A New Aim for the Triple Aim

My father (hi Dad!) recently was diagnosed with an incidentaloma. In medical speak, that is an “incidental” (or, unintended) finding on an imaging study conducted for an entirely different reason. His physician found an ascending aortic aneurysm of a certain size, on a CT scan of the chest.

Dad was interested in finding a vascular surgeon in the Los Angeles area who was experienced in evaluating and if necessary, performing surgery for this condition. “So,” he asks me, “who’s good at vascular surgery in Los Angeles?”

I was completely stumped.

I went online, as all good internet-enabled adult children do, and found several dozen websites that purport to show and rate surgeons in the Los Angeles area. NONE of them were useful. Angie’s list, HealthGrades, lots of commercial and informal sites trying to meet an important need. Either there were no surgeons listed, or maybe there is a fragment of a listing and no data, or maybe there is a marketing blurb associated with that surgeon, or maybe someone ranting about a surgeon with whom they were unhappy. Nothing in terms of quality of care, operation case volumes, patient outcomes, very little of patient satisfaction…

And yet, we now are collecting such data in our massive EHRs. What if we took the Triple Aim of improving healthcare, which includes the following:

• Improving health of populations
• Enhancing the experience of care
• Reducing costs

And gave such a tool to our patients? What if we could apply Amazon.com principles to searching for physicians and showed the screen below: how many operations of this type per year, the re-hospitalization rates; complication rates, patient satisfaction, and cost of that care, wrapped up with an overall star rating?

Yes, I can hear the outcry now. There are so many reasons why we can’t do this. As a former hospital CEO (Dennis Brimhall) said to me decades ago:

No patient shall wait. This is our vision. I know there are 300 reasons why patients have to wait in our hospital. And yet, we all know that waiting is one thing patients hate about our care. So, no patient shall wait. And it will be all of us working to solve the 300 things so that this can come true.

So it is, with this vision. It is hard, and nearly impossible with the sociopolitical structures we have now. The technology is just about able to do this, but the much harder work is convincing all the stakeholders in the healthcare industry (and in my own organization!) that this is valuable, this is important, and we must do it.

It is also possible that by the time we achieve this, the two “surgeons” pictured above will have grown up and helped solve this problem. And that clearly irrelevant, untrustworthy guy on the right will have retired.

And Dad’s fine, by the way. Thanks for asking.

CMIO’s take? If you don’t like change, you’ll like irrelevance even less.

This piece was originally published on The Undiscovered Country, a blog written by CT Lin, MD, CMIO at University of Colorado Health and professor at University of Colorado School of Medicine. To follow him on Twitter, click here.