunch of doctors talking about the patient while the patient sits there in his underwear – uncomfortable, uniformed, passive. He listens while the primary care provider and a room full of specialists talk about the series of tests and procedures that have been done and when. The doctors have the conversation but the patient’s not a participant.

That’s precisely where Geonetric comes in – we bring the patient into the conversation as an active participant. We give them the platform to have meaningful input into the conversations with their providers, so they’re engaged in managing their own health and contributing to positive outcomes.

We won’t be airing commercials during the Super Bowl anytime soon. But we’re here to make sure the patient remains an integral part of the patient-centered medical home.

The American Health Information Community (AHIC) looked into this challenge in 2007 through its Confidentiality, Privacy and Security (CPS) workgroup. We’re starting to see how some of these approaches are applied in real-world solutions.

The gold-standard for identity proofing is to have the patient appear, in person, with one or more government-issued photo identifications.  This is nearly foolproof, but it’s also impractical and a significant barrier to adoption. And even when incorporated into a visit to the hospital or physician office, consumers are often not interested in the portal solution at that time or they’ll forget they have an account, login, and password.

Google Health approaches this with a solution that is a virtual parallel to the presentation of identification.  To link a Google Health account to your hospital, lab or pharmacy, Google trusts the other facility’s judgment in connecting the accounts.  Most of us have seen this approach applied with Facebook or Twitter.  When you sign up for a related application, they often authenticate by passing you to Facebook, having you sign into your Facebook account, and then granting you rights or authorizing a link for the initiating application.

This is a good approach, but it still leaves the problem of authentication to the hospital, lab or pharmacy.  If that’s you, where does that leave you?

One approach is to send information that will allow the patient to connect accounts together to a known address.  Vanguard Investments takes this approach.  It’s more convenient than appearing in person, but it takes a great deal of time and is still inconvenient.

A more practical approach involves a challenge-response system requiring the patient to provide answers to several questions that presumably only they would know.  To be valid, this is needs to be a deeper interrogation than simply providing a mother’s maiden name or the name of your first pet.

You may have experienced this type of authentication procedure if you’ve requested your credit report online.  This is the approach that Kaiser-Permanente has taken with its KP.org patient portal.  Patients answer five questions in order to authenticate themselves. 

As we see more applications taking on this challenge, this is currently the most practical approach to keeping clinical information secure while still engaging patients in their care.

The problem is that the average person isn’t excited about plugging in data every day.  There are a few who will do it, and many people will provide the data for a few weeks following a major health event.  But most won’t and so we need to find another way to get that information.

Yesterday morning, Cleveland Clinic announced that it is piloting the import of device data into it’s EPIC EMR via Microsoft HealthVault.  It’s an attempt to do just this.  You take a blood glucose meter, weight scale, or blood pressure monitor and hook it to an internet connected computer and the readings go directly into a personal health record and then on to your physician.  The net result is that the physician can intervene when the patient’s numbers begin to get out of whack.

Another group working along these lines is the Continua Alliance.  Continua is building standards and a platform to facilitate the movement of data from home-based devices to the physician office.  Continua seeks to support health consumers’ ability to age independently along with providing disease management applications and promoting health and wellness.

One of the challenges is the need, currently, to tether these devices to a computer.  The ubiquitous USB cable is simple and secure, but how many of us have their weight scale next to the PC?  One answer is to take this wireless.  The standards in common use today like 802.11 wifi or Bluetooth could work, but aren’t ideally suited to these applications.  Continua is currently considering the low power Zigbee standard as an alternative.

So, while there is much to be worked out, there is at least movement within the very diverse world of home medical devices that will make this a real part of the overall delivery of care and management of health in the future.

Because we’re healthcare-specific, we understand their unique situation and goals. Because we’re technology experts, we can deliver software that is robust and flexible – allowing TCMC to build a separate hospital and foundation sites on a single platform. And because we’re equally passionate about building and supporting a great community, we understand the importance of helping them showcase the many ways they support their community – from sharing emergency department wait times to highlighting their sponsorship of the Carlsbad Marathon.

We’re proud to support TCMC’s mission and look forward to a long and mutually-rewarding partnership. And we echo their tagline, “We’re Always Here for You.”

Check out their new site at http://www.tricitymed.org/.

Much of the focus this year is on achieving meaningful use as providers seek to get their share of the ARRA pie.

As a part of this are the parameters for connectivity.  Although the rules are not yet finalized, it’s clear that, in the future, providers are going to be required to share data with both patients and one another.  I’m focusing primarily on the consumer side of that equation, and I’ve already seen a lot of pieces that, when pulled together, start to demonstrate some interesting eco-system models.

As we look at the eco-system, there are a number of key questions that must be answered in order for the final solution to be both comprehensive and meaningful:

• How does the provider share information with the consumer?
• How do you perform “identity proofing” to ensure you are sharing a patient’s information with them (or a valid proxy)?
• What information will providers share?  How quickly will that information be conveyed?
• Where will this information live?
• How do patients share information with their provider?
• How do patients share unstructured information  (emails) and structured information (glucose readings)?
• What are the practical and legal implications for how information from a patient is handled?
• Where is the patient-provided information going to be stored?
• How do we support the patient’s self-management of their health/disease?
• How do we support the physician’s workflows and goals?

Over the course of this week, I hope to provide insights into how each of these components may work based on education sessions and my conversations with other vendors.  Watch this blog for more information and follow me on Twitter.com/benatgeo and other HIMSS conference attendees using the hashtag #HIMSS10.

Like most organizations faced with choosing a new online partner, Dean was wary about vendor promises versus their ability to deliver. Because all vendors make promises in the sales process, right?

But could Geonetric really meet Dean’s deadlines? Stick to the budget? Deliver a “Wow!” user experience? Deliver software that was powerful but flexible enough to meet the needs of the clinics and doctors as well as the health plan? Configure the provider database so Dean could manage it centrally but display the right doctors for the right clinics and the right networks…and meet NCQA requirements?

Since I’m often the one making the promises during the sales process, I’m happy to report that Geonetric absolutely delivered on our commitments. Dean’s new site launched today – right on schedule. The site is a huge win from a user experience perspective – a unified brand identity, easier to use site structure, and engaging calls to action. Now, the online experience for customers and plan members matches the exceptional experience they’re accustomed to receiving – and clearly supports Dean’s goal of being the top provider in the state.

Maybe most impressive is how their new site meets the needs of Dean Health Plan as well as the Dean Clinics and doctors. Our powerful FlexFilter technology allows us to present providers in multiple ways. For the clinics, it’s based on criteria such as location, specialty, gender, or if a particular doctor is accepting new patients; for the health plan, it’s first narrowed down by a member’s plan type.

Dean also gives our project management process rave reviews for guiding them through the process, providing the structure to keep the project on time and budget, and stepping in with extra support when they needed it.

We’re always proud to add new members to the Geonetric community, and we congratulate Dean on their impressive new site. Be sure to read the complete press release and check out their new site.

Big Brothers Big Sisters roughly serves 800 children in our area and there are many more on the waiting list that need caring adult mentors and friends.  With the funds raised by Bowl for Kids Sake, BBBS can continue to provide resources to children.  The average cost to support a year long relationship between a “Big” and an at-risk child is roughly $1,000.00.

Big Brothers Big Sisters is or has been part of the lives of a handful of our employees as they have served in some capacity with the organization, either as a Big or as a Lunch Buddy.  One of our bowlers recently celebrated being matched five years with their Little. 

We hope that our bowling skills translate as well on the real lanes this week as they did when we Wii bowled with the entire company to raise funds for BBBS.  Watch out Eastern Iowa, here come the Bowling Alley Sallys.