healthcare 2.0

EHR: shift happens

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After several years of therapy, I’d begun to accept that I might not be the “Voice of Reason” for all things, maybe just for the important things.  Laugh all you want—most of you have been here, you just don’t blog about it.  To fully grasp the import of what I’m about to write, for the newbies, there’s benefit in reading https://healthcareitstrategy.com/2009/09/19/ehr-how-to-recover-from-poor-planning/.  If there was ever déjà-vu all over again, this is it.  It takes an idiot to be this stupid once.  I’ve managed to refine the process.

At some point, there may be benefit to society as whole for someone to do the math and holler above the fray, “he doesn’t get it and he never will.”  This is not a discussion about what is PC, it’s about my ineptitude.  I have become my own euthanasia moment.

The chicken breasts are moved from the freezer to the sink to be thawed by water because the energy used to heat water is cheaper than energy used to run the microwave.  Forgive me for tearing.  (I am at an impasse between tear and tear.)

This is twice in fewer months than it takes not to approve healthcare reform.

I am watching, “Trauma in the ER”.  It’s part of my MD correspondence course.  I’d just about learned to insert a chest tube when something reminded me of running water.  I ran to the kitchen.  The water is running. The chicken breasts are floating. Hawaiians are surfing the curl in my kitchen.  We have so been there done, that.  I am stupefied.  The last time I did this, I was able to hide it from my wife.  The oak floor boards are now warped to the point where they now look more like bread bowls from the Plymouth colonies than boards.

I wish I spent my days inventing this material.  It’s difficult to understand, but in spite of my ineptitude, I am allowed to vote to determine who will be the next president.  I have become a Mensa wanna-be gone amuck.

Where does this leave us?  There are no second chances with healthcare reform, EHR, or HIT.  We are talking about gazillions of dollars and people whose lives depend on the outcome.  This is an economy shifting moment.  This is our paradigm shift.  ess it up and we will all be saying, “shift happens”

saint

The real role of the C-suite in selecting an EHR vendor

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coolhandluke4

 

 

 

 

Cool Hand Luke.  Great guy film, not on Oprah’s chick flick list.  “What we have here is a failure to communicate.” That’s the line spoken by the captain of the prison pronouncing his summary judgment of the problem between he and Luke—Paul Newman: the line refers to Luke failing to understand the one-way nature of the communication between the chain gang prison captain and Luke. The line is an opening for a second speech directed to the other prisoners who are watching the abuse. The captain goes on to say “Some men you just can’t reach.”

A failure to communicate. Indeed. It’s not always obvious where to place the blame. For example. I had pulled together a pile of my clothes to donate to Goodwill; suits, blazers, pants—the usual mélange. Next to them, several feet away, on top of the ironing board, were two of my new suits, a taupe, double-breasted Jones of New York, and an Ungaro Uomo Parisian pinstripe—they were destined for the cleaners. Stop me if you’ve heard this one before. Seeing the pile on the floor, my wife offered to drop my donated items at the Goodwill.

It wasn’t until later that same day that I thanked her for dropping my suits at the dry cleaner, at which point the quisling replied with a look that told me she did not know that of which I spoke. A failure to communicate. All of my suits, those destined for Goodwill, and the two destined for the drycleaner had done an Elvis and left the building.  Poof, nada, nothing.  Disappeared into the fashion catwalk abyss.  Never mind that I was planning to wear the pinstripe to a rather important meeting.  Wave goodbye to the suits.

Two intelligent people separated by a common language.  Dictionary dot calm defines that as marriage.  Mars and Venus.  In our case it was Goodwill versus Chin’s drycleaner—that’s not racist, just the name of the business.

Two intelligent people separated by a common language.  Like healthcare providers and vendors. Like the IT and the hospital’s C-suite. If A implies B, and B implies C, then maybe B is just intended to be a clever roadblock. Maybe the C-suite invented B so they didn’t have to deal with A—vendors. It sure seems like it sometimes. If the C-suite was really interested in selecting the best EHR, they should start by listening and learning to the clinicians and those in IT.

black saint 2

A reply to the idea of Mandated Coverage

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Below is a comment on a Washington Post article on mandated coverage, http://www.washingtonpost.com/wp-dyn/content/article/2009/10/25/AR2009102502607_Comments.html

Great movie, poor reform—at least that’s my take on how poorly the current healthcare legislation will actually work regarding a mandate.  There are probably more federal judges with gangsta rap on their iPods than congressmen who have actually read the reform bill.

I call the idea of the mandate “must carry”.  The only option of the public option and must carry provisions is the option to “opt”.  Individuals can “opt” and so can firms.  “Opt-in”, “Opt-out”—like clap-on clap-off.

However well intended it may be, as structured, the mandate will not work; neither for individuals or for firms.  The individuals who will be required to carry, can opt out for a $750 annual fine and “opt” in when they are sick or injured.  The fine will be less than the cost of the insurance premiums.  That way, their out-of-pocket costs are actually paying co-payments not premiums.

It appears that firms may be able to pay the fines on a per person basis rather than opting to pay for healthcare insurance for their employees.

Hence, mandated coverage may only apply to those who haven’t figured out that it doesn’t apply.

sainttop5

The effect of healthcare reform on others

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"Not a real boy"

"Not a real boy"

Somebody had to do this, so it may as well be me.  Sometimes to bring clarity to issues, it helps me if I dumb-it-down.  Which got me to wondering, how would the whole healthcare reform debate play out with Mother Goose?  Here’s what I was able to learn from my interviews.

Jack & Jill went up the hill, Jack fell down, and learned Mother Goose’s insurance wouldn’t cover him because he’s not a real boy.  Having recovered, Jack was soon found not so nimbly jumping over the candlestick.  His charred wooden body is being sanded in an effort to heal the burns.  Not only is Jack not a real boy, he’s also not a candidate for Mensa.

They sent the Little Old Woman who lived in the shoe home with a can of Desenex because her AARP insurance had expired and Medicare told her she already used her share of the money.  Afterwards, she was interviewed by Planned Parenthood for an episode of “I didn’t know I was pregnant.”

And remember that tuffet upon which Little Miss Muffet sat?  It wasn’t the spider who frightened her away, it was the deductible she’d hay to pay to cover the rash she got.  She tried sussing out her own treatment using social media on WebMd.

Jack Sprat could eat no fat, but he forgot to disclose that when he completed his insurance application.  He now suffers anemia anonymously as his not so lean wife left him.

How about Peter Peter Pumpkin eater?  All that fiber blocked his colon—a little personal prevention could have saved him a lot of time posed in the Thinker position.

Mary and Little Bo-Peep had a little mutton for dinner which after having sat on the counter all day produced various toxins which were absorbed into their bloodstream.  This resulted in them being rushed to the Mother Goose Clinic with a case of food poisoning.

Simple Simon met a pieman who knew nothing of pasteurization.  Simple is sitting three seats away from Mary in the waiting room.  The Clinic has been unable to locate either of their records on their EHR which cost in excess of one hundred million dollars.

Old King Cole called for his pipe even though he had a severe case of sinusitis.  CVS was out of Z-packs, and home he went with just a tin of Prince Albert.

All the king’s men tried to make a meal out of Mr. Dumpty.  Several were to learn later that one can get Salmonella from eating a raw egg that had been tromped on by horses.

Pat-a-cake.  The baker’s man, not one for washing his hands before pattying his cakes, caused Tommy to be seen by an internist.  Apparently neither real men nor cartoon men wash there hands.

The Butcher, the Baker, and the Candlestick-Maker, were being treated for nontuberculous mycobacterial disease for poor hygiene having been found bathing together.

It was reported that Georgie Porgie who’d been kissing girls had made them cry when they discovered they had contracted the herpes simplex virus.  Their mother, embarrassed by the turn of events, reported to the school that her twins were out with the H1N1 virus.

The Three Blind Mice were found to have stitched themselves together after unsuccessfully trying to sew back on each other’s tails.  It was later discovered that the tails had been cut off by the Farmer’s wife with the Butcher’s knife.  The mice are suffering from septicemia.  The Crooked Man and Yankee Doodle are trying to ascertain why the Farmer’s Wife and the Butcher were later found hiding in the barn.  The Farmer’s wife is being treated with Effexor on an out-patient basis for clinical depression.  The Farmer was not available for comment.

It’s believed that Willie Winkie is suffering from a plantar wart after running through the town in just his nightgown.  Uninsured, he tried removing the wart with the knife he’d borrowed from the Butcher, only learn the knife had been recently use to amputate the tails of some handicapped mice.

Old Mother Hubbard, a spinster of questionable repute, upon learning that there were no bones in the cupboard for her dog Hannibal, began to get hungry herself.  She settled for a meaty broth, and fava bean soup, and a nice Chianti.  Polly was seen putting on the kettle.  The SPCA continues to look for Ms. Hubbard’s dog.

saint

Reform: Congress must answer, “What’s in it form me?”

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If reform fails to pass, what’s the reason?

Is it because Congress ignored that ninety-eight percent of healthcare is local; Hyperlocal?  I think the answer is a resounding yes.  What is hyperlocal?  You know the saying, “All politics is local?”  Well, hyperlocal is local on steroids.  It’s moms and dads making choices about who will care for their family.  It’s the doctor down the street, not the doctor chosen by some system.

I think individuals see the bill as “What’s in it for them—them is defined as anyone other than me” and “What will it do to me?”  HR 3200 isn’t viewed as improving my healthcare, nobody sees it as meCare.  That is why when viewed nationally so few are behind it.

It’s not that nobody is interested in providing healthcare to those who don’t have it.  What concerns people who do have healthcare is their belief—which may have nothing to do with reality—is that to provide healthcare to those who don’t have it requires that those who have it to give up some of their benefits.  Those with healthcare see reform as a zero sum game.

What has people trying to kill the bill is that nobody who currently has healthcare believes they will see any net gain benefit from the bill—they will see a net loss.  If any benefit will accrue to those who presently have healthcare, they certainly can’t articulate the benefit.

To gain support for HR3200, Reform 3.0, or whatever it comes to be called the bill must address first person interests, not second or third.  Does that sound selfish?  It may be.  However, they are toying with reforming a fifth of the economy and a service of which eighty percent of the people are generally pleased.

For reform to pass, Congress must learn to conjugate the care verb: First person—iCare, meCare Second and third person—heCare, sheCare, theyCare, youCare. That about covers all the various forms of caring.

What Congress hasn’t come to grips with is that there is no meCare in heCare, sheCare, or theyCare—hence, people don’t care to support reform.

What do you think?

black saint 2

What is meant by Healthcare 0.2 and 2.0?

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eat_more_chickensized

Last night I was explaining to my sister-in-law my notion about healthcare 0.2 and the need to transform it to healthcare 2.0.  She had no idea what I meant.  That’s a problem—not because she’s my wife’s sister but because she an executive at one of the top children’s hospitals.

I figured that if she didn’t understand what I meant, I may have also confused others—sort of like typing with a keyboard full of marbles.

I’ve written that healthcare is a 0.2 business being forced towards 2.0—H2.0.  What exactly do I mean by Health 0.2?  It could just as easily be 0.5 or 0.7.  The idea behind the label is that there is a large gap between where the healthcare business is, H0.2, and the future of the healthcare business, H2.0.

Permit me to share how I distinguish between the business of healthcare and the healthcare business.

  • The business of healthcare—clinical, care, patients
  • The healthcare business is paper intensive and duplicative and includes support business functions like:
    • Human resources
    • IT
    • Payroll
    • Vendor relationship management (VRM)
    • Patient relationship management (PRM)
    • Registration…and so forth

Successfully bridging the 0.2 to 2.0 GAP replies equally on foresight and planning.  For the change brought about by the bridge to take hold, change needs to be an ongoing event.

To begin the assessment, healthcare leaders must undertake an honest assessment of the organization’s strengths and weaknesses.  Sounds simple.  It’s not.  Hospitals are noted for their fiefdoms, and the fiefs, run mostly by doctors, aren’t big on being told there’s a better way to do things, nor are they keen on giving away control.

To change how the business is run, to make it more effective, and thus more efficient, requires that the major business functions be retooled.

We’ll take a look at how a hospital might go about this.

sainttop5

Healthcare 2.0, can you get there from here?

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water2

From a business perspective, not clinical, the critical success factor for H2.0 relies on healthcare’s ability to move from being an 0.2 industry.

H0.2 is the “As-is” model.  H2.0 is the “To-be” model.  To reach H2.0 healthcare must bridge that functional, work flow, change management, user acceptance, and technical GAP.  The Gap will differ by provider.  There is no singular work plan to help providers know what they need to do to build a custom plan to bridge the gap.

None of this matters until the healthcare provider willingly acknowledges that they have a long way to go to get to anything that resembles H2.0.

H0.2 – H2.0 = GAP

If you don’t mind the gap,  H2.0 is just H2O–all wet

black saint 2

Health care hero

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I continue to struggle with you as to understanding the etiquette of the social web.  In spite of that, each day I become more impressed with those who have something to say and who are able to intelligently and gracefully articulate their positions on a range of issues.

Hero is such a disposable word.  I thought it might be of interest to share the meaning of the word from the eyes of a ten year old.

Forgive me for stealing a minute of your time for these few paragraphs.  Although I rant about the healthcare system, and independent of whether it needs changing and how to change it, I am quite a fan.

One year ago my 10-year-old son was given a writing assignment to draft a paragraph about his hero.  He wrote the following, an event that happened when he was 4,  which I subsequently framed and placed on my night stand—the spelling errors help authenticate the narrative:

“An amblence driver is my hero. He saved one of my familys members lives, My Dad. One late night my dad had a hart attack (I had a horrible ear ake.  We called the hospital and an ambulance came to take my dad.  The driver took him to the hospital (it takes 30 minutes to get there going 60 miles an hour.)

I love to read and write, and as you know, I can be critical of those who do and don’t, but this is the best thing I’ve ever read.

Thanks for indulging me.saint