• a name and picture
• demographics (age, education, ethnicity, family status)
• job title and major responsibilities
• goals and tasks in relation to your site
• environment (physical, social, technological)
• a quote that sums up what matters most to the persona with relevance for your site

Defining diabetic personas is information driven

Research and information drive the segmentation of populations into discrete user groups whose characteristics will affect the design of our solution. I am particularly interested in designing software for self-management and health engagement of diabetes.

Choose which characteristics to segment population with.

Choose characteristics that will affect the design of your solution. Research and information will help determine these characteristics. I did some general reading / discovery and found research that evidenced certain characteristics affecting diabetic rates.

• Age
• Obesity
• Educational Level
• Socioeconomic status (income level)

I then found research from Forrester Research that segments the population at large according to their adoption & acceptance of technology – important for my focus (self-engagement). Forrester calls this Technographic Segmentation, meaning they segment populations based on their attitude towards and adoption of technology. They define 10 specific groups of individuals.

The table below characterizes all potential users of technology into 10 groups based on their attitudes, income characteristics and family status.

From IP Business (refers to the 2007 North American Technolographics Benchmarks Survey):

Segment the population using research:

First I find research that divides the diabetic population into discrete groups / segments. This CDC Document segments the population by age:

Choose a specific group and further refine the segmentation

I am specifically interested in the 40-59 year age group representing 10.8% of the population.

According to the National Bureau of Economic Research, diabetic rates vary according to socioeconomic and educational levels. I’ve summarized their general findings in the two trending charts below, essentially lower income and less education equates to higher diabetic rates.

Education level affects diabetes

Comparing prevalence by education group, the author finds that high school dropouts are roughly sixty percent more likely to have diagnosed diabetes and twice as likely to have actual diabetes as men who have attended college. The improvement in diabetes detection over the past twenty-five years has been larger for college-educated men (from 50 percent of cases undiagnosed to 16 percent) than for high school dropouts (from 49 percent to 31 percent).

Socioeconomics / Income affect diabetes

Further research from BMC Health Services Research concludes: 

Low income is associated with a higher prevalence of diabetes and a higher population rate of referral.

The Rand institute reported similar findings [ LINK ]

Obesity increases with lower income / socioeconomic status

Perhaps this isn’t surprising as there are numerous studies that find inverse relationships between income and obesity:

WorldFoodPrize.org : 52% of food insecure (lower income) people become overweight.

This paper by Dr Marguerite Bryan (Xavier University) states: The disease of obesity disproportionately impacts subpopulations of African-Americans/Hispanics, people of lower socioeconomic status and women.

DocShop.com puts it succinctly: Statistics show that low-income individuals are significantly more likely to be overweight or obese than those who are financially well-to-do.

CDC also states: Body weight is the result of genes, metabolism, behavior, environment, culture, and socioeconomic status. 

Type II Diabetes rates increase with obesity rates.

Science daily: Obesity is probably the most important factor in the development of insulin resistance

Obesity.org: Carrying extra body weight and body fat go hand and hand with the development of type 2 diabetes

Thus I’m making the inference:

Build Personas from your segmented population:

Forresters Technographic segmentation of the population resonates with me. So I’m going to try and map the diabetic population into Forrester Research’s 10 technographic segments. Further more, I’ll do a bit of hand waving and try to quantify how much of the population is in each segment.

1) I’m focusing on the 40 – 59 year old diabetic population.

2) I’m going to cut that population into Forrester’s High and Low Income earners, of which the low income earners with have a higher diabetic population and higher obesity population (given research above)

3) I’ll then use Forrester’s values to create personas.

Referring back to Forrester’s Technographic table (I’ll provide 2 here, from 2 sources):

Ref: IP Business

1. Techno Optimist : High Income Career
2. Techno Optimist : High Income Family
3. Techno Optimist : High Income Entertainment
4. Techno Optimist : Low Income Career
5. Techno Optimist : Low Income Family
6. Techno Optimist : Low Income Entertainment
7. Techno Pessimist: High Income Career
8. Techno Pessimist: High Income Family
9. Techno Pessimist: High Income Entertainment
10. Techno Pessimist: Low Income Sidelined Citizens

Now I’m going to focus in on a select few of these. I’m going to toss 7 & 8 and address them using a persona geared for the 10th segment. Why? B/c 7 & 8 are difficult to address with technology (as is 10) and they are less likely to have diabetes, so by having a 10 persona I can provide tools that 7&8 can use without putting much effort into them. That leaves us with:

1. Techno Optimist : High Income Career
2. Techno Optimist : High Income Family
3. Techno Optimist : High Income Entertainment
4. Techno Optimist : Low Income Career
5. Techno Optimist : Low Income Family
6. Techno Optimist : Low Income Entertainment
7. Techno Pessimist: High Income Entertainment
8. Techno Pessimist: Low Income Sidelined Citizens

Personas:

In our country, patients are the most under-utilized resource, and they have the most at stake. They want to be involved and they can be involved. Their participation will lead to better medical outcomes at lower costs with dramatically higher patient/customer satisfaction.

Charles Safran, M.D., Former President, American Medical Informatics Association, speaking to Congress in 2004

Behavioral change theories:

Behavioral psychology provides a number of models for understanding how to affect behavioral change.

Wikipedia outlines various theories and models on human behavior [ LINK HERE ]

Self-Efficacy

“Can I do it?” – the individual answer can predict how much effort they will put towards changing their behavior. If they don’t believe they can do it, they won’t try.

Learning Theories/Behaviour Analytic Theories of Change

Baby stepping to bigger changes. Behavior is a gradual process that starts with observation, imitation, and through a system of rewards leads to bigger changes.

Social Learning/Social Cognitive Theory

3 things govern change, and by reinforcing change through alignment:

1. Personal elements:  Do you believe it can be done? Do I recognize the problem?
2. Behavioral elements: Does my behavior align with the change? Must I change it?
3. Environmental elements: Does my environment enforce or detract from the change?

Theory of Reasoned Action

A person reasons whether their behavior is positive or negative subject to their own belief system and societal belief systems. Personal attitude and social pressure can change behavior.

Theory of Planned Behavior

Behavioral change is predicted and affected by:

1. How much control a person has over behavior.
2. How much a person wants to change.

Transtheoretical/Stages of Change Model

Behavioral change is a 5 step process:

1. Precontemplation: Become aware there is a problem, but do not intend to change.
2. Contemplation: Must desire to change in near term (6 months).
3. Preparation: Plan to change (usually in the next month).
4. Action: Have made changes to their behavior.
5. Maintenance: Trying to prevent relapse.
6. Termination: 100% self-sufficient – no temptation for relapse.

Behavioral health focused on Health:

Patients can affect their health through behavior. This widely held belief has led governments around the world to focus on behavioral change. Here are various models:

Health Belief/Health Action Model

According to [http://www.jbpub.com/samples/0763743836/Chapter%204.pdf]

Health behavior is determined by personal beliefs or perceptions about a disease and strategies available to decrease the occurrence.

Perception of the disease:

1. Perceived Seriousness: How serious is it? How will it affect me?
2. Perceived Susceptibility: How likely are these outcomes? How much am I at risk?
   • Notes: Seriousness + Risk = behavior change. (usually)
   • But: If risk is perceived to be low, unhealthy / risky behavior can result.
   • But: College students do not change behavior even when risk is high.
3. Perceived Benefit: How will I benefit from changed behavior?
4. Perceived Barriers:
   • The most significant factor determining change.
   • Barriers: difficulty starting new behavior, fear of not being able to achieve the outcome,
5. Self Efficacy: The perception that one can change.

• Various other modifying variables change perception: Skill, education, past experience…
• Cues to Action summon change: events, people, or other trigger events

Resources: [Chapter http://www.jbpub.com/samples/0763743836/Chapter%204.pdf]

There are a number of articles that indicate that behavior can be affected for better outcomes. I won’t go into them here, but there is a greater question. Why is so little being done to manage chronic diseases?

Why isn’t more done?

Misaligned incentives:

Organizations with pay for service revenue models are disincentisized  to better the health of chronic disease patients.

Consider, 75% of healthcare spend is on chronic diseases. Why would an industry reduce the revenue generation of their most profitable segment?

Managing chronic diseases is hard enough, but when pay per service revenue models stand in the way of better health outcomes, the solution is untenable.

Tyranny of the Urgent

Our system provides acute, episodic care. Preventative care takes a back seat. A favorite analogy puts:

A farmer was seen running around herding his cattle. He drove them back to his farm, but given he didn’t have a fence, the cattle just roamed freely. The poor farmer constantly had to herd them back to his farm.

Then a man came up and asked the farmer, “why don’t you build a fence for your cows?”

The farmer said: “Ain’t got time. I’m too busy herding them.”

If we only deal with acute problems, we’ll never get around to prevention.

Consistent change requires 3 linked things:

1. Community Resources: Gyms, community centers, etc..
2. Healthcare System with aligned payment structures
3. Provider organizations to provide the care

We need better payment models:

1. Align payment with health outcomes.
2. Move away from pay for service revenue models.

Physicians need help:

1. Decision Support.
2. Efficient workflow.
3. Information : reliable, easily accessible, more consistent, more timely.

Patients must be engaged. They must:

1. Recognize there is a problem.
2. Motivated to change.
3. Believe they can change.
4. Be given ways to change.
5. Prompted to act.
6. Supported by society (friends, family, providers) to maintain their efforts.

The work is hard. The Challenge great, but the prize is worth the fight. We can succeed.

The US healthcare system is diverse and poorly integrated, why? Because there is little incentive for Physicians, hospitals & insurance companies to integrate. Furthermore, our “free market system” does create market forces that push these various entities to integrate.

Though many experts realize the crisis facing our healthcare system, patients are grossly unaware.

http://www.gallup.com/poll/123149/cost-is-foremost-healthcare-issue-for-americans.aspx

Overall, 80% are satisfied with the quality of medical care available to them, including 39% who are very satisfied. Sixty-one percent are satisfied with the cost of their medical care, including 20% who are very satisfied.

http://www.realclearpolitics.com/articles/2009/08/13/the_health_care_reform_paradox__97866.html

Most Americans continue to support major reform. But multiple polls show they are also overwhelmingly satisfied with the quality of their personal medical care, as well as their insurance coverage.

US Healthcare: the cost without the value

We spend more than any other country in the world on a per capita basis.  The total Healthcare spend in the US is $2.4 trillion or $2,400,000,000,000. The graphic (Cost of a Long Life) shows the relative spend rates versus life expectancy across countries.

Though the US shows a huge cost spike, we rank low on the life expectancy list. To put it another way, spend does not correlate with an longevity outcome.

http://ucatlas.ucsc.edu/spend.php (the purple line represents spending)

Chronic Diseases (75% of costs: $1.8T of $2.8T)

Pragmatism begs focus on the largest part of the problem: of the $2.4 trillion, $1.8 trillion or 75% of the total healthcare spend is used on chronic diseases. These “frequent flier” patients suffer more, cost more and have worst outcomes than they need to. Much cost could be reduced by addressing this population.

Chronic diseases (at a glance: http://www.cdc.gov/nccdphp/publications/AAG/pdf/chronic.pdf)

CDC: http://www.cdc.gov/nccdphp/publications/AAG/chronic.htm

• Chronic diseases cause 7 in 10 deaths each year in the United States.
• About 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness.
• More than 75% of health care costs are due to chronic conditions.
• Approximately one-fourth of persons living with a chronic illness experience significant limitations in daily activities.
• The percentage of U.S. children and adolescents with a chronic health condition has increased from 1.8% in the 1960s to more than 7% in 2004.

 

http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=134063

Can the outcome be better? (more value for lesser cost?)

The answer seems to be a resounding YES. According to the CDC, these chronic diseases are preventable.

http://www.cdc.gov/nccdphp/publications/AAG/chronic.htm

Four common, health-damaging, but modifiable behaviors—tobacco use, insufficient physical activity, poor eating habits, and excessive alcohol use—are responsible for much of the illness, disability, and premature death related to chronic diseases.

This report by lewin.com provides a framework: http://www.lewin.com/content/publications/LewinReport-CostDrivers.pdf

Episodic care + Chronic diseases = poor outcomes

Our healthcare system focuses on episodic care via poorly coordinated care givers and institutions which results in fragmented, sub-optimal care for chronic patients.

An article published by California Healthcare Foundation highlights specific issues: http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=134063

• 33% of chronically ill patients leave a doctors office confused as to how to continue their care
• 57% said their doctors did not ask how they could manage their health at home
• Patients receive preventative care only 56% of the time (as of 2003)

In essence, the research indicates that US Healthcare takes a patchwork, episodic approach to managing chronic disease as opposed to a continual and integrated approach that seeks wellness as the outcome.

How to address chronic diseases better?

If wellness is our outcome and prevention possible, then episodic care should not be only strategy used to address chronic disease.

Improving Chronic Disease Care Organization: http://improvingchroniccare.org/

Their Model focuses on a more integrated model that extends beyond hospital / doctor visits and episodic care to a more encompassing model. The primary players being a well informed patient and integrated healthcare systems – very different from the current state of Healthcare.

What needs to be overcome / done?

http://improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2

• Rushed practitioners not following established practice guidelines
• Lack of care coordination
• Lack of active follow-up to ensure the best outcomes
• Patients inadequately trained to manage their illnesses

Overcoming these deficiencies will require nothing less than a transformation of health care, from a system that is essentially reactive - responding mainly when a person is sick - to one that is proactive and focused on keeping a person as healthy as possible

Elements of the solution:

• Patient Safety (in Health System);
• Cultural competency (in Delivery System Design);
• Care coordination (in Health System and Clinical Information Systems)
• Community policies (in Community Resources and Policies); and
• Case management (in Delivery System Design).

A large body of papers & studies have findings presented on the site. [ here ] I found this one interesting:

http://www.rand.org/health/projects/icice/ccm.html

Chronic Care Model (CCM) Implementation Emphases,
Marjorie L. Pearson, Shinyi Wu, Stephen Shortell, Jill Marsteller, Peter Mendel, Michael Lin, Emmett Keeler (not yet published)

Conclusions: Of 23 change emphases, only 4 distinguished the best CCM implementers (i.e., the organization whose change activities were most likely to have impact, according to CCM principles). These key emphases included organizing and engaging practice teams, collaborative decision making with patients, encouraging provider participation in QI efforts, and de-emphasis on traditional patient education. …

To successfully implement CCM, organizations should be encouraged to emphasize practice teams, patient collaboration, and provider participation in their QI strategies and to not over emphasize traditional patient education.

Using patient participation to help manage chronic diseases.

http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=134063

Participatory Health: Online and Mobile Tools Help Chronically Ill Manage Their Care

Jane Sarasohn-Kahn, THINK-Health

Patients recorded various biometrics through out the day, such as blood pressure. An ideal system put forth in the article would contain:

1. Support for self-defined health regiments (activities).
2. Monitor patient “status”
3. Continual modification of health regiments (patients + health coaches + providers)
4. Interpret recorded data as it relates to individual treatment goals
5. Continual learning about patient health by both patient & provider
6. Continual, timely communication to patient and actionable recommendations.

Consider what sources / information patients value & trust:

What is of particular interest is the trend of traditional care givers taking on ever more important roles, i.e. making doctors more accessible is highest value.

[Contradiction]

Regardless, e-Patients (patients that look for healthcare information online) is an increasing trend.

e-Patients : A new trend to participatory healthcare

http://e-patients.net/archives/2009/10/participation-matters.html

Internet penetration:

• 79% of adult Americans have access to the internet.
• 63% of adults have broadband internet connections at home.
• 56% of adults access the internet wirelessly on some device, such as a laptop, cell phone, MP3 player, or game console.

Adoption:

• 60% of e-patients (internet users who go online for health information) have engaged in some sort of social media related to health and health care.
• 42% of all adults say they or someone they know has been helped by following medical advice or health information found on the internet.

However, while mobile adoption is creating greater access and participation among African American adults, for example, there are other groups who remain disproportionately offline, such as people living with chronic disease or disability. They may be missing out on opportunities, but just as importantly, we are missing their voices in the conversation.

The Pew Internet/Health FAQ

by Susannah Fox on November 20, 2009

This talks about the trend.   http://e-patients.net/archives/2009/11/the-pew-internethealth-faq.html

Most people’s first stop for health information is a general search site. Google dominates the search market. A British Medical Journal article found that Google is a pretty good diagnostician. Very fewpeople report bad outcomes from their online health research.

How to get patients to participate?

Health Gaming

Health games are an entertaining idea. http://www.healthgamesresearch.org/  [Twitter: http://exergaming.pbworks.com]

The idea is to use entertainment to teach. By making players keep their avatars (game actors) healthy, they learn how to keep themselves healthy.

Even social health gaming sites have begun to pop-up: http://gaming4health.com

Medication management:

Getting patients to take and complete their prescribed medications is important, difficult to enforce and a large issue in modern healthcare. According to California Healthcare Foundation:

• 60% of all patients do not comply with their prescription regiments.
  • Reasons: (per InRange )
    • Forgetfulness. Many people forget to take their medications or forget that they have already taken their medications and take them again.
    • The medication regimen is very complex. Many people take multiple medications and the instructions for taking them can be confusing. When and how one takes their medications is critical to proper treatment.
    • Medication changes. Prescriptions are discontinued, doses are changed and new prescriptions are added. It is not uncommon for a physician to stop one medication and prescribe an alternative. However, the patient may not remember to stop taking the original medication.
• 50% of patient’s do not adhere to maintenance medication regimens within 12 months.

There are solutions addressing this such as:

In)Range’s EMMA product:

Benefits of Emma: http://www.inrangesystems.com/index.php?page=benefits-of-emma

eMedMobile uses mobile phone reminders.

I couldn’t find any reviews or online posts of people using this application.

HealthHonors: point system to incentivize regimen adherence

Currently unavailable as they are building their mobile platform.

The Carrot.com helps track compliance and health activiites:

They provide a more comprehensive list of trackers that are listed here: http://thecarrot.com/index.php?m=trac&a=tracIndex&modMode=list

Partial list:

Various other Health applications:

(Crohn’s disease)

(Diabetes)

(Wellness)

(Weight loss)

How to get better outcomes

At the beginning of this blog, the point of alignment of incentives was put forth. The system has to work together and move away from incentivized episodic care. How do we get there?

California Healthcare Foundation puts forth a road map in their article.

1. Align incentives
2. Engage Clinicians
3. Clarify Regulations
4. Inspire health engagement through incentives and personalization

Align Incentives:

As this blog shows, there are an ever growing number of applications that address various healthcare issues, but payers (insurance companies) often do not cover these pro-active solutions.

Engage Clinicians:

Doctors are paid for episodic care – when patients come in and are sick. They do not get paid for health patients. Doctor engagement must be incentivized.

Clarifying Regulations:

With Healthcare reform pushing through the Senate with a 2,000+ page bill, clarifications looks murky at best, but we’ll hold out hope until a bill is passed.

Inspiring Health Engagement:

To change requires inspiration and tools that enable engagement. There are a variety of ways people are inspired to change, incentives could play a role. One idea is P4P4P, Pay-For-Performance For Patients, even paying patients a small amount can have positive outcomes.

http://www.healthpopuli.com/2009/06/p4p4p-paying-patients-to-be-healthy-and.html

• 9.4% of smokers who were offered $750 in incentives to quit smoking were able to remain smoke free for 18 months, compared with just 3.6% of smokers who tried to quit without financial incentive
• Dieters who could earn money by loosing weight lost more pounds more quickly than those who weren't offered a monetary reward
• Patients who regularly forget to take their medication and have the chance to win an average of $3 per day in a daily lottery pushes many of them to remember to take their daily doses.

Conclusion

No doubt, patient participation, more integrated providers and engaged clinicians would help reduce costs and drive better outcomes… But as the 4 part road map shows, the way is paved with hardships. Payers will need to change their payment structure & formularies, clinicians must change their behavior, regulations must be clear & aligned and patients inspired to get involved.

We have much work to do…

1. Drug test for a new employer at Quest Diagnostics
2. Internal Medicine Appointment (Nashville, TN)

I’ve begun to realize just how far we HITmen have to go.

Question Diagnostics:

Though much work has been done by Quest to modernize their offering – integrating with Google Health & Microsoft HealthVault as well as Keas.com, little of that work is “sold” at the point of care offices. All of the technical effort is shoved aside, relegated to office corners, standing up as cardboard kiosks offering colorful brochures.

Like autumnal leaves scattered about the office, the brochures add color to an otherwise drab office but garner little attention beyond a few glances.

I came with a paper receipt, pre-filled out, in carbon-copy triplicate. The Quest tech dutifully tore the sheets apart, filed them in overfilled drawers and shuffled me to the back. I did my duty and was escorted out of the office without any mention of Quest’s technical offerings. Frankly I’m not sure she even had a computer, but I am sure she didn’t know anything about Quest’s many high-tech offerings.

As a technologist, I’m saddened to see so much effort ignored – so much value lost.

Internal Medicine Appointment : Baptist Hospital

I had a 3:00 PM appointment, I arrived at 3:05 PM was called to the back at 3:25 and finally met a doctor at 3:45 PM. Sadly typical, but what amazed me was the state of modern medicine. This is Baptist Hospital in Nashville, TN. The doctor’s office was on the top floor of a well designed, aesthetically pleasant 9 story building that towered over the Emergency Room where my father worked for 25 years as a E.R. Physician. But after my appointment, I wondered if much had changed since my father saw his first patient all those years ago.

The waiting room had modern touches: dark, wood flooring, subtle, ambient lighting, appropriately upholstered and fairly plush seating, but true to my past experience with doctors I received the age old wooden clipboard filled with a small stack of papers asking the same tired questions I had answered over the past thirty years. Age, Sex, Name, Medications, Medical History…

I asked the nurse if they had PHR, EHR or EMR – then I saw the phosphorous green screened machine she punched my credit card into, I was amazed to hear the dot matrix printer produce a double ply receipt -- I received the carbon copy. I shook my head – definitely no EHR or PHR. I explained the difference between the three, the nurse said they had some new software called NextGen (http://www.nextgen.com/), but she couldn’t tell me anything beyond that.

She drew her hand over her head, meaning she didn’t get any of the technical points I was trying to make. So I sat down with everyone else and filled out the forms with a blue, ballpoint pen.

The Technician

Once I got past the waiting room, I was led around by a unenthusiastic technician. I asked how her day was, “okay I guess.” I noticed the Fuji Lifebook she carried, and as she entered my weight (195 lbs – about ten pounds too heavy) I asked her how she liked the software she was using.

She turned the book around and showed it to me. A Windows based application with straight forward forms – 2 ways to enter data: 1) Stylus or 2) Keyboard. Though she used the software without a hitch, she hated it.

“It’s slow. Too complicated. Pens and paper are faster.”

I didn’t try to change her mind; she must have been having a bad day. I kept looking at the software. Hard to say what software package they were using, but I’d imagine it was Enterprise Practice Management:

NextGen EPM can centralize appointment scheduling, billing, collections, and other business processes for group practices, while preference settings allow different locations, and in some cases staff, to operate according to their own workflow.

Workflow flexibility is the key to productivity. Yet, management can control business processes across practices because data is collected and centrally stored in a standardized, discrete format.

This gives practices real-time access to patient records from any location, to reduce redundancy and errors – and to provide patients with better service. At the same time, managers have instant access to reports, for financial and operational analysis, that are built into the system.

NextGen EPM features other practice-configured automation tools for increased productivity and management control, such as WorkLog Manager and Autoflow, a computer-guided check-in/check-out process.

NextGen is more than vendor – we are your partners in the development and growth of your group practice. When you collaborate with NextGen, you benefit from our:

• Customized workflow that is uninterrupted, as standardized, discrete data is collected for pay-for-performance, business analysis, audits, outcomes analysis, and more.
• Single-vendor solution for integrating your administrative and clinical processes on one system for streamlined, consistent patient care.
• Stability as the most financially secure, publicly traded (NASDAQ:QSII), company in our market space, with over a thousand employees and growing.

Waiting for the Doctor

I waited in a patient room for twenty minutes. Frankly I could have used a bit longer to take in the sheer antiquity of the place. The walls were brown with a dark brown trim and dark oak doors. A mercury filled blood pressure cuff hung from the wall like a historical relic, but the technician used it ( 120 / 80 – good I was told ). A white melamine storage cube stood over an old, worn gray bed with crisp white paper covering the creased and cracking plastic cover.

The whole room felt old and out of place. The clean white linoleum floor looked sterile, the room out of some forgotten time. There were no modern amenities. Everything in that room could have come from the 80’s or 90’s – nothing hinted at the 21st century. Even the off white, plastic phone that hung on the wall communicated one thing: Modern Medicine lived in a strange reality unaffected by technical change.

In Healthcare IT we obsess over security and privacy, but those ideas were as absent as interior design. The walls were paper thin, and even the leaky faucet with its persistent drips couldn’t compete with the candid discussion going on in the next room.

The conversation was morbid, depressing – literally. The doctor advised his patient that Valium could not be used to solve anxiety in the long term. The patient discussed her bouts of depression. The doctor asked if she’d considered suicide, and she indicated there were episodes of depression in her family but that’s as far as it had ever gone.

I wasn’t prying. The conversation was loud, for a moment I thought amplified. I couldn’t ignore the conversation, they might as well have been in my room. Thankfully my doctor came in before the prognosis next door got any worse.

Meet My Internal Medicine Doctor

He was older, in his sixties, he had the same gate and demeanor as my father. He held his Fuji laptop and stylus in the same way that he had held a clip board and pen over the past thirty years. I asked him what he thought about the NextGen software, and he showed it to me with deliberate patience. He picked at the screen and navigated the forms, but he smiled when he said “I’m from the old guard. We don’t get used to computers easily.”

But he liked the software (EMR), not for the reasons that he should – for the value that we in IT should provide. The software didn’t help with the diagnosis or suggest tests or even provide an optimized, world class workflow.

My doctor admitted that this is the way of the future, but I was more interested in why?

1. No more lost charts
2. No illegible notes

To him NextGen was merely the next generation clip board. I smiled looking around that old room, at his well worn, wrinkled fingers as they hunted one key after another. Beyond that laptop, the only thing indicative of the 21st century was the the Sports Illustrated sitting on the windowsill – November 2009 edition. I walked out of that anachronism and into the modern world realizing just how far we HITMen have to go.

In the Media: NY Times { EMR No Measurable Benefit }

http://www.nytimes.com/2009/11/16/business/16records.html?_r=1

A new study comparing 3,000 hospitals at various stages in the adoption of computerized health records has found little difference in the cost and quality of care.