The World Wide World: IT Ain't Just the Web ... - Cdn.oreilly.com

You’re in this position where the patient wants you to know, and you don’t want to
disappoint her. We have let patients live in a fantasy world thinking that we are
omniscient. They often don’t realize how important it is to be involved in understanding
their own treatment. We convey the message that we can take care of it and
we don’t tell them how much they have to contribute.”
She left practice to get a master’s degree in public health and prevention, which gave
her an ability to understand the current medical literature that her medical education
had not. Four years after joining Cigna as a researcher a week before it
announced its merger with Aetna, she was running its “agile” IT development group
(as opposed to its 5,000 person IT operations group) – which had grown partly
through four acquisitions to 450 people in less than four years.
“I learned simultaneously about the potential of IT to improve health-care quality
and the challenge of doing it from the health-plan perch,” she says. “Managed care
was under fire in those days, and even with a quality mission there was always some
underlying suspicion about what we might be doing with people’s data. That was
really heavy baggage and it was hard to achieve a transformation.”
But when she got a recruiter’s call about a job at the Markle Foundation, she
demurred: “All I heard was the word foundation, and I said, ‘Not interested.’ What
could a foundation do in this space, making grants?” But she discovered it wanted
someone for an activist role, leading a team of industry players who could both
design and implement policies. Markle Foundation’s Connecting for Health program
now comprises physicians, insurers, government agencies, vendors, consumer
groups and others; under Diamond it has developed both technical and policy architectures
for creating a decentralized, networked health-care information infrastructure.
Members include the American College of Physicians, Blue Cross/Blue Shield
Association, Computer Sciences Corporation, RxHub, Surescripts, IBM, Siemens,
American Medical Association, Agency For Healthcare Quality and Research and the
Centers for Disease Control.
“Almost five years later,” says Diamond, “I know I couldn’t be effective in this role if I
hadn’t had five years in the guts of a company building these systems. On the other
hand, we had a real company mentality [at Aetna]. We knew our own metrics, but
we rarely thought about the policy environment. At my level, for example, operating
within a large, integrated system, I hadn’t appreciated how much the problem needs
to be solved in a way that deals with the competitive nature of data. Moving a
patient’s data across competitive lines creates real challenges that require careful
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