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June 20, 2012


John F. Barr


While I agree with most of your points and observation, I would beg to disagree as well.

You say..."In that regard, healthcare in the US is a business like every other business."

What other business model is reimbusement a mere fraction on the dollar for goods and services provided? I.E.: Medicare Reimbursement is a mere 27 cents on the dollar, Private Carriers or insurance companie only reimburse marginally better at 37 cents on the dollar.

I would love to go to the grocery store and buy $100.00 of groceries and only pay $27.00 dollars.

On another point.., and to answer your question, "
who in the entire healthcare value chain has the economic motivation and "societal license" to amass as much information as possible around these important topics, and has clear economic incentive to correlate them for better outcomes?"

And if you believe in an informed consumer or consumerism... the answer is the Patient! To expound, at my organization we implemented an EHR in 1997 from CERNER, and while we are not thier largest client, we are thier busiest database. We have a 17TB database that does approximately 48 million oracle transactions an hour, and grows at 500Gb monthly.. (yes the storage companies love us), and we maintain 5 copies and one online offsite at out DR site, in total MHHS has approximately 2.7 Peta-byte of online data and that information store grows at geometric rates. In that database we have approximately 12 Million active lives or patients, in fact the Order history table is in excess of 400 billion rows and growing daily. Some patients have with long length of stays, for instance a ICU unit Patient or a better example of a Neo-natal patient whose stay may exceed 120 days, on those patients alone there may be thousands of orders. And when those patients leave us, if they had personal EHR's that could be shared in the form of CCD's they store, which OBTW we provide that service free of charge to our patients/customers which they can access from any computer on the globe and is hosted with one of our partners, then they can maintain the data needed for thier physicians to provide cradle to grave or longitudal health records.

By breaking this data up per patient it puts the patient in the driver seat of thier own healthcare, which is where the information belongs, and makes the management of that data thier responsibility.

Finally, you are spot on in that IT organizations, in every industry, but particularly in Healthcare must not be complacent, and should strive to continue to improve themselves and become more agile and customer service oriented. Fortunately under the guidance of our own CIO, Mr. David Bradshaw, (formerly the head of IBM global Healthcare), who joined MHHS some 14 years ago, only months after I joined... we understand this and have maintained a posture that if we cant do it better, providing better service than our competition, the so called oursourcing companies, then we have no business being in the business that we are in! Also we understood there are no silo's and information integration into a single source of clinical truth is essential to our patients care, and we have been delivering on this model since 1997. And for this we, (IT) are seen as vital partners in the delivery of technologies and related services to our organization, in furtherance of our business which is admittedly transforming at an alarming rate, and hopefully for the better.

Thanks for your observation. If you would like to discuss the subject further, please feel free to call on me, I am at your service.

John F. Barr
Consulting Technology Architect/Enterprise Architect
Memorial Hermann Healthcare System.

Chuck Hollis

Hi John

Thanks for the thorough commentary. Although I probably won't do the thoughts any justice, I'd like to respond to some of the points you raised.

Gap between prices and reimbursement: reminds me of the diamond business, no one ever pays anything close to list price. Since most everyone gets a special deal, you have to question how those list prices were set in the first place.

I also know from experience that a routine medical procedure costs X at the local doc-in-the-box clinic, and 3x in a big hospital setting. Physician, heal thyself.

On where information aggregates and is correlated: yes, patients ought to have portable copies of their health records (congrats to MHHS for doing so), but there's a difference between my health records and health advice based on those records. The same distinction is true with financial advisors, tax professionals, attorneys, etc. We both get copies of the record; they provide value on top of that.

As you get deeper into the whole big data analytics thing, you start to realize that even the most progressive health care providers are only capturing and correlating a tiny fraction of the data available about the patient (client!) and their context. Compare what healthcare does with best practices at, for example a web-based retailer (or a casino!) and it's a night-and-day proposition.

My EHR is rather clinical in nature. There's very little in it about my life history, the status of my relationships, my financial health, my lifestyle habits, my emotional health, where I live and work, histories of my parents and other relatives, etc. etc. So much information that's potentially relevant, so little used.

Your CERNER environment sounds quite substantial. As an infrastructure guy, I'm always interested in what you're doing to run an environment like that. Here at EMC, we think about environments like yours every day, so I'm always curious as to the details and the experiences.

It sounds like you've got a very progressive IT leadership team that's not afraid to go outside when it makes sense. You see yourselves as enabling the business, which is the right way to view things.

I'd be very curious as to what you're doing (or thinking about doing) in two key areas; big data analytics and mobile-enabled enterprise applications. First, do you see either or both as a strategic priority, and -- if so -- what's your thinking to date?

I look forward to further discussions -- thanks for sharing

-- Chuck

Marketing Research

The healthcare industry is marching towards a “Creative Destruction.” Recent healthcare reforms will transform our fragmented, fee-for-service health care delivery system into an incentive-driven system for efficient, coordinated, and quality patient care. Such transformation demands structural changes in the healthcare business model through formation of the Accountable Care Organization (ACO). As more and more patient care services are moving away from a hospital/clinic to an ‘at home’ setting and also using mobile devices, patients are demanding access to their collective health information...

SEO Consultants

It's difficult to find knowledgeable people on this topic, but you manage to pull it off clearly Chuck. I'd surely share this to my friends.

Seo for Doctors

Chuck. I would love to quote your elaboration. and I certain agree with the above comment. Indeed today's healthcare based on fragmentation. It can be scary, but then you think, who can really grow upon the effects of today's industry?

The comments to this entry are closed.

Chuck Hollis

  • Chuck Hollis
    SVP, Oracle Converged Infrastructure Systems

    Chuck now works for Oracle, and is now deeply embroiled in IT infrastructure.

    Previously, he was with VMware for 2 years, and EMC for 18 years before that, most of them great.

    He enjoys speaking to customer and industry audiences about a variety of technology topics, and -- of course -- enjoys blogging.

    Chuck lives in Vero Beach, FL with his wife and four dogs when he's not traveling. In his spare time, Chuck is working on his second career as an aging rock musician.

    Warning: do not ever buy him a drink when there is a piano nearby.

    Note: these are my personal views, and aren't reviewed or approved by my employer.
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