EHRs and the Healthcare Productivity Paradox

7 11 2011

I think there are few places where opportunities for improvements are as great as they are in healthcare. Who hasn’t been hit by devastating healthcare news, treated poorly, or had the impression that going through the healthcare system is like moving through stove pipes one step after the other? For an industry that works on supposedly ‘negative demand’ according to econometric norms, it’s growing like a weed as aging populations in western countries are turning financing for healthcare on its head.

You’re probably wondering why I am blogging about this. Well, there are a lot of similarities between social media and the current evolution of our healthcare consumption. Extanz and its sister company Sterena (healthcare research and communication) have always been interested in healthcare. In fact, back in 2007, we thought the two enterprises would be one, and our first client was Syndicom (a thriving online network for surgeons). Early adopters are/were rare in healthcare though, so we diversified. But healthcare is still one area where we see many opportunities for change and improvement through participatory and social technologies, business intelligence and solving big data issues. We’ll be blogging more on those topics as we enter 2012.

Last week, I read a Austin Frakt post on labor productivity in healthcare, where they stated that healthcare is the only industry that “has experienced no gains over the past 20 years in labor productivity, defined as output per worker”. Ah, what???? Digging around in the blogosphere to substantiate this claim, I stumbled on some other interesting data points and points of view, which I thought I would share here….

It’s not a ‘US only’ problem: The NHS in England has spending cuts planned over the next 10 years, which will become the equivalent of creating a 400% increase in productivity per annum, we learn from Anna Dixon. Anna continues that these improvements can only be achievable if there is a transfer of responsibility beyond healthcare professionals. Read self-care and patient empowerment. Make people smarter though technology (or hammers) and they’ll need less costly healthcare. Right? Geez, that sounds like so much like what the social media industry has been preaching to brands when it comes to consumers — empower your consumers if you want them to adore you!

The not so mighty EHR (Electronic Health Record): This has to be one of the most talked about topics when it comes to productivity in the healthcare blogosphere. This market is expected to grow six fold by 2012 to $6.5 billion. Remember ERP (enterprise resources planning) and manufacturing companies 10 years ago?? Yep. The system never fit the ways companies were operating. Now with EHRs, throwing more training at it may not be the answer, but the cost of productivity lost over the long term will ultimately be priceless, argues Paul Roemer. ERP projects were not given the choice of whether companies wanted to be sustainable. Projects were ultimately more successful though as people and processes came together early during the design phase. Dr Reece’s blog here describes reasons for poor EHR adoption rates. Studies show that EHR projects which have 40.4% adoption rate, also have a rate of failure of 30% to 50%, according to the US Department of Health and Human Services. Other studies show much higher rates, more in the 50% to 80% range. It has also demonstrated that the larger the practice (more physicians), the higher the success rate. This should tell us something. Productivity gains ultimately appear when technology works through the workflow of users. Google pulled out of EMR after all last year after launching its effort back in 2008, highlighting the fragmentation of the US healthcare system.  The move to ACO (accountable care organizations), increase in mergers and acquisitions, as well as the $27 billion in subsidies for Health IT is now putting EHR back in the spotlight again. Will these developments be the catalyst for better productivity through EHRs? The jury remains out. You need information technology + incentive models for all parties (providers, insurance, consumers) to support positive productivity growth.

They are many sources on these topics and while we’re not trying to be exhaustive, here are some starting places to find more information:

This list below highlights who is talking about EHRs the most (relevance ranked):
– HIStalk
Then, if you’re seeking blogs discussing productivity in healthcare, these 10 should be enough to get you started (influence ranked):
– HIStalk
This list below highlights who is talking about productivity the most (relevance ranked):
– HIStalk
Once you’ve made your way through as many as you can, I would be interested to hear your thoughts on our current productivity paradox in healthcare and the role of health IT!

Real“ism” at 2011 South By Southwest Interactive #SXSWi #SXSW

17 03 2011

Did you need to go to SXSW to find out what’s been happening in the last 12 months? Did you need to attend Clay Shirky’s keynote or hear about the gamification aka. Game layer of social media? –  Just think for a minute about how you feel about Twitter, Facebook, Foursquare, Quora…etc these days. Overloaded?

No you didn’t need to attend. Nor did I. But I still had a great time there because SXSW is casual and people are still very approachable. I went to hear, discuss and exchange thoughts and words about what matters. And those I did find. No, the latest gimmick wasn’t there and launching anything in such noise would probably be a mistake. Social Media Tech is only a servant for those who want to make meaningful change happen. The revolutions happening in the Middle East are what’s important; much more important than any another location or photo app. I have ultimately come to the conclusion that I didn’t go to SXSW to see more technology, and if Leo Laporte or Jeremiah Owyang didn’t find enough (see tweet). I think it was predictable since buzz usually builds up before but none had risen before.  To quote Valeria Maltoni, “people will always outlast tools.”  Yep, we’re living it.

Let’s keep doing real work which impacts real lives. The superstar ego-system is fading away and the time of “the next killer app” has passed. If an app is really good, it will come to us no matter what. Startups don’t need SXSW to make or break it. We’re all too networked to miss the really good stuff. Yes, we’re still in a recession and it is keeping people realistic. In that same vein, Google was rumored by RWW (before retraction) to announce a new social network (Circles). Let’s not create hype when ‘we’, the industry geeks, shrinks and new media people, want real apps that add real value and do not waste the user’s time. So what did I see at SXSW?

1. An -Ism or separation between being entertained and meaningful changes. That’s right, the point of this blog. We are experiencing a real separation between the hordes of people who want to use technology, the web and applications to turn people into uber consumers or seeking fame and the OTHER hordes that believe that those technologies should serve societal change for the better.  2011 is certainly showing strong signs of an increase in both populations.

2. Gamification, aka the ‘game-layer’: The Seth Priebatsch keynote was quite interesting, as it made the case for re-creating experiences (like education) through gamification. Boredom and disengagement have been long standing problems in education, and elsewhere in our lives. Nevertheless, we are human beings with cyclical needs, not computers. Creating genuine experiences and learning is not something that should be only solved through more gaming. Being a parent myself, we ought to let people learn outside of pre-deterministic tracks like those computers and the game layer will impose.

3. Location is trying to grow up: LocalMind was quoted in many blogs as being a great step forward when it comes to location based shopping discovery. But location applications are going to have to become much smarter than they are today. Foursquare fatigue, ‘nuf said. I have, like many, subscribed to Groupon and other deal sites to experiment, and I am slowly… unsubscribing. They’re only filling up my inbox.

4. Healthcare is only getting bigger:
I spent a substantial amount of time at the OVERcrowded health track as Extanz is increasingly working in the healthcare space alongside its sister company, We simply couldn’t fit any more people in each session. The health track was an unconference at 2010 SXSW and is overflowing already. This year, it was overflowing as well as a main track. Last year, I had heard way too much marketing/PR discussion during the sessions. This year, sessions were focused on the flourishing possibilities between healthcare, new media communication and community improvement.  Asthmapolis was mentioned as a breakthrough example of such possibilities. The apple app store accounts for 8000 health or healthcare related apps. Here are few take aways:

– Users’ first apps should be to connect with their doctors.
– Change has 3 main levels by Dr — epiphany (the rare case); change of context (more feasible)’ and baby steps (needs a feedback loop)
– Recurring use and measured behavior change are key for any app to have a hope of surviving. Too many apps are asking too much from users without giving data back quickly, or even better, first.
– Information VS. Prescription: The government will probably step in very soon to define the line between a simple app and a ‘device’ (where regulation will be imposed (FDA)) Information apps, however, will face less regulation as they are ‘prescriptive’ (via Jane Sarasohn-Kahn)
– Data people vs health people – “I ran two miles but I can’t visualize that” (Jon Richman) along with Roni Zeiger, argue that “all the healthcare data in the world is useless if it is not meaningful to the patient.”

5. #140conf – looking for inspiration? This is it.
This was my first opportunity to attend Jeff Pulvers’ year round conferences. Time flew by me, with short presentations from people using social medial or technologies to make big differences. The stories of Erik Proulx (@eproulx) with the project as well as Melissa Leon @melissaleon and Aj Leon @ajleon telling us about the project are all about such change.

6. Curation is the ever coming wave even for online shopping:
The more we curate, the more we produce, the more difficult it is distinguish between noise. Flipboard, My6Sense, and all promise more signals and less noise. I was surprised to see this trend growing in social shopping. The web has diminished one thing, the ability for brands to share emotions as they do through print or TV had built. We learned from @willotoons that many new sites are trying to recreate both emotion, but more importantly, the curation of the shopping experience, like,,,,, …etc.

So…My wish for next year: Sustainable / Cleantech will finally get a track in proportion to the magnitude of the problems they address. I think we can fill up rooms but it’ll take some bridge builders. I

sincerely thought that after last year’s unconference tracks on the subject, it would have been much bigger. Clearly ‘people’ lack data to know realtime what their consumption behaviors are. Just like healthcare, step 1 is the feedback loop. We all think our houses run like a Prius, while really they are more like Hummers. Cleantech will become big at SXSW when the early data collection players (Tendril Networks and other Power Tagging folks) come and meet people who can build cool apps. Or renewable energy folks like these best sellers should get invited. I want my phone to give me real time power consumption analyses of everything around me. The “internet of things” revolution will be much bigger than “social things.”

Anyway I hope to see you next year! I’ll go for longer, be picky, do more panels, continue to attend parties, ride a bike to get around and bring my power strip to be charging at all times.