Mitch’s posterous

Mitchell,

Congratulations on the new role! Enacting a rational IT infrastructure is clearly one of the crucial steps required to make our healthcare system work. It's shocking to see how this industry has clung to its old tools. In what other (profitable) business segment do you still see people regularly using typewriters?

I'm looking forward to seeing you craft a plan to enable real progress here. Exciting times.

Fantastic news, Mitch. You're a great addition to the effort.

As a Kaiser member, I appreciate how they've worked hard over the years to come up with a respectable and very usable IT system. I like everything I see (as a patient) about their networked integration of primary care docs with lab, pharmacy, hospital and specialists. I like the features and access provided on their member site. I love the way my doc logs in, checks my history, keys in his recommendations (automatically emailed to me), and follows up in email. It's a comfort knowing that they're keeping track and proactively alerting me to my own health maintenance needs.

Paired with their integrated services, Kaiser's HC system is way more efficient and navigable than other providers I've been cursed with. Kaiser is heavy on the preventative and conservative in prescribing expensive medicines and procedures. You see their doctors consciously trying to keep you healthy while also holding down costs. Sane.

But in spite of (or because of) Kaiser's focus on prevention and networking efficiencies, they are only a pinch less expensive and restrictive (pre-existing conditions) as other plans. You save time and headaches not having to search for specialists on your plan (who are taking new patients), but it's still priced at the edge of affordability for someone my age, though I've followed their advice and stayed healthy. This pricing and member restriction model is Insane.

I'd like to see Kaiser Permanente get more in cahoots with the Kaiser Foundation to make KP's healthcare affordable for more people.

I'm sure KP's IT experience has been studied and reported, but how good is it as a model for other providers if their various in-plan services aren't all in-house?

Kaiser is an existence proof of the value of good health care IT (affordability notwithstanding).  Since they employ the doctors, set the rates, and own the hospitals and pharmacies, they have a degree of vertical integration in which they have both incentives  and means to control costs using IT.  In the more typical widely decentralized arrangements, those incentives are, as yet, still really lacking.  So, while Kaiser provides an existence proof, it's not a replicable model.

Hi Mitch,
this is fantastic news. I'm curious if you think there might be overlap between the kinds of IT infrastructure you will be thinking about for health care and that which is needed to advance education? For example, I think we desperately need some version of an electronic learning record that kids take with them, similar to health records (although not exactly). I suspect there might be overlap worth considering?

The issues with respect to IT in education and health are broadly similar and I do hope over time to develop a unified understanding of how to do IT as socially beneficial infrastructure. That said, the specifics are so different, I'm considering them as separate domains, at least for now.

hcd,

That's an interesting idea. I work in informatics at Children's Hosptal Boston and there have been some thoughts over the years about using PHR infrastructure, las a generic longitudinal record.

The challenge of any such longitudinal record whether in healthcare or education is interoperability. However there is some emerging technology, Semantic web, that could potentially make interoperability much easier. That could facilitate a lot of the potential changes in health and also education.

In my mind, interoperability means choice for consumers, and an excellent quality driver for providers, and that's a strong driver for the change I'd lke to see.

The information flow - from appointment to diagnosis to treatment to reimbursement to retro-rating of premiums to annual reporting, etc., - so overwhelms the communication of medical opinion between patient and physician, as to be offensive to the entire system the provides health care.