Are there things I should be doing on a nice Sunday instead of tossing out counterfeit intellectual chum over FIOS?

Sure, however my children are in Colombia for six weeks visiting their grandmother–the country, not the school–I can’t remember the last time the house was this quite.  Already did my run, and pretended I could swim.  Got Rachmaninoff floating through every room in the house.  Somebody needs to yell, “Step away from the computer.”

My wife is in DC for the weekend–you really don’t care about any of this, do you?  A guy weekend.  Home alone, or home lonely–this is my 12-step program, you have to invent your own.  Wearing those boxers with all the holes–stop laughing.  The perfect weekend for football, but there are no games.  It will probably all come down to a Clint Eastwood festival with cigars, body counts, and scratching.  “Are you feeling luck today?”

I was excited to learn yesterday that a Harvard psychiatrist and teacher reads the bolg.  However, now I’m afraid that these little missives could wind up as case studies in Abi-normal psych 101–so you think you know healthcare?

Once again you’ve gotten me off track.  On a personal note…

We are all consumers of healthcare.  We are it’s customers.  Without us healthcare doesn’t exist.  Rule number one in any business–Never reform the customers.

Missed that one, didn’t they?  Here’s my thought on this–the audience took a collective sigh, and many of those at the back of the theater were seen sneaking away.

What is one of the most important factors for individuals when it comes to healthcare?  You may disagree, but I think it comes to choice.  The patient having the right to choose.  The right to exercise some control, even if it isn’t real.  I think a lot of the uproar about reform has to do with people not wanting to lose what little control they have.

It’s difficult to believe you even have the right to assert yourself when you think your life may be on the line.  Laying in the back of the ambulance I knew I wasn’t having a stellar day.  Those who say your life passes before you are wrong, what passes before you is the life not yet lived.

From the back of the ambulance, one has more control over who is going to cut their hair than they have over who is going to do their heart.  When you’re flat on your back, the perspective is that the only things that may be left is your right to choose.

That’s a tad too somber for a Sunday, so let’s all fast forward.

The Term Death Panels is so negative, let’s agree to call them, “Are we going to vote you off the planet panels?”

Why can’t we all just get along?

This is where the battle win be won or lost, not in the NEJM, not on Meet the Press.

Presidents are almost omnipotent.  They can; invade Grenada, go the the moon, and let GM fail.  Some things require the support of the UN, some things happen in the dead of night.

The one thing presidents and Congress are learning is that you don’t mess with a mom being able to take her child in for treatment for an ear infection, even if that’s not what you’re doing.  Right wingers, left wingers, middle wingers.  The last time the country was so united on a single issue may have been when we jointly decided disco was dead–I still have my platform shoes.

A large majority are united; the informed, the uninformed, and the illinformed; united for many different, valid, and imagined reasons.  That’s why this won’t pass.  The message fgot away from them, and they won’t be able to get it back.  They wanted a discussion, and they got it.  It’s way past having to do anything with the facts of reform.  It has to do with each person believing that no matter what their circumstances, their personal health is in jeopardy.

Have you noticed that there is not a single instance on TV of Joe or Janet the Plumber rallying behind reform and extolling the virtues of reform?  Why?  Because is’t not seen as being virtuous.

We’ve gotten it out of the think-tank stage and into the realm of Oprah and People Magazine.  Thinking and good judgement have left the building.

My best- Paul

I’m just asking, but when push comes to shove, that’s what we’re talking about, isn’t it?  Is that the one-page PowerPoint summary slide?

If so, doesn’t that push total entitlements to around 50% of the budget?

Let’s say for a moment that that’s the plan.  If the real driving force behind the reform push is to make quality care available to those who don’t have it, do that.  Let the government build a program for that segment, just like they did with Medicare and Medicaid.

Is it not easier to design a program for 45 million people than one for 350 million?

crayon physics

There are those who may suggest I am not a fan of healthcare.  I love healtcare–it saved my life twice, really.  I’m still a young guy, and I am grateful to be able to use the phrase, “My oncologist and my cardiologist” in the same sentence.  I want others to be able to do the same.

Anyway.  I think that what the administration needs right now is a good scandal, something salacious.  Something to get this off the front page.  What are the chances they–the ubiquitous ‘they’–will find some way to vote this through in the dead of night or while we’re all out shopping.  Maybe we need a good wag-the-dog scenario.  Who haven’t we attacked lately?  I hear Greece is lovely this time of year.

With no disrespect meant to anyone, well maybe just a smidgen, we spent more time studying Travel-Gate and who killed Vince Foster than it took to write the entire reform legislation–I think it was the butcher with the candlestick in the library.

Does anyone know who wrote the pages?  How come we aren’t asking questions of them instead of the talking heads?

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.”

Judging by the violent nature of the stab wounds, I'd say the victim was probably a consultant.

I Googled it and there’s nothing.  I am starting one.  Have you hugged your consultant today?

There’s “employee of the month,’ “customer of the month,’ but, there’s no “National Consultant Month.”  Why?  Hallmark doesn’t even make a card for it.

I don’t have an answer.  However, I have not heard anyone in DC categorically state this will never be the case.

Perhaps illegal is too strong a term.  However, and I know this analogy is way over the top, but the first things that came to mind for me when I thought of it was farming in communist countries.  Farmers weren’t allowed to sell their crops on their own, they worked for the state and had to grow what the state told them to grow.

Please tell me why this idea is nonsense.

Of course it can.  Let us go forth from this time and place and let it be said it started here. Or not.  Five years from now you will buy a laptop for $100, the software will be free–it will pay for itself with ads.  Memory will be on-line, you will pay for apps.  Just like a camera and film, a cell phone and minutes.

The technology already exists for browser-based EHR.

What do you think?

Just say no to logic

My mind is a raging torrent, flooded with rivulets of thought cascading into a waterfall of creative alternatives. (Hedley Lamar—that’s Hedley)

Let’s see if we can tie this collection of thoughts into something that won’t waste your time or mine.

The sun did not shine.  It was too wet to play.  So I sat in the house all that cold, cold, wet day.  It was too wet to go out and too cold to play ball, so I sat in the house and did nothing at all. (Dr. Seuss)  It was around that time when my wife decided maybe this whole sitting around thing wasn’t optimizing my time, so she decided “we”—which can also be interpreted to mean “me”—should caulk the master shower.  Personally, I thought that why God invented the Yellow Pages, you know, the whole thing about, “Let your fingers do the walking.”

I notice we just blew through an entire paragraph without accomplishing anything.  Sorry.  I got my designer tool belt, the same one I’ve had for twenty years—still looks the same as the day I bought it.  Today’s Roemer Minute—the less you know about what you’re doing, the more important it is to dress the part.  (This does not seem to work with the people whom I’ve told that I’m studying cardiology.)

Tool belt.  Tools—caulk taker-outer, caulk puter-inner.  Paper towels—the need for these will become clear.  Worse case, this is a ten minute job, but if I finish too quickly, there will be additional assignments coming my way.  The trick with caulking is that the success or failure can all come down to how much of the plastic tip you circumcise (can I say that on TV?).  Too much and caulk is everywhere, not enough and it is nowhere.  I made the incision and started to lay down the first bead.  It was quickly apparent that I should have used clear caulk as the white stuff stared back at me like bleached bones—I try and add a little medical flavor wherever I can.

I’ve watched the same shows as you.  Sometimes people spread the caulk with a tool, others prefer a wet finger.  I am equally unskilled with both, so I went with the finger method, smoothing the caulk into the joint.  I wipe my sticky white finger on the paper towel, place the towel on the limestone tile, and return to work, only to notice that although the caulk looks good, my finger created to parallel lines of caulk on either side of the repair, sort of like a snow plow does.  I grab another piece of paper towel and begin the process of trying to remove the excess caulk, finally tossing the paper towel to the side.

Fast forward twenty minutes.  The caulking is done.  My hands are so white it looks like I am wearing a pair of Mickey’s gloves.  (That’s spelled M-O-U-S-E.)  As I wipe my hands with a used piece of towel—there are no more clean ones—I unknowingly step on one of the pieces.  The piece sticks to my shoe.  I retrieve the other pieces and notice that the caulk which had been on the paper towels is now spread all over the tile like someone had a food fight with smores.

Whatever I touched only exacerbated the problem.  I am immediately reminded of the Dr. Seuss book, “The cat in the hat comes back.”  In the book, the cat goes from good intentions to spreading a pink stain over everything—sort of like me with the caulk.

Sometimes good intentions don’t add up to much.  I’d wager that everyone in the EHR process has good intentions.  Sometimes it’s more important to pair good intentions with good skills.  Let’s call EHR one of those sometimes.  Good intentions are okay up to the point when you’re dealing with two or more commas on the cost side.

Most times it’s good to call a professional before you start tracking caulk across the floor.