I love the fresh debate about standards and the evolution of Health IT raised by the three Health Affairs articles.    I agree wholeheartedly with the perspectives of Carol and Clay - and frequently reinforce these comments to customers, policy makers and audiences alike. 

1. It's about the patient - not about the standards. Value in the form of patient care and business results can be improved by moving/reusing the data already in the system! There is no need to wait for 'standards'.  Ultimately we need to be focused on solutions that provide value to patients….better quality of care.
    
2. If it's about the patient, we need to empower consumers to be active and engaged participants in the system and they will demand 'connected' care and more health and wellness choices.  They will increasingly make physician choices based on the ability and willingness of physicians to leverage communications/connected care to improve patient convenience and outcomes.  In order to have more choice, consumers need to be able to access and leverage health IT solutions: the same ones that are being used by their physicians and other stakeholders across the spectrum of care.
    
3. Health IT is a great enabler for many things (outcomes, safety, results, employee productivity, employee satisfaction) but not an end in itself. System design matters a lot - metadata is the answer to enabling exchange of info today to evolve to standard exchange tomorrow.  Health IT is only one piece of the puzzle, but we can't wait for all the pieces to be in place; We need to start improving outcomes today. These beliefs have informed the design principles of the software products we introduced in the marketplace - both HealthVault and Amalga.

In addition to consumers as a change agent, I remain hopeful that the buyers of large health IT systems will wake up and demand more from their vendors; Not in terms of custom features, but in terms of a real commitment to interoperability and to unlocking the data that exists in systems already.   Health IT buyers are critical stakeholders/components of the ecosystem and need to demonstrate leadership in getting us to real solutions that extract the value from HIT - and not let themselves be positioned as victims controlled by the vendors. Unlocking the data that providers and patients need to make the right decisions should be the priority, with the goal of improving patient outcomes.

Last week, we hosted around 20 physicians from one of our Amalga early adopters for a two day, two-way conversation around what the most important challenges in health delivery are and how software can help address them.    It was a very instructive conversation -- from which I learned a lot and met some talented, accomplished and interesting individuals.

Part of our objective was to imagine a future where software technology enabled new types of workflows and an extended delivery network beyond the hospital.    There was a lot of energy and discussion about the shape of such a future (increase the focus on prevention - inside the hospital and as a core to the delivery network goals).   As the discussion went on there was spirited debate about where to start, how to measure and how to pick goals that would really be transformational.

I am not prepared to go into the details of the conversation here -- but there were a few non-proprietary insights for me -- that are worth sharing:

First -- I have a much deeper understanding of the diversity of perspective, understanding and challenges -- of the various specialities and practice groups within a large delivery system.    Given this beginning point -- and other factors such as physician model -- I appreciate the need for (and challenge) of leadership to enable change to really happen.

Next the dynamics of an "enterprise" health system seems more like a conglomerate than a traditional product focused enterprise -- even though they are serving a common customer and market.    This makes goal setting, prioritization of metrics for performance and resource allocation much harder -- if you want to drive to a common vision.

We started the session listening to Dr. David Pryor from Ascension Health.   Pryor described how Ascension set themselves an audacious 5 year goal (zero preventable medical errors) and then went about a series of process improvements to get there.    It was fascinating to listen to him describe the steps, the challenges, what worked and most impressively the results they achieved in a relatively short timeframe in multiple different institutions.    It truly is a remarkable story -- and given the organizational comments above -- even more impressive.    It is great that he was willing to share their best practices openly.

All health delivery organizations face big challenges on multiple fronts.    Everyone knows, that quality (outcomes) needs to improve and would reap large economic and social benefits.   And clearly -- as Ascension has demonstrated - real progress is possible.    In a truly competitive sector -- like banking -- the advancements of the certain organizations would ripple reasonably quickly through the sector (improve or lose share).   This dynamic doesn't appear to be at work in the health sector.    So it is going to be up to the leaders of our health delivery institutions -- to set audacious goals and drive to achieve them.

I had the good fortune of participating in an Allen and Co. health 'event' last week.   They brought together a small number of entrepreneurs and big company folk such as myself (and spouses) for an intimate few days of conversation, networking and recreation.    Their formula really works for forming relationships and developing deeper understanding of others' perspectives.  They also do an outstanding job with the execution -- so I found it well worth the investment in time.

Given the mix and high quality of folks -- we had engaging and wide ranging conversations with the following tidbits worth sharing:

• what is the future (and right) business model for diagnostics?    how (and when) will diagnostics dramatically change the health delivery system?
• how the existing policy framework encourages (forces) entrepreneurs to exploit the mis-alignment of incentives (find the gaps with new middleware type solutions) vs. creating end-to-end value improvement.
• what will it take to get supply-side innovation and payment reform?  is this even on the agenda of the presidential campaigns?   why not?
• does the increased use of information technology lead to consolidation of the fragmented health delivery system -- or does it enable 'virtual' consolidation through information networks vs. business organization?    or does it do both over time -- in phases?
• what form of evolution will emerging markets go through -- as they build both capacity and insurance systems?    what would we advise them to do?  and are there business opportunities for entrepreneurs or big companies only or both?

A funny incongruity, is I learned a lot about the development of a two-sided health specific market in today's connected Internet driven world -- while riding on horseback!