Of Oceans, Orcas—and HIEs

Aug. 21, 2014
A lot of very important developments are taking place in the Pacific Northwest and in Canada, and a number of them were on display Monday and Tuesday of this week during the Health IT Summit in Seattle

A lot of very important developments are taking place in the Pacific Northwest and across the border in Canada, and a number of them were on display Monday and Tuesday of this week, during the Health IT Summit in Seattle, sponsored by the Institute for Health Technology Transformation (iHT2), the sister organization of Healthcare Informatics.

It was exciting and very gratifying to be a part of the proceedings this week, and to be able to moderate panel discussions around topics like population health and analytics, and to be able to introduce important speakers like Christopher Ross, CIO of Mayo Clinic, and Wes Wright, CIO of Seattle Children’s Hospital.

Many important discussions were had. But before I comment on a few of those, I just have to say that it really put it all into context regarding the Pacific Northwest and the Rocky Mountain West, when Nancy Vorhees, COO of Inland Northwest Health Services (Spokane, Wash.), and Doris Barta, director, telehealth services, of Partners in Health Telemedicine Network/St. Vincent Healthcare (Billings, Mont.), respectively, to talk about the vast distances involved in reaching northwestern U.S. patients via telehealth and other services. Montana, the fourth-largest state in the United States, yet the 44th out of 50 in population, is vast, with a population of just over one million people spread out across an area the size of Japan (while Japan has nearly 127 million people). Even more to the point, the state of Montana has just 17 pediatricians spread out across 147,000 square miles (with the distance across the state east to west being 630 miles, or nearly as far as from Washington, D.C. to Chicago), and not a single pediatric surgeon. Not surprisingly, Denver Children’s Hospital is the third biggest referral destination in terms of patient volume from St. Vincent Health to tertiary and quaternary care.

But beyond the geography of the Pacific Northwest and Rocky Mountain West, it was great to hear about the pioneering spirit energizing healthcare delivery innovation at organizations like Seattle Children’s, Legacy Health System (Portland), Polyclinic and Group Health Cooperative (both Seattle), St. Luke’s Health System (Boise), Providence Health & Services (Portland/Seattle), and Billings Clinic (Billings, Montana). The pioneering spirit that has always been present out west was certainly clear in presentations and discussions around such topics as population health, analytics, telehealth, mobility, interoperability, and HIE.

Take for example the first-generation efforts of leaders like Sean Rogers M.D., at Polyclinic, and Sarah Miller, at Group Health, to begin to do effective, proactive health risk assessment and stratification, tied to intensified care management of at-risk plan members and patients, and further tied to dashboards to help physicians understand their patient panels. Or telehealth initiatives in both Washington state (Inland Northwest Health Services) and Montana (Partners in Health Telemedicine Network/St. Vincent Healthcare) to better meet the needs of very far-flung patients in quite isolated areas of the Northwest. Or the work being done at Seattle Children’s to lay the foundation of a broad regional HIE for pediatric care. All these are being moved forward by leaders who are both being inspired by the open, pioneering spirit of the Northwest, and reflecting its geographic, demographic, and cultural challenges and opportunities.

Meanwhile, as Nicholas Wolter, M.D., CEO of Billings Clinic, noted in his keynote speech on Tuesday, “In 2005, we put on the table that we’d like to be best in the nation on safety, quality, and service.  And then in 2010, we decided we wanted to be best in the nation in terms of safety, quality, service, and value.” Those vision statements reflected both that western pioneering spirit, and something else on top of it—the understanding that the time was at hand to show the entire nation what was possible in terms of integrated, coordinated care for entire populations.

What’s more, Canadian healthcare leadership representation at the Health IT Summit from British Columbia and Manitoba reflected the innovations taking place to the north of us, in the context of a reimbursement system whose single-payer element is making certain things more feasible in the land of the maple leaf. We would do well to consider the perspectives of Jat Sandu, Ph.D., regional director in the Public Health Surveillance Unit at the Vancouver Coastal Health Authority, and Trevor Strome, analytics lead at the WRHA Emergency Program and assistant professor in the Department of Emergency Medicine at the University of Manitoba (Winnipeg). Not every Canadian innovation will translate entirely in the U.S., but just as Canadians are learning from U.S. innovations in healthcare, so, too, American healthcare leaders have much to learn from the initiatives taking place in Canada.

Don’t get me wrong: there was absolutely no evidence of rose-colored glasses being worn at this conference. Indeed, speaker after speaker and panelist after panelist acknowledged quite frankly the huge challenges facing North American healthcare, as both the U.S. and Canadian systems struggle forward towards evolving into healthcare systems driven more by value than by volume. In particular, in the two panels that I had the privilege of moderating, X and X, there was absolute unanimity that we are collectively at a point of intense struggle in the effort to make the concepts of population health and analytics successful in boots-on-the-ground reality.

But overall, in the face of the intense challenges so well articulated at the Health IT Summit in Seattle, I came away from my two days of participation there quite encouraged. Now is without a doubt a time of intense struggle for both the U.S. and Canadian healthcare systems, at the policy, business, operational, and IT levels. But the amount of really thoughtful, strategic innovation taking place gives me great hope for the trajectory of the next few years in North American healthcare; and I’m wearing absolutely no rose-colored glasses now, as I make that statement.

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