healthsignals new york

End of the line

This blog got me started with a completely different form of using technology to explore and communicate. I had so much fun with it that I expanded and moved over to SignalHealth (link now inactive).  And I learned even more over there.

But even good things come to an end.

I've taken what I learned and, in mid-2006, joined the staff of Mike Breslin, County Executive of Albany County, New York as Commissioner of Management & Budget, where I'll continue working on health care and information technology, along with a wide range of other issues.

Thanks for stopping by.

Craig Duncan joins us as a Contributor

When Craig Duncan began, he was running a 16 bed nursing home. When he retired, he had built it into Northeast Health with an intense commitment to integrating care, especially for those with chronic illnesses. He's been one of the leaders in expanding the use of information technology to improve care, increase efficiciencies, and, even better, integrate and transform care.

Craig is joining us as a Contributor at signalhealth.com and I look forward to his observations on a wide range of issues. We could tease by calling him an elder statesman, but he's got way too much energy for that. We'll post his bio shortly.

To get the conversation going, Craig's agreed to an online interview. I'll post some questions and he'll respond with his own postings.

Craig, thanks for joining us and welcome. Here are some questions to get started:

1. What are the most significant changes you've seen in health care since you started?
2. What concerns you most about where the health care system is now or where it's heading?
3. What in today's environment or on the immediate horizon do you think offers us the best opportunities for significant improvements in patient care or system efficiencies?

Thanks. We look forward to reading your perspectives on these and many other issues.

A new online physician voice

Many of you met Dr. Paul Sorum here or here as an advocate for single-payer. Paul's not only a physician. He's also a historian with great expertise on the French medical system.

Paul now has his own blog at www.signalhealth.com and his first post is EMTALA Blues.

Welcome Paul!

Patient blogs

High Point Regional Health System, in High Point, NC has set up patient blogs! Well this is a dangerous but interesting experiment.

Patients reportedly can write about any negative experiences. We'll see about that won't we. Readers can e-mail comments. So far it's not evident what happens with those comments. Patients may post from home.

Reportedly, a hospital staff person reviews each blog to make sure it is relevant before posting it to the hospital's site.

Here's a staff posting with a bit of (self) back-patting. 

Well, think of it this way. Anybody with a computer and a connection can set up a blog in an afternoon. The way things are going, it's just a matter of time before an unhappy patient sets one up or uses one they already have to rip into a hospital. We've already seen it with a disgruntled Blue Cross employee.

So why not tip-toe into the environment in a very controlled manner?

 

Waiting for Matthew's critique

I'm usually pretty confident of my opinions (OK, quite confident) and was probably even a bit smug here.

But Matthew Holt, whose opinions are always worth thinking about has promised a critique. I confess my first reaction was one of uncertainty. Maybe I was a bit hasty.

But now I'm just sitting back and figuring that I'll learn something and Matthew's critique will help sharpen my thinking.

Expanded collaboration capability

OK, here's part of the reason I've been absent so much ...

I've had so much fun here, that we've completely revamped the SignalHealth website (www.signalhealth.com) . Sure, there's the typical electronic brochure, the "who we are "sorts of stuff. But that's only a small part and, over time it will get smaller. It's the other stuff that's fun: lots of healthcare news and commentary and forums and polls for y'all to weigh in on.

Underneath the entire site is a structure of taxonomies that can be updated, expanded, refined, or sub-categorized instantaneously. Right now there are two such structures, one geographic and one subject matter. When you click on anyone of those categories at any part of the site, it automatically displays everything in that category. We'll provide a freestanding navigation tool that takes advantage of that capability as soon as we can get it up. (Yes, I was getting impatient and chose to go ahead without it.)

We just put the site online last night and there's still a lot coming. But as of this moment, the site offers:

• News. We've selected a variety of healthcare news sources and they are automatically collected and posted. Note that sometimes the headlines don't tell you much about the healthcare news inside. They just happen to be what those who originally created the material labeled it.
• Events Calendar. Registered site users may suggest adding events to the calendar. They are reviewed by a moderator and then added to the Calendar for the convenience of all visitors. Note that Calendar Events can be categorized by geography and subject matter.
• Commentary (weblogs). Here you will find our observations and opinions and those of selected Contributors on the healthcare issues of the day. Commentary can also be categorized by geography and subject matter. We intend for it to offer new perspectives and and to filter out a lot of the extra noise. While the technology would enable me to allow any registered user to write their own "blog" here, for the time being, I have chosen not to.  I will be introducing some "contributors" over time. Note that this blog automatically gets picked up at the new site. However, comments and downloadable material posted here don't move over.
  
• Other Commentary. There are some folks already offering interesting healthcare commentary on the web. Their observations and perspectives tell us about what's going on in their communities and they make us think. Those commentaries are automatically fed to this section of the site. Click through and read them at the source. If you spot someone we've missed who's worth watching, point them out to us.
  
• Forums. Registered site users may participate in Forums. They may also suggest adding new Forum topics to the site. Suggested Forum topics are reviewed by a moderator and then added to the site. We welcome the active participation and debate of all registered users. Note that Forums can be categorized by geography and subject matter.
• Polls. Registered site users may participate in Polls. They may also suggest adding Polls to the site. Suggested Polls are reviewed by a moderator and then added to the site. We welcome the active participation of all registered users. Note that Polls can be categorized by geography and subject matter.

Take a look, register, and weigh in. I'd appreciate your feedback and suggestions too.

Best regards.

Taking a couple days off

Happy New Year!

I may get a post or two in between now and then, but I doubt it. We'll probably be back here on January 6.

Michael Kinsley discovers the blogosphere

Not about healthcare (though it does relate to Social Security), but is related to healthcare: Michael Kinsley drops an opinion and watches it ripple through the world of bloggers.

We need more of this in healthcare. Note his discovery that the blogosphere is a community.

Lake Wobegon's doctors

I've been meaning to post on Dr. Atul Gawande's latest in the New Yorker, The Bell Curve. Gawande writes on medicine regularly for the New Yorker and he writes beautifully.

But don't wait for me. Go first to the Book of Joe. (I love it. This guy characterizes himself as "the world's only blogging anesthesiologist." It's probably true for the time being.)

Then, for a followup discussion, go to A Chance to Cut is a Chance to Cure. (You can guess his specialty.)

Key thoughts from the article and the comments:

Don Berwick believes that the subtleties of medical decision-making can be identified and learned. The lessons are hidden. But if we open the book on physicians' results, the lessons will be exposed. And if we are genuinely curious about how the best achieve their results, he believes they will spread.

Once we acknowledge that, no matter how much we improve our average, the bell curve isn't going away, we're left with all sorts of questions. Will being in the bottom half be used against doctors in lawsuits? Will we be expected to tell our patients how we score? Will our patients leave us? Will those at the bottom be paid less than those at the top? The answer to all these questions is likely yes. (That may be why we need to change the rules about how we use quality stats. Comment added by JWR.)

There are always going to be "average" physicians because that's the way that statistics work. The goal of all physicians should be to shrink the distance between "average" and "excellent" to as narrow a range as possible. This is the practical solution since the number of "centers of excellence" may be small, and some conditions are so common ... centers that give the best results would be overwhelmed.

Great stuff from all three.

Spitzer has a blog

Well this takes nerve.

Not that Elliott Spitzer has a blog. But that the comments are enabled. Take a look. Already, you'll see a mix of sycophancy, people themselves running for other offices, mistaken impressions that they were at another site, strong criticism from both ends of the political spectrum, and editorial nit-picking. That's the chance you take. You trade-off message control for openness and connection.

So far, most candidate blogs have been pretty tame and obviously written by someone other than the candidate. It's takes time to keep it fresh too. We'll see how this one goes, especially over 23 months.