Will NEO become a leader of the Medical Information revolution, or die not trying?

At the January 21, 2005 City Club forum, Cleveland Clinic CEO Toby Cosgrove ended his presentation with his vision for the Cleveland Clinic leading the inevitable "socialization" of healthcare in America - he declared the age of private and small medical practices and hospitals has ended and large, efficient world-class healthcare providers like the Clinic will create a universal umbrella of coverage. He is correct, and Cleveland is very fortunate to have a world-leader of this movement here - the Clinic is just as able to be a world-hub of socialized healthcare as any other provider, and Cosgrove is clearly capable of leading NEO to the forefront of this global transition - NEO should be center of global healthcare industry and excellence - read the notes from Cosgrove's presentation [1] to better understand how and why!

But the socialized provider aspect of the healthcare revolution is just one opportunity now before NEO - another was surfaced a week later with President Bush's 02.28.05 visit to the Clinic to praise their use of information systems to streamline and automate patient records - featuring before the world the Clinic's successes standardizing how patient records are maintained and communicated. To highlight this transformation, mentioned by Cosgrove the prior week at the City Club, the Clinic was not only able to use excellent medical information management to be the first providers to identify health risks of the pain-killer Vioxx but was then able to notify their 11,000 patients using Vioxx that they must stop taking the medication, literally real-time. Thus, effective medical information systems reduce healthcare problems, saving money and lives.

Because of skyrocketing healthcare costs, largely attributable to poor medical information management and administration, and the huge loss of health and life directly attributable to poor healthcare information management - resulting in 100,000s of unnecessary deaths and complications per year - President Bush now pushes to spend $125 million in federal money to research and deploy world-class standardized medical information system solutions and a "medical internet". What he fails to articulate is that the hard part of the job is done. The United States Veterans Administration has developed excellent global standards for medical information management and we have an excellent internet and in America are nearing universal access.

What is now needed is clarity in the marketplace, integration of legacy applications and data, and training of Luddite healthcare organizations and providers, from doctors and nurses to administrators and consultants, on the transformative ways of managing health information already available today... with better interfaces here - better data entry devices there - we're seeing many new industries now in their infancy, which will mature overnight.

On the 02.06.05 "Meet The Press", Senator Ted Kennedy pointed out that the VA hospital system's standardized medical information management system allowed them last year to reduce related costs by 7%, which for a system with 100 of hospitals and 1,000,000s of patients is a considerable savings and major contrast to the industry in general, where related costs are escalating. Bush has also recognized the VA does "a fabulous job" using medical information technology. What neither mention is that they accomplish this using an existing standard called VistA, which the VA developed in-house over many years and has become the de facto global standard for medical records management across the huge VA system and in many entire other nations and 1,000s of hospitals world-wide. Kennedy and Bush may not recognize or want to promote the implications, because this is so revolutionary and disruptive to so many entrenched commercial and political interests, but Ohio government and industry leaders absolutely must recognize the implications and realize we have many opportunities to leverage this disruption for great advantages.

NEO is not on the "inside" of the entrenched, large scale, legacy medical information system industries... we have nothing to lose by becoming leaders of the revolution - no local businesses will be hurt by such success!

The sooner we get on the positive disruption side of the medical information systems industry, at a globally competitive level and scale, the sooner that offers major regional economic development impact - potentially 100s of new companies and 10,000s of new jobs in Northeast Ohio in a few short years - much greater opportunity over time.

To fail to lead this revolution as quickly represents 10,000s of lost jobs, as outside service providers will come here and do what we fail to do ourselves, centralizing our medical information services elsewhere, eliminating needs for local data administrators, programmers, call center operators, and healthcare providers. Consider this the ultimate industry consolidation of our lifetime, where either we absorb the competition, creating more jobs here, or we're absorbed by competitors, with all the strategic, leadership, management, back-office and many other jobs moving elsewhere - like in steel we saw LTV and so many other world-leaders consolidate and fail and evolve into little ISG, which was absorbed by far-offshore Mital. Which scenario is best for NEO? The answer is obvious.

Just as the Cleveland Clinic is positioned to be a global leader in socializing providing healthcare services - taking over management and operation of less effective hospitals and healthcare systems world-wide (and Cosgrove pointed out entire regions and nations approach the clinic about doing just that, each week) - new businesses in NEO can become leaders in deploying socializing solutions for medical information management, as is inevitable. Rather than waiting for consultants from DC, LA, and NYNY to come here and do the work we didn't skill-up to do ourselves, we must leverage this time and place to develop new competencies here to lead this information revolution world-wide.

Thus is the reality ahead - be disruptive or be disrupted. Don't expect NEO to stop the healthcare revolution so critical to the sustainability of the long-term US economy (both for improving quality of services and controlling sky-rocketing costs).

For an overview of the world-class standards for this at hand, learn about VistA at MedSphere [2], an open source medical information systems enterprise in the Los Angeles area that is packaging these free VA/taxpayer developed standards into an enterprise providing a packaged, supported product and selling that to hospitals (just as larger, multi-billion dollar SAIC has also done for years). As you read their success story, as yourself why not here? NEO needs a "MedSphere" - many - working to connect together all medical information systems in this region and going after the growing global pie.

MedSphere is in the unglamorous business of taking free public knowledge, already developed at taxpayer expense by the US Government VA system, and supporting the processes needed to implement and maintain end user services - not as sexy as nanotech and biotech but so much more predictable, secure and lucrative. We can develop the exact same industry here, and for the world, instead of becoming MedSphere or SAIC customers next year.

It is important to realize this is not a revolution to be led by healthcare providers like the Clinic, or University Hopitals, or Metrohealth - they are not in the information systems industry. The HUGE VA system developed VistA because they needed a global solution for global problems and had the scope of funding and resources and independence of accountability to think and act globally... such rare heroic efforts thus create global solutions that are free in the public sector for all to leverage - a related example was the huge DoD and CERN developing the open source global TCP/IP telecommunications standard enabling the public internet. There are no healthcare providers, information systems companies, or consultants in the world as resourceful and expert in medical information management as the VA - non-collaborative consultants have spent $ billions ad hoc over decades to try to address the same challenges and failed, and always will. Luckily for society, America succeeded.

Rather than every hospital, and IS company, and consultant failing to invent new solutions, every government agency of every nation, and every hospital, health service provider, research laboratory, pharmaceutical company, IS consultant. employing company, insurer, claims processor, and creator and user of medical information need to embrace one set of standards (which exist) and contract many SAICs and MedSpheres as integrators - infomediaries - leveraging many data and call centers and other back office businesses to support the one integrated solution for all. Just as this is not a job for the Cleveland Clinic, it is not a job for IBM, Accenture, EDS, Microsoft, SAIC or MedSphere alone, but for 1,000s of businesses and 1,000,000s of diverse professionals and staff, all working independently but collaboratively with one set of standards (this is the foundation for Information Technology excellence in general).

If NEO businesses don't become revolutionary with these medical information standards our healthcare providers will lag global leaders until local hospitals hire outside "MedSpheres", whose consultants and integrators will fly into Cleveland each Monday and out each Friday for several years. Then, all our local medical data will be moved to a San Diego, and we'll call a Phoenix to ask about our prescriptions, and access websites hosted in an Arlington for our medical records, and ultimately receive most of our healthcare as telemedicine from a New Delhi or Beijing.

Why not centralize as much of that as possible here at home, and become global leaders accessed world-wide. The Clinic's CEO Cosgrove believes in NEO, and so does President Bush. Do we believe in ourselves, and are we up to the challenge, or will we watch as one of our last global industry strengths, being healthcare services, is diminished through centralization and outsourcing from elsewhere?

In anticipation of Bush's visit to the Cleveland Clinic, the Plain Dealer ran an insightful story [3] on the medical information system at the VA and the situation at other area healthcare providers. This is worth reading, and reading between the lines. The PD describes a major global success - the VA - some minor local strengths - largely with the Clinic - and many local weaknesses. The article describes the largely sorry state of integration of medical records management among major healthcare providers in the region, not even considering the 100,000,000s of records in private healthcare providers' hands that are completely disconnected from the standardized solutions ahead. The bottom line is despite having here two world-class efforts well on the way to embracing global standards of excellence - the VA and the Cleveland Clinic - all other healthcare providers are failing miserably, and none of our healthcare providers are really working strategically together to make this region a center of excellence, and thus a quality, connected place.

While we are not the worst in the world, we are far sub-optimal. It is time NEO leaders declare that making NEO a global center of medical information systems excellence is our highest priority, and invest in that outcome before all others.

President Bush came to Cleveland to say he considers this one of his highest federal priorities - he is allocating $125 million to just this - he considers one of our institutions world-class in demonstrating solutions - and Bush owes us a debt for getting him reelected. Consider last Year the Clinic attracted over $100,000,000 for research and development efforts, and other area hospitals attract more, and that we are viable as a center for a $ multi-billion-dollar medical information systems industry.

HELLO OHIO - anyone home and connecting the dots here?. Let's take the money Bush is offering, create the jobs that will result, become the center of excellence he envisions, become the quality connected place that enables, and stop failing!

PD coverage of the 02.28.05 Bush visit [4] spreads good word about aspects of the revolutions ahead but misses the point of what this revolution means to our local economy and quality of life. Either NEO gets its act together and leverages two important clusters - healthcare and information technology - and becomes a world-leader, or we will have two failing disconnected economic silos at the mercy of other leaders in other regions that have the vision to pursue disruptive excellence.

Realize the President has spoken, and that healthcare is being socialized, and that a most immediate, obvious realization of that will be one global interconnected medical information system, with all medical records in one system, operated by enormously important businesses that probably don't even exist today, which will come from nowhere to dominate that industry over the next several years. We are just as well positioned as any region in the world to be the center of that new economy revolution.

For those who envision the mid-town corridor as a center of commerce, now it is clear what that commerce should entail - infomediation of medial information and all that entails - a perhaps unglamorous business, similar in many ways to Progressive Insurance, for example, that will become a multi-billion-dollar eternal-growth industry practically overnight.