Reflections from “Health 2.0 in the Doctor’s Office”

This is a repost from “The Health Care Blog“.

By William Sellman, M.D., MBA

Will Sellmann has commented on a couple of panels at Health 2.0 and been very prescient. Now he’s spent a bit of time to pen his reflections on what happened in Health 2.0 in the Doctor’s Office, which was held late last month in Florida. Will is at Alameda Family Physicians and is Director of Performance Improvement at Affinity Medical Group

  1. Why is there innovation in this sphere?
  2. What problems are we really trying to solve, and how?
  3. Is there any party missing from the discussion?

These are but three of a series of questions I asked myself during and after the enlightening, and perhaps prescient, Health 2.0 conference that took place last weekend in Jacksonville, Florida. But these particular questions are inextricable from one another when applied to the overarching goal of the movement afoot that Health 2.0 supports. I endeavor here to not only answer these questions, but to communicate their relevance to those striving to maximize a fluid patient experience through technology.

While Health 2.0 is, in my mind, a nexus of technology utilization and process revision with respect to health care, it is also a phenomenon that must be considered within the context of the healthcare industry as a whole if it is to be usefully deployed.

At 17% of GDP, the industry of healthcare in the United States may soon boast (threaten?) to involve the employment of 1 in 5 Americans. At a macroeconomic level, major costs can be found within wide-scale interventional surgical procedures (large joint replacements such as knees and hips, as well as cardiac stenting), pharmaceutical development, and imaging technologies. Policy likely stands as one of few viable interventions for controlling these costs in any significant way. Viewed from such a high level, economizing the outpatient experience through web based products might be considered akin to polishing the hubcaps of a big rig as it drives through the mud. Yet there is another macroeconomic phenomenon to consider: the combination of proposed broader insurance coverage and an aging population, with a relatively inelastic supply of healthcare providers to meet such demand, creates an unprecedented call for efficiency at the point of care if we are to avoid uncomfortable triage.

Simply put, at 17% of GDP, healthcare is where the money is, for better or worse. Fortunately, where there is money, there is often innovation. Yet the architects of tomorrow’s healthcare system, from policy creation down to care-level tools, are wise to heed the timely lessons of finance: “innovations” such as creative mortgage backed securities and off-balance-sheet financing provide short term and often misdirected benefit. Certainly those who stand to profit at the product level in healthcare will appreciate the nuances of the demands on efficiency outlined above, as well as the long-term outlook required. It is here that Health 2.0’s participants can benefit from recognizing the fundamental processes within medicine, and thus the complementary assets such processes will logically embrace [few articles, in my opinion, are more pertinent in this arena than David Teece’s Profiting from technological innovation: Implications for integration, collaboration, licensing and public policy].

The delivery of quality healthcare is the result of a large, but finite, number of processes. Communication, education, billing, availability, and transparency lie at the heart of these processes. Recurrent processes, both clinical and managerial, lend themselves to automation to every extent possible. Indeed, this has been one of the major triumphs of the electronic medical record. What is difficult to communicate beyond the walls of the medical practice, however, is the degree of unpredictability embedded into both processes. This often distinguishes medicine from a majority of process-driven vocations. Moreover, although technology will augment the availability and fluidity of virtual communication with and among health care providers, the tacit knowledge gained and applied in the actual exam room will remain a necessary fixture of the profession. Taken together, these observations present a challenge for those developing the revolutionary products displayed via Health 2.0. The following examples will clarify this challenge.

Phreesia, DrChrono, RxVantage, and CarePass are four companies that presented at the conference. During their presentations I had the opportunity to provide feedback from a physician’s perspective in regards to their relevance and position within healthcare systems. Like the other products within the Health 2.0 domain, these companies are borne out of problems, both real and perceived, with the core processes mentioned above. As a practicing physician, I am intrigued with each product’s ability to streamline traditionally time consuming tasks such as eligibility at the point of care (Phreesia), office visit management (DrChrono), pharmaceutical representative scheduling (RxVantage), and consumer health data management (CarePass). Based on individual discussions as well as observing their presentations, I have no doubt that they excel at their focused tasks. Done correctly, each preserves, ensures, and promotes the timely interaction between patient and provider.


Yet this crucial effect was seldom mentioned as a selling point for any of the products. Without commoditizing the practice of medicine itself, vendors need to continually reevaluate their products’ capacity to enable the practice of medicine. Doctors need to see the provision of care as extending beyond the exam room; in an age of growing complexity, the unit of care upon which providers can differentiate themselves is now much greater than just the physical encounter. Adeptly managing communication “upstream” and “downstream” from the encounter is not only more feasible, but also something capable of being continually “pushed” to the consumer (patient). This is progress.

Just as the rapidly expanding data base of clinical knowledge promotes sub specialization, the complexities inherent to medical practices often preclude physicians from wholly grasping all of the relationships among pre-, post-, and intra-office visit processes. This “omniscience” often falls to an office manager or other key ancillary staff member. Nevertheless, products affecting these processes, such as those mentioned above, are largely marketed directly to physicians (since they ultimately make the purchases). But Health 2.0, and its constituent members, might best realize their potential by regularly incorporating those omniscient brains behind successful offices. “Health 2.0 in the Doctor’s Office” makes sense. Asking what, and who, drives that Office makes even more sense.

Finally, it is useful to define a common thread among the exciting, innovative, sometimes helpful, sometimes misdirected, and always creative tools within the Health 2.0 phenomenon. To me, that thread is the identification of process inefficiencies and the subsequent solutions therein via web-based applications. Validating and effectively communicating these inefficiencies merit much more attention going forward. One tool that stands to greatly clarify the validation process is activity based costing. Applied appropriately, the true unit (and thus aggregate) costs of recurrent processes -as well as recurrent missed opportunities- come to the fore. Applied specifically within a potential client’s practice, activity based costing can underscore the utility (or, importantly, the futility) of a proposed solution.

Viewed historically, Health 2.0 might be considered a fundamental driver that aligned the delivery and use of health care with the modernity already enjoyed in other industries. Unbridled optimism or reflexive skepticism are ineffective extremes; their sources and arguments remain predictable and contribute little to shifting paradigms. The desired paradigm shift in medicine will utilize the enthusiasm and awareness characteristic of Health 2.0. As outlined above, there is more work to be done. I am confident it will be done well.