Cerner Health Conference

Living here in Kansas City everyone “knows” or more accurately claims to know something about Neal Patterson.  As the iconic entrepreneur walked by my second row seat and took the stage for his Keynote at the Cerner Health Conference,  I wasn’t sure what to expect.    I tried to brush aside all the good and bad I’ve heard and just listen to see if I could connect to him and Cerner.  

I expected a politician – slick with perfectly constructed and managed content.  A more accurate description is comfortable, confident and owning the content.   Dressed casually, he appeared more approachable than intimidating. His speech style was more conversational than choreographed.  The “picture in his head” is much more detailed than what he could share in the time frame.   He was funny and entertaining – much more than I expected.  I take time to describe him because when you read about what he said I want you to see this picture of him.   These are sound bites with my interpretation. 

“We must separate Health and Care”
Cerner, throughout the conference, delivered the next frontier of their ambitious goals: Managing health as opposed to maintaining a sick society.   The Solutions Gallery Floor was split into three areas Foundation, Organizational Excellence, and Community.  When you entered the solutions gallery floor the first thing you see is Foundation.  Many times when I have talked to people about being able to interpret data we have to step back and look at the way it’s collected and the model in which it is stored.  The Foundation is representing the “Care”.  How hospitals document and gather the information that improves the care of the patient.   Though the pods were a little fragmented and hard to see the vision of how they all played together the message was one foundational platform to collect data.

If you think about the future of care it’s built on the foundation of data.  Think of it this way – if you build your house on sand there is no way to maintain the stability of the structure.  If you build your house on a solid foundation then expansion and stability are givens.

Across from Foundation is the next frontier the “Health” what Cerner noted as Community.  I thought the visual was quite nice – the past was facing the future.   We MUST start managing the wellness the health of not only an individual but of entire populations. 

“What Steve Jobs did in regards to music – Cerner is doing with health data”

I found this statement extremely bold, but accurate. The challenge with most leaders is to be able to drive vision, growth and domination in an industry you are often seen as prideful.  While I agree with some of the pundits – a self comparison to the actions of Apple, the benchmark for transformational innovation, is not the most humble of statements – the only thing I would throw back – isn’t it pretty accurate?   Cliff and Neal took the documentation of processes and have systematically transformed it into a billable standard. And amazingly have driven such change into the industry that the government has seen the benefits of this documentation and will now subsidize their growth through mandates to their core customers.

The thing I would challenge Cerner on is this – Apple has the unique ability to take a complex idea and make it simple to use, visually appealing, and extremely easy to understand.  On the BI side - I didn’t quite see that in Cerner yet – not saying they won’t get there.   They have built a firm foundation – collection and storage of data.  The hard part is the presentation of the data in a useable manageable format. 

The center of their Solutions Gallery was the Organizational Excellence.   I stopped in to see their dashboards and examine their process.   My take away and I hope this isn’t too harsh – they are just not there yet….a little bland and canned.   My encouragement to them – the people who will be successful in the BI space are those who can take the data and do what Neal told the audience Cerner will do “We will future proof your organization” he said that in regards to how the government will change reimbursement based on the collected data.   Somehow you have to take your incredibly complex data set and deliver it to leaders in the hospital in useable fashion.   Most people are not data junkies.

I will say this as a note to the other EMR companies – my money is on Cerner to do this first and from being first they will build the standard.  If you are not all ready in the space you are all ready behind and if you are looking at only the EMR data set – you won't catch them.

The final two statements hit home for me and if you listened to what Neal Patterson was saying they were actually quite revealing to who he is as a person.  

“We are all mortal with a huge instinct to survive.”

There is an underlying ambition to extend life and improve the quality of life.  While not the most personable way to put this thought to the audience – it was a directive.   From a technical standpoint this is the push to build PHR and build it well.  Driving home the point that we must manage health creating a foundational platform like Cerner has done in the “Care” space for the “health” space.  Fixing PHR.  

 “If we know something and we know how to predict it in the future why aren’t we doing it?”

I am not sure if the crowd heard it, but I heard frustration in this statement.   When you hold great power, knowledge, data……when you can see the future and you are pulling those around you to understand it…..when your mind understands that all the pieces of the puzzle are there and all we have to do is put them together….. it’s almost excruciating.  It’s a blessing and a curse to have a vision. 

When that type of driving vision is mixed with a personal experience it intensifies in a way that many won’t understand.  Neal’s top 4 things he wanted to accomplish in this decade – one was “Save Linda’s Life”.    Linda, his sister in law, died from Sepsis.    Can you imagine being one of the most powerful people in healthcare and losing a loved one to a preventable medical error?   Knowing that the data contained in your servers holds a key to change possibly annihilate this and other preventable medical errors?   With great understanding, knowledge, and blessing comes great responsibility - great responsibility engages great pressure.

In closing - Cerner is not Disney World – not what I would describe as “friendly” place but they are knowledgeable and they are incredibly capable and powerful.  They will find answers and save lives.   I am not sold on them as an organization, but after this speech I do see that the leader has passion and purpose.  

The Immersion Principle

In college we were required to take a foreign language to graduate, and if you read through the information you figured out that with one additional class and a study aboard you could get a minor.  This was a no brainer for me – I got to go to Spain all in the name of education.    The purpose of the study abroad was to immerse student into the language and the culture.  Unlike a class which trickled information into your glass slowly with finite precision allowing you to drink at reasonable pace – a study abroad throws you into the lake with a small life vest and expects you to learn quickly how to tread water.   

Have you been immersed in the culture and the environments of the people you are developing products for?  Technologist, if you are in the business of creating a “business” is it really worth it?  Can you truly attach passion to it?  As for me and my house – we don’t think it’s a long term answer.   Passion comes from creating tools that really help people. 

I met some really great folks at the Connexall User conference in Toronto.   One was Craig Martin an “IT Guy” from University of Michigan Health System.  Craig and his IT team have immersed themselves into the different units to gain clear knowledge of clinical needs.    Craig described his goal of disintegrating silos and creating more effectiveness in development and decision making ideals around purchasing and creating healthcare products.   The formula is really quite simple from a high level view -  it’s to become the foreign exchange student on the clinical unit – to immerse yourself in the culture and life of the people who will be most affected by the choices on technology - the end user.  On a hospital level Craig’s “Immersion Principle” takes a person from IT and attaches them to the hip of a nurse to experience a day or week in the life of someone who is directly engaged in patient care.  Craig said  “We in healthcare IT cannot hide from the sometimes overwhelming things that go on in our hospitals.” 

I am impressed by this team they were focused on creating environments for better care by utilizing technology as an enabling tool.  I can’t say that of every hospital.   

Technologist – when was the last time you stepped foot in a hospital for something other than a sales call?  Where does your passion for product come from? Is it in a paycheck or is it in the realization that what you are doing is making a difference in the lives of the sick and helpless.  This which we do for the least of our brothers…….

After being in the hospital with #4 for a week – I will never look at a call light system the same again.  My passion is in the eyes of that sick baby.

When you immerse yourself into a culture – your perspective is forever changed.   Do you need an inspiration?  Spend a day on the floor of a hospital with a nurse doing nothing but observing – not selling, not creating, just observe.  Let their reality become your reality.  

A Coloring Page for Root Cause Analysis

The other day #2 boy brought home a coloring sheet from church.  I asked him to tell me about his picture.  He went into a wonderful description of the story of David and Goliath.   Goliath was colored blue similar to a giant smurf and David was wearing a green skirt.  He had added grass, bushes, and even some small animals.  His hands flew through the air describing his well colored picture and telling me in detail that Golliath blue from him blueberry pancakes and why David was “late to the party”.  As he talked, I began to focus in on the upper corner of his paper to the small gray airplane.  “What is that?” I asked.  Tucker’s eyes lit up and he replied “That’s the fighter pilot backing up David in case he missed.”

It's interesting when we begin see the outline of a picture and think we have the whole story.    

As I have been reviewing RCA’s from different hospitals and researching the rebuild of the incident – I find it interesting that many hospitals do not build the picture from data that is very representative of what is occurring in the room.   Many times this is simply that they do not know that the data is available or that they have systems in place that the data is locked inside and not accessible. 

I was working with a hospital on a fall analysis - extracting data to begin to layout the outline of a picture of what happened surrounding the patient fall.   The patient requests and responses are a lot like a blank coloring sheet.  The outline is your basic patient request data and based on the patterns it began to paint a picture.  The physiological alarm data, the medication data, and other bits and pieces began to color in the outlines to give a full view of what was occurring in that patient’s room.   Did the patient have a critical telemetry alarm?  Who received it? What were they doing?

Another interesting piece of the puzzle is communications between caregivers.  I was having a conversation with Voalte’s Trey Laudedale about the value of the Text Message.   As I was thinking about this blog it occurred to me – the text messages are the hand drawn fighter jet in the picture.  Sometimes the outlines and the information we are looking for does not create the whole picture. Sometimes the picture needs to have more data then what we would normally consider to complete it.  

So here is my tip for an RCA

·         Review the Patient Requests from the Nurse Call and Response of the Caregivers
·         Review the Physiological alarm data that was sent to the Caregivers
·         Review the text messages between clinicians

Remember data is always available if you are careful to set up your technology correctly.

The 3rd Annual Medical Device Conference

I am really excited about the workshop S3 is presenting at the Medical Device Conference.  The presentation will take a look at how different types of industries measure effectiveness.  We are in process of touring, interviewing, observing, and documenting several interesting places to bring value to the MDC attendees. We will be looking at Shatto Milk Company, US Toy's 750,000 sq foot Distribution Center, a Call Center, a manufacturing facility, and more.  During the workshop we will use the case studies to determine how efficiency and effectiveness metrics were used to improve productivity, customer satisfaction, and more.   We will be applying the learning to developing useful metrics (IndicaresTM) for your hospital's patient communication platform.

I will be blogging about some of the experiences prior to the class so stay tuned to learn more.

Sign Up - this will be a lot of fun!

http://www.tcbi.org/files/agendas/MDC3_Agenda.pdf

The ER Visit Blog

As some of you saw in a recent tweet, I had to journey to the Emergency Room for a brief visit.  While it wasn’t intended to give me material for a blog post – it has provided me with some thoughts that are worth sharing to my fellow technologists.

During the visit one of the questions I was asked by my fabulous nurse was "Who is your primary care physician?" This should be an easy one, right?  Well, it’s easy if you have been to a PCP more recently than your last year of college.  Yes, a little known fact about me is I have a terrible phobia of Doctors (ironic right?) As part of my discharge process both the Nurse and the Doctor said I needed to followup with a PCP.   I told them I understood and thanked them for their help – fully knowing in my mind that I had no intention of going to see a PCP….that’s where sick people go and I am not sick…I am healthy, OCD about eating right, I don’t need a doctor.   My husband had other thoughts and soon I was scheduled to see a PCP.

As I bemoaned the coming doctors visit I had a call from my conscious the voice of reason since age 12  (her name is Carrie) and without belittling me she made mention that you can’t improve when you don’t know where you start.  Then, in a way only she can, she reminded me that I preach to dozens of clients and businesses.  "Kourtney, don't you tell people there is a need for “baseline” data before starting an improvement process.  Yet there is not one ounce of data pertaining to your medical care over the past 10 years."   (other than my calorie counting iphone ap)

Sometimes, even when we are healthy we need a doctor.  Technologist, do you make products that make sick hospitals better or do you create products that enable the on-going health management of hospitals?  At some point isn't the goal for the hospital to be well - doesn't that somehow work you out of a job if you are always focusing on sick?  

Even if you are focused on fixing a pain - How do you know that your technology or service has improved their facility?  Do you know specifically what processes you impact and what things within the processes you are measuring that link directly to patient satisfaction and improved care?  Can you measure them? Will you measure them?  Or are you satisfied with the status quo technology buying cycle where people by a feature and are not guaranteed a result.

Technology enables a process.  A process is NOT worth changing or implementing if the steps are not measurable and the data derived is not linked to a meaningful goal.

Technologist, if you are not providing a baseline that is documented with data directly from an existing technology prior to implementing a new technology then you are doing the hospital, it’s clinicians, and it’s patients a huge disservice. 

In case you were wondering - There is value in driving the wellness of organizations as well as fixing a pain.

In the end – I did go to see a Primary Care Physician. To all of you doctors out there, I chose him on a few factors - he was recommended by someone I trust, time spent with patient exceeded the norm, but my final decision point for choosing him..... what made the biggest portion of my decision?  He was part of the network of the hospital that I visited and he had automatic access to my electronic patient record from my Emergency Room experience.  No phone calls – no faxes just a few clicks and there I was in all of my single entry glory.  I drive 35 minutes to his office.

I know my Data is important in decisions and that on-going my data available to my care providers for logical diagnosis decisions is critical.

Reflections of a Former Fat Girl

A wise CEO I know said that “Trended Change is the only Change of Value.”  In terms that most of us can relate to – if you lose 10lbs and can’t keep it off then you have failed.  I have been on as many diets as Oprah Winfrey and failed as many times.  At my largest I was well over 215lbs, my smallest around 140lbs.  Now, I am somewhere in between.    Whether it was a pill or a plan I would move blindly towards the current fad diet searching for my magic bullet.   I call it experiential learning, after years of failure I have figured out that the magic bullet does not exist.  

The only way to succeed in consistent long term weight loss and management is by lifestyle change.   Which is a lot different than saying “I am going on another diet” A diet may provide a specific goal but it also implies a designated time frame, at some point we reach the goal.  How many of us look forward to reaching the goal so the diet is over and we can go back to “normal”?

A lifestyle change means that you not only have identified the functional causes, but you have established a starting point.   A lifestyle change involves education and understanding, which may require technology and data. Once you have identified the functional causes you can hone in on the decisions and behaviors that are creating the situation and begin to make a change.    I applaud my friends at Cerner for the KC Slimdown challenge and www.cernerhealth.com if you haven’t taken a look pop on and see.  If you are competing with Team S3 – good luck - I like to win and I really like Sporting KC. (It's one of the prizes)

At this point you may be asking – why is this CEO of a patient experience & safety analytics company writing a blog about diets?   Improvement whether its weight or patient experience is all about making a lifestyle change, and managing yourself after the change.     One of the reasons weight watchers works is because you are consistently watching your weight.  Hospitals need tools to consistently watch their weight.   I get on a scale nearly every day which some may find excessive but seeing the number motivates me towards doing the right things during the day.   

S3 Aperum is the like the scale I get on each morning.  It’s providing patient experience and safety data in a "weight management" format to allow leadership to make adjustments and alignments as needed.  I would love to tell you it is the magic bullet, but it’s only part of the puzzle.   Like any weight loss or management program technology is a tool that enables us to succeed it’s not the tool that makes us succeed.    We have developed 4 key areas called pickle points where hospitals have issues surrounding patient safety and satisfaction.  3 of the 4 are not technology based – they are identified using technology but the root is in people, policy, and behavior.

For fun – if you have a “Slimdown” story you would like to share – please post it as a comment.  We would like to hear of your success, your process, and on-going management.  

The Patitent as a Person - my lunch with Clay Patterson

The patient’s position in the HIT marketplace is that of data….that is a really strong statement but if you look at the Medical Record you know it’s actually a fact. The focused push to enable EMR in hospitals IS critical and has to occur. The mindset around it, to me, is often concerning.

Somehow the “data” has to evolve back into a “patient” who has to evolve back into a “person”.


As most of you know – my professional passion is the patient, the one who must take up residence within the walls of a hospital for a period of time. However, if we limit ourselves to seeing the “patient” only within those walls then we limit our view of the health continuum.

On Monday I enjoyed a wonderful lunch with Cerner’s Clay Patterson. I wasn’t sure what to expect – Cerner is an enigma – when people ask me about it I say “It’s shiny” meaning it’s very exciting, cool new innovations, amazing technology, thriving business, and flashy interactive gadgets. However, nothing I had seen to date gave me the feeling of heart – innovation, yes – incredible business, absolutely – heart, not so much. The heart I was missing was the patient – the person. Then I met Clay. His passion is getting medical data in a useable format so that a person can better interact with their health. This incredibly engaging and friendly man painted a picture of Cerner unlike any I had seen before – he shared a vision of people not products.

As he spoke, the picture that formed in my head was a giant sphere and inside of it there were stations of a person’s health journey. They include Hospital, Family Doctor, Medications, Tests, and even Diet & Exercise. (which I call DEA - which is a blog for another day) all surrounding the ability to research within the platform. The components within the sphere are interconnected and the data can ride freely between them.

The Sphere is taking information that is generally spaghetti and putting it into waffle format. When it’s in waffle format it can be searched, analyzed, cross referenced, and made into useable information. Think of it like managing your finances. Many of us keep our receipts in a box – or a wallet – or the center console of our car (or for some of us all of those places). You may have to dig them out if you need to return something, but the data of what you bought and when generally goes nowhere. However, if you use an online banking service then it automatically can analyze your spending habits and you can toss your little pieces of dispirit papers. The evaluation can lead to better planning, better habits, and overall better financial wellness. WHY? Because Data itself is not valuable – Data analyzed and applied into information is valuable.

But will adoption of this medium really occur. My prediction is yes – if you look at the slow recovery of our economy, you notice that people are spending less with credit cards and more with cash. Why because when you lose your home due to over spending you must take drastic measures to get things under control. People have had to learn to live within their means. Currently, the US is one of the most unhealthy nations in the world. Out of necessity a time is coming when we are going to have to reclaim our health. Sooner than later change will occur – not because there is some cool gadget but because consumers will realize that managing their health is the same as managing their finances.

The challenge will be education, access, and funding. How are we going to teach masses of people how to engage with their health while using a computer based tool?  Encouraging people to take control of their health is only part of the puzzle.  How are people going to get access to this portal?  This is a really layered portion of the equation including socioeconomic, locations, etc.  Who is going to provide access to this cool portal and who will “own” the data? Remember the data isn’t the value, the value is in the analysis….. when the data becomes information. As with everything else, it all comes back to who is going to pay for it? In a time when socialized healthcare is looming are we going to drive consumers to pay (not likely), employers, payers, ACOs?

If you believe that the patient is the heart of all we do then you must believe that the patient’s ability to interact with their health is critical to our success.

Stay Tuned for an exciting announcement from Cerner in the coming months.