healthcarereimagined

Across the globe, health care policymakers face mounting pressure to lower costs while improving the quality and safety of care. The U.S. can learn a lot by examining other health systems, their performance in relation to ours, and their health care delivery and payment innovations. This site presents profiles of the health care systems in 18 countries. Download the full report.

Article link : http://international.commonwealthfund.org/

By PETER ELIAS, MD

The other night I participated in a very useful Google+ hangout with Adrian Gropper, Michael Mascia and Michael Chen. The discussion focused on a subject I think is incredibly important: the patient-centered health record. Unfortunately, this topic is hard to discuss without drowning in technical terms and acronyms. I consider myself fairly tech-savvy and still struggle.

A (55 minute) YouTube video is here: Click here

I think it is worth watching. before watching it, consider reviewing the following basic information to help set the stage, first without tech terms or acronyms, and then repeated with some of the key jargon.

The current EHR model is that each office or institution owns and manages an electronic record that contains information about the patients in that system. Despite the obvious need and lots of talk, there has been little actual progress towards making these separate and mostly proprietary systems ‘interoperable’ and therefore able to share information. The result is that clinicians routinely work with incomplete or outdated information, patients are locked into their home system, and it is extremely hard for patients to access their own information in any meaningful or useful way. Care is less safe and less reliable, patients are prevented from actively managing their care, and clinicians are frustrated.

The model discussed in this video takes a different approach, one that appeals to me for both philosophical and technical reasons.

In this model:

• The basic unit is a one-patient record unique to the individual patient.
  • It is ‘open source’ meaning that the code is public, maximizing the ability to improve or modify it and create added pieces for new functions.
  • This basic unit and its information are owned and controlled by the patient.
  • This is where all the health and medical information about an individual patient is stored.
  • It contains the most current, complete and up-to-date information.
  • The patient has full access to their individual record.
• This patient-centered health record has a component that allows the patient to control access by others, essentially inviting their clinicians (or others) to see and use the information.
• Clinicians can access the system through their own software using one of two mechanisms:
  • Using a straightforward process which gives them access to multiple separate patient records, and they work in the actual patient record.
  • Using their proprietary clinician or institution owned system, which is linked to and synchronized with the patient’s individual record.
  • In both cases, the ‘official’ version of the information is the patient-centered record, fully accessible to the patient.
• There are standardized connections between the clinician-based systems and the multiple patient-based records.

That was English. Now a version of the same information with some jargon:

• The patient has a record (EHR) to store his or her health information
  • Ideally it is ‘open source’ such as NOSH (New Open Source Health Charting System) by Michael Chen.  Read more about this at https://noshemr.wordpress.com/.
  • It is owned and controlled by the patient.
  • It is where all the health information about an individual patient is stored.
  • It functions as the ‘Source of Truth.’
  • The patient has full access.
• The patient-centered record (such as NOSH) has a component that allows the patient to control who can see, change or use the information.
  • This is sometimes called UMA (for user management and authentication).
  • It has other names such as HIE of One (health information exchange of one).
  • This is what allows the patient to manage who has access.
• Clinicians access the system through their own software using one of two mechanisms:
  • They use a parallel open-source software system that has a list of the patients using individual patient records they have been authenticated to use.
  • They use (work in) their institution’s proprietary system which is linked to and synchronized with the official patient-owned record.
  • In both cases, the patient’s record is the Source of Truth and fully accessible to the patient.
• There are interfaces that make connections work.
  • FHIR (pronounced fire) is the one talked about here.
  • Other ‘application program interfaces’ (APIs) can be developed or used, especially if the system is open source.

There are several important considerations in a system like this:

• Open source improves security, adaptability, flexibility
• It is based on the assumption that patients should have full control over their health information according to their own needs, not just be given limited access by clinicians or their systems.
• If patients have full control over access to their health information, it goes without saying that they can access their own health information without either delay or barriers.
• It can be adopted incrementally rather than requiring the entire US healthcare system to turn a switch.
• Patients and clinicians can help us move from where we are now to a patient-centered health record system by:
  • Understanding the concept.
  • Being at least somewhat familiar with the terminology.
  • And MAKING NOISE about wanting a system like this in their local setting.Peter Elias is a family physician in Maine. He blogs at http://petereliasmd.com
• Article link: http://thehealthcareblog.com/blog/2016/01/23/the-patient-centered-health-record/

Mark Friedberg, Francis J. Crosson, and Michael Tutty

March 11, 2014

Policy makers and professional organizations have become increasingly concerned about physician professional satisfaction.  As in the managed care expansion of the 1990s, recent health reforms, including but not limited to the Affordable Care Act (ACA) and the American Recovery and Reinvestment Act (ARRA), have begun to have effects “in the exam room,” changing how patients, physicians, and allied health professionals interact.  To better understand how these reforms are affecting patient care and other aspects of physicians’ professional lives, we recently conducted an in-depth study of professional satisfaction using a combination of open-ended interviews and written surveys with physicians and other professionals in 30 practices (encompassing 55 distinct practice sites) across the United States.

We found several factors that enhanced physician professional satisfaction in 2013, including:

• perceived ability to deliver high-quality patient care
• reasonable control over the environment, pace, and content of work
• sharing clinical values with organizational leadership
• respectful professional relationships
• incomes perceived as predictable and fair

Intense Physician Reaction To Electronic Health Records

At the time of our study, the ACA did not yet seem to have measurable effects on physician professional satisfaction, either positive or negative.  Instead, regulations stemming from the ARRA—specifically, incentives and penalties to adopt electronic health records (EHRs)—have provoked widespread and intense responses from practicing physicians.  Despite recognizing the value of EHRs in concept, many physicians are struggling to use their EHRs, which they describe as negatively impacting patient care in several important ways and undermining their professional satisfaction.

To be clear, we did not set out to conduct a study of physicians’ reactions to EHRs.  Our initial written surveys did not include questions about EHRs, since the validated source instruments for most of our questions predated the Health Information Technology for Economic and Clinical Health Act (HITECH Act, Title XIII of ARRA), Meaningful Use, and the ensuing widespread adoption of EHRs.  However, the qualitative component of our study, which included open-ended interviews, allowed us to detect important findings that we did not anticipate.  In our first few site visits, when we asked about EHRs, physicians gave detailed descriptions of how EHRs had reshaped their interactions with patients and affected their professional lives in other ways.  Based on the intensity of these reports, we revised our written survey instrument to include items about EHRs, to see how widespread our interview findings might be.

What physicians said.  Here is what we found about EHRs.  First, our study does not suggest that physicians are Luddites, technophobes, or dinosaurs.  Physicians recognized the important advances that EHRs have enabled, particularly in accessing information remotely (like checking a patient’s test results from home) and improving compliance with guideline-based care.  Of the physicians in our study who used an EHR, fewer than 1 in 5 would prefer to return to paper medical records.

At the same time, however, physicians noted important negative effects of current EHRs on their professional lives and, in some troubling ways, on patient care.  They described poor EHR usability that did not match clinical workflows, time-consuming data entry, interference with face-to-face patient care, and overwhelming numbers of electronic messages and alerts.  Physicians in a variety of specialties reported that their EHRs required them to perform tasks that could be done more efficiently by clerks and transcriptionists.

The inability of EHRs to exchange health information electronically was deeply disappointing to physicians, who continued to rely on faxed medical documents from outside providers.  Physicians also expressed concerns about potential misuse of template-based notes.  Such notes, which contain pre-formatted, computer-generated text, can improve the efficiency of data entry when used appropriately. However, when used inappropriately, template-based notes were described as containing extraneous and inaccurate information about patients’ clinical histories, with some physicians questioning the fundamental trustworthiness of a medical record containing such notes. In addition, EHRs were reported as being significantly more expensive than anticipated, creating uncertainties about the sustainability of their use.

Physicians’ concerns about EHR usability correspond to those documented by others, including the American Medical Informatics Association, researchers, and practicing physicians.  These findings are especially important in light of recent publications documenting the rapid adoption of EHRs in the United States.  The speed of the national EHR rollout might not be an unambiguous virtue, given the unintended consequences that physicians describe.

One could argue that the current state of EHRs is a transition period that is inevitable with any new technology, and that without making any new or targeted efforts, the problems of current EHRs and their interactions with care delivery systems will work themselves out in the long run.  However, no other industry, to our knowledge, has been under a universal mandate to adopt a new technology before its effects are fully understood, and before the technology has reached a level of usability that is acceptable to its core users.  In addition, simply waiting for long-run fixes may prolong the current troubled state of EHRs, potentially exposing patients to unnecessary risk.  For all these reasons, it seems vital that a more proactive approach be taken to address the problems physicians describe.

The AMA’s Initiatives

To address these problems, the AMA is undertaking a multi-stakeholder effort that includes the following steps:

• Organizing and leading an effort to work with the EHR vendor and EHR user communities to improve EHR usability. Many physicians believe that practice work flow efficiency can be improved by more user-friendly system design.
• Helping physicians become better purchasers and users of EHRs to increase practice efficiency and augment physician-patient “face-time”.
• Continuing to work with federal regulators, such as the Office of the National Coordinator for Health Information Technology, to address usability concerns and resolve problems with the details and pace of certifying EHR systems and implementing “Meaningful Use” rules.  More flexibility, especially in the Meaningful Use program – where missing a single objective by even a small amount results in failure for the program year – may be important to the success of the program.
• Working to reduce the number and pace of requirements that EHR vendors must satisfy to receive federal certification, so that EHR vendors can better focus on improving the usability and functionality of their products in response to the needs of physicians and allied health professionals.
• Working with policymakers and others concerned about institutional liability to “liberalize” the ability to use office support personnel to reduce physician “clerical work” related to EHR use.  This point is an immediate concern given the current state of EHR usability.  In our study, physicians reported that employing scribes, allied health professionals, or other staff to interact directly with EHRs reduced the degree of interference with face-to-face patient care and the quantity of below-license work.  Allowing such staff to continue or expand in these roles may mitigate many EHR-related problems.

In addition, the transition from paper to computers may present an important opportunity to fundamentally rethink the purpose and design of medical records.  Some of the difficulties of current EHRs may stem from persistent (or magnified) shortcomings also found in paper records.  For example, to meet billing criteria, providers still write separate encounter notes that replicate large quantities of low-priority, outdated, or inaccurate information from other parts of the record (the “copy and paste” phenomenon).  This replication creates “noise” in the record and fails to take advantage of efficient multiple-author document designs, such as wikis, that are enabled by computers.  Re-prioritizing clinical communication, rather than billing criteria, within the medical record may improve the “signal to noise” ratio in EHR-generated notes.

Like the physicians who participated in our study, we are optimistic about the future of EHRs.  But optimism should not blind us to current realities.  If practicing physicians are correct, the current state of EHR technology has introduced several impediments to providing patient care, undermining physician professional satisfaction.  Many of these problems—such as the proliferation of clinical information that doctors don’t trust—also should be of great concern to patients.  Patients, providers, payers, and vendors all have an interest in improving the usability of EHRs and integrating them into clinical workflows that produce better, more efficient care.

Article link: http://healthaffairs.org/blog/2014/03/11/physicians-concerns-about-electronic-health-records-implications-and-steps-towards-solutions/

BY GREG SLABODKIN
OCT 28, 2015

Officials from the Departments of Defense and Veterans Affairs got an earful from members of Congress on Tuesday about continued lack of interoperability between DOD and VA electronic health record systems and failure to identify goals and metrics to clearly define achievement.
At a joint hearing of subcommittees of the House Committee on Oversight and House Committee on Veterans’ Affairs, lawmakers questioned the wisdom of DOD and VA efforts focused on modernizing their respective EHR systems—rather than developing a single system—and the departments’ inability to successfully collaborate to share electronic health information.
“Our soldiers, sailors, airmen, and Marines who are making the transition from DOD to VA healthcare are literally told to print out hard copies of their medical records and then walk then to the VA,” said Rep. William Hurd (R-Tex.), chairman of the subcommittee on information technology. “We have sent men to the moon and robots to Mars. I feel like we should be able to move one electronic file, no matter how big or how old, from one computer system to another.”
While acknowledging the challenges of integrating the DOD and VA systems, Hurd blamed the lack of progress on interoperability as a failure of leadership rather than technical feasibility. “At its core, this is not a problem of technology. This is an issue of management,” he charged.
In 2013, DOD and VA called off a joint development program that was to have resulted in a single system known as the integrated EHR (iEHR). At the time, the two departments cited cost effectiveness as the rationale for abandoning the iEHR program but committed to DOD-VA health data integration through fully interoperable EHR systems.
Hurd noted that the two departments continue to go their separate ways. DOD in July awarded a $4.3 billion contract to a Leidos-Cerner team to upgrade the Armed Forces Health Longitudinal Technology Application as part of the Defense Healthcare Management System Modernization program, while the VA continues to modernize its Veterans Health Information Systems and Technology Architecture, or VistA EHR.
Also See: Leidos, Cerner Team Wins Coveted DoD EHR Contract
“The current plan for DOD and the VA to modernize their healthcare IT infrastructure in order to achieve full interoperability lacks metrics and goals,” said Hurd. “These are not issues of data standardization. This is management 101.”
A Government Accountability Office audit released in August found that DOD and VA missed an October 1, 2014, deadline established by Congress in the National Defense Authorization Act (NDAA) for Fiscal Year 2014 to certify that all healthcare data in their systems complied with national standards and were computable in real time. GAO also revealed that a number of key activities in the departments’ system modernization plans will be implemented beyond December 31, 2016—the deadline established in the NDAA for DOD and VA to deploy modernized EHR software to support clinicians while ensuring full standards-based interoperability.
Valerie Melvin, the GAO’s director of information management and technology resource issues, testified at the hearing that according to current DOD-VA plans the deployment of their respective EHR systems with interoperable capabilities will not be completed until after 2018.
“A significant concern is that the departments have not identified outcome-oriented goals and metrics to clearly define what they aim to achieve from their interoperability efforts, and the results and benefits anticipated,” said Melvin. “The departments’ decision to pursue separate interoperable systems, rather than a single joint system, adds to our concern. Taking separate paths to modernize their systems increases the risk that there will not be the effective collaboration and coordination needed to establish and convey a joint position on what fully interoperable capabilities will look like, and how and when they will be achieved.”
Nonetheless, Christopher Miller, program executive for DOD’s Defense Healthcare Management Systems, argued that DoD and VA share a significant amount of health data—in fact, more than any other two major health systems.
“DoD and VA clinicians are currently able to use their existing software applications to view records of more than 7.4 million shared patients who have received care from both departments,” Miller testified. “This data is available today in near real time and the number of records viewable by both Departments continues to increase.”
Likewise, LaVerne Council, the VA’s assistant secretary for IT and CIO, told the congressional subcommittees that today VA and DoD share millions of health records between their systems. In particular, Council touted the fact that over the past year VA has seen “rapid growth” in utilization of the Joint Legacy Viewer (JLV), a read-only web based health record viewer that allows both VA and DoD to see a veteran or service member’s complete health history from both departments integrated on a single screen.
“As of last week, VA had over 19,000 authorized JLV users, up from just a few hundred this time last year, when JLV became available at all VA medical centers,” she testified. “Currently, we are making JLV available to nearly 1,000 new users each month.”
According to Miller, DoD has fielded the JLV to more than 70 locations with over 8,480 military users and that as JLV capacity and use increase the department will begin to phase out existing legacy viewers, with full consolidation planned in fiscal year 2016.
However, Hurd commented that the JLV is not “real” interoperability. “The ability to view patient data and the ability to access and use in real time patient data are two profoundly different things,” he concluded. “JLV is the equivalent of using microfiche.”

Article link: http://www.healthdatamanagement.com/news/Lack-of-Interoperable-EHRs-Continue-to-Dog-DOD-VA-51461-1.html

Hearing Date: October 27, 2015 2:00 pm 2154 Rayburn House Office Building

https://oversight.house.gov/hearing/18424/

Hearing starts at time 1:06:46

PURPOSE:

• To examine the Departments of Defense (DOD) and Veterans Affairs (VA) information technology with an emphasis on the departments’ efforts to develop and implement an interoperable electronic health record (EHR).

BACKGROUND:

• The 2008 NDAA directed DOD and VA to jointly develop and implement a “fully interoperable” EHR, creating an Interagency Program Office to facilitate and coordinate the Departments’ efforts.

• In July, DOD awarded a $4.3 billion contract to upgrade the Armed Forces Health Longitudinal Technology Application, while the VA continues to modernize and evolve its open-source platform, the Veterans Health Information Systems and Technology Architecture.

• The EHR program has been listed on the GAO’s high risk list for 2015.

• Additionally, recent inspectors general audits of both departments’ Federal Information Security Management Act compliance identified weaknesses and deficiencies in cybersecurity.

Mike Miliard, Editor, Healthcare IT News | November 24, 2015
@mikemiliardhitn

In a letter to the U.S. House of Representatives this past week, Under Secretary of Defense for Acquisition, Technology and Logistics Frank Kendall wrote that DoD “has met the interoperability requirements” of the National Defense Authorization Act.

The Defense Authorization Act mandates that the EHR systems of DoD and the U.S. Department of Veterans Affairs be linked with an integrated display of data, complying with standards and technical architectures described by DoD/VA Interagency Program Office and the Office of National Coordinator for Health IT.

“DoD and VA have closely partnered to meet the 2014 NDAA requirements,” Kendall writes. “The The VA is  currently working to finalize their efforts; once both Departments have met their requirements, DoD and VA will provide a joint certification to Congress.”

In order to have a framework for complying with the NDAA, the DoD/VA Interagency Clinical Informatics Board “has endorsed 25 prioritized data domains to support continuity of care and Veterans benefits adjudication,” he writes. “For both Departments, three domains have no structured data to map. For the remaining 22 domains, the IPO has established national standards for both Departments’ electronic health record systems. This process is documented in the IPO’s Health Data Interoperability Management Plan.

“For domains that do not have structured data, the information is currently captured in the clinical notes in the legacy systems,” he adds. “These clinical notes are shared and provided in an integrated display. Moving forward these domains will be included as part of our electronic health record modernization plan.”

DoD has now mapped all 21 domains requiring national standard terminologies, writes Kendall — representing nearly 1.8 million unique clinical terms.

“Over the past year, we have completed four data mapping deliveries,” he writes. “DoD subject matter experts and the IPO conducted independent quality assurance reviews of these mappings to ensure their accuracy. Additionally, DoD has established a data governance process to actively manage and continually improve utilization of national standards as they evolve in the future. These domains are available to VA clinicians and benefits analysts through the Defense Medical Information Exchange Program and the Health Artifact and Image Management Solution (HAIMS).

“DoD health data is currently electronically accessible and viewable for the 22 data domains,” writes Kendall. “In FY 2014, data and national standard mappings for seven of the highest value clinical care domains were provided in the Joint Legacy Viewer (JLV) for an integrated display. This initial delivery comprised over 70 percent of relevant data for outpatient encounters. In FY 2015, DoD delivered two additional builds of JL V and supporting data infrastructure upgrades.

“Today, JLV includes 13 additional data domains and updated national standards mappings, for a total of 20 domains in an integrated display of data. The additional domains include both DoD, VA and private sector health data and represent more than 99 percent ofthe most frequently used and high value data terms.”

The JLV “offers an integrated display and access to more health information than any other viewer or system used by either DoD or VA,” writes Kendall. “This capability will be part of DoD’s EHR modernization to ensure continued interoperability.”

Nonetheless, he writes, “we fully recognize that medical data interoperability requires steadfast commitment and continuous improvement.”

Indeed, while DoD may have met the letter of the law as far as its interoperability responsibilities, it recognized that there was a long way to go before data exchange was optimal between the two agencies.

“We’ve done a lot to get this information to a point where it’s both shared and it’s usable, but we recognize that we’re going to continue to have to do more things to actually continue to make it as useful as possible,” said Chris Miller, the program executive officer for Defense Healthcare Management Systems, according to a news article on Defense.gov.

In the meantime, even though the Joint Legacy Viewer is still in a testing phase, it’s already proving its value, Miller said. “This data does a lot to help people and it also does a lot to improve how our clinical providers do their job.”
Article link: http://www.hiewatch.com/news/dod-interoperability-requirements-mission-accomplished?mkt_tok=3RkMMJWWfF9wsRonu6zKce%2FhmjTEU5z16uovXq%2B3hokz2EFye%2BLIHETpodcMTcJlMrjYDBceEJhqyQJxPr3MLtINwNlqRhPrCg%3D%3D

Read Kendall’s full letter here.
Read the Defense.gov article here.

It is only after a revolution concludes that one can clearly look back and fully understand what triggered the revolution. External factors such as technology shifts can create the conditions for a revolution where it may not have been possible before. A generation that has a different worldview than their elders may not accept that status quo. From what I’m observing, I believe we are seeing a revolution’s first phase happen before our eyes.

I’m convinced that the only way there will be a true revolution in healthcare is if there is a partnership between clinicians and individual citizens (aka patients/consumers/people). One without the other isn’t sufficient to unseat deeply entrenched systems. However, I feel doctors will play a unique role in catalyzing the revolution (not to say that clinicians of all types won’t play important roles as well). As I’ve been a Johnny Appleseed of sorts chronicling the far-reaching and transformational work of doc-entrepreneurs, it feeds my optimism that it’s possible to overcome the “Preservatives” who have 3 trillion reasons to protect the status quo.

For those of us who have seen how much better the system can work when goals are properly aligned, it’s “good news” that doctor burnout and dissatisfaction is at an all-time high (see The Quadruple Aim: A Square Deal for Clinicians for more). Why? Dissatisfaction is the seed corn for change and revolution. Make no mistake. There is extremely high level of dissatisfaction amongst a large chunk of doctors who yearn for change. The contrast between those inside of flawed versus optimized care delivery and payment models is stark. One the one hand, I have heard and seen docs who are seeing 30-50 patients a day, dealing with unwieldy/outdated EHRs optimized for billing (vs. care) and getting more bureaucracy thrown on top of an already-flawed model. On the other hand, it’s breathtaking when I visit clinics like CareMore, ChenMed, Iora Health, Qliance, Vera Whole Health and others where the clinicians and patients are both extremely satisfied.

In the video below, Dr. Zubin Damania powerfully captures the sorts of internal dialogue doctors have had one by one with themselves.

When people would talk about their careers or their lives, the ones that were most passionate and were loving what they did always aroused in me an unease. It was almost an anger or jealousy and I would see them and go, “Why is he so happy and fulfilled and doing what he loves to do and I’m doing everything I’m supposed to do but I feel empty?” On the other side of this waking up and being who I am suddenly, I felt like, “Oh my god, that’s me now.”

I suspect all the doctor entrepreneurs/leaders I’ve highlighted below had some similar internal discussions. This is how revolutions begin. By no means is it limited to young doctors but typically it’s the young who foment revolutions and they are then joined by those older than them. As you can see in the picture accompanying this article after the post-Velvet Revolution celebration, it’s all ages who celebrate. It’s worth noting that the Velvet Revolution was triggered by a crackdown on students.

Ignoring Exponential Growth Has Devastating Consequences for Incumbents

Skeptics may say that these revolutionary practice models are a drop in the bucket and in most places, it’s business as usual. That is true just as it was true that the newspaper business looked fantastic in the late 1990s and early 2000s while digital media was going from tiny to small. However, the mistakes made by newspapers and their Zero Sum Game thinking were happening simultaneous to startups getting funding that would ultimately crush the most profitable portions of the newspaper business, not to mention create new sectors far bigger than the newspaper industry. Sadly (for the newspapers), they could have owned, invested or partnered with these players yet most arrogantly dismissed them.

Those startups were easy to ignore or diminish just as incumbent providers are blind to the exponential growth and funding (figures in parentheses) that organizations such as Aledade ($34.5M), Alignment Healthcare ($125M), Iora Health ($48.3M) and One Medical ($116.5M) are receiving. Further, other revolutionary organizations have already been acquired. CareMore was acquired for $800M by WellPoint and and HealthCare Partners was acquired for $4.4B by DaVita. It’s worth noting that the acquisitions weren’t by traditional providers. Rather, it was deep-pocketed players seeing an easy mark in soft oligopolistic health systems.

Change Starts at Home

Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has. – Margaret Mead

I put my family where my mouth is and convinced my folks to move into one of these revolutionary practices. They had been going to a well-regarded, large multi-specialty group in Seattle. However, the care they got was typical of our misaligned healthcare system. When my father was diagnosed with a significant chronic condition, he received a couple prescriptions from a specialist and told to check back in 6 months with the doctor. His PCP had no idea he’d been diagnosed with a significant condition. Meanwhile, his world came crashing down and a huge amount of anxiety and stress was thrust on him — surely, not the best “prescription” for his condition.

While it’s rarely easy to get someone to change their doctor, let alone a senior who has a significant condition, I ultimately prevailed in convincing my parents to make the move. Six months into being in Iora Health’s Medicare Advantage program, the change is dramatic. So much so that my dad told me last weekend he’d be happy to be a testimonial for them.

Creating the New Ecosystem

You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. Buckminster Fuller

In their own way, each of the doctors listed below is contributing to building the new ecosystem and ignoring the Preservatives who are wedded to the status quo. As mentioned above, there are non-physician clinicians and individual citizens having a big impact but I focus on doc-entrepreneurs and intrapreneurs here.

• Dr. Rajaie Batniji co-founded Collective Health in the belief they could help employees receive better care and coverage than what many experience with incumbent health plans
• Dr. Steven Eisenberg for adding love & music to #oncology and humanity to medicine (h/t Bunny Ellerin)
• The late Dr. Tom Ferguson coined the term e-patient many years before others were focused on equipped, enabled, empowered and engaged patients. This is a whitepaper (PDF) finished by his colleagues after his untimely passing.
• Dr. Rushika Fernandopulle founded Iora Health to restore humanity to healthcare. They have proven to take on the most challenging patient populations and achieve outstanding outcomes and even take on individuals not addressed by the new health law with the support of a Nobel Prize winner.
• Dr. Paul Grundy has led IBM’s transformation in healthcare shifting their thinking from healthcare as a soft benefits item left to HR to something that is a critical supply chain cost and source of competitive advantage.
• Dr. Rob Lamberts showed how an independent family physician can strike out on their own and provide better care and be more professionally satisfied
• Dr. Risa Lavizzo-Mourey is leading the Robert Wood Johnson Foundation spearheading their major re-focus on creating a Culture of Health that is impacting communities throughout the country.
• Dr. Harry Leider is leading Walgreens retail clinic and telehealth expansionthat promises to reach half of the country by the end of the year.
• Dr. Geraldine McGinty for her work creating innovative radiology payment models & spearheading payment reform (h/t Bunny Ellerin)
• Dr. Farzad Mostashari described Aledade’s goals as follows: ”It’s to help independent primary care doctors re-design their practices, and re-magine their future. It’s to put primary care back in control of health care, with 21st century data analytics and technology tools. It’s to support them with people who will stand beside them, with no interests other than theirs in mind.”
• Dr. Stan Schwartz saw what Dr. Keith Smith was doing and has been creating a true transparent medical network and making that available to employers  — both doctors and patients are saved from excruciating amounts of bureaucracy in a very appealing economic model to both parties. It’s also the first Health Rosetta item to be delineated.
• Dr. Danny Sands co-founded the Society for Participatory Medicine while practicing and famously taking care of ePatient Dave.
• Four years ago, I observed how doctors such as Wendy Sue Swanson, Natasha Burgert & Howard Luks were doing something similar to how Sal Khan had “flipped the classroom”. This led to the Robert Wood Johnson Foundation initiating a major program called Flip the Clinic to improve outcomes and participation by patients.
• Dr. Mike Sevilla for using #hcsm to educate, elucidate and save family medicine #FMRevolution (h/t Bunny Ellerin)
• Dr. Eric Topol has written and spoken extensively about how central the patient will be as a participant in their care compared to traditional practices. He highlights how the smartphone is the equivalent of the Gutenberg Press for medicine
• Dr. Bryan Vartabedian is showing other doctors how to be a “public” physician & the impact that can have on outcomes
• Dr. Sheldon Zinberg founded CareMore creating a national leader in treating the frail elderly.

By no means is the list above complete. Add your comment below on a revolutionary doctor that has inspired you. Let us know what they are doing. Whether it is private practice, venture-backed startups, public health or health benefits, each doctor is contributing to the revolution. In their own way, they are fostering a Velvet Medical Revolution.

Dave Chase: Entrepreneur (2 exits), prof. speaker, new venture advisor, intrapreneur (2 $1B+ businesses), author & aspiring documentarian.

Article link:http://www.forbes.com/sites/davechase/2015/08/05/medicines-velvet-revolution/