Imagine What If

Here’s the goal:
To change healthcare as quickly as possible,
from the inside out,
so that it works for everyone.

We have reached a hinge point.
We finally have the tools.
We can ask the right questions.
It can be done.

It can be done today
- and we don’t have to wait for the leaders to lead. Once we understand the problem, we can do something from wherever we stand - in the industry or outside it, as clinicians, as executives, as patients and families, as voters and consumers, as investors, as legislators or regulators.

“Must Read” Classic Report

The Role of the Physical Environment in the Hospital of the 21st Century:

A Once-In-A-Lifetime Opportunity

From Roger Ulrich, Craig Zimring and the Center for Health Design, truly the one “must-read” document for anyone involved in planning a healthcare facility.

“Must Read” Classic Interviews by Joe Flower

Jim Collins:

Good to Great

John Seely Brown:

We Participate, Therefore We Are

Two must-reads for anyone running an organization. Collins shows how a run-of-the-mill organization becomes a truly great one. Brown shows how organizations learn, and how we can get out of the way.

The 16 Challenges

Information technology’s benefits come at a price

By Joe Flower

From Healthcare's Most Wired 11/28/05

Gathering and accelerating trends across health care pose at least 16 distinct information technology challenges. Some will be slow to build, while others will be more sudden; some will be drastic, and others more subtle. But all will have to be met and overcome in the next five to 10 years.

Five factors will make the need for better communications, better data collection and better metrics vivid in the minds of the public, major industry players and policy-makers: The advent of personal genomics will create a whole new category of privileged information that will need to be stored, handled, distributed and protected (1). The major pandemics that epidemiologists expect will throw into sharp relief the fragmented and anemic nature of our health care communications (2).

The sheer cost of health care, augmented by the rise of consumer-directed health plans (CDHPs), will make the consumer’s voice ever more powerful in health care. This, in turn, will bring an ever-sharper demand for transparency and greater clinical quality, which will require ever more computerized, automatic and ubiquitous metrics (3). At the same time, the rise of CDHPs will lead to major and direct involvement of the financial services industry in health care, which will further increase the demand for metrics, documentation and a continuous flow of financial information (4).

In reaction to demands for lower costs and higher quality, the spread of the Toyota Production System and similarly lean models will further increase the need for metrics on everything from inventory and space allocations to waiting, turnaround and transport times; in other words, every operational detail (5).

In four feedback loops, the use of IT itself will create a need for greater use of new technology. The decentralization that IT allows will exponentially increase the necessity of these systems (6). The greater transparency allowed by metrics will steadily increase the demand for greater clinical quality, which will in turn call for more metrics, more accountability in the software, and more information available at the point of care (7).

Meanwhile, advances in robotics and automation in areas as disparate as surgery, housekeeping, message delivery, pharmacy and laboratory will demand greater communications between these systems (8). Personal nanodiagnostics (think Star Trek-style medical Tri-Corders) and other home-based health IT will create a demand for communications between the customers’ technology and that of the providers (9).

Two large-scale factors - the aging of the baby boom generation and the advent of the peak of the global oil-production arc - will tend to accelerate health care inflation (10, 11). This will further exacerbate the ferocious demand for greater efficiencies in which IT plays a central role by creating better metrics, enhancing communications and reducing transaction costs.

In the face of all these rising demands, four factors beyond general health care inflation will seriously constrict the availability of both capital and operating funds for IT expansion. A move toward pharmaceutical interventions, especially in the fields of cardiovascular care and oncology, will greatly reduce some of the major revenue sources of hospitals (12).

U.S.-based insurers will incorporate overseas outsourcing of many major schedulable operations into their cost-cutting efforts, further attenuating U.S. hospitals’ revenue streams (13). And hospitals will face ever-increasing competition from privately owned specialty providers, which will sharpen the need to hold down costs and cause some hospital executives to cut IT funds, even though the technology, wisely deployed, could hold the answer to cost reduction (14).

Rates in the long-term debt market will rise, making capital harder to secure for not-for-profits as East Asian economies cease pouring their excess dollars back into U.S. instruments and peg their economies instead to "floating baskets" of global currencies (15).

Finally, the pace of change is creating a powerful need for knowledge management, sense-making and competency transfer structures within organizations and across professions, systems and communities of practice. Much of this information, of course, must be mediated through new information technologies (16).

Gathering and accelerating trends across health care pose at least 16 distinct information technology challenges.
Some will be slow to build, while others will be more sudden; some will be drastic, and others more subtle.
But all will have to be met and overcome in the next five to 10 years.

— Joe Flower

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