Ix Across America: Integrating Information Therapy Into Practice Community by Community

We are eager to identify new strategies for helping practicing clinicians to make it easier to integrate information therapy (Ix) into their clinical workflow. One model that we have conceptualized is collaborating with leading local and regional quality leaders to stimulate Ix advancement in their own communities.

We are aware that this “Ix Across America” concept requires not only a combination of a lot of intense work and patience on our part, but also strong leadership from respected champions in each partnering community. I’m happy to report that our first test of this concept is off to a great start, thanks to the leadership of Helen Riehle, Executive Director of the Vermont Program for Quality in Health Care (VPQ), and several other committed innovators in the small but creative state of Vermont.

The report below summarizes the first phase of our “Ix Across America” best test in Vermont.

VPQ devoted its 2007 Spring Learning Forum to information therapy (Ix^®). VPQ has helped diverse medical practices across the state to implement learning collaboratives, particularly around Ed Wagner’s Chronic Care Model (CCM).

After some introductory comments from the VPQ Executive Director and Vermont’s Lt. Governor, I set the context by explaining Ix in detail and contextualizing it vis-à-vis the CCM and related quality improvement (QI) strategies. Ted Eytan, MD, MPH (family practice physician and Medical Director, Health Informatics, Group Health Cooperative), presented many specific Ix initiatives Group Health has implemented in the context of its broader patient-centered informatics strategy.
Rushika Fernandopulle, MD, MPP (Internist and Co-Founder, Renaissance Health), described how he has used Ix in a small practice. In both cases, these practicing physicians provided considerable detail regarding the challenges and solutions for integrating Ix into the clinical workflow.

Forum attendees separated for breakout sessions. Practicing clinicians, practice managers, hospital administrators, and others affiliated with specific clinical practices discussed opportunities for applying these Ix approaches to their own settings. Attendees representing state government agencies, quality organizations, and those representing Vermont Information Technology Leaders (VITL, the state’s regional health information organization or RHIO) engaged in a policy-oriented discussion of how the state could facilitate greater Ix adoption.

When the breakout groups reported back to the full audience after lunch, these robust discussions resulted in several concrete next steps for Ix advancement including: implementation of multiple specific Ix initiatives in different practices; incorporation of Ix and consumer-focused activities into VITL’s pilot projects; integration of Ix components into the Vermont Department of Health’s Blueprint for Health project; and other statewide collaboration opportunities. The most popular specific Ix initiative that
Vermont practices plan to implement is the after-visit summary, but clinicians and administrators plan to pursue several other initiatives as well and there is broad interest in personal health record implementation. With respect to VITL and the Blueprint for Health, leaders believe that the architecture that is created can be used to make Ix a more explicit goal. In addition, VITL’s first implementation project related to medication history could involve components that more directly support consumer engagement in their health.

In the afternoon, Bob Corrigan (Vice President, Product Management, Emmi Solutions) discussed the “power of conversation” and demonstrated an interactive, engaging approach to Ix via text, audio, video and other graphics. All of the day’s speakers and state health care leaders involved in VITL and the Blueprint for Health (Cy Jordan, MD, MPH, Medical Director, VPQ; Andrea Lott, CIO, Northeastern Vermont Regional Hospital; and Jeremiah Sable, MD, Public Health Physician, Health IT, Vermont Department of Health) participated in a panel discussion to identify the greatest opportunities for integrating Ix and consumer-facing HIT applications into Vermont’s critical statewide health care initiatives.

Both Ted and I were able to frame all the day’s discussions after spending the day before in individual practices in
Vermont and with leaders from VITL and VPQ. These visits provided context for the specific challenges unique to
Vermont clinicians and HIT leaders.

We look forward to following up with Vermont practices, hospitals, HIT leaders, and government agencies through several concrete next steps to ensure that HIT implementation involves consumer-focused initiatives. Other quality leaders who think their communities would be good Ix laboratories should let me know.

–Josh

Who Will Be the Next Generation of PHR Users?

Looking at how young people use the Web for virtually everything from commerce to social networking, it’s not hard to imagine an increasingly virtual future health care world. If Don Berwick is right that at least half of current in-person clinical encounters don’t require a visit, this generation likely will change the character of US health care delivery.

But what about the other end of the chronological spectrum? One of the common questions I get is how we make information therapy (Ix) relevant for seniors–the population that consumes the greatest amount of health care.

Although part of the answer is that Ix need not be delivered electronically, the more compelling notion from my perspective is that we have a magnificent and mostly untapped opportunity to extend patient-centered health information technology (HIT) applications to people who really need them.

The potential of the innovative applications that comprise patient-centered HIT (e.g., personal health records (PHRs), secure messaging, online tools, etc.) can be maximized if we successfully integrate them into patient-clinician relationships. Ideally, they should be viewed as tools within that context.

More than anybody else, seniors are likely to have ongoing and frequent relationships with their clinicians.  In fact, in many cases, seniors concurrently interact with multiple providers, making the need for coordinated relationship management tools all the more important. Without them, we wind up with considerable redundancy, poor communication (not just between patient and doctor but among providers involved in that person’s care), and the possibility for dangerous medical errors.

Furthermore, other characteristics more common as people age (e.g., limited mobility, cognitive functioning issues) increase the importance of having patient-centered HIT applications. They can allow for communication without patient and clinician needing to be in the same place and for communication to be trianglulated–for example, to include the child or spouse of a senior with cognitive impairment.

Many seniors are already accessing considerable health care information online (to some, a surprising percentage), and there’s no doubt that the aging baby boomer population will vastly expand the online senior population in the near future. However, there’s no reason why we can’t do more to help more seniors capitalize on this golden opportunity now.

Community efforts involving librarians, hospital community outreach staff, senior centers, and others can effectively break down barriers limiting seniors’ adoption of e-health resources. Although I haven’t seen a lot of empirical data, anecdotal evidence suggests that, once obstacles are removed, seniors become active Internet users.

Who do you think the next generation of PHR users will be?

 –Josh

(Visit www.ixcenter.org for more about PHRs and related issues.) 

Ix is in the House: Congressman Kennedy Re-Introduces PHR Legislation

Congressman Patrick Kennedy (D-RI) re-introduced the “Personalized Health Information Act” at a Capitol Hill briefing today to incentivize adoption of personal health records (for details of the precursor PHR legislation from the last Congress, see my January 3 post: Patient-Centered Health Information Technology in the New Congress). Some of the observations about the issues that most struck me and their relevance to information therapy (Ix) about the two-hour briefing follow.

First, unlike the initial unveiling of the bill last Congress, Kennedy announced this version with a wide array of supporters. The briefing featured: a Republican co-sponsor, Dave Reichert (R-WA); provider and health plan sponsors from post-Katrina Louisiana (LSU Health Network, Louisiana Blue Cross Blue Shield); representatives of organized medicine (American Academy of Family Physicians); advocates from the voluntary health world (American Heart Association); and usual-suspect industry supporters (Microsoft, Medem, Allscripts).

Second, the message was clearer that this is less about health information technology (HIT) than about better care. Specifically, the congressman and his staff (Michael Zamore) drove home that PHRs are a vehicle to proactively delivering better, more personalized communication and care.  It is interesting to note that, although it advocates vigorously for HIT, the specific mission of the House 21st Century Health Care Caucus (of which Kennedy is Co-Chair) is “to transform the health care system through information and technology to improve patient safety and health care quality, lower costs, and coordinate care.” Note that it specifically is not about IT but “information AND technology.”

Third, and somewhat related, Kennedy (and others) made the point that even though “people aren’t clamoring for ‘health IT,’” those dealing with the challenging health care issues want the functionality of PHRs whether they call it that or not. The congressman noted that people with chronic conditions know how difficult it is to get the health care information they need and they are increasingly expressing that need in various ways. Or, as Medem CEO Ed Fotsch analogized, “I don’t care about the bank’s information technology systems, but I want the ATM to work.” He suggested that this legislation can help to harness the consumer as a market driving force, similar to what happened in the banking industry with ATMs.

Fourth, the focus on advancing proactive delivery of personalized communication to improve care was shared by all of the legislation’s sponsors. Most interesting to me was that Microsoft specifically was focused on information therapy (even if MS Corporate VP Peter Neupert did not use that terminology or “Ix”). In focusing on the fact that health care is essentially an “information management issue,” Neupert’s language literally paraphrases the informal Ix definition. He described health care being “about getting the right information to the right person at the right time and making sure that information is accurate.”

Neupert also said that “the data is a necessary but insufficient condition…for making the right decision,” much the point of the Issue Brief I authored for the California HealthCare Foundation, “Lost in Translation: Consumer Health Information in an Interoperable World “ (http://www.chcf.org/topics/view.cfm?itemID=114624). Or, perhaps more to the point, in the Q&A, he also agreed with my amendment that the “right information” must not just be accurate but also be meaningful and understable to the average consumer. In fact, several of the panelists were sufficiently interested in this issue to respond to the question. People recognized that this important legislation represents an important beginning in the government’s effort to advance personalized communication and strengthen patient-clinician relationships.

It’s clear that the raw data populating PHRs (often deriving from administrative and clinical data sources) have little intrinsic meaning to the average consumer without some mechanism for translating that data to practical and usable information. We need to develop a blueprint for patient-centered HIT that provides infrastructure for PHR adoption and the practical use of such tools by a diverse range of people with varying needs and backgrounds.

The IxCenter is embarking on such a project and you can get a taste of it from some of the work we’ve been featuring on PHRs and related topics (see our Web site at www.ixcenter.org). By the time of our annual Ix conference (October 8-10 in Park City), we anticipate this work being in full swing, so make plans to join us there. In the interim, interested parties should contact me (jseidman@ixcenter.org) to find out if their work has synergies with ours.

–Josh

Truly Understanding Consumers’ Needs…Some Lessons in “Genchi Genbutsu”

What do consumers really want? To answer that question in health care, we might want to look at leaders in other industries that have developed great reputations with consumers.

This past Sunday’s New York Times Magazine had a cover story about Toyota and how that company–now with a market capitalization of $240 billion, which is greater than GM, Ford, Daimler-Chrysler, Honda and Nissan combined–has created the most profitable car company in the world. Toyota goes to extraordinary lengths to understand consumers’ needs.

In the NYT piece, Jon Gertner writes, “Toyota’s chief engineers consider it their responsibility to begin a design (or redesign) by going out and seeing for themselves–the term within Toyota is genchi genbutsu–what customers want in a car or a truck and how any current versions come up short.” Although Toyota’s Sienna minivan already was a remarkably successful product line, Gertner proceeds to tell his readers how the lead North American engineer took on the task of redesigning it by driving “the Sienna (and other minivans) in every American state, every Canadian province, and most of Mexico.” He ultimately logged 53,000 miles over 3 years in order to understand how conditions and consumers’ needs varied across the entire continent.

Likewise, Intuit–the maker of the wildly popular financial software Quicken and TurboTax–also believes that effective consumer research and development requires what they call “follow-me-home research.” In order to understand consumer needs, Intuit insists that you have to observe people directly in their everyday settings rather than just trusting self-reported survey data. Intuit is now taking this approach in developing their health care consumer finance software tools.

At our 5th annual information thearpy (Ix) conference last fall, the Robert Wood Johnson Foundation provided the IxCenter with a grant that allowed us to bring consumers to present directly to our audience of health care professionals. By every account, their perspectives were invaluable to the diverse group of attendees, because it helped these professionals to tune in to what consumers really need as health care organizations design innovative Ix initiatives.

I’m hopeful that we’ll continue to be able to bring real-world patients, members, and consumers to our annual Ix conference. Over time, I also hope that we’ll have more opportunities to spend time observing and learning from people in their homes and doctors’ offices.

The more we do that, the more we’ll learn. The more we learn, the more we can help.

 –Josh

MyHealth, Circa 2007…More Questions & Responses…

Following up on Tuesday’s posting, another question that came up a few times in our webcast, “MyHealth, Circa 2007: Consumer Needs and Market Responses in eHealth,” related to consumer privacy concerns.

I believe three things about privacy and security related to online personal health information (PHI).

1. Every provider, system, Web site or other entity that collects consumers’ PHI must invest time and resources to protect PHI and make a firm commitment to ensuring its privacy and security.
2. It can be done effectively–if done right, these electronic entitites should be able to protect PHI better than more traditional mechanisms for storing PHI. Many successful examples already exist in health care, but we can see even more examples in other industries.  After all, it wasn’t long ago that experts said that people would never transmit credit card information online in order to buy books–yet Amazon seems to have a few customers.
3. Ultimately, what will make the difference for consumers is the value of the online tools. Most people who use online banking and shopping cannot imagine ever going back to the old way of doing business even though there always exists some risk for identity theft, etc. If online health tools provide consumers with clear, understandable, useful information that meets their particular needs, they will be willing to assume the minimal risk associated with online tools that make a strong commitment to protecting their PHI.

Let me be clear: I absolutely believe that consumers’ privacy and security concerns are real and critically important issues. We should and can address them fully.

 –Josh

MyHealth, Circa 2007: Consumer Needs and Market Responses in eHealth

We held a public webcast on this topic today. Susannah Fox, Associate Director of the Pew Internet Project, not only shared valuable insights but also some of Pew’s as-yet-unpublished data. The presentations and the audio recording from both of our presentations will be available on our Web site in the near future.

We had nearly 100 unique logons to the webcast and more than 25 questions, so we didn’t have time to answer all of them. Over the next few days, I’ll try to answer questions we didn’t get to and elaborate on a few that I have been thinking about for various reasons. Also, Susannah Fox will post comments on this blog (as time allows) as well…although I’m sure that you’ll need to tune in to her upcoming Pew reports (available at www.pewinternet.org) to get all her insightful thoughts.

Q: Why can’t we have a way for doctors to upload my personal health records to a private page on a social network site that I can then share with other providers or people in my community?

JJS thoughts: This is a great idea, and clearly an activity that would support a much more collaborative care environment that would help improve (to paraphrase Dartmouth’s John Wasson) “same-page care” (getting clinicians and their patients on the same page). Unfortunately, there has been little progress in this arena outside of some integrated delivery systems (perhaps Group Health Cooperative in Seattle being the most advanced example). Some of the organizations that Wasson works with through a couple of innovative initiatives (see www.howsyourhealth.org and www.idealmicropractice.org) are getting at this in different ways as well.

No doubt part of the reason is that an infrastructure doesn’t exist to support it, and we’re working on two aspects of that infrastructure. First, we need to address the consumer-facing side of IT interoperability so that we can effectively connect consumers to health content that they can make sense of.  I wrote an Issue Brief for the California Health Care Foundation about this issue (see “Lost in Translation: Consumer Health Information in an Interoperable World” at http://www.chcf.org/topics/view.cfm?itemID=114624).

The second infrastructure piece that we are trying to address is the payer side of the equation by creating technical specifications to define what constitutes Ix.  The goal of our Ix Payer Workgroup is to provide guidance to pay-for-performance, provider recognition, and other programs so that they can recognize when providers, organizations, or tools provide people with information that supports their information needs with respect to decision support, behavior change, or other health needs.

I’ll address other questions tomorrow and in the days ahead.

–Josh

Response to NYT Jane Brody Column on Understanding Doctors’ Communication

Although the New York Times took a pass on my letter in response to a Jane Brody column January 30 (http://www.nytimes.com/2007/01/30/health/30brody.html?ex=1170910800&en=c1237335b6037a06&ei=5070), I thought others might be interested…

To complement the expert suggestions in “The Importance of Knowing What the Doctor Is Talking About” (January 30, 2007), keep in mind that most people are “patients” in the traditional clinical environment far less than 1% of any year’s 8,760 hours.

Therefore, we should maximize the value of that in-person clinical encounter with information targeted to the individual’s moment in care and tailored to their individual needs.

More specifically, a “visit prep” information prescription preceding every encounter will better prepare both patient and clinician for their 15 minutes (give or take) together. Also, research that tells us that patients forget 50% to 80% of everything a doctor says by the time they get home, so an after-visit summary reinforces key issues they discussed.

Implementing these two strategies brings us closer to the Institute of Medicine’s first recommendation from its landmark “Crossing the Quality Chasm” report for care based on “continuous healing relationships.”

–Josh

Applying “Rapid Learning” to Behavior Change Science to Transform Health Care

I attended a fascinating Health Affairs (www.healthaffairs.org) briefing on “A Rapid-Learning Health System” this past Friday, January 26 here in Washington. The project was led by Lynn Etheridge and Health Affairs and sponsored by the Robert Wood Johnson Foundation (www.rwjf.org), Kaiser Permanente (www.kp.org), and the US Agency for Healthcare Research & Quality (www.ahrq.gov).

Your first question may very well be, “What the heck is ‘rapid learning’?” The vast real-world databases created by electronic health records (EHRs) maintained by integrated delivery systems such as Kaiser and the Veterans Health Administration (VHA) create a phenomenal research capacity. With literally tens of millions of longitudinal, clinical member/patient records, the combined power to understand the effect of all kinds of care practices is staggering.

As Kaiser’s Paul Wallace (also the IxCenter Board Chair) pointed out, the number of newly diagnosed cancer patients in Kaiser’s EHR each year (about 40,000) is roughly the same as the number of patients enrolled in US cancer clinical trials. As Geisinger’s Buzz Stewart wrote in the Health Affairs Web exclusive, there is a clinical trials also deal with “clean” populations (often excluding the “messy” patients with multiple co-morbidities). EHR databases can help to bridge this “inferential gap” to help us figure out what to do about those people with conditions for which the traditional scientific process doesn’t provide a good answer.

Perhaps even more important than the contribution that this database can make to helping to heal people with new cancers is the impact it could have on the woefully understudied issue of cancer survivorship (understanding the health impact of “cured” cancer on survivors years or decades later). When the clinical trial is over, researchers often stop collecting data on their “subjects,” but Kaiser has a quarter of a million longitudinal EHRs on cancer survivors. That could have a great impact on our ability to address unexplained health issues that arise from the intense therapies to which people with cancer are subjected.

But answering these kinds of questions are just the tip of the iceberg. As Archimedes (www.archimedesmodel.com) Co-Founder and Chief Medical Officer David Eddy (also one of the pioneers in evidence-based medicine) noted, while tremendously valuable, applying the “look up” method to EHR databases tells you a lot about the past and the present, but it can only tell you so much about the future if nothing new happens. This is where the miracle of modern mathematical modeling comes in.

Now I’m not going to embarrass myself by trying to explain how models like Archimedes’ work, but there are a few critical points to understand. First, there are powerful representational modeling techniques now used in every industry from entertainment to transportation to architecture, and there’s no reason why—with adequate investment and data sharing—we can’t do the same in health care. Second, these models employ techniques to integrate data from much more discrete components (such as the progression of disease on the physiological level). Third, because of that, these models have a tremendous capacity to assess virtually everything that can happen (depending on the data that we have). Just to give you an idea of the potential power, Eddy and colleagues have prospectively predicted the outcome of many clinical trials (not that he’s saying that we should just get rid of RCTs)—for an example, see Exhibits 1 and 2 in the Health Affairs January 2007 Web exclusive by David Eddy.

With EHRs, there suddenly is a vast expanse of new data that can be integrated into models like Archimedes. The combination of EHRs and sophisticated representational modeling techniques can, to paraphrase Eddy, “put rapid learning on turbo.”

As amazing as these models are at this point, they still may not help us address some of the major quality-of-care gaps in the US if they rely only on the clinical and physiological data that currently power them. We know that one of the critical reasons for poor performance on quality measures is our inability to inspire healthful behaviors. For example, we know that a substantial portion of mortality and morbidity in the US are due to three behaviors: smoking, poor diet, and lack of adequate exercise.

Luckily, the science of behavior change is evolving, and with it our ability to understand how to effect positive behavior change. What if we integrate the models developed by people like David Eddy with the behavior change science developed by people like Jim & Jan Prochaska? (In case this is new to you: The Prochaskas have not only done pioneering work on the transtheoretical model but have developed a series of science-based tools for effecting behavior change.)

At the briefing, I asked Eddy if this was possible. He remarked that, as long as we can measure it, we can integrate virtually anything into these mathematical models. Indeed, new measures of behavior change and patient activation have been developed by people like the Prochaskas and Judy Hibbard. Others, including those in government health programs, are beginning to explore that measurement arena as well.

The opportunity not only for rapid learning, but for truly transforming care is enormous. We need to push the envelope on the scope of our inputs to EHR databases. At places like Kaiser, Group Health Cooperative, Geisinger and the VHA, they already have the opportunity to tap into rich sources of patient-reported data (such as health risk assessments, secure messaging, and other online applications where consumers enter in personal health information—all of which, of course, needs to be protected as with any other human subjects research). Let’s find ways to move this agenda forward.

–Josh

Next-Generation Consumer Portals

With Revolution Health launching its new consumer portal, a newspaper reporter called me earlier this week to ask what I thought about new efforts such as this….

It’s clear to me that—even though they generally don’t express it this way—consumers are clamoring for information therapy (Ix). And just to be clear, Ix is not simply a shorthand for health information. Ix involves delivering information targeted to a person’s specific moment in care and tailored to the individual’s particular needs.

A wide variety of consumer research makes it clear that consumers are hungry for health information. For example, Susannah Fox from the Pew Internet & American Life Project (www.pewinternet.org) has previously described a “Dr. Google phenomenon” in that, in a typical day, more people go online to get health information than visit doctors to get answers to their health questions.

I fully support the democratization of information ushered in by the Internet and other forces, but I also realize that it’s not fulfilling the needs of many consumers. Most consumers aren’t interested in generic health information. They want answers to specific questions at a particular moment in care that relate to people in their specific circumstances.

To date, the Internet hasn’t delivered that. It’s akin to having a garden with plants, flowers and vegetables that need varying amounts of water and the weather gods delivering a monsoon.

Part of the reason that the term “information therapy” has value is because of the corollaries between it and medication therapy. Information overload can result in an “overdose.” Consumers reading the wrong information can experience negative “side effects.” The right kind and amount of information depends on the specific individual, which means that we often need to “titrate the dosage,” much the same way doctors might adjust the dose of warfarin (Coumadin) for patients with atrial fibrillation (an irregular heartbeat).

Going online for health information generally involves (at least) four challenges. First, can you find the information you need? Again, it’s not hard to find information, but it’s another thing to find it highly specific to your need at a particular time. Once you find it, do you understand it? Has it been provided to you in a way that you can make sense of it? Third, there’s the issue of whether you can remember it.

Finally, even if you can find, understand and remember the information you need, you still may need help in contextualizing it for your own situation. That’s why there often is value in having your personal health library as part of bidirectional communication system with your clinician (of multidirectional to the extent that it involves multiple care professionals). With all that in place, then you’re ready to act on the information to improve your health, decision making and healthy behaviors.

The answer I had to give to the reporter is “I don’t know.” It’s far too early to tell whether Revolution or Google Health will create the kind of navigational support that will guide consumers to the Ix they need. At the very least, however, the fact that people with the resources of Steve Case and Google are pouring money into finding answers tells us that there’s a lot of interest in figuring this out.

There’s no doubt that much research remains to better understand what the optimal dose, frequency, and duration of information prescribing is for people in different circumstances. We are beginning to pursue this as part of our Ix research agenda and, when we figure it out, we’ll be sure to let you know.

–Josh

Making the Case for Information Therapy (Ix): Recognition, Reimbursement, and Research

Since research* suggests that 50% to 80% of everything that a patient hears in the doctor’s office has been completely forgotten by the time he or she gets home, it remains remarkable to me that payers don’t require an Ix after-visit summary as a condition for reimbursing clinical encounters.

For reasons such as this, the inherent logic in Ix is so compelling from both a practical and moral standpoint for many of us. However, most of the payer community is not ready to accept that logic without a substantial body of research behind it—not that any empirical evidence exists for the value of the generic clinical encounter itself.

To be fair, we first need to define in specific terms what constitutes Ix if we think that the market should recognize it. Indeed, that is the first task before the new Ix Payer & Certification Issues Workgroup, which was launched at the end of November as part of the IxAction Alliance.

The workgroup is chaired by Eleanor Herriman, MD (Chief Science Officer of Boston-based NorthPoint Domain) and includes a diverse cross-section of organizations. The Ix Payer Workgroup not only recognized this definitional need, but also realized that not all Ix is created equal—it varies both by type and level of complexity—and therefore has embarked on the more ambitious agenda of developing an Ix taxonomy.

As we build the infrastructure for identifying when and how Ix is performed, we also need to continue to build the empirical evidence base for Ix to demonstrate the value that high-quality Ix brings to people’s health. That work is also a critical part of the IxCenter’s 2007 agenda.

One of the challenges in measuring the impact of the latest Ix innovations is that the leaders often don’t have time to design rigorous, prospective studies. They just forge ahead and innovate because they know it’s the right thing to do for their patients, members, or consumers.

That poses challenges to health services researchers (and I admit to being one myself ), who generally would prefer to have things evaluated more cleanly or traditionally. It’s harder to tease out cause and effect when studying innovation that transpires organically or as part of lean operational development processes.

However, we should not shy away from the empirical idiosyncrasies that innovative care delivery initiatives create. Rather, we should rise to the challenge by employing a broader set of research and analytical skills to tackle these compelling research questions about new innovations. Indeed, the new care delivery strategies create opportunities for health services researchers to develop their own innovative research techniques.

I hope that health services researchers out there are up to that challenge.

–Josh

*For references on this and related research, see the IxCenter’s white paper, “The Ix Evidence Base: Using Information Therapy to Cross the Quality Chasm,” which you can download from the Publications section of IxCenter’s Web site (www.ixcenter.org).