Re: “The Innovation Imperative” by Ian Morrison in H&HN Daily, July 1

Thanks for the many insights in this piece. Scaling innovation is a problem common to many industries, not just health care, and happens in part because of a surprising relationship between innovation and standardization that few organizations are designed to exploit. While most people think of the two concepts as being opposites, it turns out that standardization is actually the most massively scaling engine of innovation out there: Standard protocols are at the heart of the Internet and enable one innovation after another to be built on top of it. It has been argued that without the standardization in cargo handling brought about by the invention of the sea container, there would be no globalization. Standardization in the gauge of rail tracks enabled the spread of the railroads which, in turn, drove the standardization of time! Innovation teams, however, are neither tasked with, nor rewarded for, nor trained in, nor usually excited by, standardization. And with good reason; the word “standard” has lost its former meaning of excellence and has come to connote dullness and mediocrity. Those organizations, however, that can build platforms of excellence, of standard, shared and common elements including everything from vision to IT infrastructure to treatment protocols will find that they can deliver and scale new and differentiated solutions, patient experiences and business models far more effectively than those that insist on difference for difference’s sake.

— Henry King

Tax 'Excessive' Pharma Profits

Re: “Prescription Drug Costs and the Specter of Rationing” by Emily Friedman in H&HN Daily, Aug. 5

I now see so many of these debates in light of Thomas Piketty's Capitalism in the 21st Century and wish as a nation we were more agile in the use of the tax code to regulate the excesses of a free market. I, too, have wondered about the failure to use the 'march-in' provisions of Bayh-Dole — they seem especially designed for these cases. We were fully capable of restraining grotesque profiteering in times of war, why not in these circumstances? I recognize the chilling effect that price control might have on innovation, but think that post hoc taxation of excessive profits would have a much less dramatic effect imposed, as these taxes would be, only after a dramatically successful product has been put into the market. And last, maybe we ought to unshackle the CMS and allow Medicare to negotiate prices for pharmaceuticals the way almost every other developed nation in the world does.

— Joel Lee

Nurses as Navigators

Re: “Patient Navigators Are Growing in Number” by Susan Kreimer in H&HN, July

Thanks for sharing this salient article on the growth of nurse navigators. Experienced nurses are well-equipped to assist patients across the continuum of care by reducing barriers to quality care.

— Susanne Vendlinski

Pharmacists Can Do It Best

Re: “Half the Costs. Half the Jobs?” by Joe Flower in H&HN Daily, July 22

Adverse outcomes from medication mismanagement continue to plague health care. Our data suggest that 10 percent of acute admissions are associated with medication mismanagement. Mismanagement occurs when patients are confused about their therapy, multiple providers don't take responsibility for all medication management, and selection of therapy may not be the best. A pharmacist in a medical home, designated to be the "coordinator" of medication therapy in high-risk patients, can improve patient outcomes.

— Dave Grinder

Please Don't Call Them That

Re: "Volume to Value," Marty Stempniak interview with Adrian Slywotszky in H&HN Daily, July 8

I certainly hope much more thought is given before the title "extensivist" is given to anyone. Our history of arcane terms, acronyms and other expressions is responsible in part for our health care system being unfathomable to consumers. We must communicate more clearly.

— Rolf Olsen