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3/5/2013
09:14 AM
Chris Murphy
Chris Murphy
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HIMSS: Should Healthcare Be More Like Airline Industry?

Such a comparison says not only that the healthcare industry must change, but also that those changes will be dramatic and gut wrenching.

The boldest thing I heard at my first day at HIMSS 13, the big healthcare IT event this week in New Orleans, was that the healthcare industry needs to be more like the airline industry. What could healthcare learn from a financially strapped industry that people love to hate?

It's the fact that U.S. commercial airlines carried 52% more people in 2010 than they did in 1995, and yet they employed 2% fewer people. It's that airlines did away with unprofitable luxuries such as meals in coach and filled excess flight capacity. It's that airlines shed lots of jobs at front counters and reservation call centers and replaced them with kiosks and online bookings.

"We do a bunch of their work for them -- and we like it," said Warner Thomas, CEO of Louisiana's big Ochsner Health System, during his HIMSS opening keynote. People today would howl in protest if they lost the ability to look online for their own flights and could do it only by phone, Thomas said. "How do we get people to make more of their own appointments for us, to check their own results?" he said.

[ In related news from HIMSS, some major EHR vendors are moving to break down walls between products. See EHR Vendors Form Alliance On Data Sharing. ]

Comparing the airline industry to the healthcare industry was an inspired choice by Thomas. It says not only that the healthcare industry must change, but also that those changes will be dramatic and gut wrenching. Thomas also pointed to banks' use of ATMs to let customers do self service, and to retailers such as Amazon.com and Wal-Mart using analytics to acquire a better understanding of their customers and their own operations.

Thomas laid out the big number: Healthcare must be 15% to 20% cheaper. That's not going to happen without pain and radical change. "It's going to take changes in how we do business," he said.

One example of this radical change I saw on the HIMSS show floor was the startup HealthSpot. It offers a telemedicine kiosk for remote patient-doctor interaction that includes not only video, but also a blood pressure cuff, thermometer, stethoscope and other tools a patient could use on himself with the supervision of a remote clinician. As I walked the HIMSS floor, though, I was struck by how few ideas like HealthSpot I saw that involved really radical changes to the way customers interact with their healthcare providers.

In his keynote Thomas laid out three results he expects healthcare IT to deliver: safer, higher-quality care; lower costs; and happier, more productive physicians and other caregivers.

I doubt that last one will always be possible. Getting to that future state of healthcare, one that costs as much as one-fifth less, won't always make people working in the industry -- or getting service from the industry -- happy. The airline industry has had to make some very hard choices about what services it can and can't provide. Healthcare has many more of those sometimes unpopular decisions ahead of it.

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vliegers
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vliegers,
User Rank: Apprentice
3/26/2013 | 12:33:48 AM
re: HIMSS: Should Healthcare Be More Like Airline Industry?
Chris, the big factor I see from personal experience is the lack of "technology literacy" and irrelevant processes on the part of staff at the doctor's office. Here's my own experience (it's story style):
I called the doctor's office, and an automated receptionist quickly and pleasantly guided me to the G«£make an appointmentG«• option. The call was picked up within a few seconds and a person took me through the process of determining what type of appointment I needed, times open for me to choose, etc. She also asked me for a fairly detailed set of personal information, from age, address, medical history, to health insurance and employer information. That must have taken some 5 minutes to answer questions or provide information. But it was thorough and not hard for me to participate in the call. Good, I thought, they have captured a lot of information up front, so they must be using EMR.

When I turned up for my appointment, the receptionist asked my name and then handed me a clipboard with 4-5 sheets of paper on it, all fields were blank. She also asked for, and copied, my driverG«÷s license and health insurance card. As she returned my cards, she asked me to complete the forms.

I scanned the forms and noted that many fields asked for information that I had already provided over the phone earlier. I pointed this out to the receptionist and asked if the information was already in G«£the system.G«• My question must have been unexpected, because she replied somewhat abruptly, G«£we still need you to fill out the paperwork.G«• So, realizing that she must have been unaware that someone had already captured this data from me by phone, I sat down and spent some fifteen minutes duplicating on paper the effort of my call (and also signed a few necessary forms on privacy and financial responsibility, which was fine by me). I then returned the clipboard to her. Presumably that information will be (a) re-keyed into the system, or (b) scanned and retained and/or (c) retained in a paper file for x years. I wonder what they do if the information I first gave by phone does not tally with the information I entered on their forms?

In the treatment room, I was attended to by a nurse who carried a small laptop. She retrieved my profile and entered some text while asking me questions. Hmmm, I said to myself, they really DO have my record electronically, so why did I have to repeat the effort in the waiting room? Also, did her laptop have the information I gave by phone OR the information that I had written on the forms about 10-15 minutes earlier. Who knows?

HereG«÷s my perspective:
I like the telephone based info capture. I like the laptop based record keeping. Real time, direct entry.
I dislike the redundant form entry in the waiting room. DonG«÷t ask me to do something twice, just donG«÷t.
If you take my details by phone, then when I arrive, simply print my record (or steer me to a kiosk/tablet) and ask me to edit anything wrong or missing and sign it. You can then simply edit the EMR. I donG«÷t mind signing the privacy forms, but why not give me an electronic version?
Train your staff to know what has been done beforehand, to check the system beforehand. That way I wonG«÷t waste my time with paperwork and your staff will save time on re-keying (as well as reducing the risk of keying errors).
ThatG«÷s true electronic health care!

ItG«÷s PEOPLE, PROCESS and then itG«÷s TECHNOLOGY!
Tom Mariner
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Tom Mariner,
User Rank: Strategist
3/23/2013 | 4:08:47 PM
re: HIMSS: Should Healthcare Be More Like Airline Industry?
Whoa Chris, you are helping me go way back. In the dawn of computers in healthcare, Puerto Rico decided to form a network of connected health centers. We helped with IT that was initially modeled after on-line banking industry that we owned at that time, but found no direct model other than central mainframe and terminals there. We went to the "States" to get help -- none -- they were worse off than we were. Then we discovered the airlines -- they had this amazing reservations systems that matched a passenger family to a flight on a plane from a destination -- Perfect!

The steps forward in family medicine and controlled care were amazing!

Strangely, am still involved in helping our patients through technology including IT -- and Warner Thomas's words ring true. So I echo your headline of learning from Airlines (Really).
jaysimmons
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jaysimmons,
User Rank: Apprentice
3/11/2013 | 7:14:44 PM
re: HIMSS: Should Healthcare Be More Like Airline Industry?
With the greater convenience afforded to consumers, risks also need to be taken into account and more importantly the allocation of blame pertaining to these risks. As Andrew said above, the consumer isnG«÷t trained to take health measurements by themselves and even with a health care professional available for assistance, many things can still go wrong. In that case who would assume the risk, the consumer, the health care professional onsite, or the healthcare provider remotely?

Jay Simmons
Information Week Contributor
louisrosa
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louisrosa,
User Rank: Apprentice
3/10/2013 | 2:00:58 AM
re: HIMSS: Should Healthcare Be More Like Airline Industry?
the airlines do not have to carry everyone, just those that can pay the freight.
Michael Endler
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Michael Endler,
User Rank: Author
3/7/2013 | 5:24:29 AM
re: HIMSS: Should Healthcare Be More Like Airline Industry?
This sort of scenario came up during Cisco's Internet of Things shindig last month in San Jose. One participant asked what it would mean, for example, if IBM cures cancer. Cisco's futurists have described a lot of the ways healthcare could change that echo this article. On the one hand, check-up kiosks at the supermarket are just the beginning. At some point, basic health data could be continuously monitored by sensor-enabled objects in our daily environments-- a bathroom mirror, for example, according to Cisco. This information could detect illness earlier and more efficiently, enable better coverage in under-served areas and, when combined with other technologies, lead to much longer and healthier lives. It could also cut down a lot of overhead costs, once the infrastructure is in place. But then there's the dark side of the equation. Who owns all the data that's collected? What can be done with it? A corporation isn't going to invest in this sort of technology out of purely altruistic motives, after all. That said, most of the people Cisco gathered came from large, multinational corporations, and they weren't shying away from these concerns. If they're starting the conversation with an acknowledgement of the more dystopian possibilities, that's at least a little encouraging.
Michael Endler, IW Associate Editor
cbabcock
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cbabcock,
User Rank: Strategist
3/7/2013 | 12:09:40 AM
re: HIMSS: Should Healthcare Be More Like Airline Industry?
Getting consumers involved in their own health care can work better than many people think, if the health care providers really want it to. One real obstacle is the health care industry's tendency to engage in translucent, not transparent, practices, which leaves decision-making power mainly in the hands of doctors and other professionals. Not enough real information and choice is shared with the patient.It will be a major change to make the information transparent.Charlie Babcock, InformationWeek editor at large
ChrisMurphy
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ChrisMurphy,
User Rank: Author
3/6/2013 | 12:11:28 PM
re: HIMSS: Should Healthcare Be More Like Airline Industry?
i think you hit on a key piece of getting people interested and involved in their healthcare. but that's going to come as we all absorb more of the cost and financial risk. one way to do get them involved is convenience -- used this web portal to enter your information at home, and you'll be whisked into the doctor's office more quickly.
Thomas Claburn
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Thomas Claburn,
User Rank: Author
3/6/2013 | 5:03:28 AM
re: HIMSS: Should Healthcare Be More Like Airline Industry?
Or being told to leave the hospital because you're wearing a controversial t-shirt.
Andrew Hornback
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Andrew Hornback,
User Rank: Apprentice
3/6/2013 | 3:01:14 AM
re: HIMSS: Should Healthcare Be More Like Airline Industry?
If you want to reduce the cost of healthcare by 15-20%, I think the first place to look would be the mitigation and limitation of risk.

With regards to things like self-serve kiosks - how do they mitigate the risks assumed by the health care provider? You're essentially putting basic, triage level tasks in the hands of the consumer (an amateur, if you can call them that). Even when guided remotely by a health care professional, simple things like incorrect placement of a blood pressure cuff can cause diagnostic issues.

The second, and perhaps most important factor that I see, is that you need to get the consumer involved in what they're doing. When you have a consumer operating an ATM, they have interest in that it's their money that they're working with. When you have a consumer searching on-line for a flight, it's usually a trip that they're looking to take themselves.

Once you reduce risks (which reduces the cost of malpractice insurance) and get the patient more involved in their own health care, you'll start to see results.

Andrew Hornback
InformationWeek Contributor
Laurianne
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Laurianne,
User Rank: Author
3/5/2013 | 5:01:32 PM
re: HIMSS: Should Healthcare Be More Like Airline Industry?
In all seriousness, I hate to contemplate the healthcare equivalents of "no more pretzels."

Laurianne McLaughlin
InformationWeek
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