How Doctors Can Find Joy in Practice, Again


Pursuing the practice of medicine is a pursuit of passion.  The desire to help at the most fundamental level, saving and protecting lives, and to apply knowledge and compassion to make lives better is in the DNA of most doctors.  You have to have a strong desire and passion for the work to endure the long and arduous education and training process.  Unfortunately, the pace of change in the field over the past 30-40 years is draining the joy from practice for many doctors and creating cynical young doctors focused on “lifestyle” sub-specialties where they can make more money and have a more normal lifestyle.  And it is hard to disagree with the aspiration to have a balanced life, especially with today’s demanding practice.  The Triple Aim is the national goal of achieving three improvements, simultaneously, for a defined population of patients: (1) improving the patient experience of care (including quality and satisfaction), (2) improving the overall health of the population and reducing the per capita cost of health care.  It is also suggested that we add the additional aim of improving physician satisfaction to the Triple Aim to create the Quadruple Aim (1).  How can we heal the patient when the doctor is sick?

Physicians, particularly primary care and emergency care physicians, are struggling in today’s healthcare system.  Physician burnout is increasing.  The signs of burnout include a loss of enthusiasm for work (emotionally drained), emotional distancing or treating people as objects (depersonalization) and a loss of meaning and sense of accomplishment in work.  Most studies show that 1 physician in every 3 is experiencing burnout at any given time.  Physicians are twice as likely to suffer from burnout as the general population.  Physicians are also twice as likely to commit suicide.  Unfortunately, things seem to be getting worse.   A 2015 Medscape survey showed a higher percentage, 46%, experiencing burnout and also showed a steep increase in the burnout rate compared to 2013.  This has profound implications for the care of patients because doctors experiencing burnout make more errors, provide more costly care, have less empathy and compassion, and establish less trusting relationships with patients.  Patients seeing physicians experiencing burnout are less satisfied and adhere to medical instructions less frequently.  If you are a patient with a complex medical problem, especially Medicare patients, and you need to see multiple doctors, your risk is compounded if 1 out of every 2 or 3 doctors you see is experiencing burnout.  Over 80 percent of physicians report that they are overextended or at full capacity and that non-clinical administrative paperwork takes up about 20 percent of their time. Only 10 percent of physicians interviewed in 2014 were very optimistic about the future of the medical profession (2).

Root Causes

We are wearing down a precious societal resource and driving doctors to sub-specialize rather than enter needed primary care fields.  Primary care physicians are working harder and getting paid less when you consider increased unreimbursed time related to increased demands.  A series of studies showed that given the increased demands on primary care, it would take the average physician caring for a 2500 patient panel 24.8 hours a day to provide all the services necessary.  

In addition, chronic diseases like diabetes and hypertension often require more time to manage outside of office visits due to the need for follow-up, coordination of care and repeated testing.  One study showed that a physician may need to spend an additional 6.7 minutes, for every 30 minutes visit, outside of the visit which adds up to an average of 7.8 additional hours of work per week (3).  This time is often unreimbursed.  We are not only asking physicians to do more for less but we are also asking them to do a job that is much harder.  In order to achieve the Triple Aim and improve related quality measures for a defined population, you have to influence the behavior and lifestyle choices of that population.  It is tough enough for us to influence our own behavior (e.g. lose that extra 10 pounds) and now we are telling doctors they must influence lifestyle choices for their panel of 2,500 patients and also ensure that patients have an excellent “experience” as well.   Furthermore, the EHR in its current state does not seem to be helping.  In addition to the often awkward and time-consuming interfaces, EHRs also add an hour a day to just deal with notifications (4).  

Signs of hope

Given the passion with which physicians pursue their goal of becoming a physician, it stands to reason that a fundamental aspect of physician satisfaction is the ability to provide high quality care.  The evidence supports this point of view, however, physicians over recent years have seemed to encounter barrier after barrier on the road to achieving this fundamental beneficent goal.  Don Berwick in his typical eloquent way describes the possibility of a third era in the evolution of healthcare in the US, which he calls the “Moral Era” (5).  He states that “Constant conflict roils the health care landscape, including issues related to the Affordable Care Act, electronic health records, payment changes, and consolidation of hospitals and health plans. The morale of physicians and other clinicians is in jeopardy.”  This perspective is supported by the physician burnout stats.  He attributes some of this to the conflict of Era 1 and Era 2 of healthcare delivery.  In Era 1 dating back to Hippocrates, there was the ascendency of the physician and the practice of medicine as a noble and privileged profession.  A special warrant to self-regulate supported a strong culture of autonomy for the profession.  The idealism of Era 1 and that the doctor is always right was shaken when researchers found unexplained variation and inconsistent quality, and, in the US in particular, costs began to spiral out of control with little correlation with improved outcomes.  Era 2 emerged in response to these inconsistencies, driven by payers, regulators, and the government, to in some ways micro-manage and regulate the practice of medicine to try to ensure higher value and lower costs.  As Berwick states, stakeholders of Era 2 believe in accountability, scrutiny, measurement, incentives, and market forces while leveraging the tools of rewards, punishments, and pay for performance to attempt to improve the performance of the system.  Berwick suggests that this battle needs to be resolved by moving to Era 3 based on a “moral ethos.”  He states that it should be based on, at least, the following nine principles:

  1. Reduce mandatory measurement: He states “Intemperate measurement is as unwise and irresponsible as is intemperate health care.”
  2. Stop Complex Individual Incentives: He considers incentives at the individual physician level confusing, unstable, and invite gaming.
  3. Shift the Business Strategy From Revenue to Quality: A financial focus alone is short-term thinking and doesn’t fit the needs of the customer in healthcare for balanced outcomes.
  4. Give Up Professional Prerogative When It Hurts the Whole: The trump card of professional prerogative over the needs and interests of others is creating unintended harm and avoiding necessary transparency.  
  5. Use Improvement Science: For improvement methods to work, you have to use them, and most of us are not. Despite proven methods, they still are not as widely applied as they should be.
  6. Ensure Complete Transparency: Berwick states that “Anything professionals know about their work, the people and communities they serve can know, too, without delay, cost, or
  7. Protect civility: Authentic dialogue can only occur in an atmosphere of mutual consideration and respect.
  8. Hear the Voices of the People Served: True and systemic patient-centered care will be transformative.  Berwick suggests clinicians, in addition to asking “What is the matter with you?” that they should also ask “What matters to you?”
  9. Reject greed: Era 2 has been characterized by everyone trying to maximize their profits at the expense of or without consideration of other stakeholders.  Berwick advocates for “fair profit and fair pricing, with severe consequences for violators.”

The Era 3 Physician

Moving on to Era 3 can only happen with the engagement of physicians.  The Era 1 physician may never be happy on the Era 2 battleground while payers may never be at peak performance without physician alignment.  An evolution to Era 3 offers hope on both fronts.  The Era 3 physician must be open to the change and critical conversations necessary to move to true partnerships for the benefit of patients.  To operate with joy in the new world, physicians need an ecosystem of support to meet dramatically increased demands.  This may involve joining a medical group, partnerships with payers and/or alignment with health systems.  Team-based care, proactive planned care, increased administrative support, implementation and, most importantly optimization, of technology and automating workflows with standard protocols are ingredients to clearing away the new clutter from the physician’s day-to-day work so that they can once again connect with patients (6).  This ecosystem must support the physician in a new broader role as leader, coach, partner and manager.  If well-designed, with the patient in the center, physicians can rekindle their passion for patient care on a broader scale with greater impact.  At the end of the day, the cure for physician burnout is reconnecting with the energizing passion of making a difference in someone’s life.


  1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014 Nov;12(6):573–6.
  2. The Landscape Of Physician Practice. Health Aff . 2016 Mar 1;35(3):388–9.
  3. Farber J, Siu A, Bloom P. How much time do physicians spend providing care outside of office visits? Ann Intern Med. 2007 Nov 20;147(10):693–8.
  4. Murphy DR, Meyer AND, Russo E, Sittig DF, Wei L, Singh H. The Burden of Inbox Notifications in Commercial Electronic Health Records. JAMA Intern Med [Internet]. 2016 Mar 14
  5. Berwick DM. Era 3 for Medicine and Health Care. JAMA. 2016 Apr 5;315(13):1329–30.
  6. Sinsky CA, Willard-Grace R, Schutzbank AM, Sinsky TA, Margolius D, Bodenheimer T. In search of joy in practice: a report of 23 high-functioning primary care practices. Ann Fam Med. Annals Family Med; 2013 May;11(3):272–8.


The Population Health Dilemmas

There is tremendous momentum in the movement towards using “Population Health Management (PHM)” as the mechanism for providers to evolve from a volume- to a value-based care delivery model.  As quiet as it is kept, insurers have been practicing PHM for years, with varying degrees of success and acceptance.  However, due to the adversarial relationship with providers, the value of PHM from insurers has been diluted and diverted to more heavy-handed utilization management techniques.  As opposed to utilization management, PHM is the most proven and customer-friendly model for success when you are managing premium dollars, capitation or taking on various levels of risk.  Provider-led PHM has the potential to be more effective as well as necessary for providers to take on risk.  Mature models have been shown to be higher quality and lower cost(1).  This is what customers are demanding.  We have to shift from an illness system to a health system and PHM is the way to accomplish this goal and achieve value objectives such as the Triple Aim.  However, there are three key issues that create dilemmas for PHM as a strategy in terms of when, where and how do you implement.  The issues are: (a) effectively defining population health and PHM, (b) ensuring organizational culture readiness  and (c) determining the timing of the shift to a value-based business model.  An organization needs to resolve these questions to effectively execute on a PHM strategy.  A recent study by Numerof and Associates highlights these issues.

Numerof and Associates partnered with the Jefferson College of Population Health on the “Numerof State of Population Health Survey”.  This is one of the first studies to provide insight into PHM issues and strategies and the pace of transition from Fee-For-Service (FFS) to models based on reimbursement linked to outcomes.  This national study synthesizes survey responses from more than 300 executives and in-depth interviews with over 100 key decision makers across U.S. healthcare delivery organizations.  Some of the findings point to the dilemmas we face in executing on a PHM strategy and crossing the whitewater of change to deliver value-based care.

What is the Definition of Population Health Management?

The Numerof study underscored the continued confusion around the definition of Population Health Management.  Is it focused on specific programs such as wellness and prevention?  How broadly do you define the population?  Is it just the population of patients for which you are taking risk or is it all patients that you care for?  Does it extend to the community and consumers in general?  The study found that the definitions of PHM varied greatly and the definition greatly impacted the pace and prioritization of initiatives.  It is also important to be clear on the distinction between Population Health and Population Health Management.  PHM is an expensive and risky endeavor and how you define and scope it has significant implications for its success and value created.

Impact of Organizational Culture

An interesting finding of the Numerof study was that when asked why they were pursuing PHM initiatives, those that said it was part of their mission/culture were more progressive, successful and advanced in their movement towards value-based care.  This finding underscores the importance of leadership driving the culture shift necessary to really embrace this model of care.  At a tactical level, this culture shift has to start within primary care practice patterns and culture(2).  In many ways, it is a 180 degree shift from successful models and cultures of the past and present. This will set-up tension between the old and new but the reality is that you have to cannibalize your prior business model and dramatically shift the culture to be successful with PHM.  This brings up the question of when you go “all-in” on your value-based model?

As Andy Grove said in “Only the Paranoid Survive”, “if you’re wrong, you will die. But most companies don’t die because they are wrong; most die because they don’t commit themselves. They fritter away their valuable resources while attempting to make a decision. The greatest danger is in Standing still”

Timing of the Shift to a Value-Based Model

Until the industry fully eliminates FFS and aligns incentives under a value model, there will be an inherent conflict between players.  One organization’s cost and waste is another’s revenue.  Within a trillion-dollar industry with an estimated 30% waste, such as healthcare, the financial stakes are very high.  For providers who have been very successful at FFS, it means intentionally reducing their revenue as well as investing capital and resources in a model where the revenue and profit margins are unpredictable at best.  However, as it has been said, “the best way to predict the future is to create it.”  Some organizations such as Intermountain are directly taking on this challenge but this is not an easy strategy to pursue and one an organization needs to be well prepared for.  Some providers who have chosen to “do the right thing” and create benefit for the larger community have created financial challenges for themselves.  Even non-profits have to contend with the “no margin, no mission” reality.  Until there are clear profitable revenue streams for PHM and value-based care, the commitment from many providers will be tentative.  This is what the Numerof study validated.  Even though many organizations expect risk agreements to represent over 40% of their revenue in 2 years, currently the majority have 20% or less of their revenue from such agreements.  Although it is debatable, it seems that 30% of revenue from risk-based contracts is the tipping point for an organization to begin to fully commit to the value-based journey.  Therefore, with the exception of a few organizations, the value-based model of care is still “in the lab”.  

If reimbursement really does change dramatically over the next 2 years, which CMS is committed to do, then, as Grove stated, ambivalent organizations will be at risk.  Although it is resistant, healthcare is not immune to market forces.  It takes time and resources to establish infrastructure and change culture.  When the key financial metric shifts from “heads in beds” to “lives covered”, organizations stuck in the past or standing still may see profits rapidly diminishing with very little time to transform and recover.  Resolving these dilemmas and early and full commitment to PHM will avoid this risk.


  1. Kanter MH, Lindsay G, Bellows J, Chase A. Complete care at Kaiser Permanente: transforming chronic and preventive care. Jt Comm J Qual Patient Saf.; 2013 Nov;39(11):484–94.
  2. Cronholm PF, Shea JA, Werner RM, Miller-Day M, Tufano J, Crabtree BF, et al. The patient-centered medical home: mental models and practice culture driving the transformation process. J Gen Intern Med. 2013 Sep;28(9):1195–201.


The Patient is the Sun


As healthcare providers struggle to transform themselves into organizations that deliver value based on outcomes rather than creators of service transactions, whether they deliver value or not, the importance of engaging the patient cannot be overstated.  The mental and conceptual shift is no less dramatic than Copernicus, during medieval times, placing the sun at the center of the universe, rather than the earth.  Fortunately, there is an increasing number of efforts in-progress to alter this relationship.  According to a Health Affairs blog post, on January 15, 2016, Community Catalyst, a national consumer health advocacy organization, launched its Center for Consumer Engagement in Health Innovation to advance the role of consumers in health system transformation.  Amy Berman, a panelist at the launch event and senior program officer for the John A. Hartford Foundation who also has terminal breast cancer, captured the salient point.  She stated, “We live in a pre-Copernican model where all of the planets float around the health care system; the patient is just one of them. What we need is a shift …an entirely new frame, and this will shift everything when we do it….We need the person at the center. We need to put the sun where it belongs.”  

Physicians as individual clinicians generally do have a strong ethical and professional focus on the patient as the highest priority.  However, in the typical illness model of care delivery where the patient comes to the physician, the source of all expertise and knowledge, to be “cured”, the physician is the sun.  This reactive model has worked for centuries but now we understand much better the upstream antecedents of disease and we recognize the complexity of the interplay of genetic, environmental and lifestyle factors that trigger illness.  The patient has the central role in maintaining health.  Precision medicine will offer more opportunity to prevent illness and customize care.  In addition, in the United States, the reactive illness model combined with a fee-for-service third-party reimbursement mechanism has driven up costs way out of proportion to the value and quality our citizens receive.  Delivering more value relative to cost is an imperative and patient engagement is the critical success factor.

Providing truly Patient-Centered Care is incredibly important today.  As reimbursement becomes more and more value-based, ACOs and other risk-bearing organizations will live or die based on how well they engage their defined population.  This transformation must be systematic, fully committed, cultural, pervasive and, today, technology-enabled.  For full effect, it must also be expansive.  It should engage the patient as well as the caregiver(s), the consumer and, ideally, the community.  The design principle should be to surround the community with care and resources to enable health and healthy behaviors to permeate families, consumers, caregivers and patients.  We want to make the illness system less relevant and necessary.  There is evidence that the Patient-Centered Medical Home and truly redesigned primary care, such as Iora Health, are moving the needle on this goal.

Patient engagement is essential because regardless of how good the doctors are or your technology is, the patient must take the pill, show up for the test, change their diet, take the stairs instead of the elevator, convince their spouse to stop smoking for their sake, find a safe place and time to walk in the neighborhood and so on.  The evidence that effective patient engagement will reduce costs, improve quality and improve satisfaction (the triple aim) is well established and compelling (1).  The challenge is actually doing it.  Because it involves cultural change and redefining value and incentives for all involved, it is difficult and takes time.  However the payoff is too important and necessary to not fully commit to this goal.  This will require many providers to move beyond the gravitational pull of their hospital or clinic comfort zone.  They will have to really talk, listen and change according to what the patient says is important (2).  Putting the patient, the consumer, the community at the center of the healthcare universe and surrounding them with resources, tools, access, empathy and support in sickness and health will make a difference.  

  1. Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev.; 2013 Aug;70(4):351–79.
  2. Mohammed K, Nolan MB, Rajjo T, Shah ND, Prokop LJ, Varkey P, et al. Creating a Patient-Centered Health Care Delivery System A Systematic Review of Health Care Quality From the Patient Perspective. Am J Med Qual. SAGE Publications; 2014;1062860614545124.

Top 10 Healthcare Industry Trends for 2016


The healthcare industry is undergoing some of the most sweeping changes ever and certainly since the inception of the Medicare program in the 1960’s.  The change we are experiencing today is historic in scope and depth.  And nothing less than transformation is needed to achieve and exceed the quality and value delivered by other developed countries.  The US healthcare industry foundation, business model and infrastructure is shifting dramatically.  Ushered in by Meaningful Use, technology use has finally expanded to the point where digital healthcare on a broad and comprehensive scale is now feasible.  As Gartner notes, the digital business movement is transforming many industries and now healthcare is next up.  The Affordable Care Act and the CMS programs are catalyzing other changes.  There are huge opportunities and huge risks.  Although not comprehensive, I would cite the following as the most important trends to pay attention to in 2016.  It is important to also understand that these trends, in many cases, are mutually reinforcing and interdependent.  A successful healthcare organization would need a comprehensive strategy to address all of these moving parts from their point-of-view and market position.

Changing Payment Structures

Most healthcare organizations are beginning to experience mixed payment methods.  The Fee-For-Service (FFS) form of payment is dying a slow and painful death.  This payment method, combined with a third-party payer system, seemed to drive a disconnect between cost and value.  It created a business model where volume was king, and therefore unnecessary care and even medical mistakes were profitable.  But on a more subtle level, it also drove what services would be provided.  If a valuable service was not reimbursed, it likely would not be provided.  Now the focus is on connecting cost to quality and thereby reimbursing with consideration of the quality or value of services.  The primary driver of the trend toward value-based reimbursement models has been CMS.  CMS has committed to have 85% of all Medicare fee-for-service payments tied to quality or value by 2016, and 90% by 2018. Perhaps even more important, they have a target to have 30% of Medicare payments tied to quality or value through alternative payment models by the end of 2016, and 50% of payments by the end of 2018.  These “alternative payment models” include ACOs and bundled payments which are precursors to more progressive risk-sharing arrangements with providers.  Commercial payers are tagging on to the CMS models with their own alternative payment models.  At some point, prepared providers would be able to consider full-risk sharing or capitation.  

Population Health Management

There are many definitions of Population Health Management (PHM) and many organizations are trying to get their arms around strategies to manage populations.  The new payment structures are shifting varying degrees of risk to providers.  As more providers are taking on risk for populations that they are newly accountable for, a new model of proactive, upstream, quality and prevention focused care is necessary.  PHM is a proven mechanism to get there, but it requires new infrastructure, a different business model, realigned incentives and, most importantly for providers, a different, 180 degree shift in mindset.

The Medical Neighborhood

There is a continuing major shift of volume and revenue to the outpatient setting and an increasing importance to manage the costs and quality of these venues.  The Patient-Centered Medical Home (PCMH) has proven to be a critical component of transforming care delivery, with promising results.  It is important that the medical office culture changes to support team-based and proactive care (currently poorly reimbursed).  Integration of behavioral health has also proven to be another opportunity to improve quality and value.  However, the PCMH, even at it’s best, is a necessary but insufficient mechanism to drive optimal performance at a system level.  We need to consider the “medical neighborhood” and how the PCMH integrates and, very importantly, INFLUENCES expensive specialty care.  Access to care is a critical aspect of building the effective medical neighborhood and how urgent care centers and/or retail clinics are integrated can have a tremendous impact on this metric.  Also post-acute care management and integration into the neighborhood is important for managing overall costs as well as maximizing value-based reimbursement (e.g. Medicare Spending Per Beneficiary).

Reducing waste and the cost of care delivery

Improving the value equation particularly depends on reducing the cost component especially when you consider that it is estimated that 30% of healthcare costs are due to “waste”.  Driving out excess cost and waste are strategies that work for FFS (increases margin) and value-based care (shared savings or retained premium if at full risk).  Lean improvement and Time-Driven Activity Based Costing (TDABC) are strategies to identify and drive out waste.  Another area to pay close attention to are overall drug prices and the burgeoning cost of specialty drugs.

Repositioning of the “Health Plan”

The relationship between providers and health plans has been acrimonious for years because the provider’s income is the health plan’s costs.  The patient was often caught in the middle of the battle over medical necessity and cost.  Like it or not, as payers share more risk with providers, we increasingly are on the same side.  Recognizing this new alignment of incentives, many providers are partnering with health plans or creating their own health plans.  

The Integration Conundrum

To implement high-quality, efficient models of care having more control or ownership of more components or greater scale of the delivery system is seen as beneficial.  We have continued to see more M&A activity as systems worked to build more integrated and coordinated care delivery models.  It remains to be seen how the Federal Trade Commission will generally react to this activity but it is clear that they are scrutinizing this activity more closely (e.g. Advocate/Northshore merger).  We also are seeing consolidation of payers with Anthem planning to acquire Cigna and Aetna planning to acquire Humana.  Owning all components of the delivery system may not be realistic or make sense from a business perspective and therefore we are increasingly seeing providers creating partnership agreements with other facilities to advance their goals.   As an example, Aurora Health Care has started a partnership with seven other health systems in Wisconsin called ‘About Health.’ They compete with these organizations in some markets, but also partner with them to create scale and geographic reach.

Transparency and Consumerism

The high costs of insurance has resulted in employers shifting more cost to the consumer thereby reducing the moral hazard concern but most importantly creating a more cost sensitive consumer.  This is shifting the healthcare business model to more of a “retail” market and changing the role of the third-party payer.  Cost concerns are prompting consumers to compare pricing and outcomes of various providers. Insurers and vendors are increasingly offering tools that allow consumers to do so and there are also several third-party apps and websites offering similar services. Increased consumerism in healthcare is also being driven by consumers’ experience of higher levels of service, personalization and access (e.g. online) in their other business interactions.  This is setting higher expectations for the healthcare interaction.  Retail clinic and online access to healthcare services are often preferred and competing with the traditional visit to the family doctor.  Consumerism will be enabled by increased transparency of prices for healthcare services.  In a particular market, prices are known to vary wildly for the same service.  Transparency and consumerism go hand in hand.  The underlying implication as well is that providers will need to better understand their costs to set appropriate pricing.  

Patient/Consumer Engagement

Ultimately achieving high levels of quality and efficiency requires the consent and engagement of the patient.  In the final analysis, lifestyle choices and compliance with medical treatment causes or exacerbates the majority of quality and cost issues in healthcare.  There is evidence that providing truly patient-centered care improves the patient experience, satisfaction and clinical outcomes.  With increased risk sharing, this is an opportunity for providers and payers to align around putting the patient at the center of care.

Physician Engagement

It is difficult or impossible to achieve patient engagement if you do not have physician engagement.  The importance of physician engagement cannot be overstated as the industry transforms.  This is a tough issue because physicians are seen as the cause and solution to many of the challenges in the industry.  Physicians are at the nexus of the many changes in the care delivery model (e.g. use of Electronic Health Records, changes in compensation, quality report cards, team-based care, etc.) and the demands and uncertainty are driving high levels of burnout.  Better engagement and physician leadership will be critical for them to assume the solution aspect of their role.

Transformative Medical Informatics

Now that we are coming to the end of the Meaningful Use incentives and the tremendous increase in the usage of Electronic Health Records (EHRs) across the US, we are now solidly at the starting line.  Like the PCMH for the care delivery and business model, the EHR is necessary but not sufficient to power the degree of transformation necessary to achieve the highest level of value-based care delivery.  In fact, without the additional effort, the EHR slows down operations, frustrates providers, may increase risk and adds additional cost to the organization.  Optimizing the EHR technology requires what I call “Transformative Medical Informatics”.  This is an effort that goes beyond typical EHR optimization with tweaking of functions, reducing mouse clicks,  and improving automation.  Transformative Medical Informatics is the implementation of new structures, systems, technology and workflows to dramatically improve clinical and operational performance.  This approach addresses and considers the enabling and disruptive power of technology from a holistic and systemic perspective.  Gartner calls this the digital “Business Moment” which can be exploited for improvement as well as innovation.  This approach leverages all of the technical tools and knowledge of medical informatics including data warehousing, data integration, predictive analytics, clinical decision support, telemedicine, etc.  This approach then integrates organizational/culture development (the people aspect), change management, business process improvement (esp. Lean) and quality improvement to engineer processes that transform care delivery.  This creates the opportunity to pull together all of the organizational assets and orchestrate the creation of value for patients that is not possible any other way.  We are seeing this occur in other industries and technology is enabling new business models and new value creation.  Leading organizations in healthcare such as Kaiser Permanente and Mayo Clinic are using Transformative Medical Informatics to reimagine care delivery.  This is how we gain the multiple ROI value from the tremendous investment we have made in technology.


The Next Generation

It is well accepted that America has had a healthcare crisis for several years that is near the point of failure. The high costs of care are bankrupting individuals and making this benefit unaffordable for businesses to provide.  Despite having the highest cost, our quality is mediocre compared to other developed nations and over 100,000 patients die unnecessarily in our hospitals every year. Information technology is poorly used in a business where timely and accurate information can mean the difference between life and death. Incomplete, missing and inaccurate information drives inefficiencies and medical errors. The lack of information integration and sharing between providers leads to tremendous inefficiencies and fragmentation of care.  Yet, the solutions are within our reach if we have the will and commitment to apply them. It will also require fundamental process redesign and a dramatic cultural shift.  In recent years, catalyzed by changing reimbursement, the Affordable Care Act, maturing and expanding use of technology and market drivers, we are beginning to see the shift from volume- to value-based care.  As part of the value equation, a true focus on quality is taking root.  Technology is becoming more pervasive in healthcare and interoperability is being promoted from several perspectives.  Policy, although still a blunt instrument of change, is beginning to align with important drivers of transformation such as reimbursement mechanisms.  We are beginning to see the features and examples of the next generation of care delivery in the US.  As someone said, “the future is here but it is unevenly distributed.”  As change and innovation spreads and is more evenly distributed we will see transformation of healthcare on a scale that, hopefully, will achieve levels of quality/efficiency that will establish the US as an international leader rather than laggard.  This blog will focus on these issues and track, share and explore the many opportunities we have to transform healthcare through quality, technology, and policy.