Glenn Steele Jr., integration advocate
Glenn Steele Jr., MD, president and CEO of Geisinger Health System, is a gambling man—but you won't find him at the roulette wheel or the black jack tables. He's betting that the future of healthcare delivery will closely resemble the model that is being assembled at the Danville, PA-based integrated health system.
Anticipating the shift toward outpatient interventions, Geisinger is building outpatient facilities on a 52-acre site in State College. Steele is also betting that incentives over the next five to 10 years will move away from units of work performed and toward an emphasis on accomplishing certain tasks across a continuum of care. "We're betting that we'll be paid to do better care for chronic disease patients, and that puts us right into the huge use of our redesigned primary care," he says. "I'd say that about 30% to 40% of what we are doing is designed around bets about change in the future, not necessarily what is happening right now."
Steele's confidence is built upon a long history of success. Geisinger's integrated model, which combines the hospitals, physicians, and an insurance company under the same financial framework, has allowed the health system to adopt innovative, consumer-friendly care models like their "one-price guarantees" for heart surgeries. The integrated model also promotes cooperation and collegiality between primary care physicians and specialists, resulting in better outcomes. "You can only do those cross-incentives if the folks are in the same financial organization," Steele says. "You are not allowed to do that by and large if you're not a part of a single, integrated health system."
Dennis Quaid, actor and activist
Hospitals usually ask celebrities to be spokesmen for a new fundraising drive or to headline the annual charity golf tournament. So actor Dennis Quaid's efforts to improve hospital and patient safety is a new celebrity role that hospitals have not seen. That could be a good thing.
By now you have likely read the story of how Quaid's newborn twins Thomas Boone and Zoe Grace received an overdose of the blood thinner heparin last year at Cedars-Sinai Medical Center in Los Angeles. The reported details of the incident—an apparent mix-up between the adult and NICU versions of the drug—were eerily similar to the deaths of three infants at an Indianapolis hospital in 2006. Luckily, Quaid says his twins are doing fine, but he and his wife, Kimberly, have started a foundation (www.thequaidfoundation.org) to raise awareness about patient safety.
"I myself had been in the hospital before. I had been naïve and had complete faith that the doctors and nurses knew what they were doing, that they check and recheck," Quaid says. "And I wasn't aware of how many people get killed or severely injured each year in hospitals all over the country because of human error, which is basically what it comes down to."
Still, Quaid says he doesn't necessarily lay the blame for mistakes on physicians and nurses. "They are overworked. Human error is just always going to be part of the equation. I like to relate it to the aviation industry where they brought down the number of crashes in commercial aviation because of the introduction of things like autopilot and color-coded radar in the cockpit."
Quaid hopes to use his celebrity status to raise awareness about the need for technology like bedside bar coding. The Quaids started with a profile on 60 Minutes and later traveled to Children's Medical Center Dallas to spotlight the hospital's use of technology.
Quaid's plan, he says, is to keep it simple. "The first step is about people rising up, or nothing will get changed," he says. "I really don't have any illusions that I will really change healthcare. There are a lot more people out there doing research and on the ground making it their job to do that everyday. Those are the people who will change healthcare. But I just would like to contribute something after what happened to us so it doesn't happen to someone else."
John Halamka, champion of IT adoption
At 16 years old, John Halamka designed his first computer. He installed it—a system designed to stimulate a patient's hearing and gather electric impulse data to determine if the patient has hearing, brain stem, or nerve issues—at Los Angeles County Harbor-UCLA Medical Center during a summer fellowship at the community hospital. By the time he was at Stanford University completing his undergraduate degrees in public policy, economics, and biochemistry, Halamka knew he wanted to spend his life melding technology and healthcare. So he entered medical school at the University of California San Francisco and simultaneously pursued graduate work in bioengineering at the University of California, Berkeley, focusing on technology issues in medicine.
Today, Halamka is (take a deep breath): a practicing emergency room physician; chief information officer of both Harvard Medical School and Beth Israel Deaconess Medical Center in Boston; CEO of Massachusetts-SHARE, an IT connectivity initiative within the Massachusetts Health Data Consortium; chairman of the New England Health Electronic Data Interchange Network; CIO of the Harvard Clinical Research Institute (HCRI); and an associate professor of emergency medicine at Harvard Medical School.
He works tirelessly to promote the adoption of health IT, specifically electronic health records and personal health records. Although he spends considerable time speaking on the conference circuit, Halamka has made concrete strides in fostering EHR adoption.
In Massachusetts, he used a $10 million allocation from Beth Israel Deaconess to foster an EHR rollout and clinical data exchange to fully subsidize EHRs for community physicians not affiliated with Beth Israel Deaconess. Halamka also chairs the Healthcare Information Technology Standards Panel, where he coordinates electronic standards harmonization among 600 organizations nationwide. And during his travels around the country promoting his causes, Halamka has received so many inquiries from colleagues about healthcare technology that he decided to write a blog in his spare time. Now, his "Life as a Healthcare CIO" blog is one of the most-read med-tech blogs on the Web, with about 2,500 readers logging on each week.
How does he manage it all? Halamka's answer is simple: "There are 168 hours in a week. All you have to do is use them wisely."
Lyle Berkowitz, IT innovator
When internist Lyle Berkowitz, MD, was treating Chicago businessman and creative director Peter Szollosi for cancer, the two often discussed the fragmented state of healthcare. Szollosi's approach to problem solving meshed well with Berkowitz's background in biomedical engineering and healthcare informatics, and the two often debated how they would reengineer healthcare with a particular focus on technology and innovative thinking—if only there was enough time and money to be truly innovative.
After Szollosi passed away in 2007, his friends and family approached Berkowitz about founding the Szollosi Healthcare Innovation Program. The charitable endeavor, which launched in January, adopted Szollosi's mantra—"I don't care what you can't do"—and the goal of using diverse technologies to improve the patient experience.
Berkowitz's first project was a Web-based tool to revamp "expect notes" that doctors send to ED staff to notify them of a patient handoff. He rolled it out at Northwestern Memorial Physician Group, Chicago's largest primary care group where he practices and serves as the medical director of clinical information systems. His focus has since turned to creating a portal for patients and physicians to coordinate care at "inflection points"—scenarios where a new diagnosis transforms a patient into a high-level care user.
His goal with IT innovation isn't necessarily to revolutionize the entire system. "It doesn't have to solve everything, but if it solves that problem, that's what we're focused on," he says.