Scaling Care through Digital Health Coaching

Dr. Vic Strecher of the University of Michigan addresses the important topic of digital health coaching in the video below. When addressing TEDMED recently he spoke of the potential to create personalized online messages for patients to help then change their health-related behaviors. While this may not qualify as "rocket science" it is huge as our nation's healthcare delivery system becomes increasignly financed by capitation and as we try to scale up delivery of services to larger numbers of people. The bottom line in the presentation is that people are more likely to pay attention to (and act upon) highly personalized messages even if those messages were in fact computer-generated.



Additional information about Dr. Strecher is available here. http://www.ur.umich.edu/update/archives/100122/innovator

Forgiveness, Trust and a Culture of Quality

In this video presentation, Paul F. Levy, recent CEO for the Beth Israel Deaconess Medical Center in Boston, makes a case for forgiveness in the culture of a medical institution striving for quality care. I suppose that to somehow punish a physician or other care provider for a serious mistake may be safe behavior for an administrator. People tend to admire active administrators who can make decisive decisions. But the quality of the services provided by a caregiver is more evident in the pattern of his or her work than in the exception. Physicians tend not to identify the mistakes and near-misses of others, realizing that they each are imperfect and may someday make a mistake. A culture of punishment does not promote a culture of trust, which is necessary to create continual learning and improvement.

From social networks to social robots

At her recent TED Talk Sherry Turkle describes how she believes our electronic social and communication devices are becoming problems as we try to substitute connections for real relationships. About half way through her presentation she refers to the use of social robots in a nursing home.



I have not yet digested the relevance of her thoughts to health and administration. But I wonder if the connection (no pun intended) may be to the notion of, "patient centered care." Medical care is now team-based and individual patients sail through an entire trajectory of teams in an episode of acute care. Sooner or later someone will probably invent some charming robot that patients can carry with them through the experience and perhaps even carry home with them. It will be programmed to help the patient understand what is happening to them now and why. It may even become the repository of some data useful to medical caregivers along the way and may monitor the patient's vital signs. Those of us who remember the joys of early social technology in the era when Turkle wrote her book Life on the Screen remember fascination with live online communications. The very idea that a computer could reproduce the sound of a baby's cry or the gesture of person on the other side of the earth was exciting.

Now I observe my students who almost always have their mobile telephones in hand. I share a concern that we may be losing more than we are gaining. If someday I slowly walk or roll the corridors of a nursing home I want good meals and broadband internet access! But I hope for myself and others for more than a cute robot to talk to as I reflect upon life and circumstances. The healthcare delivery system is not friendship service. But I do believe that "patient centered" is about being person centered and that we may have used the phrase, "patient centered" to gloss a dimension that cannot scale through technology or process design.

Digital records and costs

An article in The New York Times by Steve Lohr published March 5, 2012 reports on a study using existing data that concluded that availability of digital records may not cut health costs. Someone expressed doubt in the findings because they were based on correlations in existing data rather than a controlled test intended to test the hypothesis regarding electronic records and costs.

http://www.nytimes.com/2012/03/06/business/digital-records-may-not-cut-health-costs-study-cautions.html?_r=1

In my opinion, not every study requires a method like that of a clinical trial and it is both valid and cost-effective to make use of existing data in responsible ways. Correlation certainly does not prove causality, of course. But I believe the discovery of interesting correlations resulting from hypothesis-based research can be worthy of the attention of professionals. I am not advocating for just mindlessly searching available data for any possible relationship among variables and then pretending to have completed disciplined research.

It is reasonable to anticipate that computerized medical offices have the potential to both save money (by reducing the need for repetition of tests already taken) and to spend additional money as the availability of data stored in electronic records drives the propensity of physicians and patients to want still more data. The new iPad 3 with its high resolution screen is likely to push the, "let's get more images" propensity further. Medical providers want to do what is possible and the availability of higher-quality data easily accessible extends what is possible.

Using multimedia in personalized health education

In the following TEDMED video Alexander Tsiaras, Founder of The Visual MD, discusses and demonstrates how multimedia can be used to make a patient's lab report come alive to the patient in ways that plain text cannot.

The leadership challenges of transformation

Dr. Ricardo Azziz, President of Georgia Health Sciences University (GHSU) and CEO of Georgia Health Sciences Health System, has made a blog post dated February 4, 2012 regarding the consolidation of GHSU and Augusta State University.

http://azziz.georgiahealth.edu/archives/406

The decision by the Board of Regents of the University System of Georgia will surely test the leadership of both those at Augusta State University and Georgia Health Sciences University. Twenty-five years from now I doubt anyone will credit or fault the Regents' decision based on levels of spending for higher education in Georgia. The consolidations will be judged by whether or not campus administrators and others found synergies in new realities.

From what I can observe as a student the leaders of both insitutions are accepting the new reality as opportunity. I think Dr. Azziz' blog post sets the right tone. He and others worked very hard to implement the institutional name change of GHSU to emphasize the mission of the historic institution. Now he is accepting the leadership challenge of adapting his vision to the new opportunity. The entire field of higher education in the United States is in transition and the need for adaptive leadership is everywhere. I appreciate Dr. Azziz for his leadership and his willingness to share his concerns and hopes through his blog and by other means. This is not just about the metropolitan Augusta area. The implications of this particular decision by the Regents regard the entire state of Georgia and beyond because of the scope of medical education and patient services provided by Georgia Health Sciences University and Georgia Health Sciences Health System.

Nanotechnology to the rescue?

Ray Kurzweil offers an exciting vision of the future and we learn to engineer alternative biological structures at the molecular level. Think how "positively disruptive" such abilities may be to our existing medical care systems.