Patient portal... what to do and who to ask... that's the latest dilemma. In order to build the portal with a proper interface, questions need to be answered. In order for the questions to be answered, people need to be identified to be asking the questions of. Identifying the people likely requires understanding of the process and what might work into the natural course of things best. Questions such as the following are arising and possibly keeping development from moving forward:

Who has access to the portal?
Are there varying levels of access depending on who is accessing?
Which providers are given access?
Is the provider portal inter- or intranet based?
What is the process for assigning logins?
What support is provided and by whom?
What is the process for re-assigning lost passwords?
What is acceptable proof of identity to get re-assigned a lost password?
Are there legal implications to the decisions made surrounding any of these questions?

...and I'm certain there are plenty more. The real issue is identifying the who's and how's in getting questions such as these answered. Do we form a committee? If so, who resides on it? etc..... Perhaps this has already been thought out and a solution exists. If so, it's time to share those thoughts with Web Services (especially Michael Sheehan). Perhaps some of the Shared Care Plan Summit can be spent in discussion around this issue?

Here's some information Michael has shared about his vision of the portal will work:

5:05:48 PM     comment []   Annie's Weblog     

My favorite piece of Bohm, et al's Proposal on Dialogue is the final paragraph:

"The spirit of Dialogue is one of free play, a sort of collective dance of the mind that, nevertheless, has immense power and reveals coherent purpose. Once begun it becomes continuing adventure that can open the way to significant and creative change."

4:50:17 PM     comment []   Lori's site     

Please see Marc's post, and do contact me if you would like to join our Dialogue Group.  Click on this link to view a short slide show which sets the stage for Dialogue.

Marc's Weblog. Notes from Marc Pierson before you read this proposal by David Bohm and others: This is proposal is kind of long and kind of technical and abstract. You may not like it or finish it. You may want to read at least the last section on dialogue in existing organizations. Dialogue itself is simple (if you join a group with some experience), immediately rewarding, and profoundly eye opening. You can read about it and/or just do it. In either case if you want to join our dialogue group in Whatcom County--if you are in healthcare or you are a patient or you are in a patient's support system--contact Lori Nichols (LNichols@hinet.org) for dates and times. The meetings are usually every other Wednesday from 1-3 PM. [WWPP]

4:02:53 PM     comment []   Lori's site     

Hard to believe it has been a month since we hired 8 staff to support healthcare redesign across a community.  2 more individuals will join us this week and soon the final data analyst position will be filled.  During this past month, we have built a cohesive team both excited and overwhelmed by the task ahead.  Role clarification is an ongoing process.  This is to be expected as roles have not existed quite like this before and the human dynamic of change and transition does not elude even the most talented and gifted staff.  Passion about the vision of patient-centered has not waned.   Some milestones achieved in the month include: 

• Identification of referral criteria for patients who need the services of a clinical care specialist, forms and the process of service have been developed.  The first patients were referred last week!  We are already making a difference in the lives of patients. 
• Development of a communication/document management website to post all work/documentas and teams that will implement the vision of a healthcare system across organizations is complete .  This site will work in partnership with Radio.  Feedback is welcome.
•  Began the data analysis of each organization's costs and payment for diabetes services in anticipation of Systems Dynamics modeling to occur this week. This has attracted the attention of Medicare Region 10 and congressional representatives.  Opportunity to highlight this work because of the leadership of Mark Donaldson of Group Health Cooperative has resulted in an important meeting of the minds tomorrowl.
• Networking and the building of relationships with the pilot sites has begun.  Visits to Fernadale Family Medical Center and Center for Senior Health has introduced the project staff to clinic staff who everyday strive to make a positive difference in the lives of patients in Whatcom County.
• Presentations have been made to community groups, hospital staff and a bi-weekly article called the Pursuing Perfection Corner has been launched in the St. Joseph Staff newsletter
• A single medication list across the community is closer to reality due to the excellent work of a CHF Medication Team under the guidance of Carol Boston-Fleischauer.  This team with 3 patients as full participants, retail pharmacy, and home health joined clinicans from the pilot sites to identifiy significant barriers to safety.  They have made recommendations about first steps and implementation teams will begin the work of process improvement in this area.

.......and we have just begun!

11:25:29 PM     comment []   Mary Minniti's Site     

This is proposal is kind of long and kind of technical and abstract. You may not like it or finish it. You may want to read at least the last section on dialogue in existing organizations.

Dialogue itself is simple (if you join a group with some experience), immediately rewarding, and profoundly eye opening. You can read about it and/or just do it. In either case if you want to join our dialogue group in Whatcom County--if you are in healthcare or you are a patient or you are in a patient's support system--contact Lori Nichols (LNichols@hinet.org) for dates and times. The meetings are usually every other Wednesday from 1-3 PM.

9:13:10 PM     comment []   WWPP     

Our current directory is here ->Directory

Then we can build our structure based on our interests and our focus. ... They can include anything we are interested in because we can just add another heading to the topic tree.

For instance, I have started a WWPP weblogs source based on state. We can also have a WWPP weblogs source based on the realm of health care that the author is working in. ... Anything else?

1:13:16 PM     comment []   wwppDiscuss News     

The intent for "Directories" is to create a logical way of finding our contributors as we get larger. It also gives us a very good way to organize our sources of information.

"Directories" is an outline that is housed on a single manila page. That makes it easy for us to have several people organize the outline.

9:13:07 AM     comment []   WWPP     

How do we begin to see more clearly the importance of connections?

What mental models and physical models can help us see the connections and the connected actions that can link the parts and pieces of health care?

The Chasm report challenges us to focus on the separations and the need for linkages. The ten simple rules or ideas essential for crossing the chasm include: cooperation among clinicians, knowledge is shared and information flows freely, care is based on continuous healing relationships, the patient is the source of control, safety is a property of the system, transparency is necessary, needs are anticipated, and waste is continuously decreased.

Simple yet compelling metaphors are needed. Bridges may be such a simple strong image that can help us change the culture to focus on the gaps and barriers that prevent the system from working on the patient's behalf. These same gaps constantly frustrate and demoralize health care workers. Can we begin to see ourselves and our organizations as islands that the patient must get to and from? Our patients may be swimming in cold water between our islands. If we can see ourselves as islands then we may be able to begin to see the bridges, or land fills, or boats that can connect the patient to us and each of us to the other island that patients must navigate to and from. I believe that the patient frequently must carry the cargo from island to island, since it does not reliably get across the gulf or chasm consistently in any other way. How shall we assist our patients as the journey from our island to other islands?

11:13:08 AM     comment []   Marc's Weblog     

Today I made a presentation on Pursuing Perfection to the Whatcom Coalition for Health Communites. It was well recieved. I made 3 key points:

1) It is about SYSTEMS, specifically Complex Adaptive Systems. This is the new paradigm. The essential shift in perspective from parts to connections, from mechanical systems to adaptive systems.

2) PATIENTS must be at the center, of everything. This is the key to the successful design of a system of care that works and that can be funded.

3) COOPERATION among clinicians (teams, leadership) is the real frontier. Healthcare cannot be improved in any substantial way until we develop competencies in cooperating on the patients behalf to build the systems they need.

I gave everyone Berwick's Users' Manual to the Chasm Report and Plesk's appendix on Complex Adaptive Systems. I talked from this graphic of our project.

There was much discussion of "social capital" or the lack there of. More later.

10:13:18 AM     comment []   Marc's Weblog     

The Chronicle of Higher Education: 'Superarchives' Could Hold All Scholarly Output. Several colleges are now looking to share more of that work by building "institutional repositories" online and inviting their professors to upload copies of their research papers, data sets, and other work. The idea is to gather as much of the intellectual output of an institution as possible in an easy-to-search online collection. [Tomalak's Realm]

È Interesting article.  Here's a taster:

Several colleges are now looking to share more of that work by building "institutional repositories" online and inviting their professors to upload copies of their research papers, data sets, and other work.

Some imagine a day when every research university gives its research away through the Web, allowing scholars and nonacademics to mine it for ideas and information.

Institutional repositories could create an alternative to journals, fans of the archives say.

Journal publishers, meanwhile, say that such repositories are unlikely to supplant their publications.

Journals, they argue, are still the best means of distributing and preserving research.

And even some of those supporting the new archives recognize the difficulty of getting professors to change their habits.

"We've had pretty serious interest in the system from about 30 major institutions," Ms.

What: Massachusetts Institute of Technology's project to develop a superarchive, as well as software tools for creating and maintaining the repository.

The tools will be offered to other colleges that want to use them.

When: DSpace has been under development for two years.

The university is testing it this summer, and plans to make the software available free to anyone in the fall, when the university will invite all professors at MIT to contribute to its archive.

What: Free software developed at the University of Southampton, in Britain, to help individual scholars, departments, or universities create archives of research papers online.

An updated version was released this year.

What: A series of "metadata" codes that librarians or others can attach to research papers to help search engines pull out desired information.

Universities are funded out of taxation.  The fruits of their research should be made available to all, for the benefit of all.

[Curiouser and curiouser!]

1:13:09 PM     comment []   WWPP     

Work-aholics take note: new research indicates that morning sleep and afternoon naps aid mental and physical learning. Scientists have known for some time that sleep can improve the brain[base ']s acquisition of new facts and skills, but its effect on previously learned knowledge was not known. To that end, two studies published this month in the journals Neuron and Nature Neuroscience suggest that snoozing can reverse "burnout" from information overload and improve motor skill development.

1:13:08 PM     comment []   WWPP     

At the bottom of the instructions page is a part of our instructions outline meant to help you upgrade your theme. That area has links for the new parts and instructions on how to protect and reinstall your personal ownerPicture.jpg

1:13:07 PM     comment []   WWPP     

Met with Ron Stock re: Learning about Interdisciplinary Teams in a Geriatric Outpatient Setting.  He has discovered that change is most effective when you complete steps in the following order:  10 create a team culture- where people understand their roles. 2) Introduce evidence based protocols - change in practice  3) Redesign the work.  Sounds like we're on the right track.

He also suggested there are some good resources about Acute Care of Elder program based on interdisciplinary teams.  They are exploring these for the new hospital in Eugene.  Maybe a direction to explore with St. Joseph's.  The link is attached.

Opportunities to connect with others abound- Medicaid Case Mangement set for July 25th, Greenfield Site Visit July 29th, perhaps a Seattle presentation with CMS on Systems Dynamics Modeling/Simulation for July 15th.  Life is full of possibilities. 

1:13:07 PM     comment []   WWPP     

King-Drew: Not worthy of life support (Photo by Slobodan Dimitrov)

CAN HEALTH CARE FOR THE POOR AS IT NOW exists be saved in Los Angeles County?

The answer looks like "no." Even the Department of Health Services' (DHS) usual strong supporters -- Supervisor Gloria Molina, for instance -- seem resigned to an "inevitable" downsizing that will make for longer lines at fewer facilities. Or as the Times quoted her, speaking of her own constituents: "They're just going to have to drive farther, wait longer."

1:13:06 PM     comment []   WWPP     

Progress in information sharing, got Mary up and running with Radio, although she has not yet adopted the Radio theme.  Facilitated posting of the project plan on the Pursuing Pefection Web see link in title.  Scheduled to load Radio Monday on Annie Gort's pc.

Please let me know what you think about posting the error messages during this implementation phase.  I consider it doing our part for transparency.  Will continue to post meaningful text relative to installations in the interest of making this easier each time. 

I am excited to participate in starting this new and exciting forum for sharing information as we forge bravely ahead with the transformation.  

1:13:05 PM     comment []   WWPP     

1) Patients truly at the center, "radical patientcentricity"

2) First design the healtcare system that is needed.  Then and only then, design the payment system to support the idealized system design.

• Too frequently we have tried to create as system through manipulation of the payment structures. That is like trying to make a marionette dance through strings held by puppeteers who can't see each other, can't see the marionnette and don't agree on the dance. Together we can get the dance steps right. This is the first order of business if we are to improve the patients' and providers' experience, and deliver the needed quility and value.
• In our Pursing Perfection project will use group systems dynamics modeling and simulation to design the dance for a couple of chronic diseases first.

1:13:05 PM     comment []   WWPP     

The Supreme Court ruled this month that states had the right to insist on an independent review for patients whose managed health care plans refused to pay for a treatment or drug prescribed by their doctor.

1:13:05 PM     comment []   WWPP     

We have a WWPP 1.0.2 theme to be used with Marc Barrots activeRenderer tool. Marc has his own site called S L A M. Check it out if you get the chance.

We also have a WWPPflat 1.0.2 theme to be used without Marc's tool.

They both can be reached through our new installation directions page. Link -> Instructions

1:13:05 PM     comment []   WWPP     

Welcome - Mark Donaldson  5 minutes

Introduction of those present and their role/why are they here- All 10 min

Quick summary of P2 in Bellingham- Marc  15 min

Systems Dynamics Overview and Demo- Gary Hirsch Jack Homer  1 hr

Key principles, steps of process, why they are important, relationshiip of cost, quality, issues of overuse and underuse affects the system,  our work so far, , how this can help inform healthcare payment policy

Q& A and discussion on how by working together we can create a  more robust simulation All  30 minutes

Outcomes: Shared knowledge, generate some interest in cooperation in this area

9:14:50 AM     comment []   Mary Minniti's Site     

What a week and it's not over yet.   It has been an exhausting challenge to absorb as much information as possible about who all the "players" are, what teams they are on and at what meetings/events they need to be at and when.  It has been an amazing race given the time frame we had to work in and that it feels like everyone is on vacation right now. I think its finally starting to sink in. I have to keep reminding myself that I have only been here for the past three weeks. 

Our schedule for the Systems Dynamic consultants should be out by tomorrow.   

5:18:15 PM     comment []   Heather Wilson's P2 Site     

I met with Mary Minniti and Sharon Sheremeta today regarding patient education. A work team is to be formed with Sharon as the lead and me as the liason to P2. Our primary deliverables will be:
(1) Database of all current resources for patient education and evaluation of all resources for compatibility with the goals of P2.
(2) Spread of the IOM aims and rules - educate educators on this view and create a process for creating and evaluating educational materials that is consistent with these goals.
(3) Research and implementation of electronic education for patients (e.g. development of patient web sites)

I'm hopeful that we will be educating the patients and community on what this "new health care system" is that we're creating and provide information on how to navigate it most effectively and how to get the most out of it. I'm hoping we will successfully involve numerous patients in the process of creation.

Another arm of P2 beginning to reach out.

4:45:59 PM     comment []   Annie's Weblog     

I haven't had time to check this out but I use a similar product on my Mac and it is useful. My readers would probably appreciate it since I really cannot spell, even if my life depended on it. And I'm not a great typist either.

Spelling checker for IE (and Radio!). To Answer Kate Z's Question!.

"I urge any serious bloggers out there who haven't tried ieSpell yet to go over to www.iespell.com and do so.  Immediately!  The newest version now provides support for rich edit tools (like Radio's for instance) as well as AOL and other IE based browsers.  Worthy of a micro-donation for sure.

I'm going to suggest the possibility of user-defined short-cuts (or smart tags) to the author.  It seems like the perfect tool to provide all those cross-system, bloggers like myself a way to maintain a central list of shortcuts." [...useless miscellany]

[The Shifted Librarian]

È Well spotted Jenny, downloading now....

9:13:10 AM     comment []   Marc's Weblog     

A little esoteric but I chose to post it on the my Home page as well as the Radio Category page, due to the low volume of Radio traffic at this poing.

This feature seems useful as more users particiapte. I hope that Jack Mancilla watches this one closely on our behalf.

Why TrackBack?.

More on TrackBack for KM. If Gammel and Mower both think there is something useful in TrackBack who am I to argue? I don't undersand it, but I'm open minded about it. [Blunt Force Trauma]

È I didn't get it at first either, and nor has everyone I've mentioned it to.

What makes TrackBack so important is, I think, the following:

Imagine that I read someone like Jon Udell (which I do) and I find an item of his particularly noteworthy or relevant to me.  I post it from my news page and add some editorial content of my own.

But if, like me, you are a relatively new blogger then maybe very few people read my item and nobody bothers to click through to Jon's original.   My item never appears in his list of referrers.

This means Jon, likely, will not know that it exists.  We could imagine further that Jon would have liked to know what comments I made but he  never gets the opportunity.

TrackBack addresses this problem.  It allows me as the author of an item to "ping" the original during the act of publishing.  This ping does not require someone to read my item and then click through to his.  Simply by publishing he is notified that someone has referenced him.

I think this is a very powerful idea and will help to get new bloggers into the space.  For those with interesting things to say the time to migrate from the fringe to the centre will be drastically reduced.

Gimme! Gimme! Gimme!

 

8:13:05 AM     comment []   Marc's Weblog     

We need to get more people posting consistently. I'm trying to convince Heather that she has worthwhile stuff to post, but, as you can see by her lack of NEWS, I haven't been successful. Perhaps we should begin a heated debate or an intense discussion, only to be continued via this format... something intriguing to get people more active and involved.

When we spread this, I think it will be very important to begin it by stimulating responses of new participants. Once you get rolling, it's much easier. The first post was definitely the most difficult. Perhaps we could prompt people for posts with questions? Maybe we could have some sort of dialogue session? Pass a "posting stick" rather than the talking stick? I know we're low on numbers, so perhaps these concerns are unwarrented. I'll keep my daily postings coming as promised, even if the are sparse in content as this one is =)

9:13:15 PM     comment []   WWPP     

We need to get more people posting consistently. I'm trying to convince Heather that she has worthwhile stuff to post, but, as you can see by her lack of NEWS, I haven't been successful. Perhaps we should begin a heated debate or an intense discussion, only to be continued via this format... something intriguing to get people more active and involved.

When we spread this, I think it will be very important to begin it by stimulating responses of new participants. Once you get rolling, it's much easier. The first post was definitely the most difficult. Perhaps we could prompt people for posts with questions? Maybe we could have some sort of dialogue session? Pass a "posting stick" rather than the talking stick? I know we're low on numbers, so perhaps these concerns are unwarrented. I'll keep my daily postings coming as promised, even if the are sparse in content as this one is =)

8:13:11 PM     comment []   WWPP     

Today I made a presentation on Pursuing Perfection to the Whatcom Coalition for Health Communites. It was well recieved. I made 3 key points:

1) It is about SYSTEMS, specifically Complex Adaptive Systems. This is the new paradigm. The essential shift in perspective from parts to connections, from mechanical systems to adaptive systems.

2) PATIENTS must be at the center, of everything. This is the key to the successful design of a system of care that works and that can be funded.

3) COOPERATION among clinicians (teams, leadership) is the real frontier. Healthcare cannot be improved in any substantial way until we develop competencies in cooperating on the patients behalf to build the systems they need.

I gave everyone Berwick's Users' Manual to the Chasm Report and Plesk's appendix on Complex Adaptive Systems. I talked from this graphic of our project.

There was much discussion of "social capital" or the lack there of. More later.

http://www.wwpp.org/users/0000002/images/PtCtr.jpg

6:13:09 PM     comment []   Marc's Weblog     

We need to get more people posting consistently. I'm trying to convince Heather that she has worthwhile stuff to post, but, as you can see by her lack of NEWS, I haven't been successful. Perhaps we should begin a heated debate or an intense discussion, only to be continued via this format... something intriguing to get people more active and involved.

When we spread this, I think it will be very important to begin it by stimulating responses of new participants. Once you get rolling, it's much easier. The first post was definitely the most difficult. Perhaps we could prompt people for posts with questions? Maybe we could have some sort of dialogue session? Pass a "posting stick" rather than the talking stick? I know we're low on numbers, so perhaps these concerns are unwarrented. I'll keep my daily postings coming as promised, even if the are sparse in content as this one is =)

5:24:00 PM     comment []   Annie's Weblog     

A computer program is a complex bundle of instructions like a patient is a complex bundle of all kinds of things. Occasionally the patient needs surgery to remove something bad or to add something good like a new hip. We sometimes upgrade our software and, like surgery on a human, we must have all of our instruments and our team in place. ... Still, things go wrong.

If something goes wrong with software upgrades, we are lucky, we only lose some information we have already set into the computer.

We must minimize the effects of an upgrade gone wrong. Backup! Whenever we do something to the guts of our computers or our computers software. Backup!

I am working on a Radio tool that will backup all the important parts of Radio automatically, but in the meantime it is a good idea to save a copy of your Radio folder, every once in a while.

That means about once a week to me, AND right before you do surgery on your program.

3:13:20 PM     comment []   WWPP     

 The project we discussed will help to develop an initial, shared understanding of the problems concerning access to health care in Whatcom County.  Merely listing the problems and their components is not enough.  In examining these problems, we will use elements of the System Dynamics approach to understand the interrelationship of:

á        the availability of physicians and other care providers,

á        payment patterns and rates,

á        the nature and volume of care delivered,

á        consequences of that care for the health of the population,

á        impact of health status on future demand for care,

á        efforts to solve the problems such as physician recruiting, provision of alternative sources of care, demand reduction strategies, and changes in the nature of care that is delivered, and

á        effects of all of the above on residents, providers, payors, and employers and responses of each of these groups to the problems. 

 A System Dynamics approach should be especially helpful because the situation in Whatcom County is not likely to remain static.  These interrelationships have the potential for making problems worse over time and for thwarting attempts at solving the problems.  For example, delays in receiving care because of limited physician availability may lead to patients having more serious health problems that increase the demand for care, create additional costs that stress individuals, employers, and payors, make existing health care resources even less adequate, and potentially drive overworked providers out of the community.  Attempts to solve these problems such as recruiting more physicians may not succeed unless they are coordinated with changes in payment mechanisms and rates and the manner and efficiency with which care is delivered.

 Jack Homer and I will work with a group of health care providers and other stakeholders to identify the nature of the problem and its key indicators.  We will use System Dynamics diagramming techniques with the group to map causal factors that:

á        Create and maintain the problems

á        Produce consequences for community health status and costs to residents and employers

á        Can help to provide remedies for the problems, and

á        Potentially work against those remedies succeeding.

With the group and in analyses afterwards, we will use these maps to:

á        Enumerate potential impacts of the problems on various stakeholders

á        Identify data required for more extensive analysis and richer set of policy questions to be explored

á        Identify potential remedies for the problems including some that might not have been apparent without taking this systemic view, and

á        Examine how these remedies might interact and combinations likely to be most effective.

We would meet with the group one additional time to discuss and expand on these analyses and help think through next steps for the community.  At this point, we will also be in a better position to determine the value of going further with the System Dynamics approach which could include the development of a simulation model to project the impact of various sets of remedies.  The effort we are now proposing would be limited to mapping the causal factors and analyzing the implications of these maps as described above.  The results will be preliminary in nature and provide a good context for further analysis and action.

We will limit the costs by "piggybacking" travel on work we are already doing in Bellingham on chronic illness.  We will also be alert for potential overlaps between this project and the chronic illness effort in order to avoid any duplication.  We estimate that the cost of the project I have outlined above would be in the range of $10,000-15,000 for consulting fees plus any extra travel costs such as extra meals and hotel nights and possibly a share of our air fare.

 Please let me know if you have any questions or would like to discuss any aspects of the proposal further.

 Sincerely yours, Gary Hirsch [gbhirsch@attbi.com]

3:13:17 PM     comment []   Marc's Weblog     

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

È 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?

 

3:13:12 PM     comment []   Marc's Weblog     

Met with Ron Stock re: Learning about Interdisciplinary Teams in a Geriatric Outpatient Setting.  He has discovered that change is most effective when you complete steps in the following order:  10 create a team culture- where people understand their roles. 2) Introduce evidence based protocols - change in practice  3) Redesign the work.  Sounds like we're on the right track.

He also suggested there are some good resources about Acute Care of Elder program based on interdisciplinary teams.  They are exploring these for the new hospital in Eugene.  Maybe a direction to explore with St. Joseph's.  The link is attached.

Opportunities to connect with others abound- Medicaid Case Mangement set for July 25th, Greenfield Site Visit July 29th, perhaps a Seattle presentation with CMS on Systems Dynamics Modeling/Simulation for July 15th.  Life is full of possibilities. [Mary Minniti's Radio Weblog]

3:13:10 PM     comment []   Marc's Weblog     

1) Patients truly at the center, "radical patientcentricity"

2) First design the healtcare system that is needed.  Then and only then, design the payment system to support the idealized system design.

• Too frequently we have tried to create as system through manipulation of the payment structures. That is like trying to make a marionette dance through strings held by puppeteers who can't see each other, can't see the marionnette and don't agree on the dance.
• Only by working together can we get the dance steps right. This is the first order of business if we are to improve the patients' and providers' experience, and deliver the needed quility and value.
• In our Pursing Perfection project will use group systems dynamics modeling and simulation to design the dance for a couple of chronic diseases first.

3:13:10 PM     comment []   Marc's Weblog     

 The project we discussed will help to develop an initial, shared understanding of the problems concerning access to health care in Whatcom County.  Merely listing the problems and their components is not enough.  In examining these problems, we will use elements of the System Dynamics approach to understand the interrelationship of:

á        the availability of physicians and other care providers,

á        payment patterns and rates,

á        the nature and volume of care delivered,

á        consequences of that care for the health of the population,

á        impact of health status on future demand for care,

á        efforts to solve the problems such as physician recruiting, provision of alternative sources of care, demand reduction strategies, and changes in the nature of care that is delivered, and

á        effects of all of the above on residents, providers, payors, and employers and responses of each of these groups to the problems. 

 A System Dynamics approach should be especially helpful because the situation in Whatcom County is not likely to remain static.  These interrelationships have the potential for making problems worse over time and for thwarting attempts at solving the problems.  For example, delays in receiving care because of limited physician availability may lead to patients having more serious health problems that increase the demand for care, create additional costs that stress individuals, employers, and payors, make existing health care resources even less adequate, and potentially drive overworked providers out of the community.  Attempts to solve these problems such as recruiting more physicians may not succeed unless they are coordinated with changes in payment mechanisms and rates and the manner and efficiency with which care is delivered.

 Jack Homer and I will work with a group of health care providers and other stakeholders to identify the nature of the problem and its key indicators.  We will use System Dynamics diagramming techniques with the group to map causal factors that:

á        Create and maintain the problems

á        Produce consequences for community health status and costs to residents and employers

á        Can help to provide remedies for the problems, and

á        Potentially work against those remedies succeeding.

With the group and in analyses afterwards, we will use these maps to:

á        Enumerate potential impacts of the problems on various stakeholders

á        Identify data required for more extensive analysis and richer set of policy questions to be explored

á        Identify potential remedies for the problems including some that might not have been apparent without taking this systemic view, and

á        Examine how these remedies might interact and combinations likely to be most effective.

We would meet with the group one additional time to discuss and expand on these analyses and help think through next steps for the community.  At this point, we will also be in a better position to determine the value of going further with the System Dynamics approach which could include the development of a simulation model to project the impact of various sets of remedies.  The effort we are now proposing would be limited to mapping the causal factors and analyzing the implications of these maps as described above.  The results will be preliminary in nature and provide a good context for further analysis and action.

We will limit the costs by "piggybacking" travel on work we are already doing in Bellingham on chronic illness.  We will also be alert for potential overlaps between this project and the chronic illness effort in order to avoid any duplication.  We estimate that the cost of the project I have outlined above would be in the range of $10,000-15,000 for consulting fees plus any extra travel costs such as extra meals and hotel nights and possibly a share of our air fare.

 Please let me know if you have any questions or would like to discuss any aspects of the proposal further.

 Sincerely yours, Gary Hirsch [gbhirsch@attbi.com]

11:13:16 AM     comment []   Marc's Weblog     

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

È 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?

 

11:13:11 AM     comment []   Marc's Weblog     

Met with Ron Stock re: Learning about Interdisciplinary Teams in a Geriatric Outpatient Setting.  He has discovered that change is most effective when you complete steps in the following order:  10 create a team culture- where people understand their roles. 2) Introduce evidence based protocols - change in practice  3) Redesign the work.  Sounds like we're on the right track.

He also suggested there are some good resources about Acute Care of Elder program based on interdisciplinary teams.  They are exploring these for the new hospital in Eugene.  Maybe a direction to explore with St. Joseph's.  The link is attached.

Opportunities to connect with others abound- Medicaid Case Mangement set for July 25th, Greenfield Site Visit July 29th, perhaps a Seattle presentation with CMS on Systems Dynamics Modeling/Simulation for July 15th.  Life is full of possibilities. [Mary Minniti's Radio Weblog]

11:13:10 AM     comment []   Marc's Weblog     

1) Patients truly at the center, "radical patientcentricity"

2) First design the healtcare system that is needed.  Then and only then, design the payment system to support the idealized system design.

• Too frequently we have tried to create as system through manipulation of the payment structures. That is like trying to make a marionette dance through strings held by puppeteers who can't see each other, can't see the marionnette and don't agree on the dance.
• Only by working together can we get the dance steps right. This is the first order of business if we are to improve the patients' and providers' experience, and deliver the needed quility and value.
• In our Pursing Perfection project will use group systems dynamics modeling and simulation to design the dance for a couple of chronic diseases first.

11:13:09 AM     comment []   Marc's Weblog