My videos page has recordings of various speeches. Here’s the latest – and, some are saying, my best. It was a month ago in Cary, North Carolina, at a big event conducted by SAS called “Health Analytics: From Big Insights to Big Breakthroughs.” It’s 56 minutes long.

Here’s the direct link to the [...]]]>

My videos page has recordings of various speeches. Here’s the latest – and, some are saying, my best. It was a month ago in Cary, North Carolina, at a big event conducted by SAS called “Health Analytics: From Big Insights to Big Breakthroughs.” It’s 56 minutes long.

Here’s the direct link to the video. If you’re not already registered on that site, you may need to register here.

Not all the slides are shown in the video; here’s a copy of them on Slideshare. Slideshare’s display software is pretty weak compared to what I do with PowerPoint :-) so some of the layouts display wrong on their site, but you can get the idea.

Don’t miss Peter Diamandis’s talk that day

Near the beginning I mention it. Here’s the link.

This [...]]]> Please click this image, watch the two minute video, and donate what you can.  This is THE famous Regina Holliday, who has been called “the Rosa Parks of healthcare.”  You’ll see why.  A humble but immensely strong woman who has become the leader of a movement made almost literally with her bare hands.

This modest $10,000 fundraising project (very little for a film) is one week away from completion, and has less than $2,000 to go.  As I said on Facebook when it was $2500, let’s find two $1,000 donors and dozens of $20 ones!

Click it and read. Get your name in the credits, if you’ve got the scratch!  (If you have one of these jackets, you must donate; even if you don’t and you just love supporting a great new future, pitch in!  I did.)

Incentives include a shirt, a copy of the DVD, and all the way on up to Regina coming to your company or club and doing a speech or even a lecture!

And she might even paint for you.

It seems these days internet ads get high click-through rates if they start with “Weird trick.” I’m game. For patient centered care, the weird trick is to think about this:

Listen to what matters to patients (ask them), and decide that it matters to you.

Image source: FreeDigitalImages.net, by digitalart

It seems these days internet ads get high click-through rates if they start with “Weird trick.” I’m game. For patient centered care, the weird trick is to think about this:

Listen to what matters to patients (ask them),
and decide that it matters to you.

You’ll see things from their point of view,
and you’ll become patient centered.

I know it’s weird, but think: when patients tell you something’s bothering them, do you say “Sorry, there’s nothing we can do about it”? That’s the hallmark of being disempowered. Or do you do something about it? Or as your team to see if you can?

For instance, noise: I just learned that some hospitals are letting people put up a Do Not Disturb sign! Hard to imagine? It’s in a great Wall Street Journal piece yesterday by Laura Landro.
____________

So, what is this “patient centered” thing?

A lot of good work is happening in the medical industry around the term “patient-centered care” or, sometimes, “patient and family centered care.” A key driver of this (at least in America) is that providers’ reimbursement (government payments) will now be based in part on patient satisfaction. I can’t think of a clearer example of government policy driving a change that benefits the ordinary person. Huzzah to the gummint, telling providers they can no longer get paid as much for giving a crappy experience as for giving a good one! That’s bringing bizness reality to the medical market!

The new incentive is leading some people to ask, “Okay, so what IS this patient centered care thing? How do I do it?”  Some of us advocates don’t like to hear that question – “They shouldn’t have to ask!!” But that’s not helpful – do you like it if you try to improve your ways, and that’s the answer you get? So let’s help.

Twice in recent months I’ve worked with Dignity Health, which is going through the realignment, re-organization and cultural change to succeed in the new era. (I love it when we get to do Round 2 – we go deeper, or approach it from a different angle, and it always enriches and deepens awareness in the organization’s culture.) They were in the WSJ article, and yesterday their Richard Roth @Rich_Roth tweeted it to me. Also in the article is the Beryl Institute, with whom I’ve also worked, but that’s not the point. The point is,

How freaking stupid do you have to be
to be noisy around sick people???

My mother would SMACK you for doing that
when one of us kids was sick.

I mean, really. How hard is that to understand? From the patient point of view, that’s obvious.

So if your organization is trying to understand what patient-centered care is, start with this: Just listen to what matters to patients. Really, listen – and you’ll start to see things from the patient’s point of view. Your point of view will become patient centered.

Isn’t that weird??

Vote us up! (Alicia Staley and me) Click to visit our proposal on the site, register if you need to, and use one of your votes for this awesome idea!

(Or all three of your votes. :-) It’s allowed.)

Have you ever seen the set of pills [...]]]>

Vote us up! (Alicia Staley and me)
Click to visit our proposal on the site, register if you need to,
and use one of your votes for this awesome idea!

(Or all three of your votes. :-) It’s allowed.)

Have you ever seen the set of pills that have to be managed for a person with a slew of prescriptions?  It’s nuts. What’s even more nuts is that with all we pay for healthcare and computers in this world, there’s no software anywhere that makes it easy to do the right thing. Let’s change that!

(I’m not complex at the moment (at least my prescriptions aren’t), but when I was sick I sure was. Farther down is the true story that gave me this idea.)

This is my submission for the “Blue Button CoDesign Challenge” that was sprung on us last Monday by the good folks at Health & Human Services, who are doing this radically modern thing – unusual for government, eh?  They came up with a fascinating challenge and are opening it to the public, with prizes! For details you can check out the challenge site.

Here’s my proposal. Over the weekend I’ll flesh out this blog post with more details, but for starters Friday afternoon, here’s the big idea:

Build me a Blue Button enabled tool that….

… makes it easy to manage our frickin’ prescriptions and take the right pills at the right time!

My doctors’ computers know my prescriptions and when I’m supposed to take them, right? So do the pharmacies. And computers can mash up all kinds of information from different sources, and organize it, and display it clearly, right? So why do they make ME figure out when I should take what?

Let’s have an app that can read all my prescriptions, and organize them into times of day. Even better, it could print out my pillbox and add pictures of what goes in each square. Why not?? Isn’t that what computers do – make complex information easy??

That’s the idea: go get information that already exists, mash it together, and turn it into a simple schedule grid, to be printed or viewed online.

If we go really nuts, then we have the thing go get pictures of the pills, accurately represented with images from a certified Pill Finder, such as http://www.drugs.com/imprints.php. If you’ve ever seen a patient filling a big complicated pill box, you know how good this would be – “Let’s see, two of the little yellow ones go in the lunchtime slot…”

Sample pill organizer from http://www.techforltc.org/product.aspx?id=2596

Even better, how about if you could tell it what kind of pill organizer you have, and it could get a picture?  (Here are some Google Images for “pill organizer.”) Then it could show you what it should look like when it’s properly filled. Right?? Why should we have to figure that out ourselves??

Thoughts and notes:

An application that can pull all my prescription lists from the hospital, doctor, and pharmacy….

• Keeps my prescription list up to date
• Digital/Virtual Pill Box: takes all my prescriptions and prefills them into a digital picture of my model of pillbox (Walgreens model XYZ, or CVS model J17, or whatever).
• While we’re at it, why not link to information about the pill from a certified information source, like Drugs.com?
• Maybe:
  • Have pop-up reminders. (I know, there are a million apps that do this.)
  • Click on the pill you’re taking and maybe show it dimmed in the digital pill box. Maybe the app records when it was clicked. (Maybe someday build in rewards for when the user completes a prescription (antibiotics) or completes a full week of a long term medication (ie: synthroid).)

You get the picture – once the information’s in there, in a useful form, there’s lots you can do with it. But the main idea is to simply take advantage of information that already exists, and present it simply and clearly.

Or, as I’ve often said in speeches: make it easy to do the right thing.

How is this different that other “pill reminder” apps on the market?

Access to the EHR! Information is the differentiator.

Phase II could incorporate…

• … two way feedback loop between the patient and pharmacist or physician.
• … a symptom tracker based on the standard set of known side effects, and can include basic questions the user must answer throughout the course of prescription. Could be very helpful for long term prescriptions (ie: tamoxifen, synthroid, RA drugs etc)

In short, whatever information exists in computers about my meds and my prescriptions, why let it die on the vine? Make the most of it – bring it to my life!

The story of this idea

When I had cancer in 2007 I was hospitalized seven times – once to have the kidney out, twice when the leg broke from a giant metastasis, and four times when HDIL-2 was administered. The most complex was the first week of IL-2, when I was discharged with seven medications to be taken on wildly different schedules: “Take this 3x/day with meals,” “take this between meals,” “take this when you get up,” etc etc.

Like, it’s not bad enough that I’m going home all beat to heck from a nasty treatment; now, to be successful, I also have to be clear headed and careful??

Pill organizer technology, Boston, 2007. Image credit: Grant Cochran, FreeDigitalImages.net

Happily, we were given a beautiful clear schedule grid. The odd thing was, the technology used to make it was a pencil and ruler.

In the hands of a nurse practitioner. Is that a good use of a skilled person’s time??

I asked why the computer didn’t do it, and she said computers can’t do it. Or maybe she said theirs can’t. Anyway, where we come from (Alicia and me, both geeks), computers constantly take messy information and display it clearly. Right?

The irony is that I only received this beautiful medication grid that one time – on the other discharges we were left to figure it out on our own.

I bet dollars to donuts this app will be appreciated and used … and I bet there will be delicious statistics on how much better people stick to the plan.

Doctors call that “compliance.” I call it “achievement.” And with any luck at all, we’ll all call it Better Health.

All achieved by simply combining digital assets that already exist. That’s mash-ups, baby – ain’t that modern?? Let’s do it!

I’ve blogged several times about the greatest truth I’ve learned about the business of medicine. It’s the title of a 2006 Health Affairs article by Princeton economist Uwe Reinhardt: The Pricing of US Hospital Services: Chaos, Behind a Veil of Secrecy.

The cost chart at [...]]]> Latest in my series Let patients help, cost-cutting edition

I’ve blogged several times about the greatest truth I’ve learned about the business of medicine. It’s the title of a 2006 Health Affairs article by Princeton economist Uwe Reinhardt: The Pricing of US Hospital Services: Chaos, Behind a Veil of Secrecy.

The cost chart at right shows what’s happened since Reinhardt’s paper appeared, in the middle of the chart. It’s what you’d expect if slush is flowing around with nobody watching.

Today I was reminded that it ain’t just hospitals. :-)
______

Last week I got my annual checkup. There were two separate problems in my hospital’s appointment system, so I ended up leaving too late to get the simple lab work my doctor had ordered; I said I’d get it done at a local lab.

Today I visited AnyLabTestNow, a chain with a local office. I called ahead, and for walk-in self-pay, it’s $49 for the chemistry panel I needed (Calcium, CO2, etc) and $49 for the cholesterol, total $98. And a $10 off coupon, on the site! Just $88.

Or not.

I checked with my insurance company, and the blood work is covered 100% as part of a normal checkup, because “The doctor diagnosed the test right” (her words – i.e., he ordered the test using the right ICD-9 code).

BUT, the lady was careful to point out “This is not a determination of benefits, just a description of services.” How’s that for malarkey? “We’re not saying you WILL be reimbursed when you submit the claim – I’m just telling you what the policy says.” But she’s required to say it, because the company that denies claims is not accessible through customer service and might possibly deny the claim, even though she said it should be covered.

And I am not allowed to talk to someone who does know, right now when I need the service, to actually find out. The only way to be sure is to file a “predetermination” and wait a week. If I don’t and the determiner says no later, I’m stuck with it.

And I can’t send it to the “determiner” (to invent a George W word); I have to send it to the service company, who in turn forwards it to the determiners. Then the uncontrollable delay starts – she said “We try our best to get it back in 5 days, we really do, but sometimes we can’t.”

Guess who’s holding all the cards and all the power behind that veil of secrecy?

It ain’t me the watchful consumer, and it ain’t even the nice customer service lady. She, meanwhile, explained that “It’s not a person who makes the decision – it’s the computer.” I explained that if she’s been fed that line of malarkey, there’s more funny business going on, because somebody puts the rules in the computer and I want to talk to someone who knows what the rules are. So I can be responsible about medical costs. Which nobody else seems to want to do, in this picture. :-)

Anyway, I got the blood taken, and in a couple of days the results will be sent to him and visible to me online.

But really – no, really – what did this cost?

Even though insurance paid, I care about costs, especially since my premium went up 20% last year, even though I didn’t file a penny of claims; I still want to help keep spending down. So I asked the lab’s desk lady how much it would cost through insurance. She said the classic response, familiar to readers of this blog:

“Oh, we don’t know. It’s up to the insurance company – they pay whatever they pay.”

So I called back the insurance company, and told that to the next nice lady, and asked “So, what do you pay?” And she said:

“Oh, we don’t know – it depends what the doctor charges, and your deductible and copay.”

And I said “So in my case, what would that be?” She said there’s no way to know.

Chaos. Behind a veil of secrecy.

Observe, ladies and germs: money flows around, behind a veil of secrecy, and nobody we are allowed to talk to can give us any information so we can make responsible, informed choices.

Where does the money go? Does anyone know? Looking at that cost chart, I’m guessing it’s being shoveled into someone’s pocket, behind that veil. Jerry Maguire shouted “Show me the money”; I’d settle for just being able to watch it move – “Show me the cash flow!”

I say, let patients help control the cost of care. Until then, let’s not let anyone say consumers are the cause of rising costs.
_____________

p.s. As always on these calls, I asked if I could talk to the people who do know, and this time, much to my surprise, she said yes – she gave me the phone number of the company who actually negotiates the prices!  This is the first time anyone’s offered it.

Think about that.  There [...]]]> Eight weeks ago on Forbes I noted an article I’d found that said half of all humans who’ve ever been 65 are alive today. (Actually the source said 60-75% of all 65+ people ever. But I’ll settle for half.) In less than two years that demographic bomb will include me.

Think about that.  There are 3x more people alive today (7 billion) than at the start of the baby boom (2.3 billion, 1946).  Combine it with the reality that because medicine is awesome, people who in those days would have died (e.g. me) are living much longer. Lots of old people coming. Zombie fields of old people. (We’re not “getting old” until much later, but there are a lot of us.)

Case in point: here are  the 34 obituaries in today’s New York Times.

• 90+: 11 of them (almost 1/3)
  • Composer Henri Dutilleux, 97
  • Roger L. Shinn, 96
  • Cuckoo’s Nest doctor Bill Brooks, 96
  • Short story writer Mary Ward Brown, 95
  • Jazz zealot Jean Bach, 94
  • War photographer Wayne Miller, 94
  • Battle of the Bulge honoree Vernon McGarity, 91
  • “Lyle, Lyle, Crocodile” author Bernard Waber, 91
  • Canadian abortion advocate Henry Morgentaler, 90
  • Jean Stapleton (Edith Bunker), 90
  • William Demby, 90
• 80+: 15 of them
  • Recording studio magnate Mack Emerman, 89
  • Novelist Morris Renek, 88
  • Artist Otto Muehl, 87
  • “SWAT” actor Steve Forrest, 87
  • Entertainment lawyer James Tolbert, 86
  • Aircraft executive John Bierwirth, 85   Median (midpoint of the list): age 85!
  • Priest/author Andrew Greeley, 85
  • Abscam mayor Errichetti, 84
  • Tonight Show drummer Ed Shaughnessey, 84
  • Pro Bowl guard Bill Austin, 84
  • Civil rights activist Alton Lemon, 84
  • Actress/playwright Franca Rame, 83
  • Poetry printer Kim Mercker, 81
  • Journalist Haynes Johnson, 81
  • Snapple founder Leonard Marsh, 80
• 70+: 5 of them (note that 3 were almost 80)
  • Bill Haley bassist Lytle, 79
  • French singer Georges Moustaki, 79
  • Nobel physicist Heinrich Rohrer, 79
  • Marvin Junior of The Dells, 77
  • ’71 Lakers sharpshooter Flynn Johnson, 72 (multiple myeloma)
• Under 70: 3 of the 34
  • Lewis Yocum, sports orthopedist, 65 (liver cancer)
  • “O-oh Child” singer Clarence Burke, 64
  • Jazz pianist Mulgrew Miller, 57 (stroke)

Now ask yourself: as this very large mob gets older and bigger, who’s gonna take care of ’em medically?

I suggest: teach ’em all (teach us all) how to stay on top of our health status, and give us the tools and data to do it.

Be very afraid, medicine. Or, just lighten up: Let Patients Help.

The first was Tuesday on the Health Leaders web site. (They’re the magazine for medical management that in 2009 featured Dr. Sands and me in their cover story “Patient of the Future,” then included us [...]]]> I got two wonderful surprises this week about Let Patients Help – unexpected, very favorable reviews of this little book.

The first was Tuesday on the Health Leaders web site. (They’re the magazine for medical management that in 2009 featured Dr. Sands and me in their cover story “Patient of the Future,” then included us in their “20 People Who Make Healthcare Better.”) In What the E in e-Patient Really Means, editor Scott Mace shows that he really gets it:

I’ve made a career out of documenting the empowering effects of technology. In the 1980s, among other things, personal computers were a way to engage students of all ages through the interactivity of educational software. In the 1990s, the Internet equipped us to get the most current data. In the 2000s, Web services enabled us to build “digital nervous systems” that automated the publication of that data, and our ability to subscribe to updates through the power of technologies such as RSS and search technologies such as Google.

But here in the 2010s, it’s ironic that the most personal of data we generate – that about our health – remains locked in healthcare’s vaults for a variety of reasons. …

It’s a long, perceptive essay – almost 10% as long as the book itself! The items he cites are truly the core of the message. Well done, Scott.

The second was today in Oncology Times – someone tweeted that they’d just seen it. (Why do I only learn of these things through Google Alerts and Twitter??) In the “Practice Matters” column, Lola Butcher writes Let Your Patients Help You.

Lola is informed and funny. Excerpts:

If you don’t know what [e-patient] is, click here and get with the 21st century. …

It only takes about an hour to read but if that seems like too much, skip to the “tip sheets” at the end. … Look for two sections — “Ten Things Clinicians Say That Encourage Patient Engagement” and “Ten Things Clinicians Say (or do) That Discourage Patient Engagement” — written by deBronkart’s primary care physician and co-author, Daniel Sands, MD.

deBronkart has a big smile and a humorous way of making his points but physicians who do not support patient engagement should be very afraid of him.

Afraid of moi??  I wouldn’t say they should be afraid of me, but they sure will feel uncomfortable as the new reality unfolds. And that’s happening with or without me – I only talk about it, to spread the word and shed light on what’s possible.

Thanks to both Scott and Lola for drawing attention to this little book. Its tummy tickles every time someone says something nice.

Don’t miss this. It’s Monday. Act now! (How often do I say that??)

If you’re a health geek, or a patient centered care geek, or anything of the sort, [...]]]> I know this is last-minute.  I’ve been busy and disorganized, and thrown for a loop (frankly) since the death in my family earlier this month.

Don’t miss this. It’s Monday. Act now! (How often do I say that??)

If you’re a health geek, or a patient centered care geek, or anything of the sort, and you’re in southern California, don’t miss this. Tell your boss right now that you should go – it may be the best conference deal of the entire year (and I see a lot):

Monday, June 3, Long Beach, CA, 8:30-5:00
(Details are at the form link below.)

$150 for one person in the health professions
$99 each for three or more (bring colleagues – 3 for the price of 2!)
$65 for patients and family members!

The event: Patient & Family Centered Care Partners @PFCCPartners – fourth annual conference. Speakers:

• Opening keynote (8:40 a.m.): Bob Wachter @Bob_Wachter, whom I recently heard speak at the Michigan Hospital Association (right). He’s chair of the American Board of Internal Medicine (I’ve worked with some of their people – really terrific), and Wikipedia says he’s “a prominent academic physician on the faculty of UCSF … regarded as the academic leader of the hospitalist movement, the most rapidly growing field in modern medical history.” He is a true leader and a great speaker.
• Closing keynote (4 pm): Me

Also presenting will be Martie Hatlie, a terrific moderator I worked with at a PCORI meeting earlier this year. Tons of experience in patient and family centered thinking.

All this for $150 or less, with extra-special pricing for patients and family!

Let them know you’ll be coming: fill out this info form (site includes full event details). Walk-ins will be welcome but it helps a LOT if they know you’re coming!

See you there – two global keynote speakers, bookending a great day for a great price, hosted by a great organization!

(And who knows, maybe a beverage afterward… I hear Long Beach is lovely in the evening, and I’m staying over. :-)

Since Let Patients Help was officially released on April 15 there’s been lots of praise. The most exciting just arrived today: a hospital CEO who’s making the book’s ideas into something of a mission, starting now.

On her blog “Executive Rounds,” today Leslee Thompson posted “Let patients help” and other things I am [...]]]>

Since Let Patients Help was officially released on April 15 there’s been lots of praise. The most exciting just arrived today: a hospital CEO who’s making the book’s ideas into something of a mission, starting now.

On her blog “Executive Rounds,” today Leslee Thompson posted “Let patients help” and other things I am learning. She’s CEO of Kingston General Hospital in Kingston, Ontario, where I spoke two weeks ago at their “KGH Connect” event. Please go read her post; these excerpts show how much she gets it:

One thing I do when looking at my calendar is to imagine what a patient in my hospital would think about how I am choosing to spend my time and energy. Would they approve of me sitting in my office reading reports about how to improve patient satisfaction? No. So I head on up to the wards and talk directly to patients and families.

Don’t wait for a randomized clinical trial on the value of engaging patients as partners in their care. This is real and the time to get on board is now.

I have never done a book review or endorsement like this before, but I really think this should be required reading for everyone who works in health care… [But ] reading his book is only a start. Ideas are only as good as our ability to translate them into action.

That’s right: action.

These people have serious credibility.

More than once I’ve heard people react to patient engagement by saying it’s a nice idea but it doesn’t drive results, saying things like “No leader who’s focused on performance can afford to do this.” Well, that argument stops here: this hospital has a results culture that’s working. Five years ago the place was in serious trouble, to the point where it was taken over by the government. Leslee and her team have done a terrific turnaround – I don’t have all the specifics at hand but among other things their hand hygiene (to avoid infections) is at 96%, compared to about 50% as an industry average.

So at the KGH Connect conference, the keynotes and sessions weren’t about “How can we create change,” they were about “What’s next?” And this is one of Thomson’s next initiatives.

How about you? What are you doing to let patients help?  Have you read the book?