#MEQAPI – Tweetchat Feb 2nd 2017 3ET

Next tweetchat: Thursday February 2nd, 2017 3:00-4:00 PM ET

Topic: Administrative and Clinical Workflow and Healthcare Improvement

MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare quality, and includes everyone from administrators to zoologists, and include physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

The following topics will be posed this week related to Workflow and how it relates to healthcare improvement and quality:

  1. What does care workflow mean to you, and where does care workflow start and end
  2. What care workflow risks and issues have you experienced, what harm or missed opportunity did you see
  3. How is poor care workflow contributing to the high rate of medical mistakes
  4. What role does/should technology play in improving care workflow
  5. How can providers and patients drive improvements in care workflow

Here’s some of those who attended the session:

 

meqapi-ppl

… and the Symplur analysis of the activity:

meqapi-perf

 

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#MEQAPI – Tweetchat Jan 26 2017 3ET

#MEQAPI – Tweetchat Jan 26 2017 3ET

Next tweetchat: Thursday January 26th, 2017 3:00-4:00 PM ET

MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare quality, and will include everyone from administrators to zoologists, and include physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

Three healthcare domains in which we might want to pay close attention are Care Policies, Care technologies, and care flow.

The following topics will be posed this week related to Health IT and how it relates to healthcare improvement and quality:

  1. What successes are there in Health IT – what is working well and how does that manifest
  2. What Health IT failed at least one element of Safety, Timely, Efficiency, Effectiveness, Equitability, Patient Centered – how
  3. What role should the government play in making Health IT improve healthcare cost, quality, and accessibility
  4. What role do the medical NGOs, journals, and professional bodies play in improving Health IT
  5. How can providers and patients drive improvements in Health IT

 

#MEQAPI Tweetchat Jan 19 2017

Next tweetchat: Thursday January 19th, 2017 3:00-4:00 PM ET

MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare quality, and will include everyone from administrators to zoologists, and include physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

The format will follow a similar structure to the famous and well-loved examples of #HITSM, #HCLDR, and #IrishMed – guest moderators will pose 4-6 topics in sequence, aimed at igniting discussion and interaction.

Three healthcare domains in which we might want to pay close attention are Care Policies, Care technologies, and care flow.

The following topics will be posed this week related to Healthcare Policy and how quality can be seen in terms of risks, issues, and opportunities:

  1. How should governmental or organizational health policies be subjected to Monitoring & Evaluation
  2. What policies fail at least one element of Safety, Timely, Efficiency, Effectiveness, Equitability, Patient Centered
  3. How should we monitor cost, morbidity, and mortality effects of a policy or law
  4. What role do the medical NGOs, journals, and professional bodies play in healthcare improvement
  5. How can providers and patients drive improvements in healthcare policy

 

#MEQAPI Tweetchat: Jan 12 2017

When: Thursday January 12, 15:00-16:00 ET

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare quality, and will include everyone from administrators to zoologists, and include physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

The format will follow a similar structure to the famous and well-loved examples of #HITSM, #HCLDR, and #IrishMed – guest moderators will pose 4-6 topics in sequence, aimed at igniting discussion and interaction.

The following topics will be posed:

T1 What role should the government or international bodies play in healthcare improvement?

T2 What role should the public, and especially patients, play in process or quality improvement?

T3 In what areas of healthcare do you see the biggest need or opportunity for quality improvement?

T4 What quality failure have you personally experienced in healthcare, and what was the outcome?

T5 Do you feel comfortable reporting a quality issue, and if not, why not?

#MEQAPI TweetChat

On an average year, the estimates are that between 90,000 and 400,000 patients in America die untimely deaths due to medical error and missed opportunities. (The earlier IHI studies estimated 90,000, and more recent research hints at 400,000). The toll of injury related to medical error runs into the millions, and the financial cost of waste, medically unnecessary care, and dealing with sequelae of mistakes runs into the billions of dollars.

While we may object to various technical aspects of the research papers, find fault with elements of the methodology, or just plan balk at the thought of physicians killing patients, clearly healthcare is in need of quality improvement.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare quality, and will include everyone from administrators to zoologists, and include physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

The format will follow a similar structure to the famous and well-loved examples of #HITSM, #HCLDR, and #IrishMed – guest moderators will pose 4-6 topics in sequence, aimed at igniting discussion and interaction.

If you would like to moderate a #MEQAPI tweetchat or suggest some topics, please contact us at @MEQAPI, or email mloxton@meqapi.org.

Oh, and the first #MEQAPI chat will take place on Thursday 12th Jan at 15:00-16:00 ET

See you there!

The Three Horsemen of the Coming Healthcare Apocalypse

Ok, so not really – It’s not about horsemen, it’s already partially here, and it won’t be an apocalypse either. It is however going to be a very big problem, it’s going to bankrupt some people, destroy some industries, and it’s going to put a massive hurt on almost everybody for many decades to come.

There are three healthcare issues that interact with each other, and which would have been a huge problem individually, but are going to slap us hard across the face when put together. I am talking about the Aging Population, Obesity, and Climate Change.

Aging Population

Here’s the thing. 10,000 Boomers are retiring per day, they did a horrible job of preparing the next generation to take the helm, and there are fewer of the next generation to do so anyway. We already have a looming shortage of nurses and doctors and medical technicians, and when a bolus of them retire and need medical help, we simply won’t have enough replacements to take care of the aging population. If your organization didn’t have a knowledge management, and training and recruitment plan already in motion ten years ago, the bottom line is that it’s too late. The chances are that you won’t save your organization from collapsing, and the best you can do is arrange a slightly more elegant landing than a straight-up belly flop from the highest diving board.

The medical schools have been focused on keeping profits high, the APA on keeping competition down, and who in heck knows what legislators were doing. Probably nothing. Maybe just pulling practical jokes on each other. So we have let the Magic Sparkle Fairy of the Invisible Market and siloed interests and perverse incentives drive how we scaled, staffed, and recruited for medical schools, and we are going to be massively, monstrously, marvelously short. We are already short, and it gets worse.

We are going to have the same problem across every part of healthcare, and our normal go-to plan of stealing skills from other countries isn’t going to work because they have the same problems.

That was the good news.

The bad news is it’s going to be much, much, much worse than I said. We didn’t invest in the infrastructure or save for this either, so this is going to be a huge, nasty drag on getting anything done in healthcare.

Obesity

The entire world is getting heavier, and the US is one of those leading the charge. I mean of course the people are getting heavier. All ages, all genders, all races. All income groups. Some a bit more than others, but all of them are slowly getting heavier. Actually, not so slowly. Kinda fast. In fact, very fast – the rate has doubled globally since 1980. Obesity is now something that 35% of Americans can call their own, and the number is climbing.

With obesity comes a rapid increase in a whole raft of medical conditions, including diabetes, coronary disease, cancer, depression, and so on. All of them very expensive, chronic, and thoroughly entangled in social determinants of health and perverse incentives. One example is that we subsidize corn production. That creates cheap corn syrup. Corn syrup is added to every food and drink imaginable. It contributes to obesity, diabetes, stroke, and tooth decay. Wonderful stuff. So we fund a thing that kills us. Wonderful. We do that a lot.

We have entire industries whose focus is to craft very unhealthy food that is very appealing to our instincts, the way our brains work, and are kinda habit forming. The more money they make, the sicker we get, and they like making more money.

Climate Change

Despite Congress being really conflicted over whether it is happening, whether we are causing it, whether it is more important to bring out tortuous laws about gender assignment and public restrooms, Climate Change is increasingly a topic in healthcare. The anticipated effects of Climate Change of healthcare can be seen in research papers, conference sessions, and lectures at medical schools. The news isn’t very good. Well, actually not “good” as much as really bad.

There is almost no healthcare problem that is not made worse by Climate Change. On its own, Climate Change would be a darned pest. It will disrupt the agricultural supply chains, submerge some of our business transport links and cities, and increase damage to infrastructure through storm surges, hurricanes, tornados, and other forms of interesting peak weather. However, that’s just the entertaining stuff. It will also lead to resurgence of old medical enemies, shift vectors into novel regions, and hike up emergency visits for everything from asthma to zoonotic infections.

Conclusion

So even together these three aren’t an apocalypse, and won’t end the planet, our species, or even halt the amount of sports we watch. From the couch. With a Big Mac and Fries. And a soda. A big one. The super-slurp one that’s five times the size of our bladders and has enough corn syrup to kill off a platoon of insulin-producing beta cells. Not an apocalypse.

While it won’t be an apocalypse, each one will be a bit like getting a backhander through the face. On a cold morning. With a fish. A large wet fish. The three together will be like getting three individual fishy-slaps through the face, followed by another, bigger fish. With spines and slime. And frozen. A hearty backhander though the face on a cold morning with a large frozen fish, wielded by an Olympic medalist in fish throwing.

A bit like that.

Are you ready?

BPM & CM – My takeaway from the Global Summit

Thanks to Dr. Charles Webster (@wareflo), I attended the 2015 BPM & CM global summit in Pentagon City last month.
During the three-day summit, Dr. Webster interviewed me and several other attendees, and broadcast live over Periscope.
His intention was to find out what we each hoped to get out of the sessions, and then to follow up afterwards to find out what we saw as the major takeaways.

It has taken me nearly a month to settle on what I took away from the seminar, but here is my answer to his question:

  1. There was an elephant in the room
  2. The field has achieved a great deal of progress, but still has a long way to go
  3. There is a huge opportunity to improve healthcare

Before I talk about those, here are my top three favorite sessions

  1. Chuck Webster’s session on wearable workflow featuring @MrRimp. (It’s not every day you get that level of geekiness crammed into a presentation)
  2. Anne Rozinat’s session on process mining using Disco
  3. Aaron Drew, U.S. Department of Veterans Affairs & Business Architecture Leadership Panel, who spoke about the future of the VA’s VistA EHR design

Chuck thrilled us all with MrRimp, and hinted at a future in which wearable technology would form part of seamless workflow. From door to doc and beyond, wearables are going to play a major role in healthcare, and will shift the patient to the center of a care team, rather than simply being the topic of clinician discussions. Wearable workflow also has the promise of having adaptive business processes in which the currently error-prone activities of basic data capture are shifted from clinicians to machines. Shifting this burden will free up hours per day per clinician, while increasing data reliability.

Anne eloquently stepped us through the concepts and technology behind process mining, and gave examples that were clear and compelling. Process mining is a big deal in healthcare, as I discuss in a whitepaper on process discovery in quality improvement. The big deal is that current methods to discover the as-is workflow are resource intensive and slow. Variation in healthcare settings is high, and processes may vary not just from hospital to hospital, but ward to ward, and even shift to shift.

If you have a healthcare system with dozens or hundreds of care facilities, scaling this is close to impossible, and even in a single facility with a small number of wards, can be daunting and expensive. Process mining does not entirely overlap with observational methods of process discovery, but it comes close enough to bring real-time process discovery within the reach of small and large healthcare systems alike.

Aaron described a future in which BPM is built into the EHR, and where patient centered care teams could interoperate seamlessly without the EHR creating obstacles and pitfalls. The original VHA EHR was built to solve the problem of running a single medical facility and managing diverse treating specialties within a single environment. Since then it has been pressed into service as a means to do care and bed management across the nation as well as handle medication ordering, medical imaging, and disaster planning.

This venerable but dated EHR has architectural limitations that are no longer up to the challenges and demands of the modern care environment. The VistA Evolution project details a ground-up rebuild of the architecture and technology, and will put VHA back in the lead with a groundbreaking EHR.

That’s my top-three picks for sessions.

Now for the elephant

During one of the sessions, the presenter was explaining how he wished that US management and C-Suite were as tuned into the need for efficient and effective BPM as the executives he encountered in Germany. What followed was, from my perspective, a remarkable response from the audience. As a qualitative researcher and quality improvement practitioner in healthcare, whenever an audience is animated it’s important to pay attention.

Nowhere on the agenda was a discussion related to management itself, none of the sessions involved management best practices, and no speaker directly addressed the topic of executive sponsorship and behavior. Governing policies regarding process improvement and quality weren’t a listed topic. However, what came thick and fast, in raised voices, were accounts and agreements that US business practices were a major impediment to improving processes.

One person gave an account of how short-term focus and lack of forward vision was crippling attempts to improve workflow in the business operation. Another described how quarterly metrics resulted in punitive reactions to improvements, and that improving a process for long-term success were often cancelled by management because of a short-term focus. Somebody else gave a personal account of management cancelling projects that were designed to improve quality and efficiency. The projects couldn’t deliver within a financial quarter, and so they were terminated.

Whether the specific projects were viable or not, is something we can never know. What was clear is that the tone and degree of participation in this session, and on this specific topic, were remarkable. The topic evoked a far higher degree of audience participation, and the degree of vociferous agreement stood out. The thing that nobody was talking about, but was evidently on everyone’s mind, was that US business models are a significant cause of bad business processes.

That bears some thinking, especially in the US healthcare market, where the cost of bad processes is paid in blood and death.

BPM & CM advancement

With the release of BPMN v2.0, and the advent of DMN v1.0, the field now has an accepted set of standards that can be used to model business processes. This is great news for fields that include quality improvement, business reengineering, and business design. This means that a wide variety of workflow and process design tools will produce interoperable if not entirely interchangeable process models. It also opens the door to being able to build processes that can be directly embodied in business logic in the workplace.

What is less stellar is that while over 80% of all process models are created and reside in Microsoft Visio, the model you created in Visio only pretends to be a BPMN model. It’s like a picture of a dollar bill – it looks like one, and it can be named “dollar bill”, but you can’t buy anything with it. You can’t just flow your business data through the Visio diagram to see if something is wrong.

Perhaps with time that will change, but it isn’t a pretty picture right now.

Opportunities in Healthcare

Putting this together, if there is one industry where wearable workflow, process mining, and BPM standards could benefit operations, it is healthcare.

  1. Healthcare costs in the US, account for up to 60% of bankruptcies
  2. Preventable medical mistakes are the third highest source of untimely death
  3. Incompatible processes are the daily reality for patients and providers alike

 

Improving the performance and conformance of business processes, placing patients at the center of their care team, engineering humans out of data entry, and standardizing processes across points of care could save lives and money. It could shift US healthcare from being the most expensive in the world to being at least on par with the OECD averages. It could move US healthcare outcomes from the doldrums to being in the top five percentile.

That’s my story, and I’m sticking to it!