Louisiana Health Information Exchange DesignSession

Mark Frisse: Welcome to Tennessee. When Vanderbilt University was formed, Cornelius Vanderbilt charged them to find the northern most southern city and that is how Vanderbilt ended up in Nashville. We have a unique place here and a unique bunch of people that have joined us from my team, who has been successful in putting this infrastructure in Memphis. We also have folks from HCA and Indianapolis here today.

This meeting is about you. We have tried to anticipate what needs to be done. You will be successful, one of the most successful endeavors the country has seen. You are here, which is step number one. You were able to get this diverse group of people together and start the process. I know many of you were frustrated that you did not get an agenda. We have an agenda, but our job is to help you work successfully so the agenda is flexible. At the end of the day, when you think about what you need, you will have to have a common story to tell. We have a few ways to do that. We don’t give you an agenda so that we can spring stuff on you and push you to work hard. We have structured your experience so that you will work in different groups continuously for two days.

At the end of the event, you will leave here with swim lanes on an action plan. First of all you have an impossible objective; if you refer to the swim lanes, you can see we have the first year spread out. At the end of two days we will have representation of the coordination team, what their high level objectives are, and what it is you need to get done.

We have divided into two markets, Baton Rouge and New Orleans. At the end of this, we don’t think it makes sense to talk about this project if we do not talk about all of the other issues you are facing. We also want from the folks who have to commit resources that they will receive a return on investment. Finally, we have the Technology team.

In the other room we have a Map room. All we have done is put maps of the state and the individual regions on the white walls. You are welcome to build and add to the maps.

At the end of this you will receive pictures of all of your work, transcription, and a website to help you create your common story. In the back of the room you will see a Knowledge Wall to help start telling your story. You need to start figuring out how to tell your story, and bring out your concerns and commitments. There are some fundamental issues you have to address. At the end of today we want to address your top levels of concern. We have a superb team that you will be working with from the Center: Kati Thompson, Tom Lloyd and Elizabeth Calhoun have done this work for years and are prepared to facilitate a very productive event.

Tom Lloyd Tom Lloyd: I want to confirm how we refer to the markets. One market is Baton Rouge and let’s refer to the “other” market as the “x” market. Mark referenced the maps we drew of Louisiana. We would like you to start to identify what these regions are and, if you know of other projects going on in the state, please add them.

Vanderbilt has invested in this place. I have had the chance to play in places like this for over 12 years. Who wants to describe some of the things you saw when you walked into the Center for Better Health?

Discussion

Flexible, moveable. Yes, we can move the space to flex whenever we need.

Whiteboards. This place is about getting ideas out and I challenge you that if you do not agree with something that is written, then you need to be able to articulate that.

Circular. Are there any science fiction fans here? This is called the Radiant Room. It’s referenced in Isaac Asimov’s Foundation series and refers to the prime radiant where knowledge is focused and disseminated. Psycho-history is about inventing the future. The gentleman who invented this architecture was into science fiction and the future.

Colorful multi-media. Matt Taylor was an architect who apprenticed with Frank Lloyd Wright, and his wife Gail is a teacher who is focused on accelerated learning.

Seventeen percent of you prefer to sit in a room and read; the rest of you respond to what Frances Gillard is scribing on the walls.

Fun environment. When Matt brought his thinking to the world of group decision making, he developed the process we try to push people through which is designed to emulate the habits of creative people. Walt Disney was the first one to create the story board, and he had someone in the back of the room transcribing his story. That is why we have someone in the back of the room taking notes.

One of the other creative habits of highly effective people is that they don’t take formal breaks. We will work through lunch and that is also why we don’t put out an agenda; we will flex the agenda based on your progress and needs.

We will work hard to keep you on schedule and we ask that you remain here until 3:00pm tomorrow, which is when we will sign off on the plans for this investment.

This work is about iteration, getting feedback, improving our work and honing in. If you want to take notes, feel free if that is your learning style.

As far as tools go, Mark wanted me to talk to the swim lanes, or the circle, square, diamond technology. Anyone a fan of Edward Tufte? He has a quote that basically says you have to get the whole thing in view. He goes into a lot of detail. He is a fascinating gentleman. One of the big problems that most organizations have is that they attempt to plot every project in their organization, which tends to lead to failure. We have tried to represent three major things.

Circle = goal. Circles normally appear at the top of the swim lanes as they are goals related to the entire map. We do not put goals in the swim lanes.

At Vanderbilt, out goal is about having a culture that values evidence-based individualized systems of care. This goal is actually out to 2008. As we work through this, we need to think about what the goals are for this project.

The difference between a square and diamond is that they are normally the end milestone of a project.

Square = project bringing some functionality online.

Diamond = plan or a decision that needs to be made in the future.

This is not to say you cannot have another level of detail, such as a very high level project plan.

Now if you will all reach under your chair and pull out your Hypertile. Think 3M sticky on one side with a sheet of paper and magnet on the other. One of the things that this place has been designed for is to help people come to agreement around conceptual models that you will go make real. We are going to go through an exercise as to what we think the key outcomes are for a strategic model; you will make four drawings.

For the first drawing, draw a picture of A merging with B.

One of the basic concepts of strategic modeling is understanding what the basic concept is you are trying to get people to understand. The key components to any model that you build here or anywhere in the world are those things. My term of art for A and B are “actors”. The space in-between them is the relationship, how you draw what you draw representing the actors is key. The frame is the thing that defines the context, or the scope of work. Getting agreement on those frames in relation to your model is important. The last element of conceptual modeling is annotations, or the text. The “A” and “B” are the annotation of this model.

What does a cloud represent? What does a square represent? Early on try to stay in the “bean” world and not get too realistic in your images. Pick symbols that do not have any meaning associated with them.

Let’s try a second model, draw A over B with a frame that represents an intersection (the overlap) of the two things.

Your biggest challenge today is going to be communicating. You will use words, language, and make assumptions that others will have no context for. This exercise is for us to create some basic tools for communicating.

The entire process we are going to go through today is based on four teams working throughout the event: the coordination team, Market team 1, Market team 2, and the technical team. We will break out in a minute to discuss your current state. This afternoon we will mix up the teams so that the market, technical and coordination teams will work together. So this is the work that needs to be done before we have wine and cheese later this evening.

This first assignment is called Take-A-Panel. This 3’x7’ sheet of enameled steel is a panel, some of you will want to take two panels but we ask that you only take one. This is part one of a three part assignment. You have 30 minutes to complete this work. As you meander to your team area, please stop by the map room to review the maps and add any frames or boundaries to the room. This is your chance to tell everyone else in the room where you are and what is going on in your environment.

[click to view larger image: 1, 2]

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