The Good Enough Revolution
Edmund Billings
Flip Video vs Sony, Canon
Edmund
________________________________
Edmund Billings MD
CMO & EVP Product
Medsphere
1971 Palomar Oaks Way, Suite 200
Carlsbad, California 92008
edmund....@medsphere.com
www.medsphere.com
www.medsphere.org
Skype: edmundbillings
415-505-8953 c
760-692-3713 o
760-683-3701 f
fred trotter
Edmund Billings
Edmund
__________________
Edmund Billings MD
415.505.8953
On Sep 21, 2009, at 3:26 PM, "fred trotter" <fred.t...@gmail.com<mailto:fred.t...@gmail.com>> wrote:
If you blog it, they will link (and me too!!)
-FT
This HBR article is spot on in regards to the CCR vs CCD question. The vendors of complexity will do what they may and create more of the same for there existing market. But, its the cheap, simple and fast that is opening up the markets. Lo-fi hitech that is accessible.... is what goes mainstream.
Flip Video vs Sony, Canon
Edmund
________________________________
Edmund Billings MD
CMO & EVP Product
Medsphere
1971 Palomar Oaks Way, Suite 200
Carlsbad, California 92008
<http://www.medsphere.com>www.medsphere.com<http://www.medsphere.com>
<http://www.medsphere.org>www.medsphere.org<http://www.medsphere.org>
<http://www.fredtrotter.com>http://www.fredtrotter.com
David Kibbe
<Article The Good Enuf Rvlutn.pdf>
Ben Mehling
http://www.wired.com/gadgets/miscellaneous/magazine/17-09/ff_goodenough
My direct take-away is the importance of simplicity in the user interaction. Flips are drop-dead simple to use -- it's a big red button. Likewise, all the gizmos and features on EMRs only serve to alienate the providers who are supposed to use them.
Simplicity = Adoptability.
- Ben
From: David Kibbe
Sent: Monday, September 21, 2009 4:18 PM
To: open-ehealth-...@googlegroups.com
Subject: Re: The Good Enough Revolution
right on! When and where is this article from? DCK
David C. Kibbe, MD MBA
Senior Advisor, American Academy of Family Physicians
Chair, ASTM International E31Technical Committee on Healthcare Informatics
Principal, The Kibbe Group LLC
___________
fred trotter
What this implies is that it is not merely enough to say that "this simple solution is good" but that more importantly "the complex solution is worse for most users most of the time"
Again, I think a full exposition of this idea warrants a good blog post from somebody.
-FT
David Kibbe
Edmund Billings
These are ideas whose time has come: open source, good enough. If the government mandates the CDA and the CCD it will force the use of CCR to be compliant. This is exacty what the Vista CCR CCD Gateway project had to do. Use the CCR and transform to CCD.
Perfection is the enemy of GE.
________________________________
Edmund Billings MD
CMO & EVP Product
Medsphere
1971 Palomar Oaks Way, Suite 200
Carlsbad, California 92008
edmund....@medsphere.com
www.medsphere.com
www.medsphere.org
Skype: edmundbillings
415-505-8953 c
760-692-3713 o
760-683-3701 f
From: David Kibbe <kibbe...@mac.com>
Reply-To: <open-ehealth-...@googlegroups.com>
Date: Tue, 22 Sep 2009 04:16:41 -0700
To: <open-ehealth-...@googlegroups.com>
Conversation: The Good Enough Revolution
Subject: Re: The Good Enough Revolution
Matthew King
I think one weakness of the "good enough" idea in Healthcare is it implies (to me) stagnation. In fact, once in place, it needs to be subjected to the same iterative improvement process (CQI) as anything else.
Matthew King, MD
Elwell, Tim
Edmund, et al….
I’ve been reading these posts with great interest but have been in customer meetings that have prohibited a direct and thoughtful response. So please accept my apologies to the group for the lateness of this response…
I am on the same page with you (almost) WRT to the ‘good enough’ concept. Customers need to be offered solutions that are not bloated with an accompanying bloated price tag. However, I am opposed (philosophically) to the phrase “Open source, good enough”. This leaves the reader with the perception that they may be compromising if they use open source – which is incorrect. An application that meets the base requirements may be ‘good enough’ – no more; no less -- and, in fact, is exactly what we argued when we presented to Mark Leavitt, et al, at the CCHIT meeting at HIMSS. As you may recall, I argued that the provider should decide what the definition of ‘meaningful use’ should. That determination by the individual provider should define the application functionality that defines ‘meaningful use’ to their practice. Since then, the government, with all their ‘experts’ (some of which subscribe to this list) have weighed in to tell providers what is best for them. One of the positive outcomes of this debate has been the compromise recommendation by CCHIT around the CCHIT-M certification description – which I think is a good compromise. However, putting the CCHIT compromise aside, to say that ‘open source’ is just ‘good enough’ confuses the issue.
You began your posts saying that the CCD requirement over CCR was too complex and based on David’s post (below), it would appear that you have strong support for your position. However, before we throw the baby out with the bath water, I ask that no one (including Medsphere) hide behind what they have today as representing the ‘good enough’ concept that is meant to represent the minimal requirement. The mere fact that you have created the CCR-CCD Gateway acknowledges the fact that this is a necessary path forward.
ONC has taken a position on what is needed (and what will be funded) and CCD is the path forward. And it makes sense. Why?
1. CCD harmonizes the two earlier standards for Clinical Summary – CCR and CDA. It shares patient summary in an easy-to-read format with a CCD template (provides all necessary information about a patient medical summary, separated by Sections )
2. New CCHIT certification criteria require all ambulatory and inpatient EHR systems to be CCD compatible, making CCD the most preferred standard for clinical document exchange
3. CCD recognizes the standard by HITSP (C32 and C48 Clinical Summary Document)
4. All IHE based HIEs require CCD document for XDS.b transactions
5. All NHIN transactions for Document exchange are based on CCD
6. Those systems which are in compliance with CCD will be readily compatible with new standards and systems, thereby opening doors for standards based interoperability and a better quality of care
Now, so that no one, including MOSS (Misys Open Source Solutions), hides behind any hidden agenda, MOSS has built out our HIE open source solutions to accept CCDs – in compliance with the IHE direction set by the ONC. But we have done so (and made the requisite investments) because it’s the right thing to do and will move us all forward.
Let’s not take a step back on what is needed to move toward true interoperability. And most of all, let’s not present open source as a ‘compromise’. It sends the wrong message and will not help position any of our efforts in a favorable light. Open source is just as good and in the promotion of interoperability is the best answer.
Thanks,
Tim
Tim Elwell
Vice President
Misys Open Source Solutions ("MOSS"), LLC
123 Main Street, 8th Floor
White Plains, NY 10601 USA
"Misys" is the trade name for Misys plc (registered in England and Wales). Registration Number: 01360027. Registered office: One Kingdom Street, London W2 6BL, United Kingdom. For a list of Misys group operating companies please go to http://www.misys.com/corp/About_Us/misys_operating_companies.html. This email and any attachments have been scanned for known viruses using multiple scanners. This email message is intended for the named recipient only. It may be privileged and/or confidential. If you are not the named recipient of this email please notify us immediately and do not copy it or use it for any purpose, nor disclose its contents to any other person. This email does not constitute the commencement of legal relations between you and Misys plc. Please refer to the executed contract between you and the relevant member of the Misys group for the identity of the contracting party with which you are dealing.
K.S. Bhaskar
[KSB] <...snip...>
> I think one weakness of the "good enough" idea in Healthcare is it implies
> (to me) stagnation. In fact, once in place, it needs to be subjected to the
> same iterative improvement process (CQI) as anything else.
[KSB] Why should it imply stagnation, Matt? To me, good enough means
good enough to be put to use today, but not so good that it cannot be
improved for tomorrow.
Regards
-- Bhaskar
Matthew King
m
Blaine Warkentine
As for ease of use.
I think an interesting book to read would be a book called Trade-Off “the ever-present tension between quality and convenience” http://www.amazon.com/Trade-Off-Some-Things-Catch-Others/dp/038552594X/ref=sr_1_1?ie=UTF8&s=books&qid=1253720133&sr=8-1
Interesting to think about how you can create the application so that it is convenient (easy, low cost, small features) which is one way to succeed
But to then house the data from the use of these convenient solutions and sell with a feature rich dashboard (high cost, adaptable, realtime, cost saving, administration, government, etc..) with appropriate monetization for a business to be created.
Cheers, Blaine Warkentine M.D.
--
David Kibbe
I would love to see this environment take hold. I would like to form an environment where many apps (mobile/otherwise) that are relatively easy to use and singularly focused can be compiled into a larger atmosphere through integration into a consortium approach so that the data from the use of these apps actually has a story to tell and does not just live on the thick client of the phone. Creating this integration is something I have wanted to do for some time.
As for ease of use.
I think an interesting book to read would be a book called Trade-Off “the ever-present tension between quality and convenience” http://www.amazon.com/Trade-Off-Some-Things-Catch-Others/dp/038552594X/ref=sr_1_1?ie=UTF8&s=books&qid=1253720133&sr=8-1
Interesting to think about how you can create the application so that it is convenient (easy, low cost, small features) which is one way to succeed
But to then house the data from the use of these convenient solutions and sell with a feature rich dashboard (high cost, adaptable, realtime, cost saving, administration, government, etc..) with appropriate monetization for a business to be created.
Cheers, Blaine Warkentine M.D.
--
<image.png>
On 9/22/09 7:16 AM, "David Kibbe" <kibbe...@mac.com> wrote:
Blaine Warkentine
ortho...@gmail.com
610 310 8104
On 9/23/09 1:05 PM, "David Kibbe" <kibbe...@mac.com> wrote:
Richard Peters
"Misys" is the trade name for Misys plc (registered in England and Wales). Registration Number: 01360027. Registered office: One Kingdom Street, London W2 6BL, United Kingdom. For a list of Misys group operating companies please go tohttp://www.misys.com/corp/About_Us/misys_operating_companies.html. This email and any attachments have been scanned for known viruses using multiple scanners. This email message is intended for the named recipient only. It may be privileged and/or confidential. If you are not the named recipient of this email please notify us immediately and do not copy it or use it for any purpose, nor disclose its contents to any other person. This email does not constitute the commencement of legal relations between you and Misys plc. Please refer to the executed contract between you and the relevant member of the Misys group for the identity of the contracting party with which you are dealing.
Edmund Billings
The adoption of HIT by the early adopter “have alots” started in the early 1990’s and these solutions have not crossed the chasm to the mainstream.... To “The Haves and The Have Nots”. 1.5% EMR adoption by US hospitals in 2009 is glaring evidence.
I can’t tell you have many times when asking physicians what they thought of the EMR’s in the market... They say, “they are just too much”. “Too expensive, too complex, more than my practice needs”. The reason chasms like this occur is because as Geoffrey Moore wrote in Crossing the Chasm.... The early adopters drive technology to the 100% case and the products do not translate to the mainstream. When innovative companies apply a pareto analysis and the 80/20 rule, technologies can be dramatically simplified and they are translated for mainstream adoption.
If you have been to an HL-7 or an HITSP meeting, clearly it is early adopter driven. If you look at the CDA, its comprehensive and looks to cover the 100%. If you look at how XML is applied, it requires an understanding of XML and health informatics and ....most critically the nonstandard applications of XML within the standard. Its a science project not an innovation.
So as Clayton Christianson describes in “The Innovators Dilemma”
“A DISRUPTIVE INNOVATION IS A TECHNOLOGY THAT BRINGS A MUCH MORE AFFORDABLE PRODUCT OR SERVICE THAT IS MUCH SIMPLER TO USE IN THE MARKET.”So, if we focus on adoption and take CCR as an example of a good enough innovation. It is simpler to apply or use and thus is more affordable to develop and anyone that knows XML can use straight off.. Its accessible.
“AND SO, IT ALLOWS A WHOLE NEW POPULATION OF CONSUMERS TO AFFORD TO OWN AND HAVE THE SKILL TO USE...., WHEREAS HISTORICALLY, THE ABILITY WAS LIMITED TO PEOPLE WHO HAD A LOT OF MONEY OR A LOT OF SKILL”.
So the question for the ONC to answer regarding standards is not an issue of what the “large” organizations need over the “small” organizations. The question is as it was for the CCHIT Comprehensive Certification,
“Do you want to cement-in requirements that have not been adopted by the mainstream?”
“Do you want the early adopters from “have alot” organizations defining solutions or standards that must be a adopted by the mainstream?”
“Can we ignore a standard that technology companies have found much easier to innovate with?”
If good enough does not become sanctioned and perfect does..... Innovators will use good enough to get to the same results anyway. For the VistA Gateway, George Lilly used CCR and then transformed it to a CCD.
Well, good enough then.
Edmund
________________________________
Edmund Billings MD
CMO & EVP Product
Medsphere
1971 Palomar Oaks Way, Suite 200
Carlsbad, California 92008
edmund....@medsphere.com
www.medsphere.com
www.medsphere.org
Skype: edmundbillings
415-505-8953 c
760-692-3713 o
760-683-3701 f
Reply-To: <open-ehealth-...@googlegroups.com>
Date: Wed, 23 Sep 2009 11:00:38 -0700
To: <open-ehealth-...@googlegroups.com>
Conversation: The Good Enough Revolution
Subject: Re: The Good Enough Revolution
Richard Peters
David Kibbe
Elwell, Tim
I appreciate the comments Edmund as I have the same Christiansen sound bites in my pitches too. But let’s not kid ourselves. The 1.5% hospital EMR adoption rates or the 17% (using the optimistic number) EHR adoption rates in provider practices have nothing to do with the CCD/CCR argument. It’s much more about perceived value and return on investment – however the customer defines it. The expectation is that ARRA incentives will help to solve the ROI imbalance. I hope the Feds are right.
The CCD train has left the station and with the increased EHR adoption that will be promoted using the ARRA incentives, CCD usage will increase as well. I’ll let the techies argue what’s technically best but the directional decision has been made.
Lastly, this is about open source and standards. When it comes to interoperability, we need to be beating the drum that this is one place that there are no compromises. Black box solutions around interoperability are not sustainable.
Tim
Tim Elwell
Vice President
Misys Open Source Solutions ("MOSS"), LLC
123 Main Street, 8th Floor
White Plains, NY 10601 USA
"First they ignore you, then they laugh at you, then they fight you, then you win.” Mahatma Gandhi
"Misys" is the trade name for Misys plc (registered in England and Wales). Registration Number: 01360027. Registered office: One Kingdom Street, London W2 6BL, United Kingdom. For a list of Misys group operating companies please go to http://www.misys.com/corp/About_Us/misys_operating_companies.html. This email and any attachments have been scanned for known viruses using multiple scanners. This email message is intended for the named recipient only. It may be privileged and/or confidential. If you are not the named recipient of this email please notify us immediately and do not copy it or use it for any purpose, nor disclose its contents to any other person. This email does not constitute the commencement of legal relations between you and Misys plc. Please refer to the executed contract between you and the relevant member of the Misys group for the identity of the contracting party with which you are dealing.
K.S. Bhaskar
deployment problem differently. We who are technologically savvy,
think of electronic medical records as information technology. But
your typical doctor doesn't want to think of IT (all my physician
friends outside the VistA world are more interested thinking of
patient care than about IT).
Practices can deal with EMRs if they are treated like appliances with
a service plan, like a copier, a sterilizer or a building alarm
system. A vendor ships a preconfigured EMR appliance. The practice
plugs it into power outlet and the network. It's an EMR appliance
that they can connect to from any PC. The vendor remotely administers
the appliance as part of a service that is priced like a utility
(e.g., $x per provider per month, $y per patient visit, etc.) and
*zero* administration for the practice.
The appliance is actually a commodity PC (maybe with the vendor's
sticker on it, or even painted lilac & taupe in the vendor's corporate
colors). It's inexpensive. The disks/databases are encrypted so that
if it is stolen, nobody is out much money and patient data is still
secure.
The benefits of having an appliance in the practice are (a) lightning
fast LAN response times even for a practice in the boonies and (b)
something that people can touch and feel (the EMR system is a thing
rather than an abstraction and the people in the practice know that
their patient data is inside the appliance, just as it is today inside
their filing racks).
As part of the service, the appliance has a low bandwidth real time
streaming backup to an environment in the vendor's data center (or to
a server rented by the vendor somewhere). This backup is only
milliseconds behind the appliance. In the event of a failure in the
local appliance, the practice can switch within a couple of minutes to
the VIstA in the data center, and all their latest patient data is
right there. The vendor ships a replacement, the practice ships the
failing appliance, the new appliance catches up with work done against
VistA in the data center and switches back to the local appliance.
The practice has no access to the server except from their PCs, but
there is a "break the glass" way that they can access all the data in
it if the vendor goes out of business or if there is a dispute. By
using a "break the glass" approach, the vendor is protected.
*All* of this is technologically feasible *today*. The disruptive
technology is here. But it needs to be productized, packaged and
presented differently.
Regards
-- Bhaskar
[KSB] <...snip...>
Edmund Billings
As far as proxies go, it would be most telling to correlate the rate of HL-7 3.0 and CDA adoption to that of mainstream EHR adoption. And then to look at the rate of CCR adoption.... It might help us project how good enough applications and services might be adopted.
For anyone who has not read Crossing the Chasm, do it and follow it with the Tipping Point. The mainstream adopts not based on a ROI assessment or due dilligence or a lengthy product selection, they adopt because its a no-brainer and they feel the me-too pressure. The mainstream do not relate to the early adopters. They relate to the practical early majority who they look up to. If they now have one, I better get one too.
Edmund
________________________________
Edmund Billings MD
CMO & EVP Product
Medsphere
1971 Palomar Oaks Way, Suite 200
Carlsbad, California 92008
edmund....@medsphere.com
www.medsphere.com
www.medsphere.org
Skype: edmundbillings
415-505-8953 c
760-692-3713 o
760-683-3701 f
Reply-To: <open-ehealth-...@googlegroups.com>
Date: Wed, 23 Sep 2009 15:45:19 -0700
To: <open-ehealth-...@googlegroups.com>
Conversation: The Good Enough Revolution
The CCD train has left the station and with the increased EHR adoption that will be promoted using the ARRA incentives, CCD usage will increase as well. I’ll let the techies argue what’s technically best but the directional decision has been made.
Lastly, this is about open source and standards. When it comes to interoperability, we need to be beating the drum that this is one place that there are no compromises. Black box solutions around interoperability are not sustainable.
Tim
Tim Elwell
Vice President
Misys Open Source Solutions ("MOSS"), LLC
123 Main Street, 8th Floor
White Plains, NY 10601 USA
T +1 914 821 2566
F +1 914 422 3659
M +1 914 260 4402
E tim.e...@misys.com
Kevin Peterson
Kevin
Sent from my Verizon Wireless BlackBerry
From: Matthew King
Date: Tue, 22 Sep 2009 21:23:33 -0700
To: <open-ehealth-...@googlegroups.com>
Subject: Re: The Good Enough Revolution
Blaine Warkentine
I am writing to by Steve Adams, CEO, RMD Networks and Acting President, Clinical Groupware Collaborative
sad...@rmdnetworks.com
Blaine
On 9/23/09 1:05 PM, "David Kibbe" <kibbe...@mac.com> wrote: