It’s time to quit tiptoeing around 2011 and HIT and Meaningful Use and Certification, acting like they are relevant. Since the unspoken general consensus is that their relevancy has passed shouldn’t we be using our efforts to formulate a plan to make them relevant?
Month: September 2009
EHR Integration-A good read
Robert Connely in the HIE blog makes some bery sound points about how the enite EHR intergration could and should work. Note, could and should are not closely aligned at this point.
He writes, :This is not to say that the “standards and stimulus” approach isn’t a good thing – it’s just that the day-to-day problems we really deal with may not be adequately addressed by the current approach.”
I think he’s being generous to the extent of the words, “may not be adequaltely addressed.” I can’t prove my statement, however I think that the mere fact that more than one group are working on standards is not standard.
How much more difficult will interoperability be, my guess is at least one more order of magnitude that what’s planned.
And as for interfaces? I think Jimmy Weeks recently wrote having 400 he needed to meet.
My best – Paul
Solutions for individual doctors
A nice piece by Mark McGraw regarding the move by large firms to build and deploy EHR systems and potentially deploy them on-line.
I think individual practitioners have little to lose by waiting for someone to shrink wrap the application.
Baucus: Math for librarians
What part of this do I not understand? The poor, who can’t afford insurance, will have to buy the insurance they can’t afford or pay a fine which they can’t afford.
Who was supposed to be watching the customer?
Sometimes it’s easier if I simply shoot myself in the foot rather than having to wait around for others to do it. Permit me to begin with a disclaimer; my comments and questions almost always pertain to the non-clinical side of healthcare.
We’ve spent time discussing how we take an industry that in many respects functions on a 0.2 business model and transform it rather quickly to one comfortable operating in a 2.0 model—effective and efficient.
So, while that’s going on, what other things are underway which will impact that transformation? Reform is one. What will be the impact? Nobody knows, but it may not be pretty. One of the largest implications of reform is that the industry is being forced to integrate. For example, it’s one thing to build a phone company. There is a whole new order of magnitude of difficulty when one phone company has to integrate seamlessly with all of the other phone companies.
That integration is being driven by hundreds of different teams of vendors, standards setters, certifiers, and networkers, each having its own goals and working in their own vacuum chamber.
As I’ve studied this business problem for the past few years it becomes more and more apparent that something has been overlooked. It gets it share of lip service, however unless it is addressed concurrently with reform and EHR, EHR will prove to be of such low value as to stymie people who later have to justify the expenditure.
It’s the missing link, the customer. I know customer is not the politically correct term in healthcare because it sort of blemishes the notion that nobody is in this for the money. We’d rather talk about patients. Patients are on the clinical side, customers are on the business side. Healthcare needs systems that work for both.
Where does customer care, customer relationship management (CRM), and customer equity management (CEM) fit within the realm of EHR? The wrong answer to this question could set your EHR effort back years and millions.
The following link takes you to a presentation of mine on CRM and discusses the merits of looking at treating customers via CEM.
http://www.slideshare.net/paulroemer/good-CEM-deck
I am curious to learn how you are incorporating the customer into your transition.
Certification Tax
Isn’t certification nothing more than a tax on healthcare providers? Or, has someone seen some value in being certifed other than paying money to get money? For the large providers, the ARRA money will amount to little more than a rounding error on the total cost of their EHR.
I encourage you to look at John’s post about the cost of certifcation, http://www.emrandhipaa.com/emr-and-hipaa/2009/09/14/cost-of-new-cchit-ehr-certifications/comment-page-1/#comment-120681
It seems like a lot of money for no ROI.
Fantasy Healthcare
What if we create fantasy-healthcare.com? Annual registration fees must be paid prior to the fantasy draft, and may be paid at healthcarefantasy@paypal.com. Participants will have to participate in the annual draft from the pool of available doctors and specialists, and will be limited to two specialists per person, five for a family. The same process will apply for selecting a hospital. If your choice is no longer available when it’s your turn to draft, you may submit another bid, or offer to trade with another member. Each trade will cost you one thousand Healthcare Points. Additional points may be purchased at the Public Option web site, www.we’vegotyoucovered.com .
You may purchase fantasy insurance to protect your fantasy-healthcare investment. In the event your doctor is sued or retires, you have the right to pick one of the doctors provided they are in the same or lower price category. For those who are concerned about the possibility of disputes, we have created www.fantasyhealthcaredisputes.com. You and your provider submit your arguments online, and the winner will be notified on-line. Additionally, we’ve added a new feature this year to help you understand your medical costs and bills, www.fantasyhealthcaremath.com. Join now, or take the chance that there may not be any doctors left within a three-hour drive from your house. Good luck
EHR: How to purchase an EHR
Are you really going to where that? Do these pants really make my…
Did you ever have one of those non-halcyon days when you felt the need to ask someone “Did a house fall on your sister?” Try to stay with me, it will come to you. Enough about falling houses Toto.
I sought the counsel of a friend before heading down this path, and I’ve decided to choose the road less traveled anyway.
I may have written that I have observed differences between men and women. You too? Here are a few examples from my side of the gated compound.
- We are willing to make mistakes as long as someone else is willing to learn from them
- A good excuse is almost as good as getting it right
- Good intuition will often make up for a lack of any facts
- We refine our personality flaws, for without them we may not have a personality
- Peter the Great heard the voices too
I regret that I am unable to share my list about women, for I am a coward.
While shopping the other day, I noticed that women shop for clothing differently from men. For women, shop is a participatory verb—whatever that is—involving all twelve senses, for men it’s something we’d rather do online while watching the game. From what I’ve observed, in fostering the she-conomy women:
- Do their homework—what’s in, what’s not, what’s on sale
- View shopping as a competitive sport, for some, a blood sport
- Try on things, often more than once
- Buy something they may need in case they someday find some other thing they may need that may go with it
- There is no rule about having too many shoes—buy in volume
- There is no rule about having too many black shoes
So, let’s see if we can segue beyond this jingoistic tractate on one to something more in line with the lofty subscription fee you paid for this site.
Permit me to employ two definitions which help me keep my ideas cogent.
- IntraEHR—EHR statements that relate mostly to the healthcare provider
- InterEHR—EHR statements that relate mostly to the movement or transport of the EHR record from point A to point B
EHR and shopping. Can one be at one with this duality? How can one not be? From having spoken with a number of healthcare providers about their IntraEHR selection, my take on a lot of the process is that more often than not there is no process. It’s a lot like watching men shop. It’s over and done with without much reasoned or substantiable—I was afraid I’d have to invent this word but I found it on Google—thought. Over and done with, now back to the game.
Maybe EHR scholars will one day be able to trace speed buying of IntraEHRs back to that whole Neanderthal hunter gatherer thing in the Pleistocene epoch. Sort of a think fast on your feet or you’ll be eaten approach to software selection—an awful metaphor, however CNN ran a feature with that title, so it has some legitimacy. Maybe the hospital’s executive committee will be able to trace the hastily made IntraEHR purchase back to a lack of a plan, the lack of business requirements, and the lack of an adequate request for proposal RFP. Maybe your successor will figure it out.
For those who haven’t contracted for their IntraEHR, it may be better to approach this like a woman. To those who are women—you should know who you are—you are probably already approaching it that way.
Now, where did I leave my black pumps? And no, I am not going to finish my thought about the pants.
How large is the reform effort?
A trillion dollars.
What does a trillion look like? A dollar bill is about six inches long. Stacked end to end, a trillion dollars would go from the earth to the sun, and back, twice.
Healthcare is one fifth of our economy.
One fifth of our GDP is larger than the GDP of five of the G8 countries, including France and the UK. Would we try to reform the entire economy of the UK? Would we succeed?
We have about six million miles of paved roads in the US. How long do you think it would take the government to repave twenty percent of them, 1.2 million miles? Could they do it?
Maybe we really should have a plan before we write a check.
Public option dead? Let’s lead with a solution
Who Will Lead
Dirk Stanley posted this link from the NY Times about the death of the public option.
http://www.nytimes.com/2009/09/13/health/policy/13plan.html?_r=1
Now, we can either bemoan this or we can try to lead. Here’s my take on how to strat the discussion.
To insure the uninsured we don’t need a public option. When poor people were denied access to banking and credit, the government did not create a public bank. It regulated the banking organizations and made it illegal for them to redline the poor.
Can we not regulate the payors in the same fashion, requiring them to insure the uninsured? Were not Medicaid and Medicare created in part because payors relined the elderly?
The government requires everyone to have automobile insurance, placing the onus on the individual. Why not flip it? If the goal of reform is to get people access to healthcare, which under the existing business model implies insurance, require the payors to provide it. The government can subsidize the payors, or pay it in full, and it can do so without adding to the bureaucracy of further entitlements via a public option.
To me, two other ideas make much more sense, one of which I’ve previously offered. Large groups of people are without insurance or are under insured. The government wants them to have access to medical care. As stated above, the government already created two agencies to address this problem, Medicaid and Medicare. Why create a third? Can’t those people be added to the two existing agencies?
The other idea may be the same, but if implemented differently, could streamline the processes and the cost. Make the cost of the coverage to those groups an offset against whatever tax they would owe. If it costs ten thousand dollar to insure a family of five, offset it against their income tax obligation. Net net its’ the same cost whether you collect it and refund it or simply don’t collect it. Give these families so sort of smart healthcare debit card, the government owns the account, and all healthcare providers can accept it for payment.
Sure, there is unlimited fraud potential, just like there is under any other option.
Pale Rhino Consulting 