I just fell out of the stupid tree and hit every branch on the way down. But lest I get ahead of myself, let us begin at the beginning. It started with homework–not mine–theirs. Among the three children of which I had oversight; coloring, spelling, reading, and exponents. How do parents without a math degree help their children with sixth-grade math?
“My mind is a raging torrent, flooded with rivulets of thought cascading into a waterfall of creative alternatives.” Hedley Lamar (Blazing Saddles). Unfortunately, mine, as I was soon to learn was merely flooded. Homework, answering the phone, running baths, drying hair, stories, prayers. The quality of my efforts seemed to be inversely proportional to the number of efforts undertaken. Eight-thirty–all three children tucked into bed.
Eight-thirty-one. The eleven-year-old enters the room complaining about his skinned knee. Without a moment’s hesitation, Super Dad springs into action, returning moments later with a band aid and a tube of salve. Thirty seconds later I was beaming–problem solved. At which point he asked me why I put Orajel on his cut. My wife gave me one of her patented “I told you so” smiles, and from the corner of my eye, I happened to see my last viable neuron scamper across the floor.
One must tread carefully as one toys with the upper limits of the Peter Principle. There seems to be another postulate overlooked in the Principia Mathematica, which states that the number of spectators will grow exponentially as one approaches their limit of ineptitude.
Another frequently missed postulate is that committees are capable of accelerating the time required to reach their individual ineptitude limit. They circumvent the planning process to get quickly to doing, forgetting to ask if what they are doing will work. They then compound the problem by ignoring questions of feasibility, questions for which the committee is even less interested in answering. If we were discussing particle theory we would be describing a cataclysmic chain reaction, the breakdown of all matter. Here we are merely describing the breakdown of a national EHR roll out.
What is your point? Fair question. How will we get EHR to work? I know “Duh” is not considered a term of art in any profession, however, it is exactly the word needed. It appears they are deciding that this—“this” being the current plan that will enable point-to-point connection of an individual record—will not work, and 2014 may be in jeopardy—not the actual year, interoperability. Thanks for riding along with us, now return your seat back and tray table to their upright and most uncomfortable position.
Even as those who are they throw away their membership in the flat earth society, those same they’s continue to press forward in Lemming-lock-step as though nothing is wrong.
It is a failed plan. It can’t be tweaked. We can’t simply revisit RHIOs and HIEs. We have reached the do-over moment, not necessarily at the provider level, although marching along without standards will cause a great deal of rework for healthcare providers. Having reached that moment, let us do something. Focusing on certification, ARRA, and meaningful use will prove to be nothing more than a smoke screen.
The functionality of most installed EHRs ends at the front door. We have been discussing that point for a few months. When you reach the fork in the road, take it. Each dollar spent from this moment forth going down the wrong EHR tine will cost two dollars to overcome. To those providers who are implementing EHR I recommend in the strongest possible terms that you stop and reconsider your approach.
A cold wind is blowing in from the north, blowing so hard that at times that the rain seems to be falling sideways, echoing off the windowpanes like handfuls of pea gravel. The leaves from the walnut trees, that had prematurely yellowed, dance a minuet as they slowly make their way to the ground in the woods. It feels like the first day of fall, a day for jeans, a long sleeve shirt, and a pair of long woolen socks. The temperature has nosedived. On a normal day, the first indication of sunrise would have begun to push the darkness from the sky. But today is not a normal day. The clouds are hanging low and gray against the dark sky.
I was thinking about the time I was teaching rappelling in the Rockies during the summer between my two years of graduate school. The camp was for high school students of varying backgrounds and their counselors. On more than one occasion, the person on the other end of my rope would freeze and I would have to talk them down safely.
Did you ever notice when you’re watching a sports movie that a down-and-out, last-place team can always be rallied into first place in one season by the simple addition of one player with a winning attitude? Some people keep going to see Gone With the Wind thinking that if they see it enough times the south might win. Fantasy works well in almost any setting where popcorn is served.
If you watch too much television your brain will fry. Sometimes I feel like mine is in a crepe pan that was left sitting on the stove too long. Two nights ago I’m watching Nova or some comparable show on PBS. The topic of the show was to outline all the events that took place that helped Einstein discover that the energy of an object is equal to its mass times the speed of light squared, better known as E=mc². It was presented to the audience at a level that might best be described as physics for librarians, which was exactly the level at which I needed to hear it. It’s physics at a level that is suitable for conversation at Starbucks or any blog such as this.
So I’m making dinner the other night and I’m reminded of a story I heard a while back on NPR. The narrator and his wife were telling stories about their 50 year marriage, some of the funny memories they shared which helped keep them together. One of the stories the husband related was about his wife’s meatloaf. Their recipe for meatloaf was one they had learned from his wife’s mother. Over the years they had been served meatloaf at the home of his in-laws on several occasions, and on most of those occasions his wife would help her mom prepare the meatloaf. She’d mix the ingredients in a large wooden bowl; 1 pound each of ground beef and ground pork, breadcrumbs, two eggs, some milk, salt, pepper, oregano, and a small can of tomato paste. She’d knead the mixture together, shape into loaves, and place the loaves into the two one-and-a-half pound pan, discarding the leftover mixture. She would then pour a mixture of tomato paste and water, along with diced carrots and onions on top of the two loaf, and then garnish it with strips of bacon.
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