From the Magic Kingdom to the EHR

Re: “What Health Care Can Learn from Disney and Five eHealth Trends Reshaping the Industry’s Future” by Marty Stempniak in H&HN Daily, Oct. 14

Being an annual passholder MagicBand frequent flyer at the Disney parks in Orlando, Fla., I have likewise seen the application of this technology to health care. Disney quite often knows where you go in the park and when, what you purchase and consume, and when you return and to which park. Imagine that application to inpatients with admission date and time, medications, meals, location (CT, OR, ED, room, etc.), discharge, and more — and how much we could learn about patient flow and satisfaction along the way.

— Barbara Duffy

It Starts With Direct Messaging

Re: “Overcoming Interoperability Gaps in Population Health” by Andy Nieto in H&HN Daily, Sept. 10

Great article! Direct messaging, although not the end-all to interoperability, is a great starting point for automating health care simply and easily that will get us much further along in a short period of time. Every potential clinical document/data exchange in health care is "direct-eligible." Direct as the transport, implemented correctly and not narrowly, is interoperable. The payload attached to the direct message, should remain interoperable also.

— Therasa Bell

Nuanced Communication

Re: “How Strengthening the Relationship Between Medicine and Management Improves Care” by Atefeh Samadi-niya, M.D., in H&HN Daily, Oct. 1 

Good points. In order to establish positive relationships, we need to get away from the unilateral organizational approach of telling physicians what they want them to do to an approach that encourages and enables physician input and involvement in helping to redesign health care service delivery. Physicians need to be educated about the growing complexity and challenges of today's health care environment, be given an opportunity to have input to discuss their own needs and priorities, be provided with appropriate organizational support to help them better adjust to the pressures of medical practice, and focus on mutually derived goals for the best patient care.

— Alan Rosenstein

Acknowledging  the Value in Home Care

Re: “IHI Lays Out 10 Ways to Radically Transform Health Care” by Marty Stempniak in H&HN Daily, Oct. 7

Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement, is clearly a visionary and health care thought leader. IHI is one of the most influential leaders in shaping the new health care system. I applaud her presentation, but believe that there needs to be an acknowledgement of a shift that needs to happen and will inevitably occur: the shift from hospital- or health system-centric care to health care at home.

Given the aging of the population, the increased numbers of people needing health care, quality challenges and cost from traditional models that are not sustainable, there needs to be/will be a shift to the least costly option. The goal must be to provide services in settings that are equal to or better than existing services.

Thanks to new treatment protocol (chemotherapy to cumin checks), new clinical insights (risk-assessment protocols, hospitalization-reduction protocols) and, of course, new clinical technologies (telehealth, online education and monitoring), the home is steadily becoming the far better, far less costly option.

The challenge now is not simply to move to health care at home, it needs to be done in a manner that responds to the reality that many of the procedures that are shifting to the home historically have been revenue generators for an already fragile hospital/health system bottom line. Ensuring the financial stability of many, albeit not all, hospital/health systems throughout the country is not only essential, it is required.

Thoughtful, yet aggressive, transition to providing services in the inevitable location of the vast majority of clients, health care at home is a must. So, too, is the need to acknowledge that this move must be at the heart of the evolution to the new Triple Aim health care reality. For any wise and strategic hospital or health care system, this reality needs to be at the forefront of its planning. It also needs to be at the forefront in any national or international discussion on the transformation of our health system.

— Bob Fazzi