Wednesday, November 16, 2011

Joy's Law Means Hospitals Need to Look for Partners

A recent trip to Denmark to speak to an IT conference reminded me how important it is for hospital executives to remember Joy’s Law. Bill Joy famously observed “No matter what business you’re in, most of the smart people work for someone else.” There should be a corollary that states “No matter what industry you’re in, you can learn a lot from people in other fields.”

If you take Joy’s Law seriously you start to think beyond the boundaries of your hospital system and realize that there is much to learn and borrow from others. Don Tapscott and Anthony D. Williams in Wikinomics (New York: Penguin, 2008) describe how cutting edge companies outside of health care are benefiting from mass collaboration made possible by digital tools.

To continue reading this post go to this link for original blog on Hospital Impact:

Monday, November 14, 2011

What I Learned in Denmark II: The Online Health Track

In a previous blog post ( I discussed how much I learned at the J. Boye Aarhus 11 Conference in Denmark from a fabulous opening keynote by Michael Edson and from presentations on search and going mobile. Today I would like to summarize the discussion at the Online Health Care Track that was expertly moderated by Lau Hesselbaek Andreasen.

In my opening remarks I revisited some of the themes from Edson’s brilliant keynote and tried to understand what they might mean for health care. Kathy Sierra’s observation that the digital world makes “every user a hero” was extended to embrace the idea that “every patient is a hero.” The concept that the patient is the most underutilized resource in health care was introduced, and social networking sites like Patients Like Me were given as examples of mass collaboration in health care that results in patients learning from others with the same disease and presenting themselves to physicians as empowered and engaged patients. Lawrence Lessig’s observation that synchronicity is a costly impediment that can be overcome by digital means was briefly mentioned, and Clay Shirky’s books Here Comes Everybody and Cognitive Surplus were discussed.

We then talked about the two worlds of health care: the evidence-based medicine world of doctors and clinical trials and the patient experience world of people living with their diseases and coping with help from others. I mentioned Clayton Christenen’s observation in The innovator’s Prescription that “doctors spend about two hours each year with their diabetic patients, but patients spend 8,758 hours managing the disease on their own.” The two hours are spent in the evidence-based world, and the 8,758 hours are spent in the patient experience world of unclogging insulin pumps and learning when hypoglycemic crises occur for an individual patient. We discussed the need for more clinical trials to increase the percentage of proven knowledge in the evidence-based medicine world from the current 25%, and the fact that the right answer changes when new scientific studies are completed. We also discussed how much the patient experience world has changed with the advent of patient social networking sites and the ability of amateurs to avail themselves to much of the scientific literature about their medical conditions.

I completed my overview opening presentation with a survey of how American hospitals were using social media compiled by Ed Bennett of the University of Maryland. I also presented slides examining how social media could be utilized for personal health records, clinical trial recruitment, treatment and hospital selection, health professional training, disease management, and wellness. My slides are available here

Dr. Abir Al-kalemji of the Odense University Hospital in Denmark delivered the second talk: Do Patients Benefit from Social Media? The short answer is we think so, but we need to do research to document what does and does not work. Al-kalemji reviewed YouTube videos for teaching patients exercises, smartphone transmitted pictures of rashes, remote monitoring of anticoagulant therapy, and psychotherapy via social media. She discussed the obvious advantages of improved access, time saving for both patients and physicians, increase in patient safety, and the possible enhancement of therapeutic possibilities. She also listed the limitations of not being able to perform a physical examination, trust and privacy issues, and reservations about the quality of health care information available on the Internet. Al-kalemji finished up with a discussion of Facebook. Some physicians believe becoming friends with patients on this social media site reveals important information about the patient; others were opposed to physicians ever relating to patients via Facebook. Dr. Al-kalemji slides are available here

Dr. Poul Jaszczak, Chief Surgeon, Department of Gynecology and Obstetrics at Herlev Hospital and Chairman of Danish Medical Association Ethics Committee, presented his views on digital strategies and methods for communication. Dr. Jaszczak stated that social media can blur the boundary between a person’s public and professional life, and he recommended adopting conservative privacy settings on social media sites. He emphasized that the ethical and legal duty to protect patient confidentiality applies equally to both the Internet and other media. Dr. Jaszczak does not believe that health professionals should accept Facebook friend requests from current or former patients, and he worries about derogatory comments posted on public Internet forums. Dr. Jaszczak’s slides are available here

Dr. Jaszczak shared the following posting from a social networking site:

“Dear emergency Registrar:

Thanks a million for misdiagnosing my patient’s perforated bowel as constipation and treating aggressively with laxatives. I’m sure she appreciated the subsequent cardiac arrest and multiorgan failure. Don’t worry, she just needs a new set of kidneys and a liver and she’ll be right. And with that kind of performance, I’m sure you can help her acquire them.

Kind regards,

Lowly intern”

Line Berg Ostergaard, Manager Global Digital Marketing for Zimmer, presented how one medical device company is using social media in the health care space. Ostergaard nicely summarized statistics about patient use of social media, and she emphasized that many patients have changed the way they view authority figures when dealing with a serious health issue. Zimmer has recognized that patients like to talk to other patients, and their website allows patients contemplating hip replacement to talk to patients who live nearby and who have already undergone the surgical procedure. Acknowledging that Zimmer has not yet leveraged the full power of Facebook and Twitter, Ostergaard discussed some of her ideas for the future. She also addressed the current obstacles of the complexity of providing both global and local information and the lack of guidance from regulators. Her slides are available here

Jens Ole Henriksen, the former CIO at Odense University Hospital, wrapped up our online health track with Smartphones: Healthcare in Your Pocket. Henriksen reviewed the Danish strategy for welfare technology and telemedicine with its emphasis on cost containment, building super hospitals to replace rural facilities, and attention to the needs of the elderly. He also commented on how new technologies like smartphones and cloud computing are disrupting the IT department. According to Gartner, by 2014 the IT department will lose control of over 25% of the organizations’ IT budget and by 2015 there will be four times as many mobile development projects as PC development projects. Comparing the smartphone with its apps to a Swiss Army Knife, Henriksen taught me that all of the following can be done on a smartphone: geographic locator, movies, speech recognition, connect to USB device for weight, blood pressure and other metrics, compass, connect to Internet, accelerometer, light sensor, speaker, and proximity sensor. He also did a masterful job of explaining to the layperson (me) the differences between the three platforms for smartphone apps: IOS (Apple), Android (Google), and Phone7 (Microsoft), and he described the advantages and disadvantages of producing apps for each of the three platforms.

Perhaps most useful was Henriksen’s description of a smartphone workshop he held at Odense University Hospital where physicians, IT experts, administrators, and developers brainstormed on how to best use smartphones in a hospital environment. After coming up with ideas for clinical, patient, encyclopedia, and location applications, the workshop concluded that they should concentrate on creating interfaces for the apps to the old legacy electronic health record, developing patient information apps to help them navigate a complex and large hospital plant, create lab result notification apps, and create an app to support anesthesia and preop processes. Henriksen’s slides can be found here

The online health track at the J. Boye Aarhus 11 Conference succeeded in opening my eyes to different ways to look at digital strategy. The informal and warm atmosphere during the keynotes, the breakout sessions, the refreshment breaks, and the conference dinners made networking effortless and effective.

Sunday, November 13, 2011

What I Learned In Denmark

Even after I had agreed to speak in Aarhus, Denmark at the J. Boye Aarhus 11 Conference, I did not really know what to expect from a gathering of IT and communications specialists who run intranets for large organizations. My experience confirmed the wisdom of going to meetings outside one’s own field and seeing the world through a different lens. Health care has a poor track record of learning from other disciplines, but I discovered a lot that could help us transform the American clinical delivery system. This blog post will be my first attempt to understand what I learned in Denmark.

Michael Edson, the Director of Web and New Media Strategy at the Smithsonian Institute, delivered the opening keynote: Come, Let Us Go Boldly into the Present, My Brothers and Sisters ( Edson and I chatted the night before his keynote at dinner, and I found him to be friendly, interesting and a good listener. As a lecturer, he is of the pacing and twirling dervish school of keynotes complete with the flashy slides I usually abhor. Even though we belong to different keynote camps (mine is the simple words on simple slides school), I was captivated.

Noting that the new ideas have been around for 5 to 10 years, Edson quoted Howard Rheingold (Smart Mobs), Lawrence Lessig (The Future of Ideas), Don Tapscott and Anthony D. Williams (Wikinomics), Tim O’Reilly (What is Web 2.0?), William Gibson (Zero History), Clay Shirky (Cognitive Surplus), and Thomas Friedman (Serious in Singapore).

Edson’s new ideas include overcoming synchronicity, the changing nature of now and the future, Bill Joy’s Law, cognitive surplus, network effects, Kathy Sierra’s hero, and Moore’s Law.

Lessig wrote, “The open and neutral platform of the Internet has spurred hundreds of companies to develop new ways for individuals to interact…. Public debate is enabled by removing perhaps the most significant cost of human interaction – synchronicity.” When I heard Edson read this quote, I realized that my teaching HPL 500 online for Jefferson University School of Population Health took advantage of this development so that practicing physicians could participate in my class whenever their busy schedules allowed. I also connected this concept with how twitter has enhanced my participation and learning from conferences I do not attend in person or from comments in the twitterstream months after I have given a talk.

Drawing heavily on Gibson, Edson states that the future no longer matters as much as it used to because now is much narrower than it used to be. Things change so rapidly today that we really cannot plan for the future; we have to do it right now.

Bill Joy famously observed, “No matter what business you’re in, most of the smart people work for someone else.” Tapscott and Williams build on this idea and describe how mass collaboration becomes so much more important and powerful. “As a growing number of firms see the benefits of mass collaboration, the new way of organizing will eventually displace the traditional corporate structures as the economy’s primary engine of wealth creation.” Edson also reminds us that Shirky estimates that there are a trillion hours a year available for networked people to collaborate and create, and Kathy Sierra reminds us that since every man (patient) is a hero, all of us should help everyone else achieve their dreams and goals.

Edson wrapped up his talk by describing a Thomas Friedman column about how Singapore elementary school kids learn about DNA by reenacting CSI crime scenes in class. Edson and Friedman would have each of us ask the following questions: 1) What world am I living in? 2) What impact do I want to have in that world? 3) What should I do today?

Feeling totally inspired, I sampled various presentations from the ten tracks: digital strategy and governance, going mobile, higher education, user experience, web content management, digital marketing, intranet, online communications, online health, and standards and technology.

Highlights for me personally included a deeper understanding of search and how organizations are struggling with going mobile. Martin White of displayed an encyclopedic knowledge of the past, present, and future of search. I especially enjoyed his story of the company that discovered the most popular search was for “conference call” because nobody could remember how to call into meetings, and his classification of searches as successful, failures, or disasters. Disasters occur when employees find old documents and assume, for example, that the old list of banned chemicals is the same as the new list of banned chemicals. Products are made with banned chemicals and a disaster has occurred for the company. It was also sobering to learn that companies with 1000 employees have 200 terabytes of information and that manufacturing companies have 1 petabyte of information that needs to be searchable.

Robert E. Johnson of Bob Johnson Consulting, LLC utilized his extensive experience of consulting with North American universities to deliver a compelling message for all of us to go mobile by identifying our top tasks. His Law of Top Tasks states that not everything on our website is equally important, our visitors determine what is most important, and we have to give up control over what we feature on our websites. When the City of Liverpool developed a mobile website, they were surprised that the number one task citizens wanted to accomplish was to find out about recycling and trash collection days. Needless to say, this was not the top priority of the mayor. Quoting Gerry McGovern who said, “How much of your content is dead and useless junk that impedes navigation and search results,” Johnson said if it won’t fit on your mobile website maybe you should consider deleting it from your traditional website. He also shared a US government website that I have found extremely useful

The conference ended with a town hall debate moderated by Janus Boye himself featuring Katrine Thielke of the Danish Patent Office vs. Raymond Boissevain of the Dutch government. Internal communication was declared dead; video is not annoying; remix and mash-ups still add value; big systems like IBM, Microsoft, Oracle, and SAP are not great; apps are here to stay; and we do not need more governance. Thielke won the debate, and Boissevain conceded graciously and retired to the dinner to drink local beer.

In a future blog, I will share the insights I learned at J. Boye Aarhus 11 participating in the online health track.