Day: November 20, 2009

“We need to talk about your TSP reports”

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If you recognize the stapler, you know the movie.  “Office Space”—Possibly the best movie ever made. Ever worked for a boss like Lumbergh? Here’s a smart bit of dialog for your Friday.

Peter Gibbons: I work in a small cubicle. I uh, I don’t like my job, and, uh, I don’t think I’m gonna go anymore.

Joanna: You’re just not gonna go?

Peter Gibbons: Yeah.

Joanna: Won’t you get fired?

Peter Gibbons: I don’t know, but I really don’t like it, and, uh, I’m not gonna go.

Joanna: So you’re gonna quit?

Peter Gibbons: Nuh-uh. Not really. Uh… I’m just gonna stop going.

Joanna: When did you decide all that?

Peter Gibbons: About an hour ago.

Joanna: Oh, really? About an hour ago… so you’re gonna get another job?

Peter Gibbons: I don’t think I’d like another job.

Joanna: Well, what are you going to do about money and bills and…

Peter Gibbons: You know, I’ve never really liked paying bills. I don’t think I’m gonna do that, either.

One more tidbit:

Peter Gibbons: Well, I generally come in at least fifteen minutes late, ah, I use the side door – that way

Lumbergh can’t see me, heh heh – and, uh, after that I just sorta space out for about an hour.

Bob Porter: Da-uh? Space out?

Peter Gibbons: Yeah, I just stare at my desk; but it looks like I’m working. I do that for probably another hour after lunch, too. I’d say in a given week I probably only do about fifteen minutes of real, actual, work.

I like to think of Peter as my alter-ego.

When I’m playing me in a parallel universe, I’m reading about a surfer dude cum freelance physicist, Garrett Lisi. Even the title of his theory, “An exceptionally simple theory of everything,” seems oxymoronic. He surfs Hawaii and does physics things—physicates—in Tahoe. (I just invented that word; it’s the verb form of doing physics, physicates.)

Ignoring that I can’t surf, and know very little physics, I like to think that Garrett and I have a lot in common. I already know Peter Gibbons and I do. So, where does this take us?

It may be apparent that I look at healthcare IT and reform from a different perspective than most; I’m the guy who doesn’t mind yelling ‘fire’ in a crowded theater. The guy who will never be invited to speak at the AMA convention unless they need a heretic to burn for the evening entertainment. I can live with that.

Like Garrett, I too see an exceptionally simple theory in everything, especially when it comes to improving the business of healthcare. It’s not rocket surgery, but then, it was never meant to be–before someone writes, I know it should be scientists.  It’s process, change management, leadership and foresight.

Sometimes I like to look at the problem from a different dementia—Word didn’t have a problem with my usage of that word.  I look at healthcare and ask myself three questions:

1. How did they ever get so siloed?

2. How did they ever get so so big without a cohesive IT strategy?

3. Is it possible to reverse both of those AND improve the business.

I am convinced the answer is yes.

Why the N-HIN will be owned by public firms

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Here are a few more thoughts just to Emerilize the discussion—to kick it up a notch.  Not only do I think the national EHR market is ripe for the taking by a big three like Microsoft, Google, and Oracle, I’ll go so far to suggest that when the dust settles in 5-7 years, the N-HIN, the National Health Information Network, will be a regulated combination of a handful of those firms.

As for the other firms offering or planning to offer PHRs, permit me to suggest the following scenario.  Let’s say I am in charge of Google’s so far somewhat nonexistent healthcare line of business.  One of my goals would be to have more users of my PHR than any other firm.

Why does this model make sense?  Two ways, both of which come from the cable/telco business model.  Rule number one, content is king.  In cable, it is shows like HBO and Discovery.  In healthcare it is data; patient data, effectiveness data, disease data.

Reason number two, the cable/telco model values the businesses based on the number of assets.  What are the assets?  Subscribers.  You and me.  Each body adds somewhere between five and ten thousand dollars to the valuation model of a Comcast or Verizon.  Downstream, some valuation will be placed on each PHR subscriber.

So, back to the example of me running Google’s healthcare offering—if you don’t like Google as an example, insert your favorite firm.  If I’m Google, am I troubled by the fact that other firms are building their own solutions?  No, and here’s why.  The difficult part of the business model is adding users, adding subscribers.  Why not let a bunch of firms do the business development work for me, do the dirty work to get the users, and then just devour those firms?  Once I own them, I convert them to my platform.  Do I then get some ‘ownership’ or right to use the data?  That would certainly be the business goal.

One million users valued at five thousand dollars adds five billion in valuation.  Ten million adds fifty billion.  Ten billion is about 2.5% of the US market.  Do I stop at the border?  Of course not.

By the way, while all this is going on, Google, MS, or whoever will also be creating standards and be building or buying up EHR firms.

The Dark Side versus the Blind Side

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My take on this is probably far-afield from the mainstream. I think the Dark-Side, firms like Google, Microsoft, and Oracle look at the confusion and lack of planning in terms of what the final EHR/PHR platform will look like and they simply drool. With hundreds of EHR vendors and RHIOs and RECs and standards groups all operating independently, all aiming at an undefined target, which group is best positioned to solve this platform problem, the Dark Side, or the Blind Side?

The Dark Side’s plans are underway and visible through their PHRs. Like the tip of an iceberg, I bet that most of what they are doing to own this space is presently unseen. Practice Fusion, if their product attracts enough customers will be devoured, or they will be ignored. RECs, RHIOs, Meaningful Use, Certification, a lack of standards, and no network are large red flags from the government saying “we don’t know where we’re going, but we’re making real good time.”

Here’s a reply I drafted at the request of Brian Ahier to his blog, http://radar.oreilly.com/2009/11/getting-personal-with-health-t.html

The Dark Side knows exactly where they’re going. They don’t need a network; they have one. The Internet. There are those who argue HIPAA and security. HIPAA and security can be more readily handled on a network that’s been up and running for twenty years and was built by the military than they would be under anything developed off the cuff under Washington’s leadership.

Now for the Deathstar issue–ownership of the data. The question is are ownership and possession one in the same? I bet they will not be. I’d also bet that five years from now somehow that Dark Side will have at least access to it. I can’t prove any of this, but I’d love to sit in on the strategic planning committees of the Dark Side. I bet some or all of this is underway. The Blind Side may be blind-sided.