Wednesday, October 21, 2009

In consulting, experience is everything

I cringe to think of marketing firms that claim to meet the needs of all clients. I know there are general rules of engagement that might apply to sports drinks, exotic lumber, and healthcare information system but it is the knowledge that underlies these industries, not the mechanics of marketing, which produces results.

As a consultant, I ensure that I bring value to my clients by staying tucked into a niche defined by healthcare information technology above, medical devices and life sciences flanking the sides and wireless technologies underfoot. Inside this nook, years of professional experience serve me well recently I found a fresh source of valuable insight tucked into in an even smaller place.

Though it would be an imprudent business plan for me to rely on being a patient myself to gain experience, a recent visit to UCSD Medical Center’s CT/PET Imaging Center turned out to be consulting gold. I gained new insight on four truths of healthcare:

First, the balance of power in this consumer experience is off kilter before you ever hit the registration desk. You are either ill or potentially ill, or you would not be having a $15,000 body scan. This fact ensures that you are probably a little off your game. To exacerbate this disadvantage, I noticed that every room in the building had a “Warning: Radioactive” sign on the door. It dawned on me that it is actually the patients in the rooms who are surging with radioactive isotopes. Headed for my own personal day-glo lounge, I’m stunned to discover that the lead door is so heavy that I have to pathetically pry my way out of the bathroom with one hand while securing my peek-a-boo gown with the other.

Second, not everything in healthcare is featured in episodes of House, ER or Grey’s Anatomy. As a result, patients are often caught completely off guard by the details of a procedure. I eyed my little lead room with its heated massage chair and frothy drink with suspicion. It was only a scented candle away from a spa day. The mood was broken when a mountain of a man named Claude arrived with a lead lunch box. A moment later I had an IV catheter in my arm as Claude drew a cartoon-esque shiny metal syringe out of the box. It was a 007 moment for sure, and I fought the urge to look for razor wire on Claude's teeth. I was instructed to sit motionless - no typing, no talking, no NOTHING - for 1 hour to let the radioactive isotopes soak into my nooks and crannies uniformly. I talked Claude into letting me read from my Kindle because I could do it with one finger. (Maybe there is a marketing angle for Amazon in this?)

Third, for all those medical procedures we have seen on House, ER and Grey’s Anatomy, the reality pales in comparison to TV. There is little to no drama involved, except within the patient’s own frantic mind. It is your job to follow directions which you do carefully because – well, your life may depend on it. After my inert solitary confinement, I took my place on the metal plank of the highly intimidating PET/CT machine that consumed the majority of a room just slightly warmer than a meat locker. I demonstrated that I could lie on a 2-foot wide table with my hands above my head - elbows at my ears. I promise to stay this way for the next 25 minutes or so but I resisted the urge to laugh when Claude asked, rhetorically, if I’m comfortable - lest he glare at me with towering concern as I cost the Center hundreds of dollars per minute with my senseless sarcasm.

As the conveyor belt pulled me into the machine, I saw the red laser cross hairs and realized this is the point in House when the patient starts to asphyxiate or bleed from a facial orifice. Neither happen commonly, it turns out. Instead, the machine’s robotic voice (not a stylish doctor in an intimately lit tech room) ordered "breathe in" "hold your breath" and "breathe out". Steadily my arms went from uncomfortable to agony but I held my pose like a high diver going for gold.

My fourth realization was that many medical procedures elicit little known physiological effects. A wonderful sampling of such effects which relate to child birth are described in “What to Expect when you are Expecting.” They remain little known because, these surprises don't qualify as a topic of polite conversation. I now know that when you are injected with contrast agent for a CT study, you will experience a false sensation that you have just wet yourself. Thankfully, Claude warned me that this might happen or I would have certainly called for a time out. Eventually Claude extracted me from the bore just long enough to wrap my torso and arms in a Velcro sealed ace bandage and send me back in, snug as a bug, for a 40+ minute motionless PET marathon.

By four-thirty that afternoon three different radiologists had read my CT chest study, my PET scan and my contrast images. The radiology reports and images were electronically available to my primary care doctor, surgeon, and medical oncologist. Before dinner, I received the call telling me that my morning adventure was well worth the time – I was certifiably cancer free from head to toe.

A week later, a client called me to rework a slide deck on their medical imaging module. As I pondered the right clinical scenario to illustrate the value of connected health data, I didn’t have to search far. My experience along with my new insight is at least as valuable to my clients as a grasp of search engine optimization or consultative selling techniques. With me, they get the whole package – albeit radioactive.

Tuesday, October 20, 2009

Healthcare Informatics webinar: User authentication

Balancing security and convenience for logging into clinical applications puts IT leaders between a rock and another rock. Join me and our panel as we discuss user authentication and whether newer multi-factor techniques such as biometrics are ready for prime time.

The webinar is Thursday, October 29 at 1 PM Eastern and more information can be found here:

Thursday, October 15, 2009

4th Floor Thinking

I live most of my life four stories above sea level. I live in a 4th-floor loft in downtown San Diego, and Jamie and I work in Suite 422. This consistency of elevation is completely coincidental. It's less accidental how Jamie and I approach our work.

We're comfortable developing strategy with the executives on the top floor. Unlike many consultants who constrain themselves to strategy-only, we like to mix it up with street-level tactics. We can see both extremes from the 4th floor. In all our work, executive-level perspective is embedded in what we deliver.