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Measurement has its Place, but Doesn't Always Tell the Whole Story

Basketball Backboard

I love the game of basketball. There are all sorts of statistics collected – 2-point shots scored, 3-point shots scored, free throw percentage, field goal percentage, assists, rebounds, blocks, fouls, steals, turnovers, etc. The statistics often tell a lot of the story. Steph Curry, point guard for the Golden State Warriors, scored 402 3-point shots this season, setting a new all-time record. Most would view this statistic as success and he was voted the most valuable player in the professional leagues this year. Nevertheless, statistics don't tell the whole story in basketball. Rarely do we quantify hustle, such as getting up the court quickly; team work like sharing the ball with others; or sacrifice when a player dives for a loose ball. These efforts, which few track, are often as important as points scored. Statistics can be focused on, to some degree, successfully (e.g. tonight I'm going to try and get more rebounds in this game). But in my opinion, too much focus on the numbers can be debilitating. There comes a point where you have to go play the game, have fun, do the best you can and not worry about the numbers.

Just as the statistics in basketball don't tell the whole story, such is also the case in health care. I was intrigued by a quote I read recently in the New York Times by the scientific health care quality pioneer Avedis Donabedien whose main focus was on measurement. He said during the last days of his life, "the secret to quality is love."1 This was a man who was dedicated to health care statistics. There are areas in health care we don't quantify but are extremely important, such as time spent with a patient discussing end of life care, treating co-workers respectfully and timely follow up with results. Although hard to quantify, few argue against the direct health benefits of the health care professional who spends extra time listening to a patient who has just had a difficult life event.

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25 Years of Advancements: Change at HealthInsight and in Health Care

Open Road

Twenty five years ago I stepped into the HealthInsight office, then called Nevada Peer Review, in Las Vegas and began my career in health care improvement. I was thrilled to have an advanced piece of equipment—an IBM Selectric self-correcting typewriter. Staff used dumb terminals to verify patient information for our Medicaid and Medicare review work, and our health care analysts had very large computers taking up a good bit of space in their office. Within a couple of years, we all upgraded to PCs and before long, cables and cords were draped everywhere as we established our first company-wide network.

We’ve come a long way at HealthInsight, and as I reflect upon my 25 years here, I think about the advancements made in health care over that same time period, and which of those, in my opinion, have had the biggest impact. There are many, and I’m sure each advancement may resonate differently, depending on your own personal perspective. These are just a few that made my list—focused on either public policy impacting an individual’s ability to manage their own care or technology advances.

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Embracing the Cloud

People using laptop and iPad

We've all heard the words nimble, adaptive and security when it comes to information systems. We want those systems to be more nimble and adaptive to users, while ensuring that data and infrastructure remain secure. These needs are a key priority for HealthInsight as we strive to remain a trusted partner and leader in our field. We are constantly looking for ways technology can help us achieve these needs.

This is where cloud services can come in. Cloud services, as defined in Webopedia.com, are "services made available to users on demand via the Internet from a cloud computing provider's servers." These services can allow businesses to offload tasks such as server maintenance, storage needs and software licensing to cloud providers, at what is becoming a very compelling and competitive cost structure. Use of cloud services can allow the IT department to focus their work on strategic projects instead of the day-to-day tasks that infrastructure requires.

But IT isn't the only one that can benefit from this potential approach; the business can too. Moving key services like file storage to the cloud can create a centralized repository where data can be collected and accessed from a wide variety of devices. Cloud providers have a high degree of availability, so it's unlikely that users would ever be without their information. Imagine accessing a report on a laptop while another user is able to make changes to the same document from their iPad, while yet another user is able to pull up the latest version on their cell phone. The collaborative and productive possibilities are plentiful.

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Putting the “Health” Back in Health Care

Doctor with patient

You're not feeling well. You have a fever, a sore throat, an unusual pain. What do you do? You seek medical attention, of course. Why? Because when you are sick, you go to the doctor. But are there reasons to go to the doctor when you're not sick?

When my husband was 55, he went to his primary care doctor and suggested that it was probably time he got a colonoscopy (an initial one is recommended at age 50 and his mother had colon cancer), maybe an EKG or treadmill test (his dad had a massive heart attack at age 52), and maybe a shingles or pneumonia vaccination. His doctor said, "Why are you asking for all of this? I don't get paid for ordering or providing these services." In other words, "I provide sick care, not wellness/preventive care." Not only was his statement true, but in most cases, commercial insurance does not pay for services that are intended to prevent, not treat, a certain condition; so if patients want these tests, they have to pay for them themselves.

Fast forward to 2012. Medicare expanded benefits to their fee-for-service beneficiaries to include an annual wellness visit. This is a visit focused on maintaining and improving health, making a plan for preventive and screening care, and keeping the clinic up to date on all the care a patient is receiving. An annual wellness visit includes a review of all the medications a patient is taking, the names of all other doctors they are seeing and the patient's medical/family history. Among other things, the doctor conducts a screening for depression, assesses the patient's ability to perform activities of daily living, his or her risk of falling and any hearing impairment.

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Recycling: Forethought, Not Afterthought

Bag of recycling material

Recycling and forethought go hand in hand – deliberation, consideration and planning for our future.

One of the Albuquerque programs I am most impressed with is how our city has fostered a robust and visible recycling program. The City provides blue recycling bins and these blue bins, like soldiers in uniform, line our curbside every weekday morning.

HealthInsight has whole-heartedly embraced this program. Recycling is ubiquitous in our HealthInsight New Mexico office. We have set places for mixed and glass recycling and have incorporated taking these items for recycling as part of our kitchen duty rotation. Blue bins for material to be shredded are in every office suite. During the recent renovation of our offices, we recycled many hundreds of paper hanging file folders, manila file folders, and even the metal file cabinets that held those items.

A few months ago however, I noticed not everyone plans for the recycling of their plastic, paper and glass. My sisters and I went to an annual festival at a local park where we had a great time sampling all the wonderful food, listening to music and watching the kids play games and run around on the grass. It was when it was time to leave and we looked around for a place to recycle our bottles and plastic cups that we discovered there were no recycling bins. Instead, we saw clean-up crews throwing bulging plastic bags into a dumpster.

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Inspiring Ourselves

Hiker celebrating

Imagine you are in a position where you are expected to help people change unhealthy habits or otherwise maladaptive behavior. You're not expected to be a miracle worker, but you want to make a difference. Finding effective ways to help these people is important to you. Now, let's make the problem a little harder: the people you're expected to help know that it's in their best interest to change; they've known for some time. Many have made prior attempts to change and have been discouraged by their results.

You are not in an enviable position. It may be even worse than it seems. The very people you are expected to help might see you or what you have to say as being threatening to their sense of self-worth and become defensive. What can you do to help them change?

A recent study points to a simple and inexpensive technique that you might consider. In the field of positive psychology it is called self-affirmation. It works like this:

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The Alien in My Neck

Measuring blood pressure

In director Ridley Scott's iconic 1979 sci-fi horror film "Alien", a rather gruesome, extra-terrestrial creature suddenly and violently bursts from the chest of a crew member on a deep space mission—a scene as vividly unforgettable as it was unexpected.

A few months ago, I had a somewhat similar experience ... albeit mine occurred in an outpatient surgery center, and the circumstances were a bit less dramatic. Let me explain.

Last summer, I attended our annual wellness screening event at work. Happily, all my lab values—glucose, cholesterol, triglycerides, etc., as well as my blood pressure—were in favorable ranges. My wellness "Health Score" was excellent! Even so, in the months after the screening I had a recurring impression that I should get an annual medical exam with my primary care physician. After initially resisting the impression, I finally set the appointment.

As I fully expected, the outcome of my exam was very positive: no health issues or presenting conditions. "Fit as a fiddle." Then, just before ending the exam, the doctor decided to check my neck. "Oh ... you have a mass on your thyroid. Pretty large, actually." I had no idea.

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Care Options for the Frail Elderly

Mother and daughter

While at the California Dialysis Conference last week, I attended a thought-provoking session with a panel discussion between three medical directors from the largest dialysis organizations in the U.S. – Davita, Fresenius and U.S. Renal: Dr. Allen Nissenson, Dr. Dinesh Chatoth and Dr. Stan Lindenfeld, respectively. These physicians grappled with many issues affecting dialysis patients nationwide.

As the topic turned towards the Centers for Medicare & Medicaid Services' (CMS) goal to have alternative payment models implemented in 80 percent of the Medicare population by the year 2020, the trio discussed the benefits of the new renal Accountable Care Organization (ESCO), including the unquestionable benefit of providing integrated care for patients with kidney disease. While these doctors agree that cost savings are an ultimate driver, by providing comprehensive services including palliative care, our medical community will be able to provide an alternative to dialysis and have painfully honest conversations about the benefits and challenges of treatment, particularly for the frail elderly. Surprisingly, at least to me, frailty has a medical definition. Frailty is identified when a patient meets three out of five criteria: weight loss (10 or more pounds within the past year), muscle loss, a feeling of fatigue, slow walking speed and low levels of physical activity. With aging frailty comes naturally; patients over 75 represent our largest growing segment with chronic kidney disease – the precursor to kidney failure.

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Achieving a Work-Life Balance—is it Possible?

Man throwing papers

I have felt at many times my balance between work and life has been out of sync. I think it is something most people experience at one time or another during their working years; struggling to maintain balance between work, home and everything else.

Jeff Davidson, an expert in work-life balance, said, "Work-life balance is the ability to experience a sense of control and to stay productive and competitive at work while maintaining a happy, healthy home life with sufficient leisure. It's attaining focus and awareness, despite seemingly endless tasks and activities competing for your time and attention."

If you're finding it more challenging than ever to juggle the demands of work and the rest of your life, you're certainly not alone. We all need some breathing space each day with time to enjoy life, while still feeling a sense of accomplishment at our jobs. Perhaps the following will help bring a little more balance to your daily routine:

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Football Lessons on Leadership from Peyton Manning

Peyton Manning

I had the privilege of being in attendance at the annual conference of the Health Information Management System Society (#HIMSS16) in Las Vegas a few weeks ago when Super Bowl Champion Peyton Manning gave the closing keynote address. He shared insightful personal stories that resonated with health care transformation, involving leadership and teamwork. His perspective as a leader on the football field can help us as we consider what it takes to be successful teams and leaders in health care today.

He started by sharing that he felt that he could relate to the crowd of Health IT professionals in the room: "both football and health care require leadership in a world that spins on an axis and is constantly throwing hurricanes at us." He explained that the new word for nimble is pivot. He said "Pivot is the ability to change strategy without changing or losing the vision; being nimble to take whatever is thrown at you."

He shared how it felt to be learning on the run as he started out in the NFL. Peyton humbly shared that he set the single season record for most interceptions by a rookie quarterback. He joked that he is "still pulling for someone to break that record!"

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