At HealthCampBoston, the convergence of thought around various challenges facing health care was evident. And this was not the development of a myopic view but a vision of a path through challenges.

To illustrate, I’ll dive into one challenge discussed in one of the sessions throughout the day-long unconference. The challenge was the major one of reporting clinical patient data by providers.  Most people agreed that this is necessary and may soon be required by providers seeking to qualify for economic stimulus funding for healthcare. Yet some providers are disinclined to do so as reporting exposes too much too quickly. Professionals in any field would hesitate at exposing business “tricks” on which they have become reliant. Provider offices faced with a difficult coding systems for billing sometimes place diagnostically inaccurate but monetarily accurate codes into health records for billing purposes, and so some fo these providers are understandably hesitant to have these seemingly harmless shortcuts cut short.

These shortcuts which can generate inaccurate data are not different than the many outside healthcare (just check out banking), but the impact of these shortcuts can be severe to individual patients when it concerns health records, as was evidenced by ePatientDave’s experience. At HealthCampBoston, a realization emerged that different solutions would have to be developed and used in concert to determine what would work best for providers and patients. John Moore suggested a virtual weigh station where patients would validate information before it was added to their PHR as a way to keep bad data out may be needed. Who better to manage one’s data than oneself. Another suggestion was that provider facilities would clean up the data before publishing it. You broke it, you own it. Another idea was to exclude billing data and only publish clinical data to PHRs, but this alone would not solve the problem. A physician noted that sometimes, non-billing related information such as temporary conditions (like pregnancy) were left on a patient’s record indefinitely. The convergence of thought came not from groupthink but from the realization that solutions often did not have to be mutually exclusive and that no single one is an obvious a silver bullet to this problem of effectively publishing and reporting clinical data that could be shared by providers and measured by payers, to align with paying for reporting and performance, which also brings other challenges.

The fact that there are incentives, both publicly and privately funded, aimed at providers which pay for reporting now and that they are being followed by a nascent wave of pay for performance incentives is heartening. The fact that there are now robust PHRs from Microsoft, Google, and others and that data can be electronically signed by the providers publishing this data also makes it more likely that increasingly clean clinical data will be provided for patients. I suggested that given choices, patients will reward providers who can a) publish data to PHRs at the request of patients and b) publish clean and complete data. This might be the best incentive and stimulus of all.

Now social networking is making its buzz in healthcare. The social model is being applied to chronic disease management, wellness and fitness management, and other areas where peer-to-peer support or pressure can play a positive part.

But how effective will these social health networks be?

The Economist recently ran an article that highlights the limit of our brain to participate in social networks. Even though a person could be connected to hundreds of friends, she would most likely only regularly interact with a handful of people in her network. With this data point, you can argue that social networking online is not helping to build new or longer lasting relationships.

In the area of healthcare, any connection between patients and others, tight or loose, short or long-term, is valuable. First, everyone is sharing her own condition and experience openly and willingly. Seeing that there are 5,000 people out there who are just like me is encouraging. Being able to see what other treatments and outcomes are available is beneficial. If she wants to, a patient can communicate with another patient directly. Finally, for some seasoned patients, they can even provide insightful advice.  To take it a step further, PatientsLikeMe.com merges social networking with care management by the patient. A patient’s profile includes detailed information about mood, physical symptoms, treatments, etc. These social interactions can be based on not only an individual’s impression and experience but also facts and supporting medical data.

If social networks are designed appropriately and used effectively, socializing healthcare can empower the individual to become an active contributor to the course of her care, physical and mental health. Incremental improvement of individual care leads to a healthier society.

Time will tell, but I am optimistic!

Everyone came with something important to contribute to the summit and with a mission to take away new perspectives as well. The networking before the night’s speakers and the panel was a good time to meet people and share expectations about the event. Most revealing for me was how connected so many industries are to healthcare. It is reflective of the relative size of healthcare expenditure in the GDP.

Steve Wardell, the head of the HILForum, which organized the event, started his talk with some level setting. By doing a quick poll, he demonstrated that most of the people at the symposium work towards improvement in treatment outcomes for patients and also to reduce the costs associated with healthcare. There is a lot more to gain for everyone involved if these two goals, which are not mutually exclusive, are kept in clear focus. This was the best start for what is almost always a heated debate. I say almost because despite the few points of contention that came up, there was a general consensus in what needed to be done and where most of the waste in health care delivery was happening. There was also widespread acknowledgment of what has been working well – social networking amongst patients – through little or no industry help at all.

One observation as to the biggest problem that needed to be corrected was that Medicare, as it exists today, has inadvertently rewarded specialization for physicians and has discouraged the practice of primary care. Where the population of physicians was about evenly split about 50/50 forty or so years ago, it is now heavily skewed towards specialists and away from primary care practitioners. Charlie Baker of Harvard Pilgrim also made the point that this skewing had taken place gradually but consistently and that undoing this change might also have to happen at this pace. The correction to the rewards and incentives to improve what providers did was a generally agreed-up point.

Another panelist, Jonathan Bush of Athena Health, dramatically made the point that there is a need for pragmatism in addressing health care cost issues, and that without it, the result may be passing along the burden of high costs of healthcare to the generations to come. Both Charlie and Jonathan believe that incremental changes were happening in the right direction and that incentives were helping and would continue to help. The health IT budget in the stimulus was one big incentive, that might trigger the flow of health data which could then be measured by the right authorities, both private and public, in order to improve quality, determine comparative effectiveness, and reduce costs. There was general agreement on this point as well.

A physician in the audience raised the point that she spent a significant amount of time trying to determine if her patients were being compliant with their prescriptions for recovery after being discharged, and that if this time could be saved by making it easier for her to follow up on her discharged patients, it would be worth spending the additional time to use electronic prescription systems (ePrescriptions) as opposed to continuing to write them by hand.

The other panelists were John Glaser and James Roosevelt of Partners Healthcare and Tufts Health Plan respectively. They contributed a wealth of perspective and balance to the issues as well. James Roosevelt was the keynote speaker and his message was that all stakeholders needed to be ready for compromise in order to accomplish change. John Glaser touched on an item that everyone agreed on – what does “meaningful use” mean? It is language included in the recently passed bill that is the qualification for a medical practice to receive some of the stimulus funds, but the exact definition of what that is still has to be clarified. Jonathan Bush made the point that everyone was contemplating – that “meaningful use” will be different for providers, insurers, and patients.

A patient named Dave also brought into perspective another dimension into the conversation when he asked about what was fair for patients who had rare enough conditions that did not attract the industry to accommodate their needs to improved flow of information. A panelist thought that even though a company may be more incentivized to target a larger potential pool of consumers than a smaller pool that might have a rare condition, it might be that through improvements targeted at a larger pool of consumers, a smaller but different group could benefit as well. These would be incremental changes in the right direction.

There were also many ideas from entrepreneurs which were more optimistic in the accomplishment of major impacts, even if from seemingly small and minimally disruptive changes in the delivery of care. David Williams logged perspectives from several CEO’s on his blog. Among those pushing innovation, there remains optimism that big changes can happen fairly quickly if the right solution were matched to the right opportunity.