Advice to new HIT professionals

Several weeks ago I was invited to speak to a Masters of Health Informatics class     at the University of Toronto along with two health IT thought leaders who I admire and respect.  Richard Booth, of the two instructors for the class, asked me and the other two invited guests to offer our thoughts on several topics including our advice to the students as they pondered their career options.  I  offered the following advice:

Learn from other industries.  While healthcare, like other industries, has unique characteristics, it also shares many similarities.   Since many other industries are further advanced in their use of information technology and in managing the digital information that they collect,  they offer many lessons that can be applied to healthcare.   I encouraged the students to seek out these lessons and figure out how they might be applied to the delivery of healthcare services.

To make my advice more concrete, I cited The Ottawa Hospital as an example of an organization that is actively seeking best practice examples from other industries.  For starters, The Ottawa Hospital’s CIO, Dale Potter, was hired specifically for his experience in other industries.   In turn, Dale has engaged organizations outside the health sector and created learning opportunities for his staff.  One such organization is Nav Canada, the agency responsible for air traffic control in Canada.  According to Dale, Nav Canada’s focus on moving people safely through the skies is similar in many ways to ensuring optimal patient flow through a hospital.

Listen and Observe.  Mark Douglas, co-founder of this blog and my frequent sounding board, likes to remind me that God gave us two ears and one mouth and that we should use them in that ratio.   Effective IT professionals in any industry are the ones that learn the business in which they work and figure out how to make IT useful to the organization and the people that work there.  I encouraged the class to take the time to listen to and observe the people delivering healthcare services and to work with them to figure how IT can make the most impact in their day to day activities.

Technology Drives Strategy.  My final piece of advice was, admittedly and quite purposefully, intended to buck what I see as a commonly accepted practice in healthcare IT.   I have heard numerous presentations over the past year make that the case that  business strategy and objectives should drive IT plans and architecture.  While I don’t argue that the merit of this seemly prevailing viewpoint, I think that it ignores the often disruptive nature of continued technology evolution.

Technology can and does drive business strategy.  Hence, I believe that one of the important roles of the healthcare IT professional is understand the possible impact of technology evolution on business strategy and to help the organization understand how it can take advantage of technology developments.  IT will drive business strategy as much as business objectives will drive IT strategy, whether an organization likes it or not.

Mike

 

 

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Guest Blog – South West LHIN Consumer eHealth Innovation Session

Richard Booth is a nurse and PhD candidate with a strong interest in the use of information in the delivery of healthcare services.  Richard has a particular interest in social media and is doing what he can to educate fellow clinicians on the power of social media.

Richard and I both attended the recent Consumer eHealth Innovation Session hosted by the SouthWest LHIN.  We both actively tweeted from the event and I asked Richard if he would write down this thoughts for a guest blog post.  The remainder of this post contains Richard’s observations on the event.

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On June 30th, 2011, I had the opportunity to attend the South West LHIN’s “Consumer eHealth Innovation Session” held at The University of Western Ontario. As described in Michael’s previous blog post, the event was billed to provide a venue for attendees to see how various eHealth tools were being used to support the LHIN’s eHealth strategic plan. On the agenda were a number of companies and organizations working with the SWLHIN, including Telus, Microsoft, thehealthline, Sensory Technologies, Sykes, Patientway, OTN, and CareLink.

Unfortunately, I was not able to arrive to the session until around 10:00am which meant I missed the introduction by Glenn and presentations given by both Telus and Microsoft. I’ll touch upon some of the points from each presentation I attended and outline what I thought to be salient:

• thehealthline.ca was presented by Brian Ashby. This online portal to health information in the SWLHIN looks to be a fantastic resource – similarly, the document “Help yourself through hard times” is a booklet that organizes all the key community and social resources that may be required by individuals and their families during “hard times”. What I think makes this document invaluable is that each organization/agency listed in the booklet has a descriptor of the services offered and hours of operation. This document is freely available on the thehealthline.ca website.
• Sensory Technologies spoke about their eShift 2.0 model for homecare. In a nutshell, in an eShift delivery model, nurses work remotely and act as a delegator and knowledge broker of healthcare. Personal Support Workers (PSWs) with extra training deliver the health services to the client, in the client’s home. The PSWs and nurses are connected by way of an iPhone, and if the nurse deems further care is required, a higher skilled assessment can be authorized and delivered to the client. I believe my tweet related to this presentation summarized my feelings regarding this care delivery shift: “eShift 2.0 is a delivery model I need to examine more closely. Like it or not, this typology of care delivery is the future #swlhin.” I will be curious to see how regulators like the College of Nurses of Ontario respond to the remote monitoring of patients by nurses and unregulated healthcare providers, like that outlined in the eShift 2.0 model.
• Sykes presented next, introducing a self-management care model – CareCoach and teletriage. The presenters also listed various other services offered by Sykes, including chronic disease management, tobacco cessation services, and health education services.
• PatientWay had an engaging presentation outlining their kiosk and way finding solutions that are currently used in a number of healthcare organizations around Ontario. Their concise and succinct presentation outlined how the use of their systems had significantly reduced costs for organizations, and at times, facilitated an increase in engagement by consumers. Jay from PatientWay described to me that by engaging consumers in a meaningful and productive fashion during their healthcare interaction(s), you can sometimes reduce the anxiety and stress of the situation. I guess the old mantra of ‘an active mind is a healthy one’ rings true in this instance. By engaging consumers during their various ‘wait times’ (i.e., waiting for registration or information taking), you can potentially increase efficiency and engagement consumer in the health process.
• Laurie from Ontario Telemedicine Network (OTN) presented next, outlining the results of their pilot research examining the effectiveness of remote monitoring technologies to support the healthcare of consumers suffering from chronic illness at home. Nurses at a family health team would remotely ‘check’ the results of their assigned clients in the community and decisions regarding care were made appropriately. At the end of the four month study, Laurie stated that many of the clients wanted to keep the remote monitoring technology as they had found value in its use. Yet again, another call to engage consumers in a meaningful fashion and move away from purely paternalistic approaches of health delivery.
• Finally, CareLink provided an interesting presentation on their suite of remote monitoring technology. The range of monitoring technologies offered by CareLink to ‘wire’ a house was extremely impressive. If/Than programming could be directly fed into the smart house to enable prompts to be pushed to caregivers in the circle of care (e.g., if Grandma doesn’t open the fridge and/or her pill bottles by 0900, a message is sent to caregivers prompting of the situation). Video cameras and other sorts of surveillance systems were also offered by CareLink as a means of being able to view in real time, a loved one living at home. In other words, CareLink modifies the current suite of home security technology for use within a health/individual monitoring context. What was not touched upon in the presentation were the potential ethical and privacy issues related to this type of invasive surveillance. Although I can see the functionality of this technology for some cognitively compromised populations, it does raise some important issues regarding autonomy and dignity.

The Innovative Ideas Workshop occurred after lunch – we were tasked with answering three brief questions related to how the technologies/ideas presented over the morning could be used to assist healthcare of individuals. The 30 minute task led to some interesting (and at times divided) discussions in the small breakout groups. This eventually fed into a large group feedback session led by Glenn who asked all groups to report their findings. In sum, these were the salient ideas I captured and tweeted during the discussion:

• LTC patients, and repatriating to the home is ‘doable’, but should be looked at closer as it is currently a difficult and cumbersome process
• We need to examine the 5 percent of the population who are the highest users of the health system. Engage and utilize eHealth in these areas appropriately improve care and reduce inefficiency.
• Need to refocus on the consumer; vendors need to work together to achieve this.
• Homecare is “imminently important”
• Business drivers from healthcare are currently missing – we need to use the data that the government currently has to help build a better business case
• Accountability – need more discussion on this topic, from all angles, including patients, clinicians, consumers, vendors, government, etc.

Upon closing, Glenn stated that he hopes to hold another event in six months time. The unfortunate lack of tweeting from the event was a bit of a surprise – the smartphone penetration in the room was 100% (we did a show of hands). At future events, I hope participants utilize twitter in a bit more functional and consistent manner. Similarly, I believe future events would benefit from having ‘consumer groups’ in attendance. There were a number of specific consumer groups mentioned and highlighted during the workshop (e.g., homecare, ALS, diabetes, mental health, long-term care, etc.). It would be interesting (and probably dynamic) to have these stakeholder groups present during the presentations and discussion. Finally, I was disappointed at the number of clinicians in attendance. At one point during the morning, a show of hands was requested for “practicing clinicians”. I counted only five or six out of the audience of well over 50. Although the reasons for the lack of clinician attendance is probably extremely multidimensional (e.g., workload, scheduling, potential lack of interest, etc.), it does warrant further reflection.

Overall, I was extremely impressed with the workshop. This was the first event that I’ve been to with eHealth vendors which felt collaborative, rather than competitive. Equally, it was one of the few instances where talk of ‘technology’ generally took a backseat to the ‘client’ and ‘health’. Normally at eHealth events, the discussion is extremely techno-medical-centric. This Consumer eHealth Innovation Session was a breath of fresh-air.

Richard Booth, RN, MScN

Social Media Panel at HIMSS Ontario AGM

It was an offer simply to compelling to refuse.  In my day job I was approached by HIMSS Ontario to sponsor their annual general meeting.  In return for this sponsorship I was given the opportunity to moderate a panel discussion on social media.  Given my company’s current efforts to encourage use of social media by healthcare organizations AND my personal involvement in various social media activities, I jumped at the opportunity.

The HIMSS Ontario AGM takes place next week on June 23rd, 2011 at the Royal Woodbine Golf Club; check out details here.   Four panelists will discuss “The impact of social media on health and healthcare”.    The panelists are:

• Richard Booth, a doctoral candidate at the University of Western Ontario and a fellow social media advocate
• Karim Keshavjee, MD, and CEO, Infoclin.
• James Williams, a privacy consultant
• Glenn Lanteigne, CIO, SouthWest LHIN

This panel offers a diverse perspective on social media and I look forward to a stimulating discussion.  Colleen Young, #hcsmca founder and expert community manager, has agreed to tweet from the event.

Anyone thinking about how to use social media in their healthcare organization should consider attending this event.  If you read this blog and decide to attend, please make sure that you introduce yourself.  I really enjoy meeting readers. For those of you who cannot attend the event, I encourage you to send your questions for the panel to either Colleen or me in advance of the event or even during the event.

Mike

Healthcare and social media – forgetting the ‘social’…again?

Richard Booth is a post-graduate nursing student, instructor at McMaster University, lecturer at the University of Toronto, and the Project Lead for the Registered Nursing Association of Ontario’s (RNAO) Nursing & eHealth project.  I have known Richard for several years and we have shared information on various eHealth issues from time to time.  As we are both interested in the use of social media in healthcare, I was thrilled when Richard offered to write a guest blog post on this topic.

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Over the last two years the interest in social media has become a palpable force within healthcare organizations in Canada and the world.  To date, I have been approached by three organizations interested in leveraging ‘social media’ in their clinical environments to spread their message or build awareness.  It has been from these interactions and my involvement within the informatics discipline that I’ve begun to notice a trend that is mirroring much of what I saw during the early rise of ‘eHealth’ back in the early-mid 2000s: technology first, people second.

The most commonly asked questions I receive pertaining to social media always seem to be technology focused.  There appears to be a consistent trend toward individuals wishing to implement the latest ‘buzz’ social technology, without first appreciating (or recognizing) the inherent complexities of the social environment in which the technology exists.  Worse still (and potentially more scary), I found that the majority of organizations I’ve come into contact with still do not truly appreciate the potential decentralization of power that social media imposes on the ‘owners’ of the information.  For instance, I’ve spoken with individuals who were upset that a pharmaceutical company linked to their blog/RSS feed without their permission.  This individual felt violated that information she put up on her health blog was being capitalized upon by others in a way she never intended.  My reiteration of “that’s kind of how social media works” did not do much to appease her frustration.

Equally, I’ve found that a number of healthcare organizations have truly underestimated both the potential and limitations of social media in the dissemination of health advocacy, awareness and promotion.  At this point, most of the ‘functional’ healthcare social media examples I’ve seen in Ontario have been developed in-house by technologically savvy individuals who were able to generate enough managerial/leadership support to have their visions implemented.  Similarly, some of the larger health organizations around Ontario have begun to create various social media policies that range in strength from Orwellian directives to flexible guidelines that encourage commonsense on behalf of staff/clinicians.  I’ve found these corporate social media policies to be excellent barometers of a given organization’s receptivity toward social media and their corresponding willingness to accept a decentralization of power in terms of communication with staff/consumers.  That said, there is currently significant diversity in opinions regarding the value of social media in healthcare and alignment of philosophies seems unlikely in the near future.  Since the return on investment of social media does not tend to align to traditional ‘success’ metrics, I foresee reluctance by organizations to treat social media as anything more than a playful novelty.  Hopefully time (and health consumers) will change this.  Recent examples of the power of social media during the Toronto G20 demonstrations (i.e., by the media, protestors, bystanders, and police alike) and the widely successful OldSpice viral commercials (http://www.youtube.com/user/OldSpice) will undoubtedly provide a bit of reinforcement to the potential importance of this modality of communication.

In the meantime I’ve created a basic social media policy outline that I use when speaking with individuals/organizations interested in the topic.  Normally I use this framework as a vetting tool to establish some sort of common ground between an organization’s expectations and the realistic outcomes that social media might be able to provide.  I also hope this framework outlines some of my previous arguments regarding the social environment in which the social media exists – this area is all too often neglected when speaking of ‘technology’.

Finally, although I realize this model still contains some significant conceptual gaps (namely in the area of sustainability, privacy/ethics, and consumer interactivity), it has helped me begin the process of framing how social media might interact with healthcare organizations in the coming years.  Similarly, as Michael noted on an earlier draft version of this posting, the interactive potential that social media provides appears to be missing from the following model.  Therefore the current iteration of the model presents a largely one-way framework of communication using social media in healthcare – hopefully in time, and as receptivity of this modality of communication is established, a true ‘social’ mode of communication will occur between healthcare organizations and the consumers they serve.  Given some of the arguments tabled in the preceding paragraphs, true interactivity with consumers will probably be a slow evolutionary process, tempered by concerns regarding privacy and information security.  It should be an interesting process to watch unfold over the next few years.

1) What is your purpose? What is the organization’s purpose?
2) What is your demographic?
3) How does your demographic access information/content in 2010-2011, and potentially beyond?
4) What is the message you want to convey?
5) Is this message important? It needs to be important to not only you, but others who will be reading it….and potentially important to those who it wasn’t even intended to reach (e.g., politicians, news, government, vendors, business, academia).
6) Tools (this is 6th on the list on purpose….technology should never come first…the people/message should)
7) How these tools and humans work synergistically together? (this will require some experience with said tools… if you are unfamiliar with the tools and are leading the project, I would suggest highly that you start to immerse yourself quickly).
8) How do you plan to evaluate success?  Your traditional metrics will probably not give you a good idea of the penetration or success.  You’ll need to rethink what ‘success’ will be in this decentralized, largely self-evolving modality of communication.

Richard Booth