My Doctoral Journey – Part 4

I really appreciate the support from my friends and family for my decision 17 months ago to begin the doctoral journey. I promised periodic updates and that is the purpose of this posting. I have now completed 27 credits of coursework out of the rquired 62 — approxmiately 43%. I completed a course in health care marketing in January and am now taking a course in health care economics. In December, I attended a second residency in Atlanta. The third residency will be in October. It will be an important step as it is the launching point from which I will be able to submit a proposal for my research study and dissertation.

The goal that every doctoral student shares is to successfully complete a dissertation as the final step in earning their degree. Some say that at least half of doctoral learners never complete their dissertation because of the incredible detail required to get a research topic developed and approved for research. A typical dissertation is 200-300 pages in length. Some consider the process more than challenging – a friend of mine told me he had an ABD degree – all but dissertation. A visit to Amazon and you can find a lot of books on how to “survive” a dissertation. I still remember the meeting with the academic review committee when I had to defend my masters thesis forty years ago. It seemed challenging at the time, but I can now see that it was nothing compared to what lies ahead for the doctoral dissertation.

I have completed a concept paper, which is the precursor to a proposal for a quantitative research study that I have in mind. The study relates to the cost of care and lives lost due to congestive heart failure (CHF). My mother passed away from CHF a few years ago and I learned a lot about the disease during her final months. As a member of the board at Western Connecticut Health Network, I can also see the impact from a hospital point of view. The concept paper is eleven pages long. Following are a few excerpts from the paper to share a few of the things I am considering.

Chronic heart failure (CHF) is the leading cause of hospitalizations and readmissions for the elderly, and accounts for a large share of developed countries’ healthcare expenditures. Although CHF is a condition for which hospitalization is often avoidable, nearly 20% of Medicare patients discharged from hospitals are readmitted within 30 days at a cost to Medicare of $15 billion annually.

The problem is that the frequent readmission of CHF patients to the hospital has a negative impact on the patient and the hospital. For the patient, it results in a reduced quality of life and a negative impact to their psychosocial and financial condition. For the hospital, it means using extra capacity for care while facing the risk of not receiving reimbursement for the associated cost. The purpose of my proposed quantitative research study will be is to answer the question of whether home-based telemonitoring with coordinated care could improve mortality and reduce hospital readmissions for patients with CHF.

Experimental research attempts to identify cause-and-effect relationships between variables by conducting a controlled experiment. The proposed research method I am considering would use a randomized controlled experiment in which patients are randomly allocated into two groups; one that receives pharmacological treatment with coordinated care (control group) and the other, which receives pharmacological treatment with telemonitoring and coordinated care (enhanced care group).

Telemonitoring makes it possible to gather daily data from patients in a consistent and automated manner. A wireless gateway device similar in size to a cellular telephone can automatically capture data from other wireless devises such as a weight scale, a blood pressure cuff, and a pulse oximeter to measure pulse and the level of oxygen in the blood (oxygenation). Since my last update, I have discovered several companies that have interesting technology for monitoring. These include cardionet.com and corventis.com. Around-the-clock access to a patient portal could display patient data and enable caregivers to respond proactively to the patient. For example, if the data from telemonitoring shows a sudden increase in the patient’s weight, a nurse might make a dietary suggestion or obtain authorization to make a change in medications.

There have been a number of similar studies but none have shown a significant benefit from telemonitoring. The research I have in mind would be focused on whether the right combination of healthcare delivery and technology can improve outcomes. The result could be improved quality of life for patients and, if the care plans are implemented in a cost-effective way, reduced financial risk for hospitals and the ability to invest more in their community healthcare mission.

I will have a further report on the proposal in a few months. In the meantime, I will be continuing with more course work. Since the program began one year ago, I have written 47 papers. Many more to come and then the big one! If everything goes right, I could be just a little less than two years from completion.

Index of stories about My Doctoral Journey

Tags: chf, dissertation, doctorate, e-learning, hospital, scholar, telemonitoring

Speech at SIIA

It was a privilege to be a speaker at the Software & Information Industry Association (SIIA) conference in New York on January 25. The subject of the speech was The Future of the Internet but I included an emphasis on impact to healthcare and publishing. The conference was attended by executives from the publishing and software industries. I do not know why the video was captured in five segments, but until I get a consolidated version, the links are below. The slides were on my iPad and the video doesn’t show the screen the audience was looking at. If you want to see the slides, they are here.

Part 1
Part 2
Part 3
Part 4
Part 5

Tags: future, health, Healthcare, hospital, internet, john patrick, medicine, music, publisher, siia, technology

Big Data

The storage capacities of laptop and desktop computers has been growing rapidly, but the growth may not be fast enough. According to IBM, we create 2.5 quintillion bytes of data every day. Perhaps quintillions of bytes are not meaningful to most of us, but it is the growth rate that is staggering — 90% of all the data in the world has been created in the last two years. Where does all the data come from? Data comes from everywhere: from sensors used to gather climate information, physiological readings taken 1,000 times per second from a patient, posts to social media sites, digital pictures and videos posted online, transaction records of online purchases, and cell phone GPS coordinates to name just a few. Collectively, the phenomenon is called “big data”. (See  IBM Big data and information integration for smarter computing).

Note: Data is plural. The singular term is datum. Should we say data is or data are? There are many views on which is right.

 IBM describes big data as spanning three dimensions: Variety, Velocity and Volume.  Variety refers to the fact that big data extends beyond structured data like we might find in a spread sheet. It includes unstructured data such as text documents, email, audio and video recordings, click streams from the web, log files that record financial and business transactions, and much more. Velocity of data refers to the fact that data can be time-sensitive such as bid and ask data in a financial market or physiological data that affect the lives of patients. In these cases, historical data is interesting but real-time data is critical. The third parameter is volume. IBM says that big data comes in one size: large. Organizations are flooded with data — terabytes, petabytes, or even yottabytes.

Big data is a challenge in various technical ways, but more importantly, it is an opportunity to find insight in new and emerging types of data and to answer questions that, in the past, were not possible to analyze effectively. Data that has been hidden can be surfaced and acted upon. The result can be a more agile organization or in the case of health care, better outcomes for patients.  Picture a hospital neonatal environment where a plethora of medical monitors connected to babies are used to alert hospital staff to potential health problems before patients develop clinical signs of infection or other issues. There are breakthroughs on the horizon for how this will be done. Today the instrumentation generates huge amounts of information — up to 1,000 readings per second — which is summarized into one reading every 30 to 60 minutes. The information is stored for up to 72 hours and is then discarded. If the stream of data could be captured, stored and analyzed in real-time there could be a huge opportunity to improve the quality of care for special-care babies.

The Hospital for Sick Children in Ontario, Canada developed such a vision and is acted on it. Dr. Carolyn McGregor, Canada research chair in health informatics at the University of Ontario Institute of Technology visited researchers at the IBM T. J. Watson Research Center who are working on a new stream-computing platform to support healthcare analytics. A three-way collaboration was established, with each group bringing a unique perspective — the hospital focus on patient care, the university’s ideas for using the data stream, and IBM providing the advanced analysis software and information technology expertise needed to turn the vision into reality. The result of the collaboration was Project Artemis which pairs IBM scientists with clinicians and`researchers to explore how emerging technologies can solve real-world business problems, in this case developing a highly flexible platform that aims to help physicians make better, faster decisions regarding patient care for a wide range of conditions. At the Children’s hospital the focus is real-time detection of the onset of nosocomial infection (often called hospital-acquired infection). Regulatory, ethical, privacy, and safety issues were addressed and then two infant beds were instrumented and connected to the system for data collection. The team then created an algorithm that deciphered the streaming data. By establishing the impact of moving a baby or changing its diaper, those things can be filtered out to help spot the telltale signs of nosocomial infection.

Dr. Andrew James, staff neonatologist, at the Hospital for Sick Children is optimistic that as they learn more they will be able to account for variations in individual patients and eventually be able to integrate data inputs such as lab results and observational notes. In the future, any condition that can be detected through subtle changes in the underlying data streams can be the target of the system’s early-warning capabilities. It is likely that sensors attached to or even implanted in the body will allow monitoring of important conditions from home or anywhere. Big data has the potential to improve the health of patients whever they may be.

Other healthcare-related stories on patrickWeb

Tags: analytics, big data, health, Healthcare, hospital, IBM, monitoring, neonatal

Hospital Cafe

The merger of New Milford Hospital and Danbury Hospital into the Western Connecticut Health Network has been very successful. Both hospitals are learning from the other. Now the public is learning about the Cafe. The New York Times featured it and said New Milford Hospital Cafe Defies Stereotypes.

The 85-bed Litchfield County community hospital has a longstanding reputation for high quality and exceptionally compassionate patient care. In addition to their great food, they add many other special touches in its facilities and programs using the Planetree focus on healing and nurturing body, mind and spirit.

Tags: cafe, danbury hospital, hospital, new milford hospital, planetree, western connecticut health network

The iPad Is Tops With Doctors

Bertha Coombs at CNBC reported that there are two things Dr. Larry Nathanson can’t work without when he’s on duty in the emergency ward: his stethoscope and his iPad. Early adopting physicians have been embracing the iPad since day one and now the trial stage has moved to a rush. Not only can a doctor scroll his or her list of patients to be visited, but they can also share information with patients. Dr. Henry Feldman, a surgeon at Boston’s Beth Israel Deaconess Medical Center, told Coombs that when it comes to treating surgical patients, being able to pull up diagrams and x-rays at their bedside has been a real game changer. Feldman said that he has been told more than once “That’s the first time I’ve understood my disease”.

Does this mean that Apple will dominate healthcare tablet computing like they do music? What about the Blackberry and Android and the many other tablet entries? The market is certainly large enough for a lot of players but Apple has some distinct and relevant advantages including ease of use and a vetting by Apple before apps are made available. CNBC reported that in February, four out of five doctors surveyed by health marketing company Aptilon said they planned to buy an iPad this year. The major push by healthcare information technology currently is on the electronic medical record. This is in part because the federal government has declared this to be “meaningful use” of IT and has put billions of dollars of incentives in place to accelerate adoption.

I see a major shift ahead similar to what happened 30 years ago when enterprises were focused on solidifying their mainframe computer applications but department chiefs wanted their own solutions and they opted for local area networks of PCs. It took chief information officers a couple of decades to regain control of IT.

Dr. John Halamka, chief information officer at B.I. Deaconess, summed it up for CNBC. “I would call this a perfect storm for medicine,” he said . “You have alignment of funding; a cultural change where doctors want to use devices to improve quality; you also have new devices and new software that is much easier to use.” One of the big unknowns is how federal regulators will respond to the grass-roots demand. There are many questions to be answered. If a doctor takes a picture of a patient with the iPad, does that make the iPad a medical diagnostic device? A similar set of questions were raised in the field of aviation but the demand from pilots was so strong that the FAA found a way to certify the iPad for paperless flight charts. The FDA has already cleared a handful of apps for the iPhone and iPad including a remote patient cardiology monitoring system and a radiology app for reading of medical images.

It is common knowledge that errors are made in healthcare and patients can be harmed. A major contributing factor is imperfect information communication. Can a handheld device such as the iPad improve communications. There is no doubt about it when it comes to patient interaction. The missing link is connecting the iPad to the “backend”. For music the backend is iTunes. For healthcare the backend will be the health information exchanges that are springing up around the country. When that linkage is made, the iPad will become the window into our health and be a tool for improved outcomes. The sooner the better.

Other healthcare stories at patrickWeb
Other healthcare stories at Health Discussions Forum

Tags: apple, cardiology, emergency medicine, Healthcare, hospital, ipad, radiology, surgery, tablet

Home Monitoring

My mother lived to just weeks short of 90. During the first 89 1/2 years she had a good quality of life, but during the last six months it was very difficult for her and her family. Having spent a lot of time with her between the assisted living home and the hospital, I learned a lot about healthcare for patients with chronic heart failure.  For those over 65, somewhere between 6 and 10% have CHF and the estimated annual expenditure for their care and treatment is $35 billion.

A typical scenario would be for an 89 year old person to enter the emergency department with shortness of breath. After a few hours or more in the ED the patient is admitted to the cardiac care unit. The patient is taking a dozen or so medications which are changed by the hospitalist to conform to the hospital formulary. After a week of tests, fluid infusion, and monitoring, the patient is ready to be discharged back to a nursing or assisted living home. The goal is to have the primary care physician see the patient within a week to make sure he or she is on track to stable health. The patient is confused about the new medications they have been discharged with and the appointment with the PCP may or may not happen in a week. Things go fine for a few weeks and then it is back to the ED and a readmission to the hospital. Repeat.

There are many long term solutions involving diet, exercise, and medications, but in the meantime there are millions of people with CHF who will likely follow the scenario above. Is it possible that using home monitoring can have a positive impact on quality of life and reduced healthcare expenditures? The jury is out. Research studies are underway at distinguished medical centers around the country. The idea is that by monitoring weight, blood oxygen, blood pressure and some basic questions like “How do you feel today?”, “Did you take your medications?”, etc., a stream of data is created every day that may be predictive of what is ahead. A recent study by Yale and reviewed in the New England Journal of Medicine concluded there was no difference in outcomes between those under monitoring and those not. I read the study and found that my idea of “monitoring” is different than what their study used. Although many experts were involved in the study, the data collection was done by the patients calling an automated telephone service and entering data. That is not monitoring from my perspective. Apparently it wasn’t for some of the patients in the study either because many did not enter their data.

Major companies including GE, Intel, IBM, and others are putting millions of dollars into research and development in the telemedicine market. I visited a lady in Connecticut that was being monitored by equipment provided by the Visiting Nurses Association. It was basically a PC with plug-in measuring devices. Each day the patient interacts with the PC and answers a couple of dozen questions in addition to providing weight O2, and blood pressure measurements. What struck me about the visit was not the technology but the social aspects of the process. The lady was “attached” to the PC — not technically but emotionally. She was taking responsibility for her health. She had previously been called a “frequent flier” by people at the ED. Now she doesn’t visit so often. Maybe she fears being away from her PC? The PC had become her buddy. It was Facebook to her. Some studies have shown that a person being monitored will fess up to having had a fall which they would not have told a nurse about for fear of being told they would have to go to the ED to be checked.

The data collected by the PC is sent through a dial-up telephone connection to a monitoring center, much like an alarm center. I can envision vast improviements to the system being used today. Instead of a big clunky PC how about something the size of an iPhone? O2, blood pressure cuff, and scale all connected by wireless. Data transmitted via broadband in realtime. Data going to a patient-centered medical home facility where a resident scans the data rather it going to an alarm center. Supercomputer analytics being applied to the data to look for patterns between weight, O2, blood pressure, and answers to various questions with the result being a prediction of fluid buildup that will lead to problems in 6 days unless the intake of diuretics is increased by 50% for ten days. Compared to the monitoring and predictions that are made by NASA for a spacecraft, the monitoring and predictions made for CHF patients is archaic. Skeptics say that there are too many factors involved and that only a doctor can make sense of them. I have the utmost respect for physicians but I also know, as sure as I can spell my name, that a few years from now we will be asking why it took so many years to realize that complications of various chronic diseases are in fact related to data that is collectible and very nicely subject to sophisticated analytics which can improve the quality of life and dramatically lower cost.

Milt Freudenheim at the New York Times summarizes many of the issues with home monitoring in his story Wired Up at Home to Monitor Illnesses. It is an excellent story that I can highly recommend reading.

Tags: chf, chronic heart failure, ge, health care, Healthcare, home monitoring, hospital, IBM, intel, telemedecine

Back to School

The grandkids have their backpacks loaded up. I hate to see them bent over hauling many pounds of books and look forward to the day when they have just a Kindle and some wholesome snacks in their backpacks with room to spare. The four grown children are thankfully gainfully employed but two of them are back in school to advance themselves. Believe it or not, Pop Pop is also in the mix.

I have been thinking about a doctorate for years. I have been fortunate to be able to earn a good education during my life, including three degrees, but I have a personal desire to achieve the pinnacle of education and use it to make an impact on something I am passionate about — healthcare. My education and career up until now have been heavily focused on technology. I believe that in the near future there will be a merger in the healthcare field of traditional information technology and clinical information technology. Bioinformatics will make personalized medicine a reality and we will no longer have to rely on anecdotal medicine. It will not be long until the healthcare information technology industry will be larger than the IT industry as we know it today. I want to be part of this revolution. By combining my information technology experience with a new focus on healthcare I believe that as a doctor of health administration I can help develop techniques that can improve healthcare outcomes and quality of life for many people.

Having been a member of the board of the regional hospital near where I live and having participated as a member of the planning, technology and medical affairs committees, I have been able to learn a lot and have become passionate about the key issues and opportunities that lie ahead. I plan to focus my dissertation on the intersection of the Internet, mobile computing, video chat, and remote primary care for patients. More on this as things develop.

Studying for a degree using the Internet as the classroom is hardly a new idea. When IBM made forays int0 this area years ago it was called “distance learning”. Some call it e-learning. I call it the natural way to learn. Whatever you call it, e-learning has come a long way. Over the last ten years I have looked at various programs that are offered. Most universities have some form of e-learning but the one I found to have the broadest and deepest commitment is University of Phoenix. For them it is big business — $4 billion in revenue and $600 million in profit last year. I was particularly impressed with their doctoral program. They follow what their School for Advance Studies calls the scholar, practitioner, leader model. The idea is to combine scholarship and theory with practical skills and knowledge that you can use in the workplace. The course work is almost entirely online but there are three intense week-long residencies during the next three years to support and expand on the education received online.

Being a student again fits well with e-tirement. I started on August 31 and have been doing research, writing papers, and participating in the online forums. So far, so good. The journey has begun. No turning back. Wish me luck! Oh, and if you don’t see an many posts here, rest assured I am posting scholarly work in the online classroom.

Index of stores about My Doctoral Journey

Tags: bioinformatics, dha, doctor of health administration, e-learning, facetime, health information technology, hospital, video

Smarter Cardio Care

More than 25% of deaths in the United States are caused by heart disease. There are many statistics on the subject but to me the stunning one is that between 1,500 and 2,000 people die of heart disease every day. Most people would assume that heart disease is the leading cause of death for men but many are surprised to learn that it is also the number cause of death for women.  In fact, half of the deaths due to heart disease in 2006 were women. In 2010, heart disease will cost the United States $316.4 billion including the cost of health care services, medications, and lost productivity. In China the numbers are even bigger and this is why Beijing Goodwill and IBM have launched a joint effort to improve detection of cardiovascular diseases.

Although great strides have been made in the understanding and treatment of heart disease, there is much more that can be done. We all learned that the heart is a pump. If NASA had a pump that was experiencing difficulties it would put the pump in a lab, connect it to various sensors and testers and study it until the issue was resolved or the pump replaced.  In some cases a similar regimen is followed with humans but in most cases the analysis of a heart is done on a much more distributed basis. A primary care physician may look at a routine electrocardiogram done in the office. If anything in the ECG looks suspicious, you may be referred to a cardiologist for further examination. A second ECG is likely to be obtained. The specialist may have you wear a holter for a week or so. A cardiac stress ECG may also be requested. If some special testing is required you may be sent to the hospital. Then back to the cardiologist who does his or her best to integrate all the data and determine what is going on.

The model I described is not ideal. Part of the problem is that the reimbursement model provides an incentive for more visits and more tests. Physicians are not paid to cure you — they are paid to see you, to test you, to see you again, to re-test you, etc. Part of the problem is that the data is distributed among multiple technologies and locations. That is the problem that IBM and Beijing Goodwill are working on.

The joint project will launch an all-in-one electronic cardiogram management system in China. The idea is to achieve smarter healthcare by helping hospitals analyze real-time patient information generated from electrocardiography (ECG) examinations thereby getting better insight and a better ability to detect cardiovascular diseases with more accuracy.   The project will also empower doctors with mobile devices to monitor heart patients rather than wait until a holter is returned and a report is created from the data it contains. Physicians will be able to review test results from a single databank of centralized ECG information available to them anywhere.

Doctors will now be able to retrieve patient’s current and past cardiogram data, medical reports, and relevant scientific research. The integrated analytics tools of the system will automate the examination and diagnosis of results in real time, helping physicians increase the speed and accuracy of their diagnosis. As a result of this high-level of integration, the system will help hospitals to diagnose more effectively, eliminate human errors, reduce cost, optimize resources, and enhance research and educational capabilities.

IBM is investing heavily in Healthcare Industry Solutions Labs in Beijing and around the world and hiring doctors to work with IBM researchers to speed the evolution from anecdotal medicine to smarter information based medicine. There is a lot to be said for the laying on of the hands and comforting words of a physician but to make great strides in reducing the loss of life from curable diseases and conditions, we need to supplement emotion with more integrated data and collaboration in the healthcare model. With the efforts of IBM and many other technology companies focused on healthcare in partnership with providers and payers, I believe we will see tremendous progress in this regard over the next few years. We have many reasons to be optimistic.

Tags: analytics, cardio, cardiovascular, china, ecg, Healthcare, healthcare it, healthcare solutions, holter, hospital, IBM

Smarter Healthcare

We have a long way to go but things are accelerating in the world of healthcare. Thanks to improved technology and enlightened healthcare administrators, information technology investments are being deployed at a rapid pace and adoption by caregivers is growing. I am especially pleased to see IBM jumping into this arena and leveraging its considerable resources and talents. Not that it is a new area for IBM. A year after I joined the company in 1967 three IBMers saw a big opportunity to provide mainframe outsourcing for hospitals and left to form Shared Medical Systems. SMS went on to become a $billion company with more than 7,500 employees. It was subsequently acquired by Siemens which is one of today’s leading solution providers in healthcare. IBM was a partner and supplier to SMS and is today a strategic partner with Siemens. IBM’s focus has shifted dramatically over the last half-decade. In addition to providing servers, storage, and software, IBM provides highly advanced services. It has supplemented it’s legions of PhD’s in physics, math, and engineering with medical doctors, nurses, and others with clinical experience. The strategy to assist in the transformation to a “smarter planet” approach for healthcare is to engage in deep partnerships in areas that can have high impact. A couple of current examples follow.

IBM and the University of Pittsburgh Medical Center (UPMC) are teaming up to bring “smarter” hospital rooms to patients. The system, created by UPMC three years ago, features a system to automatically organize and prioritize the work of nurses and other caregivers.  The IBM SmartRoom uses ultrasound tags to identify health care workers as they walk into a patient’s room, displaying the person’s identity and role on a wall-mounted monitor visible to patients. It also automatically provides various physician, clinician and support staff with the relevant real-time patient information pulled from the electronic medical record, including allergies, vital signs, test results and medications that are due on their monitor. The system also evaluates tasks for each patient and helps determine which tasks should be completed in which order to most effectively and safely provide care needed by the patient. It also alerts the appropriate caregiver by mobile device or when they walk into a patient’s room. Unexpected interruptions — from new physician orders to lengthy discussions with a patient’s family — are factored into the dynamically changing priority list. Using a simple touchscreen interface on a monitor in the patient’s room, a nurse or aide can document the completion of tasks in just a few seconds. The SmartRoom provides real-time links to key clinical systems, including pharmacy and lab services. Patient email, testing schedules, education and other features are also offered through the SmartRoom technology.

In the electronic medical record arena IBM and ActiveHealth Management, an Aetna subsidiary, have announced the Collaborative Care Solution — a low cost, cloud computing based subscription service that gives medical practices, hospitals and states collaborative and analytics technologies for their accountable care and medical home efforts. (These two new approaches are fundamental to the reshaping of how healthcare will be delivered in the months and years ahead). Sharp Community Medical Group in San Diego announced that it will use the new solution. The Sharp network includes over 200 primary care physicians and over 500 specialists who care for more than 165,000 patients in   San Diego county.

The IBM cloud computing approach combines information from electronic medical records, claims, medication and lab data with ActiveHealth’s advanced analytics software so care can be coordinated among teams of physicians, nurses, nurse practitioners, aides, therapists and pharmacists. Additionally, the solution provides advanced analytics that help physicians, or entire healthcare organizations, measure their performance against national or hospital quality standards. The solution can also show trends in how patients are responding to treatment for chronic asthma, or adhering to drug regimens and automatically alert doctors to conflicting or missed prescriptions.

John Jenrette, M.D., CEO for Sharp Community Medical Group says, “This is going to revolutionize how we practice medicine. Instead of digging into volumes of paper to coordinate services, we’re going to have that information available at our fingertips. It’s going to make us all more efficient.” Using Collaborative Care, hospitals and medical practices will be able to connect, analyze and share a wide range of clinical and administrative data from disparate systems and sources via a regional health information exchange. The system will automate the measurement, tracking and reporting of clinical quality performance at the patient and practice level using the Active CareTeam, and it will improve patient care through the use of evidence-based, clinical decision support powered by the ActiveHealth CareEngine. The by-product will be a transformation of practices that will assist them in achieving the goals needed to achieve Patient Centered Medical Home status and become Accountable Care Organizations. There are also a range of tools to engage patients in their own care. The Collaborative Care Solution analyzes multiple patient data sources to give doctors actionable decision support on their desktop – highlighting gaps in care, clinical research or potential drug interactions. It also helps doctors see trends in patient populations, for example by showing among 2,000 patients how many have uncontrolled diabetes, or how many women haven’t had their mammography screening, a snapshot they haven’t been able to see before. All of these things combined move us one step further away from anecdotal medicine toward information based medicine. The result will be better outcomes at lower cost.

Tags: accountable care, aco, active careteam, activehealth, careEngine, Healthcare, hospital, medical home, patient centered medical home, patient centric, smart room, upmc

e-tirement

I was browsing through Pulse on the iPad reading the news and happened upon my friend Irving’s post “Reflections on the “Post-Retirement” Phase of My Life“. It reminded me that I have been meaning to write something similar about my “e-tirement”, a term coined by Irving back in 2001 when I e-tired. Irving wrote his reflection after three years and I have yet to write mine after nearly nine years. This is the problem with “retiring” — there just isn’t enough time to do all you want to do. It reminds me of a reflection by a retired friend who said that he needed to go back to work so that he would have more spare time. This post is intended to share what e-tirement is all about for this one fellow traveler.

For many people, the shift from full-time employment is all about golf. Nothing wrong with that and I can see how happy it makes many people. I played golf once. It was in August 1976 in Cherry Hill, New Jersey. That was enough — the day confirmed that golf was not for me and I still do not see it in my future. Like Irving, I have found the shift to be from one primary focus area at one company to multiple focus areas with multiple organizations. As I say on my homepage, I am fortunate to have quite a few affiliations and I get to work with people from whom I am constantly learning.

Serving on boards, both corporate and non-profit, is a very rewarding experience. Not financially — but in the sense that you are able to help with a new idea, or to share an experience that can be helpful. In the old days being a board member meant going to a quarterly meeting and hearing from management and then voting to approve their actions. Governance has evolved significantly and in a positive direction. Directors are expected to read board materials and be prepared for discussion at meetings and to speak out when there is something they don’t understand or agree with. Directors also participate in committees of the board and that is often where more significant ground work takes place. Serving as a member of the planning and technology committees at the regional hospital enables me to be involved at the forefront of the rapid changes in healthcare. Serving on two compensation committees and as chair of the audit committee at two for profit companies is “continuing education”. All things considered I find that board service is a way to remain challenged while at the same time giving back some of the experience gained from nearly four decades at IBM.

When asked for “occupation” on various forms I usually say “consultant” but I don’t make visits and write reports in the classical consulting model. I do maintain a relationship with IBM and act somewhat as an ombudsman at various technology conferences. This enables me to provide an “outsider” perspective to the company from time to time. Not sure if I am an inside outsider or an outside insider. Conferences provide an important dimension of e-tirement for me. Speaking at them or just attending them is a way to stay involved in the industry. There are a lot of good conferences where technologists, investors, business leaders and media come together to network, share ideas, and explore the business impacts of key innovations. Catching up with former colleagues and making new friends is also a highlight. The social networks and many great blogs provide a huge amount of information but there is no substitute for getting together in person and chatting in the hallways during coffee and meal breaks a few times a year. The speaker circuit at company and industry trade group sponsored conferences has suffered an understandable slow down with the economy but hopefully will bounce back during the second half of this year. It has been a privilege to be on the roster of the Washington Speakers Bureau since 2002. Speaking at various not or profit events is also rewarding. Public speaking has been a key part of e-tirement.

And then there are hobbies — so many hobbies, so little time. The patrickWeb blog has many stories about the motorcyling adventures, conducting Beethoven and Mozart, personal computing, gadgets, hiking, geocaching, home automation, reading, and travels. The one hobby that dropped off the list is running — too many marathons and decades of pounding the pavement wore out my knee. Technology came to the rescue and the new oxinium knee has allowed for a full rehabilitation. Although running is not possible, walking and the elliptical cross trainer have enabled me to reach an average 13,000 steps per day — just short of 5 million steps since the new knee was implanted 21 months ago.

All of the hobbies are shared in the blog and, of course, blogging itself is an important hobby. As Irving pointed out, blogging is a way to chronicle one’s activities and connect with many people who have common interests. There are roughly 1,000 stories in patrickWeb dating back to 1998. Someday my grandchildren will find the blog of interest. How about if the Romans and Greeks had been bloggers? What an impact blogging will have hundreds of years from now as researchers try to understand what pepole were thinking and doing way back at the turn of this millenium. I marvel at the research done by Edward Gibbon as he wrote the six volmues of the History of the Decline and Fall of the Roman Empire. As I read his autobiography and also that of Benjamin Franklin recently I thought how awesome it would be if they had been able to blog their thoughts.

I don’t say much in the blog about my wife, our four children, or the three grandchildren (about to be four). I leave it to them to decide what and how they want to share. I will just say that I am proud of them all. Thanks to Irving for inspiring me to write something about e-tirement. Now when I mention the word in future posts I will have a permalink to point to!

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