Quality indicator data for Q4 2007 has been posted at eCommunity.com/quality.

The data reflect Community's high quality of patient care for indicators in three categories:

• Heart attack
• Congestive heart failure
• Pneumonia

Community's quality data are compared against national hospital averages and are provided for all network hospitals: Community Hospitals North, East, South and Anderson, and The Indiana Heart Hospital.

We also have added a new section for Outpatient Quality of Care. On this page you can review quality measures regarding care provided at physician offices and/or by Community physicians. Quality measures are compared across 2005 - 2007 for diabetic and heart failure patient care, pediatric immunizations, women's health, safety, patient satisfaction and improvement projects.

More information, including national averages for hospital quality data, can be found at http://www.hospitalcompare.hhs.gov

Community Health Network and Summit Construction Co. were awarded the 2008 Outstanding Project Award from the Metropolitan Indianapolis Coalition for Construction Safety (MICCS) for their collaboration on the Community Hospital North expansion.

“This award demonstrates that our culture of safety goes beyond our core business of patient care to touch all that we do,” says Mark Hayden, senior project manager. “Winning sends a signal through the construction industry that we care and that we pay attention.”

According to the MICCS Web site, “The 2008 outstanding project team was able to manage a coordination effort that not only allowed a safe working environment for craftspeople, but also a safe working environment for the occupants of the existing structures connected to this project.”

The construction team at Community Hospital North successfully managed several challenges, including the need to prevent the development of infections and minimize noise levels for the patients in the existing hospital while meeting an aggressive construction deadline.

To create a safe environment for construction workers, the team took an innovative approach by using new technology. The Community North expansion project was the first of its type in the country to use a Magic Arm crane, which lifts construction materials onto each floor safely and efficiently without the use of scaffolding or platforms.

This is the 12th year the MICCS has presented the Outstanding Project Award and the second time a hospital has been recognized. The Indiana Heart Hospital was the winning project in 2004.

Congratulations to Community Hospital Anderson and The Indiana Heart Hospital for being selected to receive 2008 Leadership Awards for Clinical Excellence from VHA Inc., a national health care alliance based in Irving, Texas.

Community Anderson and The Indiana Heart Hospital were recognized at the VHA Leadership Awards Recognition Banquet on Sunday, May 4, at the 2008 VHA Leadership Conference in Philadelphia.

• Community Anderson received an award for Clinical Excellence for Acute Myocardial Infarction Care
• TIHH received awards for Clinical Excellence for Congestive Heart Failure Care and Surgical Care

The 2008 VHA Leadership Award for Clinical Excellence honors VHA member organizations that have distinguished themselves by meeting or exceeding national performance standards in specific clinical activities. To be selected for a Clinical Excellence award an organization’s composite score must be in the top 10 percent for at least the core measure category beginning third quarter 2006 through fourth quarter 2007. All information was based on data from the Joint Commission. VHA serves more than 1,400 not-for-profit hospitals nationwide.

Community Anderson: Acute Myocardial Infarction Care

See how Community Health Network compares for heart attack care >>

Community Anderson is one of 16 VHA member hospitals nationwide to receive a 2008 Leadership Award for excellence in treating heart attack patients.

For heart attacks, best practice standards include:

• Aspirin prescribed at time of patient’s arrival
• Aspirin prescribed at time of patient’s discharge
• ACE inhibitors or beta blocker administration for left ventricular systolic dysfunction
• Adult smoking cessation advice/counseling provided to patient prior to discharge
• Beta blocker prescribed at time of patient’s arrival
• Beta blocker prescribed at time of patient’s discharge
• Amount of time until thrombolysis administered
• Amount of time until PCI administered

"At Community Hospital Anderson and throughout Community Health Network, we treat common health care problems uncommonly well, always focusing on quality and safety, which leads to better outcomes for our patients." says Bill VanNess, M.D., president and CEO of Community Hospital Anderson. "We are proud to be recognized for these high standards and to provide exceptional health care in Madison County and across Central Indiana."

TIHH: Congestive Heart Failure Care

See how Community Health Network compares for congestive heart failure care >>

TIHH is one of 20 VHA member hospitals nationwide to receive a 2008 Leadership Award for excellence in treating congestive heart failure. The best practice standards for treating congestive heart failure include:

• ACE inhibitors or beta blocker administration for left ventricular systolic dysfunction Detailed discharge instructions provided to patient
• Left ventricular function assessment performed on patient
• Adult smoking cessation advice/counseling provided to patient prior to discharge

"Our participation in VHA helps us achieve a higher level of performance both operationally and clinically, and we are pleased to receive recognition from VHA for our work in cardiac care," says Tom Malasto, president of TIHH.

Surgical care

TIHH is one of 13 hospitals nationwide to receive a 2008 Leadership Award for surgical care. These steps toward quality include:

• Administering antibiotic within one hour prior to surgical incision
• Selecting appropriate antibiotic for surgery patients
• Discontinuing antibiotic administration within 24-hours after surgery (within 48 hours for cardiovascular procedures)

"The award validates the dedicated focus of our clinical staff and physicians to pursuing excellence in the care provided to our surgical patients," Malasto says. "Preventing infections following surgery is a key objective of our surgical team. To ensure the proper outcome, our staff focuses on national indicators of quality."

Today I read an article from Jakob Nielsen "How Little Do Users Read?" and I began thinking about my experiences as a web developer.  The concept of text scanning and that users read between 20 and 28% of the text on a web page feels right to me.  One thing that I have learned and that I always say:


This is part of what I call the paradox of content.  There exists the desire to fix usability issues with an application by adding more instructions.  When that doesn’t help, even more instructions are added.  All the time, the user is not even reading them.

The way to fix usability issues is by fixing the real issue with application design, flow, etc. and by not adding more content.

This idea obviously can also be applied to content, information architecture, and web site design. 

Actually, I would like to call it a methodology.  The Paradox of Content Methodology. 

Or maybe I can create a movement.  The Paradox of Content Movement.

Today I am celebrating a day of no meetings by working on several things on my to do list, including some blogging. And ironically I read this blog post with the image below from Seth Godin, one of my favorite marketers.

In the interests of being transparent, I would like to state that I think my blog post, Creativity, should have been broken up into a few paragraphs for easier readability.  I realized that after I posted it that I had puked one big paragraph of words into that post and didn't consider that the reader might not be able to quickly scan that post and is being asked to read it more carefully or not at all.  I am trying to be better about my paragraph length to promote content scanning.

I was at the annual meeting for my homeowners' association last night and I begin to think about open communication and transparency.

There a lot of complaints and questions about what's been going on with the leadership of the community.  There is only one meeting a year, the monthly board meetings have been either closed to the public or unadvertised.  The main source of communication has been phone or email from a web site that many homeowners didn't know about.

There have been issues with the former property manager and people in the community didn't know about that or the resignations from the board.  Consequently, many felt disenfranchised, and were distrustful of the board members and how the dues have been spent.

Watching all of this I realized that if communication had been kept in the open and homeowners informed of changes in the board and property management, their distrust would have been minimized.  And giving people a chance to speak during the previous year would have lessened the complaints in the meeting.  I believe that most people respond to open honest communication.  Explanations of community issues before this meeting would have lowered the level of hostility in the room.

How does this apply to health care?

Imagine if health care providers were open and honest all the time about what a patient is experiencing.  

You arrive on time for your doctor appointment but wait forty-five minutes to see the doctor.  Why did that happen?  The doctor may have had a complicated patient case come in and needed to spend more time with someone.  Or other patients’ lateness has caused the doctor to be running behind.  I read an article somewhere I can’t remember that stated that the main reason patients need to wait for their doctor is that other patients before have been late.  I don’t think most people know that.

Would knowing one of those situations help you be less frustrated with your doctor when you have to wait?

There are many other examples that can be imagined.  Ones that apply to hospital visits or even organization decisions.  The tools and technology for open communication are different depending on the situation.  In a hospital, talking to the patients individually would be more effective then later blogging about the event; for an organization blogging about a decision or event is more effective than individually talking to everyone interested.

I believe that open, honest communication in health care would reduce complaints and malpractice suits and allow the health care industry to spend more time treating patients.

Some reading for Friday, sent to me courtesy of Pete Turner, V.P. of Business Development at The Indiana Heart Hospital.

Besides just creative and non-creative people, I think there are two types of creative people:  Those who think of lots of ideas and those who think of ideas that they can execute.  I believe that I am one of the latter.  I have at times thought that I am not a creative person, but I recently realized that I have thought of creative ideas, bringing together concepts, etc. and my ideas are ones that we can create or that we have created.  I build off of work that we have already done or have a vision that I work towards.  Just because I don't have lots of ideas (including some that can't be done), doesn't mean I'm not creative.  One of the benefits of the person who has lots of ideas is that they can inspire ideas in others.  I filter the ideas that I have and don't spend time working out ideas that can't be actualized.

I have said this many times.

Reading this article on NPR, Internet Health Records: Convenience at a Cost?,  prompted me to think more about Personal Health Records (PHRs) and Electronic Medical Records (EMRs).  In re-reading my previous post The Ideal Personal Health Record, I'm not sure that it was clear about my thoughts.

The other day in a meeting I described the relationship between the EMR and PHR this way:

Think of the PHR and the EMR as two separate entities sitting side by side.

The patient’s PHR can look at the patient’s EMR but is not allowed to change it.  The patient can add items from their EMR to their PHR.  Then they are able to modify that item only in their PHR to add additional details, etc.

The physician’s EMR about a patient can look at the patient’s PHR but can’t change it.  The physician can pull pieces of the patient’s PHR into the EMR as they feel it is appropriate because they are ultimately responsible for the accuracy of the EMR.  The physician is able to modify a patient’s EMR.

The two systems exist separately but are able to communicate with each other.

This system will only be able to work if the PHR is linked to a health care provider’s EMR.  The larger PHR systems like HealthVault and Google Health may be used to transmit data between PHRs so if a patient moves they can take their data with them.

We now have RSS feeds available for our health news! You can select from a number of categories:

• Breaking News
• Breast Health
• Diabetes Health
• For Your Child
• Heart Care
• Men's Health
• Mind and Body
• Women's Health

Breaking news stories are published once a week on Wednesdays. News stories in all other categories are published once a month.

Visit eCommunity.com/news to subscribe.

Not ready to subscribe? You can also just listen to the story by clicking the "Listen" link next to the headline.

Tomorrow our team will be hosting a Web publishing workshop. We've invited members of our marketing and communications departments, leadership, and others involved in development of our brand strategy. We have also invited a couple of our external partners, Compendium Blogware and Custom Scoop, to discuss Web publishing, in particular blogging as it relates to brand strategy.

We plan to educate a bit on the Web publishing tools we have available internally and how content owners within the organization can use them to publish messages and content in a rapid-cycle manner. Our tools include a homegrown CMS, RSS capability, e-mail marketing tools, interactive/rich media, collaborative software, blogging application, etc.

We're also going to dive into how we can use our tools to create a more interactive user experience on our Web site—one that integrates our brand message and effectively communicates Community's services and exceptional experience model to patients, families and employees.

There are many viewpoints and I'm looking forward to a lively discussion with constructive takeaways to help us as we move forward with our content strategies. Stay tuned!

I just finished reading John Maeda's "The Laws of Simplicity", and I was struck by an application of one of his laws this morning. I was loading my iPod with some music and I wanted to add my Time-Life "Living the Blues" series to listen to today. I usually load just my favorites from the ~25 CD series but today I wanted to also add the ones that were not ranked five stars. I wanted to listen to some variety and I realized that my favorites weren’t so favorite unless they are contrasted with songs that aren’t my favorites, just like Maeda’s fifth law, DIFFERENCES Simplicity and complexity need each other. Maybe this is the purpose of radio and something that we have lost in the iPod/iTunes/web 2.0-get-what-you-want-when-you-want-it era that we are in?

A crucial piece of our health care technology arsenal is a homegrown content management system (CMS) we (read: I) use for publishing our Web content. After a year of design (and redesign) sessions, the brand spanking new "CMS2008" is in production! We are still working out some kinks as is to be expected. However, there are many upgrades: The information architecture is more logical, the WYSIWYG-ness is more user-friendly and the editor functionality is more robust.

In addition to the Web content publishing piece, CMS2008 also contains administrative tools that we can use to mange user-generated content, such as that found in our eCommunity blogs, discussion boards, and SharingSites.

The big idea here is that if we can make our CMS tool easier to use, this will help the content owners distributed across the organization feel empowered to also be active content publishers.

Several employees at Community Women's Health brightened one patient’s day recently when they presented her with more than $350 in baby gifts they had purchased. Angie O., medical assistant, Monica R., sonographer, and Amanda S., biller, gave patient Vanessa bags of new baby clothes, blankets, bibs, bottles, diapers and other infant items along with hand-me-downs from their own children. The co-workers surprised their patient during one of her routine medical appointments.

“She was shocked,” Amanda says about this exceptional patient experience. “She’s not an emotional person, but she was really affected. It was great. And it was fun buying pink stuff because I have two boys.”

“I thought it was great,” says Vanessa. “It was a nice thing they did for me.”

The mini baby shower was Angie's idea. After talking with the young mother-to-be during another appointment, she discovered that Vanessa hadn’t yet had a baby shower and no one planned to throw her one. Angie enlisted her co-workers to help. “I told them that I was going to buy her some small gifts, but it turned into something bigger,” Angie says. “I just liked her and we wanted to help her.”

Jeanne N., site manager, was the first to share this story. “I am so touched by their generosity."

I had the pleasure of listening to a lecture/conference call with Seth Godin yesterday talking about his book "Meatball Sundae."  I began to wonder how the health care industry fits into his model.  At first glance it seems like health care provides a meatball service, but there are unique aspects to it that work well as the whip cream, cherry and other toppings.  Health care and health care technology doesn’t seem to fit into his model.

The e-Business team has seen a lot of new media/new marketing trends that work really well in health care.  Patient blogs are one example that we have built.  Our SharingSite application allows patients to blog about their condition and treatment in or out of the hospital.  We are also using it to post our baby/nursery pictures.  This eliminates the phone calls to family and repeatedly telling relatives the same information by a patient or family member who is already stressed and busy.

Our discussion boards that we have really not promoted are gaining more and more usage because people want to talk about their health condition, ask questions and compare their experience to other patients.  This is a common patient behavior that used to (and still does to some extent) happen in person, but now you can go online and talk to many more people.

Patients also want to find out more about their health conditions so they are using online health information libraries along with just reading blogs, discussions boards, etc to find out as much as they can about their health issues.

I believe that health care is different, that it doesn't fit the Meatball Sundae model.  Maybe it has to do with all the regulations, etc. on our industry, or that we aren’t selling a product that users generally have a choice about purchasing or not.  But they do have a choice about where to purchase it.

I met with a vendor earlier this week and one of the services they are selling was Business Process Management (BPM).  I realized that the e-Business team has been doing this for several years now, before it was the new thing.  We have been building applications that are designed with the process in mind.  We build applications that improve process and workflow.  Our applications work within the process workflow already created.

On the other hand, IT in many organizations builds or buys an application and fits the process to it, or tries to.  One reason for project failure with applications and vendor product purchases is that they don't match the process previously developed in the organization.  The project fails because there is an attempt that doesn't succeed to change the process or the process isn't understood.

In our requirements gathering we review the current process and sometimes make suggestions to improve the process.  But then take the process requirements and build an application that meets the requirements and matches the predefined process.  I think that is a major factor in our success in this organization and outside it.

I believe this is especially true in the health care field.  The medical staff is very busy and there checks in place that need to be met to insure quality health care.  Processes have been created and in place for some time and it can be difficult to change them.  Health care technology systems generally don’t work together well and there are difficulties with interoperability.  Forcing a system into this environment without considering the work flows and processes already in place will ultimately fail.  Failure can mean a lack of usage of the system, a break down in work flow or issues with patient care.

Community's bariatric services has partnered with Medical Animatics, LLC, to provide weight loss surgery patients with access to an online, interactive, media-rich educational program. The program's tools help patients and families learn about upcoming procedures, manage their post-surgical lives and "make healthier lifestyle choices." A highlight of the online tools is a self-paced informed consent agreement that guides patients through the details; this replaces the traditional paper-based consent form. Bariatric patients simply log in to My Informed Choice to interact with the product.

I used to work in the e-learning industry, so I find this company and program interesting, particularly the niche approach the company takes by focusing on scientific and medical content. It will be interesting to see the measurable outcomes of this program in terms of patient understanding and knowledge application as well as any process improvement in bariatric surgery services.

In the latest issue of Wired (Alright, I'm still catching up on my reading.), there is a mention about an online article about Gary Gygax written before he passed away.  I was doing some reminiscing about the time I played Dungeons & Dragons (I actually played and preferred Advanced D & D.  I quit playing around the time that the 2nd edition came out, a long time ago.) and I realized that all that role playing in my teen years has helped or shaped my skills for my current position.  Yes, that’s right, playing D & D is like programming.

The rules can be compared to a programming language that a Dungeon Master creates a scenario with.  Just like a programmer writes an application from a set of rules or a programming language.  Other players play the scenario the Dungeon Master created with their characters or roles.  Users interact with an application attempting to perform a task and in usability terms have a role or a set of defining characteristics about their experience, etc.

My playing of AD & D in my teens has prepared me to be a productive member of society with a paying job (after a detour of several years).  Who would have thought?

If you liked this post, stay tuned for next time when I explain how an action film has the same structure as a musical!

(I had the chance to meet Gary Gygax when I went to a GenCon conference in Wisconsin.  My friend and I decided not to stand in line to meet him because we didn’t have anything to say to him other than I like your game, etc.  The same stuff that everyone else says to him.  And being "cool" teenagers we didn’t want to act like everyone else and look stupid.)

(I think I still have my dice I used to play AD & D with somewhere in my house.)

(Once you read the Wired article about Gygax, you'll realize that a 20-sided die is revolutionary. I first learned about probability and bell curves from this game.)