Shared Care Plan. This is a very exciting program. Shared Care Plan is clearly a major step forward in improving the communication between... [:: Chemo Chronicles '04 ::]

Craig Miles writes, "As a cancer patient, I deal with my cancer as a chronic illness and I found this document to be better than anything I had for keeping informed and for sharing with caregivers. I plan to share this with my healthcare team at Kaiser."

"Too often, we think empowerment is patient-oriented, I think this misses the point. The entire healthcare team needs to be empowered."

POLLARD'S PRINCIPLES OF KM, AND AN INVITATION TO JOIN AOK.

I am delighted to have been asked to be this month's moderator of the online forum Association of KnowledgeWork (AOK) featuring some of the founders of, and some of the brightest and most creative thinkers in, the discipline of Knowledge Management (KM). My subject for the discussion, which runs from March 15 to 26, is officially "Weblogs and other Personal Content Management and Social Networking Tools in KM", but the discourse is always wide-ranging, so just about anything about KM may be discussed. If you are interested in this subject, I welcome you to join AOK (sign up here -- it's free), read the introduction to this month's discussion here, and contribute your two cents' worth by replying to any of the discussion threads, or starting your own, either by e-mail reply (if you sign up to receive the discussion by e-mail) or by responding on the archive pages. All comments are reviewed and edited by Jerry Ash, AOK's extremely friendly and competent manager. Some of the members of AOK are a bit impatient with "technology-obsessed" KM practitioners, so to keep them interested in the discussion, I'm going to broaden the issue to encompass dialogue on the principles underlying my belief that Personal Content Management (PCM) and Social Networking applications are critical to the survival of KM in large organizations. Here are those principles: Pollard's Principles of Knowledge Management KM should be about Front Line Worker Effectiveness: The key 'value proposition' for KM must be improving the effectiveness (not the efficiency) of knowledge workers (defined by Drucker as 'anyone who knows how to do their specialized job better than anyone else in the organization including their boss' -- i.e. almost everyone on the front lines of the organization). In other words, don't worry about what 'knowledge' or 'knowledge work' is -- as long as what you're doing improves front line knowledge worker effectiveness, it's KM and you're on the right track. There is an Urgent Need to Improve Front Line KM & IT: If you talk to knowledge workers, they will almost unanimously tell you that they desperately need help in improving their work effectiveness, and that little of what KM & IT have provided thus far has been useful to that end. Knowledge Workers Don't Know How to do Knowledge Work: Knowledge workers perceive a crisis of information overload, and feel they do not have the time nor the skills to manage information effectively. Knowledge is Best Transferred by Conversations: The principal and most effective means of knowledge transfer in organizations is conversations, the best of which are oral and face-to-face, iterative and context-rich. Everyone Learns, Organizes and Processes Information Differently: Taxonomies, tools and processes that force people to use a different model for doing these things than the one they use naturally, will be resisted. Most KM & IT Tools are Unintuitive and Over-Engineered: Simpler is better. If you have to teach people to use tools they're probably too complicated. Best are tools and processes that emulate the natural 'information behaviour' and artefacts of workers i.e. mimicking their physical workspace (desk), the physical media (paper), and the processes (conversing, subscribing, stacking, shuffling, filing documents, highlighting, annotating, writing in and crossing out with a pencil) they intuitively use to acquire, process and disseminate information. Conversations Rarely Include the Best Possible Experts: The risk and cost of misuse (theft, hacking, inappropriate use) of knowledge pales in comparison with the risk and cost of not using the best available knowledge. That includes not knowing who the best experts are (inside & outside the organization), and relying on lesser expertise. Management Doesn't Want or Need KM Decision Support: Executives are hired and paid top salaries because they supposedly have the skills, experience, judgement and instincts to make near-optimal decisions quickly. They pride themselves on their ability to make decisions with imperfect information. They use their selected inner circle of advisors as a sounding board. They (mostly) don't use KM systems. KM is not for them, it's for the Front Line Knowledge Worker. A major KM challenge is that management is paying for it, but they don't use it themselves -- a hard sell. Stories are Critical to Knowledge Transfer: More than just examples, stories are a language for translating knowledge between our personal, unique, unfathomable mental models. A good narrative is almost inherently more effective, clearer and more persuasive than a good exposition or a good analysis. If we can teach knowledge workers to tell, and write, good stories, we can massively increase the value of stored knowledge. Humans are Inherently Poor Collaborators: You can't just blame poor tools for the lack of progress in virtual and asynchronous collaboration in business, and the failure of team and community knowledge tools and 'spaces' to get much traction -- at least beyond the short life and limited purpose of specific projects. Business by nature is undemocratic and uncollaborative: The hierarchy exists to reinforce that instructions flow down, work is done by individuals according to those instructions, and the results are reported back up. There is little room (and often little perceived need) for consensus building or any of those warm fuzzy things we are taught to do in Teamwork 101. In fact, most teams exist principally to dole out tasks to their members and aggregate the status and results of that individual work. Even inherently collaborative tasks like editing are usually done sequentially by individuals. If it's really important to improve collaboration and teamwork in organizations (i.e. if it's not just a smokescreen by management to make the organization appear more democratic), we're going to have to fundamentally change the way businesses are organized and operated. You might even have to change our human culture (or at least fire all the males). Much of What We Do at Home is Also Knowledge Work: The commercial applicability of tools developed to improve knowledge worker effectiveness could also be leveraged for home use. Example: If you want to move videoconferencing out of the stone age, figure out how little Janey in Seattle can use it to chat and play with Grandma in Florida (and remember principle 6). My argument for focusing KM first and foremost on improving (and simplifying) the Personal Content Management and Social Networking tools available to knowledge workers follows directly from these principles. Without good tools we cannot support effective processes and bring about productive behaviour change. Inherent, too, in all these principles is the need to stress quality over quantity -- we need fewer, simpler-to-use tools with fewer, intuitive functions, and less, better-quality, more useful content. I am hopeful that much of the AOK discussion will be about principles 4, 7 and 9, because even with best tools in the world, there will remain cultural and learning obstacles to effective knowledge work and effective knowledge transfer. I look forward to seeing you on AOK

[How to Save the World]

Building Trust, by Flores and Solomon is a really good book. I rank it with The Wisdom of Insecurity, by Alan Watts as two of the most mind altering books I have read. Watts turned the conventional wisdom of insecurity on it's head, essentially showing that security or fixedness is closer to death and that insecurity or uncertainty is closer to life. When his wisdom sinks in, one comes to appreciate insecurity for what it is--the experience life-giving growth. On can then quit amplifying a certain amount of natural stress, by dropping the judgment that insecurity is bad.

Flores and Solomon turn broken trust and betrayal on their heads, as Watts did with insecurity. They allow one to see that trust and betrayal are sides of the same coin (one meaningless without the possibility of the other) and they also allow one to see that creating and rebuilding trust is the key act in creating a better and shared future. Without such acts of trusting and rebuilding of trust from moments of betrayal, no better future is possible. Trust is not a thing to be shattered. Trusting is a competency for all forward looking people to practice and learn--a verb, not a noun.

Below is a kind of relationship diagram that captures some of the ideas that filled my head as I read the book.

PatientPowered.org wins award!

My invaluable assistant, Jill Hickok, told me about an NPR presentation on the use of story telling in medicine. We are trying to do something similar in Whatcom County to heighten the awareness and understanding of the relational aspects of medicine, especially chronic conditions.

We are coming to believe that among all the change and stresses of medicine the experience is loosing it's meaning for some providers and patients. Focusing on people and their stories is one way to combat the cynicism fostered by a broken or non-existent system of care. Most of us came into the profession because of a love people and a deep interest in people and their stories.

Here is a link to the NPR piece: http://www.npr.org/features/feature.php?wfId=1480863   (I hope their RealPlayer download works better for you than it did for me. May be a firewall issue. I will try it at home tonight.)

Here is a link to a piece on the physician that is spearheading the effort, Rita Charon, M.D., Ph.D.

http://litsite.alaska.edu/uaa/healing/medicine.html

Here is a link to a biosketch on Dr. Charon. http://www.medinfo.ufl.edu/other/histmed/charon.html

I hope to learn more about this approach.

 

I have heard Dr. Rachel Remen talk about the power of story telling.  I find stories more transformative than powerpoint and analytical data. Perhaps it is because they contain what we find most interesting and important--other people.

Here are links to her work: http://www.rachelremen.com/; http://www.meaninginmedicine.org/about_fmm.html; http://www.almanacnews.com/morgue/2000/2000_04_12.hfa.html.

When we began the Pursuing Perfection journey with IHI and Robert Wood Johnson foundation, IDX leadership started that journey with us, traveling to Boston and meeting with all the participants.

Today we had the good fortune to meet Mark Leavitt, MD, an internist who started Medicalogic company and developed the ambulatory medical record Logician.

I must say that the similarity of vision that among Mark, Malcolm Gleser, (founder of Phamis--now IDX LastWord and CareCast), and this community is remarkable. Kindred spirits.

In an complex environment of medical information software and mal-aligned economic incentives for connecting and deploying electronic medical records--this alignment of vision and value is cause for hope and continued collaboration.

Mike Raymer, head of LastWord division of IDX, joined us for discussions with patients and several of the participants in Pursuing Perfection in Whatcom County, WA.

I hope to report on opportunities that arise from our common vision and from a real intention to work together on the behalf of the patients in this community.

Let's hope.

Some interesting thoughts about weblogs in corporations: http://www.mcgeesmusings.net/2003/06/16.html#a3376

Here are suggestions from Todd Brehe on weblogs in business. Sooner or later this level of openness and commitment to what we think and do will arrive.  I believe that organizations that can take this step, from paternalism toward their employees to partnership will begin to dominate their industries. Yes it is a prediction.

http://www.optinnews.com/read-article.php?id=1718

John Udell reports on seperating rules form databases. Boy do I ever agree. We have looked at Blaze Advisor to do this sort of thing. I am hopeful.

http://weblog.infoworld.com/udell/2003/05/16.html#a692

Today we program this stuff in procedural languages, and we make a hell of a mess doing so. Wouldn't it be great if we could declare a bunch of rules and have a rules engine work out the consequences? As Ted points out, this is the moral equivalent of using SQL to say what you want done with data not how. [Full story at InfoWorld.com]

We have the streaming audio and video (QuickTime) server installed and will begin the learning curve to enhance the patients' and healthcare workers' stories with multimedia on the web. We have begun a discussion to track our progress: http://www.wwpp.org:8080/wwppDiscuss/discuss/msgReader$50. Follow along if you are interested.

I have been using Groove (http://www.groove.net)  for a little while. I think that it is the third and essential piece of information technology needed for cross-organizational communities of learning. (not counting e-mail which I take for granted). The first is Weblogs--the place to hold context, to get to know people. The second is something like WebCrossings--a place to have and keep discussions and documents by topic. And third, Groove for private, secure, multi-participant collaborations.

Here is a link to a web post that describes how I think Groove fits in. I like the idea "center to edge to center".  We get what we know from the center, we take it off and work on it and we return it with our innovations and learnings to the center for others to then elaborate and improve upon. So Paresh Suthar, in his own words http://radio.weblogs.com/0111019/2003/05/08.html

Word Bursts.
Six months ago I said I would write about blogging as a topic -- to try to capture my thoughts about how profound and important blogging is. There has been so much written by so many thoughtful people that it would be hard to offer new ideas about it and frankly, I have been putting off the task. Yesterday I got an email from Irving Wladawsky-Berger, my friend and former boss at IBM, about Word Bursts. Irving's note motivated me to get going and put my thoughts down -- time to blog about blogging.
----------
I think the biggest economic potential of blogging is inside the firewall. Intranets are now cluttered with millions of pages of “stuff” and most of it is poorly organized and the relevant things are often hard to find. To some extent the intranet has become an information dumpster. Portal software (like WebSphere) is making an impact but there is a long way to go for most organizations. Every company, government, university or non-profit has inside "experts" and people really care about what they think. They would find it much more productive to go to the expert's blog than do a search with the intranet search engine. Knowledge Management is not an “in” term but to me that is what blogging is about – sharing knowledge. (read more), See John's short bio, [John Patrick's weblog]

In my first post into the category of Transformation, I must say that I am deeply skeptical that leadership as we currently understand it has much to do with transformation. What caterpillar has ever planned to enter a cocoon to come out as only God knows what? Who will lead their organizations into the radical process of transformation?
    Learning about organizational and community transformation is essential if we are to bridge the chasm between the quality of care patients could have and what they currently do have.
   Transformed mental models may need to precede any organizational planning for transformational change. This is a true opportunity for exploration and learning.

The Cluetrain Manifesto has something to do with Transparency and with Patient-centered and more. I had never seen it until tonight. It is definitely not business as usual.

This is something that a community could support and afford that may not be adopted by many small practices. If the usual adoption delay in health care, 10+ years applies, maybe it is on the horizon.

I have been watching and wanting this for about 7 years.

We have been working on many fronts.

Carolyn Turkovich: Team development

Jack Homer and Gary Hirsch: Systems dynamics modeling and simulation for cross-organizational policy making.

Bill Mahoney: Social Network Modeling to understand, strategize, and communicate relationships and spread (contagion). Also, Bill thinks that teamwork at the microsystem level is the key to change and I certainly agree with him.

Gene Nelson: Bill has recently directed me to the work at Dartmouth on microsystems.

Bobby Milstein: innovated by linking System Dynamics and Social Network Modeling and he has focused on the community level.

Jack Silversin: teamwork and cooperation in health care.

I have worked for years on the information flow and human connections between microsystems and between organizations.

This interesting book pulls much together and I think the models articulated here will form the basis for models we can share in this community to show how the community health care system (however dysfunctional) works and how it can work. I recommend it for all of us: Small Groups as Complex Systems: Formation, Coordination, Development, and Adaptation.

http://www.amazon.com/exec/obidos/ASIN/080397230X/102-3988174-1364949

I am not a research scientist of any persuasion so I hope these authors stand up to your review. In any event I see lots of options for using System Dynamics and Social Network Modeling to help folks understand the world in this new way. We may be able to usher in the needed paradigm shift called for in the IOM report--shifting understanding and focus from the parts (generally disconnected and sometimes broken) to systems. Rearrangement of parts alone will not get us where we want to go.

Several of you have heard me say that I hope Whatcom County becomes the next Framingham, but instead of the domain being population medicine it will be the sociology of medical systems at the community level. I believe that it is here that the customers experience the disjunctions and here that the capacity for leverage exists. In the literature and among my acquaintances I see very little attention to connections or to community. People may to be working on the things that seem possible or amenable to research, even if they cannot provide the level of transformation called for it the IOM Chasm report.

I hope that we can explain the situation in these terms, reorganized by these authors, and I hope that we do it in graphical and understandable ways.

Let me know what you think.

Dr. Jacob Reider will continue to discuss the prospect of the American Academy of Family Practice creating an open source EMR.

WSJ.com - The Informed Patient.

Big news day .... Today's Wall Street Journal has this report on the AAFP's efforts to create an open-source EMR. 

I've got to run .. but I'll comment on this later today.  Very interesting that this is making such big news.  It's good.  But I'm guarded about the AAFP plan.  HERE IS HIS FOLLOW UP

[Family Medicine Notes]

Here are three new documents on Idealized Design of Clinical Office Practice. Each is well worth the time to read, study, and then implement the ideas and suggestions contained in them.

Microsystems in Healthcare: The Essential Building Blocks of High Performing Systems (Exec. Summary for Health Care Leaders. (PDF file format)

Clinical Microsystems Action Guide (PDF file format)

Putting the Pieces Together--a complete primary care system redesign (PowerPoint file format)

Be patient all three are large files and will take some time to down load. The first two documents are from Dartmouth, the thrid is from Alaska Native Medical Center, an internationally recognized leader in implementation of these innovations.  Happy reading. What you learn will prove to be critically important to your business and your persoanl satisfaction with medicine.

Bill Mahoney sends us a very useful web link: http://clinicalmicrosystem.org/ 

These folks give us much useful information on clinical work place improvements. Robert Wood Johnson Foundation supports their efforts. There is a strong team involved in the work and tools make available from this site. OD specialists and Process Engineers/Facilitators will find it useful as will folks in clinical work units.

For the pursuing perfection grant we have the challenge of creating spread of the innovations in care and also the challenge of implementing sustainable changes to the system.

At AMIA (the American Medical Informatics Association) this month I learned about a movement that is likely to make healthcare more sustainable: it is the internet communities that support patients with chronic diseases (each other) 24 X 7 at no cost and with high levels of user (patient) satisfaction. This movement is likely to reduce the pressure on over-burdened primary care physicians and specialists.

As Dr. Tom Ferguson says, "Condition-specific electronic support communities appear to be best at what doctors are worst at and worst at what doctors are best at."

Here is an interesting post  from the a retired IBM CIO.

You can subscribe to John Patrick's web log by placing http://patrickweb.com/weblog/rss.xml in your NEWS Subscriptions.

Health Care Integration. (From John Patrick)

I just read a piece in CIO Magazine entitled "Health-Care Integration May Be an Expensive Prescription". The story talks about a bill proposed by Senator Edward Kennedy which would require that hospitals, doctors' offices and insurance companies develop systems for sharing administrative and patient data. The story says that experts in health-care IT "are leery" of backing the proposal without "proof of its ROI". I don't belittle the importance of ROI overall -- spending money without a ROI is foolish.

On the other hand some things seem so obvious. Did companies do a ROI analysis to decide to buy a fax machine? Would a company without a web site have to do a ROI to invest in one? I believe we are about two percent of the way into what the Internet has to offer. When we get to esoteric applications then it will be time to sharpen the pencil and discriminate between investment opportunities based on ROI. I am not suggesting that prioritization isn't important at this stage too but there are some things that businesses should be racing to do regardless of the ROI calculation. We are not even to the early stage of addressing the basics. (read more)

[John Patrick's Weblog]

TouchGraph GoogleBrowser.

3. TouchGraph GoogleBrowser V1.00 (12.1 points). touchgraph googlebrowser ... TouchGraph ... The TouchGraph GoogleBrowser [( blogdex : recent )]

» Interesting to look at but I'm not sure of the practical applications for this yet.

What does a visualization of these backlinks tell you?

Why is it useful to be able to visualize these particular networks?

Are there useful metrics that can be applied to give conrete information?

 

[Curiouser and curiouser!]

Information should automatically appear where ever it is needed on the patient's behalf.