This little muse, like most of my others, will be written using reverse Rube Goldberg logic—I just thought of that, but it seems to fairly represent how my synapses seem to fire.  For those who don’t feel like googling—not sure what tense of the google verb that is—Rube is the person noted for making highly complex machines to perform the simplest of tasks.

There are things I can’t answer, and sometimes it makes me more than a little cranky.  Like the other night.  I am attending a board meeting for a non-profit.  The organization is a youth sports association—soccer, softball—sports.  There are sixteen of us.  Adults.  We meet more often than the US Cabinet Secretaries—I’m unsure about the capitalization, but it passed Word’s threshold.  We manage a budget, which if divided amongst the board members, would pass for petty cash in most firms.

Big issues, big decisions.  The meetings make me want to drill holes in my own teeth as was done to Dustin Hoffman in the movie, “Marathon Man.”  We now have an agenda for each meeting.  That was a huge effort.  In my year on the board, we have never had a ‘no’ vote, not one; not even a ‘maybe.’  I’ve been tempted to vote no on several occasions just to see if anyone is paying attention.

So, Tuesday night we spent an hour trying to agree if I should be allowed to write a plan for the organization (on my own time); a few goals, and a few tactics to help offset out declining membership.  I was going to call it a strategic plan, but we both know that would be unfair to the work ‘strategic.’  Sixteen adults.  More than 64 years of college sitting at a warped Formica table who looked like we were trying to reach an agreement on the relationship between string theory and why the Chicago Cubs haven’t won the Series in a hundred years.  They knew I was upset, but they couldn’t understand why, which upset me further—or is it further upset me?  One of those split infinitive things.  Have your editor call me.

So, here’s the punch line.  This simple—simple may have multiple meanings in this sentence—group of people arguing minutia over such mundane affairs foretells the problem.  I wanted to figure out how to squeeze the word mendacities into the sentence to go for a bit of alliteration, but it didn’t fit.

Do you see where I’m headed with this?  Here’s the Rube Goldberg part.  If grownups can’t pull together on simple things, pull together in a way that almost guarantees they will make a sound decision, how can they be expected to do so in much more complex matters like healthcare reform and EHR?  Nobody is in charge, nobody is the decider.  Can you name the person?  Can you even name what it is nobody is in charge of?  (Sorry for the preposition.)  I can’t.  Congress.  A thousand pages in one house, a thousand in another.  What’s a few thousand between friends?  Do those people understand the issue?  Not.

We have reached the point in the reform discussion where in the “Wizard of Oz” the Wizard instructs Dorothy to, “Pay no attention to the man behind the curtain.”  The finish line is so blurred that we wouldn’t recognize it if it sat next to us at dinner.

EHR.  There are valid business reasons for implementing EHR.  Washington made me do it is not one of them.  Stimulus money isn’t either.  No standards.  Plenty of intermediate stops along the way to a national network.  The technology exists today to remove the middle man.  The technology exists today to build one national EHR system instead of building thousands of them and then trying to give them the Elmer’s treatment—that’s glue, not Fudd.

EHR.  Who will lead?  I guarantee it won’t be vendor led.  Steve Jobs told his people to build a phone with no buttons.  Don’t you wish you were a fly on the wall in the coffee room listening to the reactions to that mandate?

EHR.  What’s needed?  A mandate.  And a leader.  A decider would also be nice.  To the ninety-plus percent who haven’t attained EHR enlightenment—stage seven—you may be the lucky ones.

I could be wrong about this—I was wrong on a Tuesday once—but within the next five to seven years I think we will have a national browser-based EHR that relegates the current EHRs to something akin to microfiche.  So, if you’re in the process of building, acquiring, or implementing a nine figure fiche system, stop.  Please.  Ask yourself if you understand the business problem you think an EHR will solve.  If so, go forward with caution.

If not, click your heels together three times and repeat after me, “Go Cubs.”