This piece is actually a continuation of a previous entry, “Look Ma, No Wires. “ If you’re reading this, you probably already know that especially with upcoming readmission penalties, there is an increased focus on keeping patients healthy while at home. Whether post-discharge or simply for prevention and wellness, there are more and more tools and devices available for use in our homes and while on the road to help with any number of conditions – especially chronic ones. And while there are many available out there, there are also some that I wish we had but have not yet been invented.

Start with a digital scale. Easy enough – patient steps on, is weighed, and that data can be wirelessly transmitted to any number of devices and applications. Especially when combined with a similarly equipped blood pressure monitor, here is one of the most effective ways for a care team to monitor and manage patients, including those recently discharged with a heart failure condition – one of the diagnostic groups targeted by October’s readmission reimbursement changes.

Let’s face it though. Wouldn’t that data be more effective if it were also tied to the refrigerator and other kitchen appliance usage? Sure, we could have the data flash on the fridge door as a reminder as you approached it. But it would be more effective either with audible cues during between-meal times (“Hope you’re getting something healthy”) or when accessing certain sections of the refrigerator (“Sure you want that ice cream, tubby?”). Even better, combine it with automated dispensing technology to control what is available and how much. How about Coffee? Sure, but your blood pressure will regulate the mixing of decaf with regular. Gained a pound last week? Only skim milk in that coffee today instead of 2%.

What I really want is an adjustable fun-house mirror that is linked to my scale. Lost some weight this week? Great – make me look even thinner as positive reinforcement. And if I’ve gained a couple, exaggerate the view for encouragement to get back on track. Number of chins shown is an optional setting.

Real-Time Location Services (RTLS) now also show up in the home, particularly in monitoring the activities of the elderly and homebound. A Personal Emergency Response System, (aka, the “I’ve fallen and can’t get up” alarm) is an active measure. RTLS-based solutions, however, can now not only monitor a person’s activities in a given space, but learn from them as well. Grandpa never sits in that chair for more than 30 minutes at a time? Then trigger an alert if that time period is exceeded. There are sensors that can determine if you’re lying in bed or how many times the toilet has been flushed. While this may seem like too much information for some, it is valuable in managing patients wishing to remain at home rather than in a facility.

Based on my own grandparents, I think what we really could use is a PDLS (Personal Denture Locator System) and auto-sensing television volume controls that lower the sound when others are present or want to speak.

Wearable devices now track our steps, calories burned – even how much we sleep. All of this data is automatically uploaded to a record that can then also be integrated with other applications. I love these. By being aware of how active we are or how many calories we are burning, we can set goals and monitor performance. Started taking the stairs at work instead of the elevator? Let’s see the difference. What we really need though, is an integrated system that will take our weight from the scale, use the information from the wearable device, connect to the GPS tracking system in our phone, and create a steering mechanism in our footwear that will then – if I have not yet hit today’s activity targets to maintain or lose weight – guide me away from doughnut and ice cream shops and over to the fruit stand.

And how about those band-aids that monitor your cardiac status and transmit the results via Bluetooth? Certainly, these may be one of the most powerful tools in managing heart failure patients (remember those readmission penalties?). But consider the larger potential commercial value. Wearing one of these cardiac monitors, you might see someone to whom you are attracted. We know when that happens there is often a resultant change in cardiac function. Combine this with a portable and wearable pheromone misting system that is triggered by such cardiac activity, and we’ll put dating websites out of business.

I’m pretty sure this is not what Pliny was thinking about.

Copyright: 20th Century Fox

Speeling Erorrs

Without the use of full-sized keyboards and flat surfaces, mobile devices provide fertile ground for spelling errors, thus giving birth to the popular pre-emptive e-mail signature line, “Sent via <insert device type here>, please pardon any typos.” There is a corollary condition in which autocorrect suggestions are accepted unintentionally. See also “How to Avoid Having Your Text Messages Show Up on damnyouautocorrect.com.”

Hand Disorders, NEC

There are a variety of hand disorders, not elsewhere classified, that affect many users of mobile technology. Digitas gros (fat fingering) occurs when the letters on keyboards, both physical and virtual, are smaller than the user’s fingers, resulting in both incorrect and multiple characters being selected. Maniclaw results when long nails result in the user’s hands being held at an odd angle to hit the correct keys (see also CNS – Chipped Nail Syndrome). Finally, there is what has been well-documented as Blackberry Thumb. Though no longer exclusive to devices made by RIM, cramping of thumbs has been well-documented since the advent of the portable device keyboard. See also “Why Fingerless Gloves are a Necessity and Not a Fashion Statement.”

Device Envy

This is a common condition among both men and women and, not surprisingly, it’s not always about the size of your device but how you use it. See also “How I Spent My Day Off Waiting in Line Outside the Apple Store for The New . . .” and “What Do You Prefer For Protection – Leather or Silicone?”

PTSD (Power, Telephone and Signal Disorder)

The anxiety caused by not being able to use your device because either your battery is run down or there is no signal, cannot be underestimated. People afflicted with this disorder can often be seen roaming airports glassy-eyed, grimacing, and seemingly looking down at the carpet when, in fact, they are scanning for power outlets. These same people who may be wearing expensive clothing will think nothing of sitting down on a dirty floor and leaning against a trash can if there is an outlet nearby. And while some people quote memorable commercial lines such as “Where’s the beef” for laughs, those with PTSD are not reliving fond memories of a Verizon commercial when asking the other party, “Can you hear me now?” The reason your Starbucks is empty at 8 o’clock in the morning? The coffee is ready but the Wi-Fi is out. See also “Why Are There So Many Different Sizes and Versions of USB Charging Cables?”

Baldwinism

A condition in which you believe that what you are doing on your mobile device is more important than anything else. See also “@aplusk”

False Imagery

A potentially life-threatening or career-ending occurrence in which that embarrassing photo of your sister from the holiday party you meant to post on Facebook is, instead, uploaded to a patient’s chart. See also “My Facebook Friends Are Wondering Why I Posted a Picture of a Gaping Wound to My Timeline.”

Rosacea Embarrasser Mobilus

Related to the chronic skin condition, Rosacea, in which patients’ faces turn red, this particular version is caused by awkward incidents related to the use of mobile devices. Possible symptoms include: Picking up someone else’s device by mistake; Your child’s having changed an alert tone without your knowledge to something sounding like a biological function; Instant messages or texts popping up while sharing the screen with a patient or colleague; Forgetting to charge the device (see also “PTSD” above); Usage while in the rest room.

If you know anything about me, you know that I love whiteboards. I’m very visual and the opportunity to create, to brainstorm, to collaborate is all facilitated by a huge white board with lots of different colors of markers.

I was standing in front of just such a white board a few months ago with some very smart people. I like smart people. They make me think. They make me realize that I can always get smarter than I am today. Many of them also have a very good sense of humor. That’s not relevant to my point, but does help explain why I like to spend time with them.

I was trying to draw a picture that showed the interaction of all the things that EMC does to support two of the foundations of modern healthcare – patient engagement and care collaboration – and how we surround it all with analytics and a security framework. I drew lots of boxes and lines. I erased some, moved others around, drew some new lines and boxes. It was very colorful. It was very messy.

Finally, I got it just right. A relatively simple picture with enough detail to tell the story. We called it the Patient Engagement Platform because at the end of the day, it really is all about the patient. Again, remember this for later – I’ll come back to it as well.

If you’re reading this, chances are that your life is full of acronyms. It is just one of the ways that we make things easier and save time in this fast-paced world we live in. Why put money in an Individual Retirement Account when you can contribute to an IRA? Car won’t start? When was the last time you called the Automobile Association of America? Even the U.S. government couldn’t help themselves, not only turning the Centers for Medicare and Medicaid Services into an acronym, but then by going and shortening the acronym itself (unless you still say “Hick-Fah” for HCFA instead of CMS).

No big surprise – both healthcare and information technology are full of acronyms. How many of us have actually spoken sentences that had more acronyms than words in them? (You can’t see, but I’m raising my hand). Later this month, many of us will be attending the Annual Conference of the Healthcare Information and Management Systems Society. You’ve never said it that way? I think that the organization itself prefers that we say “Aitch – Eye – Emm – Ess – Ess” but how many people do you know that are not employed by that organization say it that way? We’re all going to HIMSS. In Vegas (forget the “Las”).

So after a few weeks, the more I looked at what had come from the white board (yes, I’m back there now), the more I realized that it wasn’t a platform at all, but more of what we commonly refer to as an ecosystem. And using the dictionary definition cited earlier, it really is an ecosystem in which the “interactions between a community of living organisms in a particular area and its nonliving environment” are managed. Like an ecosystem in the true biological sense,, there are many dependencies and leverage points, and when finely tuned and humming along, optimal levels of patient care and resultant outcomes will emanate. I now started calling it the Patient Engagement Ecosystem.

Many of you are probably now way ahead of me.

Here’s the thing. Many people involved had already started calling this the Patient Engagement Platform, or PEP. They all liked the shift to referring to it as an ecosystem, but a revised version of the acronym never really surfaced. That is, until I started working with our Marketing department on preparing a presentation I was going to give about it at the HIMSS conference.

The unfortunate fact is that Patient Engagement Ecosystem captures so well what we have created, that we really couldn’t come up with a better name . . . and acronym. As you might imagine, since I said I like people with a good sense of humor, I have endured some taunting. So I’ll just leave you with this. Want to learn more about Matt’s PEE? Come by the EMC booth (#2018) at HIMSS on Wednesday, February 22^nd at 3:00PM when I’ll be speaking about it.

And in the interest of good taste, I will now end this piece before going any further.

My refrigerator, like most, has bins for fruits and vegetables, and a sliding drawer for meats and cheese. There are pre-formed cups for eggs and a butter compartment in the refrigerator door. The freezer has a little shelf for ice cube trays. I tend to follow these subtle suggestions and store such products appropriately. A place for everything, and everything in its place.

But what happens when the need for specific space changes or scales up? My refrigerator probably runs at about 75% capacity on a normal day. At times, however, such as at the holidays – that need changes. I have a set amount of physical space but the distribution of that space needs to change quickly and temporarily. Need room for that turkey? Well, then some non-produce items are going into those lower bins. That bottle of Korean Soju I got as a gift 3 years ago but have yet to drink – on the pantry shelf until after the holidays. All that extra cream cheese for the Pumpkin Cheescake? Ain’t going to fit in the cheese drawer so better make room elsewhere in the fridge. It’s a dynamic re-allocation of resources based on demand.

Historically, a healthcare IT department faced with a need for additional compute or storage would have to add hardware. And if the application vendor recommended specific brands or types of equipment that did not match what was already in-house and on the floor, then that would result not only in additional capital expense, but potentially training and/or skills to operate and maintain as well.

Would you think the following? “Hey – for Thanksgiving, we need to go out and get a second refrigerator. Oh, and we’ll need space and power for it too.” Of course you wouldn’t. But unless you are operating a private cloud, or using a public or hybrid cloud, that’s pretty much how IT departments have traditionally scaled up to meet demand. The fact that many health IT vendors specify brands and models has also inhibited moving to an environment in which compute and storage can be allocated dynamically to meet and scale to demand.

In Leveraging the Cloud to Meet Today’s Healthcare Challenges we discuss the fact that “IT resources of all kinds must be managed as a flexible platform, rather than configured only to operate in set ways. A platform enables an organization to operate more efficiently (by better matching service to need), to experiment and innovate more quickly (because resources can be reconfigured), and to connect and collaborate more easily (because connections are standard). In other words, it enables an organization to be more agile.” Providing IT as a Service, a flexible platform with resources that can be provisioned easily and on-demand, and where the load on resources can be adjusted to compensate for temporary needs, is where healthcare providers need to be. Gone are the days when a vendor would specify that you need “n” number of physical servers to run their application – with many of those servers not even running at capacity nor with the ability to balance the load to take advantage of under-utilized resources. Today’s environment requires that we provide a robust and secure end-user computing experience. It requires efficient use of available resources. It requires us to be smarter about creating a consistent and efficient environment that optimizes management and operations as well. All of that can be accomplished through IT as a Service; through the use of cloud computing.

If you go into my refrigerator at the holidays, you might find a tray of canapés on the shelf where the ice trays were. The ketchup? It’s behind the 18-pound turkey defrosting on the bottom shelf. You might find I’ve repurposed that butter compartment for the extra cream cheese. By moving that cheese, I was able to scale to the demands of peak refrigerator season without adding any additional capacity. Where in your data center will you move your cheese?

Credit: Putnam Adult, 1998

I was going to end this blog entry there, but then realized that my reference to “Who Moved My Cheese?” – Spencer Johnson’s popular book on dealing with change – might have been too subtle. It is easy to talk about the journey to the cloud, but it is another matter entirely to make it happen. And in healthcare, where change is often in conflict with culture, that journey may be more difficult. That’s why, if you’re in healthcare IT for a provider organization, you should take a look at the piece I mentioned earlier. There’s some good information in there about how to start working towards moving that cheese.

Sometime in the late 1980s, I had the old Super 8 movies taken when I was a kid transferred to videotape.

Wow – typing that line which includes both “Super 8” and “videotape” makes me feel old.

Then, a few years ago I converted that videotape to a digital file so I could create a DVD.

DVD? Really? Now that we’re in 2012 are people even using DVDs anymore? But then again, that’s kind of the point of this piece. When I was viewing that old footage of the home I grew up in (and where my mom still lives), I couldn’t help think about how old-fashioned and dated everything looked. Certainly, seeing my now octogenarian mother as a younger woman contributed to that feeling, as well as how people were dressed in the fashions of the day. But I also noticed the technology – the television with rabbit ear antennae, the phone with a dial instead of buttons, the radio in the kitchen with the big knob you turned to tune to your desired station, and the old hi-fi that played . . . wait for it . . . vinyl records.

For you young whippersnappers, a hi-fi was a device that produced high-fidelity sound (hence “hi-fi”) from analog sources such as the afore-mentioned vinyl records, and in some cases from broadcast radio as well. Big honkin’ speakers were connected to these devices with ten to eighteen-gauge copper wire. Oh, and there was no remote control for any of these devices. That was a contributing factor to lower obesity rates back then – you actually had to get up and walk over to a device to change a TV channel or what music you were listening to. This included going over to the phone to answer it – no wireless or cell phones back then.

So I started thinking about what will happen when my kids look back at videos shot when they were young. What about those images will look old-fashioned to them? Aside from our age and clothes, what will be different when they are adults and have their own children? And I realized that they would ask me one simple question – “What’s with all the wires?”

Today, my home is in migration. No more Cat-5 connecting computers or USB cables connecting printers, but I do still have a stereo with wired speakers. The main phone line is digital with primarily wireless phones, but my second line which I use for the fax machine and as a back-up is still a POTS line running on copper.

The data stream has clearly been eliminated as a source for cables and wires, and we’re entering an era in which we are seeing the start of cables disappearing as sources of power as well. It’s an interesting cycle – older homes often have fewer power outlets and certainly none for any other type of cabling except a few strategically-placed copper POTS junction boxes (both my mother’s home and that of my in-laws still have some hard-wired units; no RJ-11 jacks for them). Then, homes built within the last couple of decades added plenty of grounded power, some in-the-wall Cat-5 with RJ-45 jacks for data, and cabling with RCA jacks for your music system. Now, we’ll start to see a shift back to fewer and fewer outlets needed as cables and wires disappear.

So what does this have to do with mobile healthcare? Everything.

First of all, walking around many healthcare provider organizations today elicits a similar response when we think of what things looked like even just a few years ago, starting with the data center. Data center? What data center? It’s in the cloud.

Then, we go to the doctor’s exam room. Vital signs taken from a machine on a pole wirelessly transmit your data to the Electronic Health Record (EHR), and the provider team is tapping away on a tablet device. Document the healing of your wound? Digital camera with a Wi-Fi-enabled memory card, Smartphone, or the one built into your Mobile Clinical Appliance.

My mother was recently hospitalized (she’s fine now, thanks for asking) and even she – who does not have a cell phone or use ATMs – noticed all the wireless technology in use in her room. Bedside medication management occurred via a wireless handheld device, food service orders taken on a tablet, and the hospital knew where the nearest IV pump was and its decontamination status because of the Real-Time Location Services solution implemented. And what’s the name of that robot making its way down the hall delivering supplies?

Wires? Cables? We don’t need no stinkin’ cables!

And I’m not finished yet – stay tuned. Next up, health management tools and devices now available for use in your home. And the ones that I wish we could have.

As this is the first entry in my role blogging for mHIMSS, you should know a little bit about me. I have been in the health IT industry for more years than I care to admit. Let’s just say that in my career I have hooked up lab instruments by making RS-232 cables from scratch, developed CPOE interfaces before there was HL7 and integration engines, and I have actually used punch cards. I spent the first half of my career working for an academic medical center, and the second half in consulting, primarily because I loved what I did at the hospital and wanted to do it more places.

I also look at the world through a few different lenses, including viewing healthcare through the eyes of all stakeholders – including patients. I also look through a lens that resembles a fun house mirror so that we all get to chuckle occasionally.

So with that in mind, and in recognition of the explosive growth of mobile health applications, I decided to start from a place close to home – my new iPhone 4S. My kids have played with it incessantly in the few weeks that I’ve had it, primarily testing the limits of Siri. I have been impressed with some of Siri’s capabilities, especially as she leverages the WolframAlpha computational knowledge engine. Yes, I referred to Siri as “she”. Even though Apple claims androgyny, she sounds female, as opposed to the male-sounding voice being used in France. I also find myself addressing her by name and politely as in, “Siri, what is the weather at my current location please?” I do that because deep down, I have a fear that, like her cousin the HAL 9000, she will set me adrift in space if I’m not careful.

We already know from Apple’s commercials that Siri can tell us the fastest way to Hartford Hospital. With increasing focus on the patient’s role in accountable care, particularly around management of chronic conditions, I decided to see how Siri could help a healthcare consumer in that regard. I came up with the following questions using a very scientific method that involved staring off into space for a few minutes, and list them along with Siri’s responses as well as my commentary.

Q: Am I too fat?

A: I can’t answer that Matthew

I could not detect if she activated the front-facing camera and perhaps chose a more politically correct response.

Q: How do I stay healthy?

A: Would you like to search the web for “How do I stay healthy”?

Okay, I’ll give her this one. Kind of an ambiguous question.

Q: What foods should I avoid if I have diabetes?

A: Sorry, I don’t understand “What foods should I avoid if I have diabetes”

This one I thought should have at least called up a web search request or reference to WolframAlpha.

Q: What is a personal health record?

A: OK . . . how about a search for “What is a personal health record”?

Clearly, if Apple had hopped on the bandwagon with Microsoft HealthVault and Google Health, there would have been a different response. I might have also expected a prompt to search the iTunes App Store.

Q: I’m feeling depressed.

A: Matthew, I don’t understand “I’m feeling depressed”.

Now this question I would have liked to generate references to local mental health providers, national associations, or maybe even a suicide hotline.

Q: How do I know if I have asthma?

A: WolframAlpha result showing “asthma – reason for patient visit” and listing what appears to be percentages of patients by gender presenting with cough and with high blood pressure.

Finally, WolframAlpha was engaged, but with limited usefulness of the information provided. I guess if I have a cough and am hypertensive, I might have asthma. Given how few people monitor their BP themselves, however, I would expect that the healthcare provider who identified the hypertensive condition would also pick up on the asthma.

Q: What are the symptoms of congestive heart failure?

A: WolframAlpha result showing “congestive heart failure – symptoms reported at visit.” One symptom – shortness of breath – was presented with percentages by gender, but then followed by a simple laundry list of 59 other possible symptoms.

Now, the pendulum had swung back in the other direction to information overload. Shortness of breath would, hopefully, prompt one to seek medical attention. But the list of those other symptoms was so long and diverse as to be useless. And what is a typical healthcare consumer to make of the fact that the list included the opposing forces of both diarrhea and constipation?

I am sure that the iPhone 4S has a lot to offer healthcare consumers in terms of tools to support health and wellness. And since the Siri function is supposedly self-aware and will learn over time, perhaps her responses will be more helpful in the future. For now, however, there are better sources than Siri for professional medical advice.

Siri? Hey Siri – why are you opening the pod bay doors?

What the . . .?

Aside from those like my relative, I would say that there are two types of people today who do freely provide their credit card information over the Internet or through some other electronic means:

1. There are those who do so with little or no concern for the privacy and security of that data. They have either developed a sense of trust or the convenience factor outweighs privacy and security issues so they simply don’t care;
2. There are those who do so with some trepidation but are careful – they may monitor what domain name they are on, they make sure that any pages collecting and processing information use the https protocol, and they use strong passwords. They may even monitor their credit card statements to watch for unauthorized charges. They have struck a balance between convenience and being careful, primarily because they recognize the value of electronic exchange of information while still aware that there are potential pitfalls.

Simply as an aside, I would guess those in group #1 use the default privacy settings on Facebook while those in group #2 tweak those settings. To those in group #1 – I can see those pics of you drunk at the company holiday party. You looked great in that reindeer hat.

I bring all this up (the credit card issue – not the reindeer pics) because it is commonly accepted that many people consider the privacy and security of their health information at about the same level as the privacy and security of their financial information. Yet the healthcare industry is woefully behind other industries in applying appropriate measures. Don’t misunderstand me – the regulatory protections are in place. HIPAA and HITECH are to healthcare what the Financial Privacy and Safeguards Rules of the Gramm-Leach-Bliley Act are to financial services. I said that healthcare is behind in APPLYING those measures.

And why is that? One reason is that historically, any efforts around disaster recovery and business continuity were focused on maintaining critical applications in a hospital, so that’s where the funding went. Computerized Provider Order Entry and Electronic Health Record systems had to have 5-9s availability, but other systems less so. Even though those other systems contained Protected Health Information, they often lacked in adequate security simply because they were not deemed critical.

Another reason is that securing desktops was both onerous and impeded users’ perceived right to personalize and utilize devices as they saw fit. “What do you mean you’ve disabled the USB port? How am I supposed to use my <insert name of cool device that is unrelated to work here>?” In healthcare, there has been a culture of entitlement that includes computing resources.

Healthcare CIOs  now realize that leveraging cloud computing, including virtualizing desktops, provides them with flexible and agile platforms that are much easier not just to manage, but to protect. It also provides a manner in which to secure desktops while still providing a personalized experience to the end-user. “That USB port? Sure you can use it – we just set up your session so you can’t offload protected data.” Especially in an environment in which sharing of personal health information is now not only being encouraged but also rewarded, “trust” is what must be built into the entire environment from end-to-end in order to foster both the convenience and value of information exchange. ” In Leveraging the Cloud to Meet Today’s Healthcare Challenges, we state that “Cloud computing enables healthcare providers to build the platform and weave the fabric of trust.” It is that fabric of trust that must cover (sorry about the pun) not just a patient’s information, but their perception of how seriously an organization takes their responsibility to protect that data.

Just as most people inevitably trust that their financial information is being protected, so must they feel about their health information in order to achieve the value of coordinated and collaborative care that is the cornerstone of patient-centered and accountable care.

Still worried about your personal information? I’d be more worried about handing over my credit card for the co-pay at my next doctor’s appointment.

In March 2011, I began a new phase in my life of healthy eating and increased activity. Sounds a lot like diet and exercise, doesn’t it? It’s all semantics. Diet and exercise are dirty words and often represent something with a temporal scope. Healthy eating and increased activity are lifestyle choices.

By August, the results of my efforts were quite clear in terms of weight loss, muscle tone and general well-being. My daughter looked at me one day and said, “Dad, you’re looking really good. I’m really proud of you. You’re my role model.” I was floored and speechless. “You’re my role model.” What better words could a daughter say to her father (Okay, aside from “Dad, HIS family wants to pay for the wedding.”)? All of my efforts, all of my sweat, all of the desserts passed up were suddenly worth it. To heck with my own self-satisfaction – my daughter was proud of me. I was her role model!

As I walked around elated, I was reminded of a conversation I had also recently had with George Brenckle, the Senior Vice President and Chief Information Officer at UMass Memorial Healthcare in Worcester, MA in which we were discussing patient engagement related to chronic condition management. He said that in addition to more common strategies of fostering compliance through reminders, UMass was also piloting a positive reinforcement approach in which “Good for you!” type messages were sent to patients for achieving specific goals or maintaining their health. He said that this was particularly well-received by teenage patients.

It seems so simple, doesn’t it? Positive reinforcement for a job well done. Even if that “job” is something you should be doing anyway, doesn’t it make you feel better to get that acknowledgement, that pat on the back? Any Human Resource professional will tell you that positive reinforcement is a great employee morale and retention tool. Why? Because people want to feel valued, that what they are doing matters. They want to know that their efforts are recognized.

My perception is that most physicians don’t necessarily give the positive reinforcement that many of us would like or deserve. I am lucky that my new primary care provider is not one of those. She has been seeing the same results that my daughter has – augmented by improved biometric screenings – and told me that I was an inspiration to her. That meant a lot to me and I was quite pleased with the positive feedback, but it still meant little compared to the recognition I received from my daughter.

So why does this matter? Should physicians be nicer? Should healthcare providers consider implementing processes in which positive reinforcement is used as a patient engagement strategy, as a motivator? Yes, but not for the altruistic reasons one might thing (i.e. it’s the right thing to do). Healthcare providers should be doing this because it makes good business sense.

Quite simply, as models of accountable care are deployed in which providers will now be reimbursed for quality versus quantity, patient compliance and the resultant improved outcomes will mean more money in their pockets. There will now be a “ka-ching” motivator for positive reinforcement. You’re keeping your patients healthier? We’re going to reward you for that.

But in order for patients to feel more engaged and motivated, healthcare providers need to develop new strategies and think of their patients in new ways. This means providing them with information and equipping them with tools so that they can effect change in their lives; so that they can take a role in living healthier and more active lives; so that they can achieve better outcomes and be rewarded with better health while their providers are rewarded with better reimbursement. It’s a win-win. Kind of a no-brainer, don’t you think?

So why is this such a new concept? Maybe it’s because in the past, there was no reward associated with providing positive reinforcement. Maybe there was no perceived need. I doubt there were many patients out there that said to their physicians, “Hey – you better give me some more kudos when I do something right or I’m going to find me a new doctor.” But the rules are changing. Engaged patients are healthier patients, and healthier patients are more profitable patients.

We have always referred to my daughter as an “old soul” – she has the wisdom and insight of someone much older. We always thought that while her older brother will probably end up in the performing arts, she could conceivably be a CEO. With her instincts around positive reinforcement for a healthy lifestyle, we may be right.

Now wipe that smirk off your face. I know you’re thinking that what I have just stated exists only in a world where unicorns live and clouds are made of candy. But that’s not the point – what I described is the way that a GC is supposed to work and regardless of the horror stories everyone has heard or lived through, many GCs exist that do what they are supposed to do and have happy customers. Back to our story.

In healthcare, the only party that has ever served in a GC role has been the payer. Yes, your primary care physician may have referred you to specialists, and may have even visited you during a hospitalization. But when it comes to knowing every type of treatment that you have had regardless of venue, knowing every prescription that has been written and filled, every service provided and paid for – only your payer has had that information. And with that information, they have exercised control over your care within the terms of your health insurance contract. Need medication for a condition? Your payer will tell you which ones you can have. Need physical therapy after an injury? Your payer will tell you how many visits you can have. Think you need an MRI? The payer may decide that an x-ray will do just fine.

Payers have had the power to do all this, to be the gatekeeper and the coordinator of care, because they have had the information. They know everything about what kind of care has been prescribed for and provided to you. They know what conditions and co-morbidities you have. And they have the data, the tools and the actuaries to determine what works best most of the time and for the least cost. They have been the single point of contact – and often the last word as well – for the coordination of your care. They have been your GC for healthcare.

But all of that is changing. Today, most healthcare is paid for on a “fee-for-service” basis. Providers are paid for the quantity of care they provide, oftentimes independent and regardless of the outcome. The advent of accountable care, however, is changing that model. Instead of being paid for quantity, providers will be paid for quality. And that care and its resultant quality will be coordinated. What does that mean? In certain scenarios, rather than each individual provider being paid for their role in a particular diagnosis, one bundled payment will be made for all of the care involved. Let’s take a not infrequent occurrence – an elderly parent breaks their hip. There will be a hospital stay, surgery, post-operative care in a rehabilitation or other sub-acute care environment, medical supplies and home care. Today, the hospital, the surgeon, the nursing home, the surgical supply house and the home health agency would all be paid separately and the payer would be responsible for making sure that everything that took place was appropriate and that everyone got paid for their role.

Under some models of accountable care, the payer will now make one single bundled payment for the entire episode from injury to completion of rehabilitation. And guess what? If the outcomes are better than average (i.e. patient does well and has no post-operative issues), the payer will pay even more as a reward for a good outcome. It will then be up to the care providers – acting in concert and in a coordinated manner – to determine how that payment gets split up.

In this new model, in which coordination is required to ensure that quality is maintained through the care chain, the primary care physician often serves as the quarterback. Your physician becomes your GC rather than the payer. They are responsible for keeping you healthy, for involving you in your own care, for ensuring that whatever care you receive is coordinated and collaborative in nature. And the better job they do, the more they can get paid.

What a novel idea, you say! Why haven’t we done this before? It all makes sense  – one person who knows me very well and who will make sure that I stay healthy and am well-cared for when I fall ill or are injured. One person who will manage a single payment by making sure that everyone works together in the most efficient manner to achieve a positive and desired outcome. There’s even a bonus for a job well-done. They will become my General Contractor for my health.

Why haven’t we done this before? I’ve already given you the answer. The reason that payers were successful over the years, with the commercial ones generating millions in profits for their shareholders, was that they have had the data and the tools to convert that data into actionable information and knwoledge. Most healthcare providers don’t have access to all of the data they need, nor the tools to share and analyze that data. The data is there. Sometimes it’s in a paper chart. Sometimes it’s in an electronic health record (EHR). Sometimes it’s in multiple EHRs and the hospital’s systems. Some of it is in billing systems. The need for data ranges from the simple; a specialist re-orders a lab test already performed by the primary care provider because they didn’t have access to the first set of results: To the complex; understanding what preventable risk factors are involved in a readmission for congestive heart failure among male patients over 55 years of age so that such factors can be proactively mitigated and those patients kept healthier and out of the hospital.

While most hospitals and healthcare providers are looking for ways to cut budgets and save money in anticipation of various health reform measures, those that will be successful under accountable care are those who understand the power and value of information, who will have the ability to share that information, who will be able to gain access to that information, and will have the power to make that information work for them through the use of analytics. Looking at the upcoming rules related to healthcare payment reform, there is an analytics mandate. Healthcare organizations that do not have an analytics solution in place by 2014 will not be able to compete or survive in the new world order. They need data, information and knowledge to do that.

And the key to delivering that high-quality and low-cost care will be that front line coordinator, the patient’s primary point of contact. The person who will manage their care over the course of their lifetime. The key will be their primary care provider; their general contractor who will make sure that the appropriate resources are used when necessary, in a cost-effective and efficient manner, and who will be incented to do their best to ensure a high quality outcome. Now let’s just hope that when they squat down, it does not give rise to the new term “physician’s crack.”

I put down my sandwich. This is no small thing as I love sandwiches and had been quite hungry and looking forward to this one. I put it down because I was suddenly consumed with trying to figure out what I would want to talk to Boar’s Head about. What would I say to them? “Hey, I like your honey-baked ham, but the smoked turkey is a little too salty for my taste.” What would I want to hear about from them? They don’t sell direct retail so there would be no news of sales or discounts. New products maybe? I can’t say that there have been a lot of new goods recently in the world of smoked and prepared meats.

People use social media to communicate with or about a brand, product or service for one of three reasons. First, because perhaps they really like something and want to share their taste in <insert name of product or service here> with their friends. Second, because there is a “cool” factor involved and people want to be associated with that quality by “liking” particular pages. Third, because the product or service offers something of value using social media such as discounts. As you can see from my picture, my shampoo tab is zero, so I “like” the Facebook page for HeadBlade, a company that sells products designed exclusively for those who shave their heads. I like that page for all three reasons. I use their products and value their quality; They have cultivated a very trendy and hip image and given that there is very little else about me that is trendy or hip, this is a weak attempt to appear so; and they occasionally offer discount codes for ordering their products by mail.

I can’t say the same about Boar’s Head. I have no particular brand allegiance for cold cuts, I can’t for the life of me think of anything cool, hip or trendy about deli meat, nor would there be any discounts or sales. But it did remind me that about two years ago, I noticed the first attempts at the use of social media by healthcare providers – especially hospitals and health systems.

At the time, I didn’t fully understand the power of social media and thought that it was an attempt by such hospitals to appear that they were keeping up with the times both medically as well as socially. But it didn’t take me long to figure out the marketing potential. And now, in the era of accountable care where patient engagement will be a key foundation for success, it serves that purposes as well – engaging patients across multiple platforms and venues. For patients, there is an additional value – the ability for social media to make connections for us and suggest resources we might not otherwise have thought about.

From a marketing perspective, those with a social media presence make use of the characteristics of services like Facebook that many of also rail against – access to our personal data. In many cases, “liking” a page provides that page’s owner with information about you. It may be demographic information, it may be access to your friends and their information, or it may be access to the other pages that you like. That information can be valuable to a health system that is trying to better understand its market and social media feeds are now being incorporated into the analytics programs that hospitals and health systems are building to manage their operations and succeed in accountable care. It also provides another avenue for marketing. Updates about health and wellness programs and new technologies, services or special events can be pushed to their “fans.”

By engaging patients in this manner, it also increases the likelihood – especially in a competitive market – of keeping those patients rather than losing them to the competition. Since many accountable care models now being implemented still provide for patient choice of provider, keeping patients will be a success factor. It will also enable care collaboration and, therefore, better outcomes from such coordination. Under accountable care, better outcomes means better reimbursement. Keep your patients, keep them engaged, keep them healthier, make more money.

So why would a patient want to connect with a hospital or health system via social media? It could be any of the three reasons I wrote about earlier. Maybe they have had great experiences with a particular hospital and want people to know. Maybe the hospital is doing something very cool and they want to be associated with it. And maybe they are health conscious and like the information being provided to them via Twitter or Facebook.

There is additional inherent value for the patient as well. Remember that social media platforms are also very good at inferring things, whether it is suggesting people who you might like to be friends with or pages that you might like. For example, let’s say that you have liked a hospital’s page as well as the page for a particular weight loss program. The social media platform may suggest a local gym or health food store that would be of interest. Now that same information is collected by the hospital and recognizing that there are a certain number of their “fans” that have liked similar pages, they may choose to highlight existing or create new offerings that cater to those who wish to lose weight.

You can see how such connections can be made and potentially benefit both patients and their families. Did you become a fan of the hospital and an Alzheimer’s organization because a parent has been diagnosed? Maybe a local support group will be suggested. And with this information, perhaps it will be the local hospital creating that support group in response to the needs indicated through their analysis of social media data.

After chewing on this for a while, I turned my attention back to chewing on my roast beef sandwich. I still don’t know what kind of a conversation I would want to have with Boar’s Head.  I suppose I could ask them what is actually in Olive Loaf, but I’m not sure I want to know the answer.