I\’ve been going about this all wrong.
It\’s not my dumping of the payment system so I can focus on care over codes, my use of technology to connect better with patients, or my vision of the \”collaborative record\” that is wrong.  It\’s the fact that I am doing this without my most important resource: my patients.

I realized this while driving in to work this past week.  My first patient was a tech-savvy guy I\’ve known for a long time.  Not only does he know me, and knows more than me about technology, he also is a regular reader of this blog (bless his heart)…and he still chose to switch to my practice!  So I was looking forward to running some of my ideas by him to see if my thoughts have strayed to the land of silliness (which they often do) or if I am actually onto something.  This line of thought led me to think about collaborating with him to work on my IT vision, since he does work for an IT company.  My line of thought then careened into the brick wall of the obvious: why just him?  I\’ve been getting suggestions and offers for help from many of my patients, who are clearly intrigued by my direction and desirous to lend their expertise on the project.  So why not involve any of my patients who want to be part of this project?

So this morning I sent out an invitation to all of my current patients:

Many of you know that my biggest frustration at the moment (besides congress) is the total lack of software that supports a practice like mine.  I have a vision for what I need, but right now that is only possible using multiple tools in different places.  In other words, it\’s confusing and chaotic — something the old way of doing health care was good at, but something I am trying to avoid.  As I\’ve worked to figure out what to do with this project, I\’ve been getting lots of offers for help and suggestions on what to do from some of my patients.  It occurred to me recently (not sure why it didn\’t sooner) that I need to involve you, my patients, in the building of this system.  First off, you are real smart (as witnessed by your choice of doctors, of course), and could give me significant insight and help in this area.  Second, these are your records, and I believe this whole thing won\’t work unless I build something that works for you.  Here\’s what I need:

  • A \”brain trust\” of patients who can help me get to the best solutions in this area.  I need a group of folks who know software/databases/IT (or who are good at faking it, like me) to discuss, brainstorm, and possibly build the tools that will work for both me and my patients.
  • A group of folks willing to test various tools (Twistle is an example of one of those tools), and give me their opinions on what is good/bad/ugly about them.

We can meet in person, but since this is a geeky thing, I suspect most of our meetings will be held in the far reaches of cyberspace.  If in the end we come up with an ingenious piece of software, I have no hesitation but to share the piles of cash that fall out of the sky on us.  I don\’t really care about that side of things, actually.  I really just want a system that will let me take care of all of you most effectively.

If you are interested, please let me know.

I am not sure why I hadn\’t thought of this earlier (except that my mind is still affected by the \”doctor is the center of the universe\” reality-distortion-field that our wonderful system perpetuates).  The truth is, my patients have as much if not more at stake in this project.  They want me to succeed because that success will mean better care for them (and that I can stay in business and not move to New Zealand to wait for my Medicare Opt-Out period to end).  Many of them have joined me because they share my vision for care that is better for patients, better for doctors, and saves money.  Besides all that, anything I build won\’t fly at all unless it works for them.

So I\’ve started on this new project: the true collaborative health record.  It\’s important to me because it enables me to run the system as well as possible.  I believe my model of care can only succeed if supported by an infrastructure to support it, but that with that infrastructure, it can become a viable alternative to the spend-care, sick care system both patients and doctors hate.

15 thoughts on “Collaborators”

  1. Dr. Rob I have said this before and will always repeat it: YOU ARE MY INSPIRATION, I love reading your posts and updates. From California, I am sending you greeting and best of luck! Sincerely, Kelnia BSN, soon-to-be RN.

  2. I wish you were my doctor! I wish I could get MY doctor to read your blog! *sigh* “doctor is the center of the universe” reality-distortion-field…so true …

  3. Great idea, curious how this will work out given closed EMR systems, open source software stacks, and semi open and closed software APIs and app distribution platforms. Are you on twitter?

  4. Closed EMR systems are a problem, so I’ll either have to get them to agree to communicate with what I build or use open-source EMR systems to build something myself.

    I am on Twitter, @doc_rob

  5. I think you’re thinking in the right direction; patient engagement is key in both executing appropriate health care, but also to ensure proper “master patient indexing” and exchange of information amongst both the formal and informal care communities.

  6. After building tech companies for 12 years (and I can’t write a line of code – thank God), I am now working full time pro bono to see if i can make a difference. We are building a Personalized Medicine Project at a Canadian children’s hospital where we will leverage the best tools in genomics to try and diagnose tough cases that have a genetics root.My personal beef is about collaboration. In technology, we had a breakthrough 10+ years ago with Open Source solutions. Thousands of smart people making something better every day.
    Listen. Medicine and “sickness insurance” (there is little true health insurance after all) and all the structure around it is broken and will be driven off a cliff by people like me (I am 66) and my fellow “Boomers” who are now entering the age where we will need more health interventions – more demand and less people contributing.
    So the answer MUST work backwards from the person (don’t call me a patient – I am not patient) and we each must take full charge of our own health outcomes.
    So thanks for your thoughts. More please!!!!!

  7. I can see how they would make things difficult for what you are trying to do. As a disclosure, I work for an EMR company.
    Part of your choice may hinge on how much overhead you are willing to commit to IT. It sounds like you are trying to run a lean operation, which may conflict in some ways with having your own custom EMR.

  8. Informative Article! Good to see somebody who really knows what they are talking about and can additionally produce common sense blog for us the reader. Certainly looking forward to your next article.

  9. Hi Rob,
    Like Mike, I have been tameing the technology monster to apply applications that actually solve business problems. I have been applying that goal to healthcare for about 15 or so years. Always has amazed me that the patient is rarely involved in any designing or decision-making around HIT, especially when one is taking about Personal Health Records!!

    Your concept of a collaborative record with the patient is a very intriguing one, and I’d like to participate. Also, I hope you won’t hold it against me that I work with national groups on the meaning of Meaningful Use!
    Let me know how I can engage.

  10. Dr. Lamberts,
    I just stumbled on this blog trying to learn how to operate my new tablet. I wish I had bought one for myself years ago, I would’ve saved you the trouble. I am associated with a charity and we donate our services to…. well I’ll simply post a link here because it is much easier to read it there than filling up your blog with my words. We’ve spent years developing a system that take us “back to the future” and we are in the process of working on the next two phases of the project. We have considered suggestions and are making modifications to suit other professionals and their needs and we would surely appreciate accommodating any reasonable requests as long as they don’t deviate from our Mission statement. We will gladly donate to you, or any care provider reading this, an “HCP” account to see what needs to be added to accommodate your needs.


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