I’d hate to be thought of as superfluous

If you and I agreed on everything, one of us wouldn’t be needed.

Of the many special things associated with growing up in this country, one is held dearly by every American eight-year old male who owned a flashlight and an AM transistor radio with an earplug. During those long hot summer nights when the adults sat on the back stoop nursing a bottle of Carling and waiting for their window air conditioners to suck out enough of the heat to make the inside of the house bearable, thousands of boys across the country lay under their bed covers, with a flimsy plastic earplug dangling from their ear as they continued to turn the dial to tune in the lone radio station covering the home team. In spite of the static, they faithfully kept score for their favorite baseball team in the back of their black and white Composition notebook.

The scorecard was homemade, carefully drafted using a pencil and something relatively straight to draw the lines that separated each of the nine innings. Unlike today, when the concept of team has given way to the concept of personnel whose loyalty lies with the highest bidder—free agents, the lineup for the home team rarely changed by more than a player, the pitcher, and had been mostly the same for years.

My team was the Baltimore Orioles. Their team pennant hung on my wall, a team photo was on my dresser along with my membership card to the Junior Orioles. Under the blanket with me was my taped-up shoe box containing my collection of baseball trading cards, sorted by team and held together by rubber bands I had removed from the Baltimore Sun. A few hundred stale sticks of the pink powdered bubble gum that came with each five-pack of cards was stacked neatly in one end of the box. The cards for the opposing team were spread before me so I could get the lineup and study their batting statistics.

What made me think of this was that yesterday my son and I went to see a minor league game. Although the grass was just as green, and the hot dogs smelled the same, nothing was the same. Still, it beat a stick in the eye. Things change. Baseball changed, and nobody conferred with me before changing it. I didn’t see a single person keeping a scorecard, let alone a dad teaching his son or daughter how to keep it. The only constant throughout the game was the commercialization, to the point where it made it difficult to simply follow the game.

That’s progress. Or maybe not. Some progress is good. Some progress doesn’t exist even though everybody around it believes that it does. Buying technology doesn’t in and of itself confer progress, it simply means you bought more technology. For those who are so fond of metrics, look up some ten-year old figures and see. See if patient satisfaction has increased. Still not convinced? Add up all the money you’ve spent on improvements and technology during those ten years and divide it by the percentage of decrease or increase of any decent metric. Was it worth it? I bet not.

Ray, people will come Ray. They’ll come to Iowa for reasons they can’t even fathom. They’ll turn up your driveway not knowing for sure why they’re doing it. They’ll arrive at your door as innocent as children, longing for the past. Of course, we won’t mind if you look around, you’ll say. It’s only $20 per person. They’ll pass over the money without even thinking about it: for it is money they have and peace they lack. And they’ll walk out to the bleachers; sit in shirtsleeves on a perfect afternoon. They’ll find they have reserved seats somewhere along one of the baselines, where they sat when they were children and cheered their heroes. And they’ll watch the game and it’ll be as if they dipped themselves in magic waters. The memories will be so thick they’ll have to brush them away from their faces. People will come Ray. The one constant through all the years, Ray, has been baseball. America has rolled by like an army of steamrollers. It has been erased like a blackboard, rebuilt and erased again. But baseball has marked the time. This field, this game: it’s a part of our past, Ray. It reminds of us of all that once was good and it could be again. Oh… people will come Ray. People will most definitely come.
-Terrance Mann in the movie, “Field of Dreams”

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

The Spandex Insecurity—the Ego has Landed

Now before you get all upset about the sexist picture, at least read a little bit of this to see why I selected it. Yesterday morning, five miles into my run, I was feeling pretty good about myself. I had passed seven runners, had a nice comfortable rhythm, no insurmountable aches, and Crosby Stills & Nash banging away on my MP3. I don’t like being passed—never have. Some people say I’m competitive. They say other things too, but this is a family show.

I’m a mile away from my car when I see a slight blurring movement out of the corner of my left eye. A second later I am passed by a young woman wearing a blue and yellow, midriff revealing spandex contraption. Her abs are tight enough that I could have bounced a quarter off of them. She is pushing twins in an ergonomic stroller that looked like it was designed by the same people who designed the Big Wheel. I stared at her long enough to notice that not only was she not sweating, she didn’t even appear winded. She returned my glance with a smile that seemed to suggest that someone my age should consider doing something less strenuous—like chess. Game, set, match.

Having recovered nicely from yesterday’s ego deflation, today at the gym I decide to work out on the Stairmaster, the one built like a step escalator. I place my book on the reading stand, slip on my readers—so much for the Lasik surgery, and start to climb.

Five minutes into my climb, a spandex clad woman chipper enough to be the Stepford twin of the girl I encountered on my run mounts the adjoining Stairmaster. We exchange pleasantries, she asks what I’m reading, and we return to our respective workouts. The first thing I do is to toss my readers into my running bag. I steal a glance at the settings on her machine and am encouraged that my METS reading is higher than hers, even though I have no idea whether that is good or bad.

Fifteen minutes, twenty minutes. I am thirsty, and water is dripping off me like I had just showered with one of Kohler’s full body shower fixtures. I want to take a drink and I want to towel off, but I will not be the first to show weakness. Sooner or later she will need a drink. I can hold out, I tell myself. Twenty-five minutes—she breaks. I wait another two minutes before drinking, just to show her I really didn’t need it.
She eyeballs me. Game on. She cranks up her steps per minute to equal mine. Our steps are in synch. I remove my hands from the support bars as a sign that I don’t need the support. Without turning my head, I can see that she’s noticed. She makes a call from her cell to demonstrate that she has the stamina to exercise and talk.

When she hangs up I ask her how long she usually does this machine—we are approaching forty minutes and I am losing feeling in my legs. She casually replies that she does it until she’s tires, indicating she’s got a lot left in her. I tell her I lifted for an hour before I started; she gives me a look to suggest she’s not buying that. I add another ten steps a minute to my pace. She matches me step for step.

Fifty minutes. I’m done toying with her. I tell Spandex I’m not stopping until she does. She simply smiles. Her phone rings and she pauses her machine—be still my heart—and talks for a few minutes. I secretly scale down my pace, placing my towel over the readout hoping she won’t notice. She steps down from the machine. My muscles are screaming for me to quit, but I don’t until I see that she’s left the gym.

Victory at any cost. What’s the point? For what was lost, for what was gained (McKendree Spring). Men and women. Customers and companies. Most parties will deny they are competing, yet neither will yield. The customer is always right. Turns out it makes a better bumper sticker than it does a business philosophy. Nobody’s business policies reflect that attitude. If anything, were you to listen to what CSRs are instructed to do for the callers and compare that with what they are instructed not to do for the callers, it’s clear that their mandate is to minimize the negative impact to the firm, without regard to the negative impact to the customer. Remember the last time you tried to dispute an insurance claim?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

How daughters relate to EHR

The other night as I’m sitting on a hard bleacher watching my seven-year-olds baseball practice I noticed the mom sitting next to me looking a little forlorn. Being naturally inquisitive, I asked if everything was okay.

“I lost his glove,” she replied.

Noticing a glove on her son’s hand, she saw my look of confusion. “Not his. My husband’s. I had it with me last Thursday, and I left it here.”

“I don’t suppose this was a new glove. Judging by the look on your face I’d say this was his favorite glove; thirty years old, supple, broken in, fold flat as a sheet of paper.”

“Twenty-five years,” she corrected as she lowered her eyes.

“It’s rained the last three days,” I told her, which caused her to grimace even more. Having nothing better to do, I flayed her emotions. “I bet that glove meant the world to him. He probably planned on giving it to your son in a few years. The glove probably reminds him of some of the big events in his life, every scar, each stain on the leather, points to something important. You know, if it was outside for a few days, the field mice will have chewed on the leather.”

She brushed away a tear, and headed to the lost and found.

“Any luck?” She shook her head in despair. “In some countries, if a wife does something life that, the husband can sever the relationship, literally,” I said as I made a slashing motion with my hand. She made the briefest of smiles. At least she knew I was pulling her lariat. Reeling her in, I continued.

“You’re not thinking of spending the night at home, are you? If you are, you should at least call someone and let them know of your plans. He’ll heal over time,” I told her. “But he won’t forget it. Twenty years from now the two of you will be watching something on TV, and something will remind him of the glove YOU lost.”

Fast forward to last night. My daughter and I are getting out of the car so I can coach her and her softball team in the playoff game.

“Is your glove in the trunk?” I asked. This is after I spent several minutes grilling her at home about whether she had everything she needed for her game.

“I hope so,” she said shamelessly as I popped the trunk for her. “You hope so?” I repeated with an edge in my voice.

“It’s not here Daddy.”

I left her with her friends and drove home to look for it. Ten minutes. Nothing. For some reason, I looked in the trunk. There it was. Death by 1,000 cuts.

Does it all come down to baseball gloves?  “I hope so.”  What kind of a response is that?

Will these EHR expenditures help? I hope so.

Can you confirm for me that user satisfaction won’t fall any further? I hope so.

Are we ready for the changes coming to the business model?  I hope so.

Do you think we should continue to employ you? I hope so.

Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942

My profiles: WordPressLinkedInTwitterMeetupBlog RSS

I got a little sidetracked today…

The nurse left work at five o’clock.  A twelve-hour shift—only lost one, better than some nights, worse than others.  Two hours before sunup, the icy wind gnawed at her ankles.  With her caffeine gauge on empty, she ducked into Starbucks, glancing waywardly at the plethora of coffees posted overhead on the menu board.

“Do you guys actually pay someone to think up all this stuff?”  She asked rhetorically.  The still groggy looking twenty-something barrista behind the counter ignored her, not a bright move.  His hair looked like it was cut with a mower; an errant flap of it skittered over his right eye with each movement of his head.  His right ear lobe was pierced in three places, although he only wore one earring.  The nurse noticed a barbed-wire tattoo around his left bicep.

Intent on continuing the conversation, even if it was to remain one-sided, the nurse inquired, “I suppose Starbucks has a marketing think-tank to invent the product names.  That word “Grande,” that’s Italian, right?”

Twenty-Something occupied himself by steaming a pot of skim milk.

“So, help me think this through,” she implored.  “Since Grande is the one in the middle, it must be Italian for medium.  And, “Venti,” that must mean large.  Right?  So, here’s where I’m confused.  The one labeled, “Tall.”  Something tells me that doesn’t translate to small in any language.  If you take a small cup of coffee, and make people order it as a tall cup of coffee, maybe they will actually think it’s larger than it really is.  QED.  Quod erat demonstrandum.  That’s Latin for cut the crap.”

The nurse knew she was jousting in soliloquies with an idiot.  Nonplussed, Twenty-Something merely rolled his eyes and asked her what she wanted.

The nurse was usually not a half-caff, double mocha, skimmed latte kind of person.  In fact, it troubled her that some people were—troubled her a lot.  The person she had hogtied and left in the trunk of her car was one of them; he hadn’t known when to shut up, so she had done it for him.  By the time she had checked on him during her break, he’d frozen solid.

“Any ideas?”  The Twenty-Something foolishly pressed the nurse.

“What do you recommend for somebody who just wants a cup of coffee?”

“Do you want regular or decaf?”

“What’s the strongest you have?”

“Ethiopian.”

“Give me your largest.”

“Shall I leave room for cream?” asked Twenty-Something.

She looked at the prices.  Two dollars for a cup of coffee.  Why would anyone pay that much and then hide the taste of the coffee with cream, she wondered?  “No cream.  Instead, give me a latte grande with skim milk.”

“One grande latte,” Twenty-Something replied, correcting her syntax.  “Is that all?”

“Better give me a large orange juice.  That’s what’s it’s called, isn’t it, or is that also a grande?”

Her wit was lost on Twenty-Something.  “Large,” she murmured through her teeth.  “And a bagel, plain.”

“Toasted?  Cream cheese?”  She knew he was toying with her.

She’s had enough, grabbed the coffee, and headed for the door.

He hollered for her to pay, but the look she gave him told him to let it go.

Too bad the trunk couldn’t hold two.  She’d come back tomorrow to visit the boy.

The RHIO Answer

It may be helpful as you read this to use your highlighter on the screen to accentuate the important parts or some white-out for the parts you don’t favor.

Do you ever kick an idea around, speaking about it, writing about it, until at some point you finally capture it in a way that makes sense to you?  That’s how I reason things through.  I write like I’m talking aloud and sometimes it lands in my lap.

That just happened to me as I was trying to get my arms around what it is about the concept of the RHIOs that has been bothering me.  Bear with me.  I was on LinkedIn emailing someone using the ‘send a message’ feature.  I was returning an email which she was returning which I had initiated.  The process works like this.  I get an email from LinkedIn telling me I have a message.  I go to LinkedInm read the message and send a reply via LinkedIn.  She receives an email indicating she has a message, goes to LinkedIn, and so forth and so on.

Do you see it?  In this scenario, what is the added value provided by LinkedIn?  Nothing.  It’s all hat and no cowboy.  LinkedIn serves simply as a pass through, contributing nothing.  I wrote in my message to her, “Send me your email address, I feel like I’m in my own RHIO.”

When is a RHIO not aRHIO?  When there’s no need for it.  Is there any functionality intended for the hundreds of RHIOs which couldn’t be dealt with at the N-HIN?  What do you think?

Which EHR mistake would you rather make?

Which EHR mistake would you rather make?–My first post as a contributor to @healthsystemCIO http://ow.ly/1xDx5

When Children Parent

It’s not easy being green—I think that is how the Grinch mat have felt when little Cindy-Lou-Who saw him stealing her Christmas tree.

Cindy Lou Who: “Santie Claus, why? Why are you taking our Christmas tree? Why?”
Narrator: But do you know, that old Grinch was so smart and so slick, that he thought up a lie and he thought it up quick.
Grinch: “Why my sweet little tot…”
Narrator: The fake Santie Claus lied…
Grinch: “…there’s a light on this tree that won’t light on one side. So I’m taking it home to my workshop, my dear. I’ll fix it up there, then I’ll bring it back here.”
Narrator: And his fib fooled the child. Then he patted her head, he got her a drink and he sent her to bed.

I’ve been a father for eleven years.  I have had heart disease for the last seven.  I was a smoker and stopped three and a half years ago.  My children knew the heart attack was a result of my smoking.  Those who have smoked know have difficult it is to stop.  I started again two months ago—sneaking around, burying the butts, washing clothes, gargling—doing whatever it took not to get caught.

My children had never seen me smoke—never until last night.  I snuck out on one of our decks to have a smoke.  One puff later, out pops my Cindy-Lou-Who.  She’s ten.

“Are you smoking Dad?  Why?”

I am not sure which one of us was more upset.  I stood there for a second wondering what to say, wondering if I had the where-with-all to create a Grinch-like fib—a lie.

A good lie may have made the situation disappear, at least temporarily.

One of our family rules is no lying.  I’ve told the children I will never lie to them, and they should never lie to me.  I had to decide which the greater wrong was, telling her a lie, or telling her that I was doing something she knew could kill me—something which would crush her.

I told her the truth.  Her face was expressionless.  She turned and walked away.

We talked.  It takes more than talking.  My wife told me my daughter told her she was upset and what upset her.

I previously tried hypnosis and acupuncture—both worked right up to the point when I got back in my car.  If anyone has any good ideas about how to attack this, please let me know.

My daughter is very smart, and pretty brave.  Now it is my turn.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

“Who moved my cheese?”

Sometimes you find something that is too good to mess with.  The following comes from “Who Moved My Cheese” by Spenser Johnson.  It is the perfect allegory for healthcare.
Change Happens
They Keep Moving The Cheese
Anticipate Change
Get Ready For The Cheese To Move
Monitor Change
Smell The Cheese Often So You Know When It Is Getting Old
Adapt To Change Quickly
The Quicker You Let Go Of Old Cheese, The Sooner You Can Enjoy New Cheese
Change
Move With The Cheese
Enjoy Change!
Savor The Adventure And Enjoy The Taste Of New Cheese!
Be Ready To Change Quickly And Enjoy It Again & Again
They Keep Moving The Cheese.
saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

We’re losing money, but making it up in volume.

I wrote this in response to an article in modernhealthcare.com titled New doc payment system needed
I posted this question on a dozen healthcare Linked in groups; How Can Doctors and Hospitals Make Money in a Post-Reform, Health 2.0 World?  The reason for the question was to probe for ideas for a speech I am giving in May at ICSI.
My takeaway of the responses is that every approach seems to be triage.  I see the business of healthcare, as juxtaposed to the healthcare business (the clinical side) as a 0.2 business model.  Plus or minus variants of IT, the business continues to run in much the same manner it has for the last fifty years.

Analyzing the model, it appears appears to me to be similar to the pattern created by dropping a pebble into a pond–ever expanding circles, but circles none-the-less.  Sort of a fractal business model, each fractal differing only by size.

The business of healthcare could not be facing more fundamental changes–most of which are external, most of which are unknown.  This is especially troubling for an industry whose P&Ls more closely resemble those of GM than of Apple.
It is time to stop relying on the adages, “We don’t know where we are going but we are making really good time,” and, “We’re losing money but we are making it up in volume.”
Rule number one for change–executives must admit they have a busted business model.  Rule number two–executives cannot change Rule number one.”
saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

The Easy Button

In Woody Allen’s movie Bananas, the dictator of the small country San Marcos declares that, “All the children under 16 years old are now 16 years old.” That was easy.

In the movie in my head, “The EHRs of Madison County,” I run customer service for a EHR vendor.  Customers kept calling to complain. I declared, “Tell the all the customers nothing’s wrong with our products.”

That was easy. Does that work for your implementation?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer