I’ve been on the road for the past few days, describing the importance of patient and family engagement using mobile applications to healthcare leaders in Europe.
The dialog has been bidirectional. I learned a great deal about the technology and policy challenges in each country. Patients, payers, and providers are struggling with issues such as usability, security, and supportability.
My schedule has required several time zone changes - a keynote in Seattle on Saturday, a flight to London on Sunday for meetings with NHS leaders on Monday and a keynote in Birmingham on Tuesday. In my discussion with UK leaders, they invoked the Chatham House Rule, something I had not heard about previously. To encourage open dialog, anyone who attended the meeting was welcome to use information from the discussion, but not allowed to reveal who made any comment.
In the UK, I heard a great deal about misalignment between IT departments and clinicians. IT departments are reluctant to embrace social, mobile, analytics, and cloud, instead insisting on centralized command and control of Windows desktop devices, often running Citrix/Virtual Desktop. Clinicians want mobile devices, universal access to applications anytime from anywhere on any device, and big data visualizations. There is innovation, with forward thinking firms creating novel mobile apps and piloting them in several NHS sites.
In Berlin, I met with a diverse array of stakeholders from the entire EU and Russia. All are facing the challenges of an aging society, chronic disease, and rising costs. Several expressed frustration with the pace of healthcare IT innovation in Europe. Regulators and IT departments are reluctant to be early adopters. Windows and client/server platforms predominate. Despite extraordinary engineering in Germany, there is still a fear of technology change.
Today marks the end of my travel for 2014. I’ve cancelled planned speaking in Copenhagen and Amsterdam to support my father-in-law’s care. As in previous years, my international collaborations have demonstrated to me that all our societies are making healthcare IT progress, but there is still a sense of urgency to do more. Technologies move faster than politics and culture. The work of John Kotter remains true in every location I visit - there must be a leader with vision, a guiding coalition, a reason for change, and an incremental step-wise approach to an idealized future state. No technology, no matter how magic, can succeed without change management.
Thursday, November 6, 2014
Dispatch from Europe
Posted by John Halamka at 3:00 AM
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That was interesting on the Chatham House Rules and I had not heard of it either. I just posted a 57 minute documentary featuring doctors and employees of the NHS, some of it talking about their fears on not being able to speak up and what happens to whistleblowers, it showed up on YouTube yesterday. The big portion of it is talking about US companies taking over the NHS and hiding behind the name and specifically United Healthcare is mentioned many times, and back in April a former executive from United took over the NHS.
In London, where the big concentration of Billionaires live according to several news accounts, 3 NHS facilities have gone bankrupt, so they are not happy with the privatization that is occurring there and when people fear they fear the technologies as well.
Myself I have blogged and kept track of United here for years and we have fears here too with how they function and how large they are and I have a couple former CMS folks that found me and told me about the mentoring that has gone on with United there for years and they fear right now for what is happening so again I see the resistance and fear as well with one company becoming too big to fail with such an army of subsidiaries that developed over a few years, yet hiding in plain sight.
I had a nice long chat with the World Privacy Forum on this as well and we are in full alignment, so until we get some better privacy rules and establish trust, instead of embracing new technologies, folks are running for the exits to stay outside the radar. I don't mean to be negative here at all but just rather addressing the real story as to what's going on and I chat with a few Quants as well to get more than just my viewpoint and we all seem to come to the same conclusion and I call it the Attack of the Killer Algorithms. People confuse virtual with real world values today everywhere we turn. Doctors live and deal with the real world, name for that-patients.
People also fear another Bloomberg failed Big Gulp model too and I like to use that as an example as everyone knows what it is and saw how no matter how much money and influence one has, if the proof of concept and model is broken from the start, it's not going to work and all remember what we went through reading about all the various stages and look at the time and effort wasted there as the Bloomberg bunch themselves were living too virtual and didn't know where to stop.
"People don't work that way" a phrase I borrowed from Emanuel Derman at Columbia seems to say a lot and Quants are very much aware of virtual versus the real world and maybe that's something that needs more thought today as we don't function like data on markets and can't move that fast when we have to find new doctors, new policies, etc. at the drop of a hat when a new model kicks out.
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