My twelve-year-old son overheard a conversation I was having about EHR, Meaningful Use, and ICD-10, and I watched his eyes glaze over. So I tried to explain it to him in terms I thought he might understand. Maybe this explanation is the one I should have used with my client.
John and Sally have a thousand dollars in the bank. They pool some of their money and have a hundred dollars to spend on video games. The game they really want, Project From Hell, costs sixty dollars. About half the people who play Project From Hell never make it to the end, and never get the chance to claim their prize. It takes two years to play, and one or both of them could be eliminated from the game for failing to play well.
The second game is a take-off on Faust, Sell Your Soul to the Devil. To play this game, you must first beat Project From Hell. Sell Your Soul costs thirty dollars. However, the upside is that if you win, which is not very likely, you can earn two dollars.
The third game, Bet Your Savings, is the most intriguing. All kids who have a computer must play Bet Your Savings, which costs thirty-five dollars. The way Bet Your Savings works is that if you do not play, or if you play and lose, ten percent of the money in your bank account disappears.
I asked my son which games John and Sally should buy. He said if they bought Project From Hell and Sell Your Soul, they would only have ten dollars left, and that the reward from Sell Your Soul, two dollars, was not worth much. He also noted they do not have enough money to buy all three, and that since Bet Your Savings was mandatory, unless John and Sally wanted to automatically lose ten percent of their savings, they must choose Bet Your Savings.
He decided they should buy Project From Hell and Bet Your Savings.
By now you have figured out the Project from Hell is your EHR, Sell Your Soul is Meaningful Use, and Bet Your Savings is your ICD-10 initiative.
Resources are scarce. Do you have enough money to do Meaningful Use and ICD-10 correctly? Many hospitals do not, and yet they are charging full tilt at meeting Meaningful Use to possibly net a few dollars. Many hospitals have not invested enough to meet ICD-10.
Where should you place your limited resources? If you are still confused, feel free to ask my son.
I remember the first time I entered their home I was taken aback by the clutter. Wet leaves and small branches were strewn across the floors and furniture. Black, Hefty trash bags stood against the walls filled with last year’s leaves. Dozens of bright orange buckets from Home Depot sat beneath the windows. The house always felt cold, very cold. After a while I learned to act normally around the clutter.




The hospital we use just dedicated a new wing. For months the job site was a maze of people, duct, and tools. It cost $145 million. There’s a plaque displaying the name of the architect, the contractor, the mayor, and the rest of the adults who made it happen. While it was being built there were numerous permits, certifications, and sign-offs taped to the building. Their purpose was to ensure the public that the adults were keeping an eye on things. A phase of work couldn’t be started until the prior phase had all the requisite sign-offs.
Several years ago I was invited to go on the ultimate boys’ toys, weekend getaway. A dozen of us flew from Denver to Utah, and then drove to a point somewhere west of Bozeman Montana. It was to be a weekend of sport, a weekend of competition, and a more than occasional libation. To say that the people who organized the trip came from money would be a major understatement. They were in the oil bid’ ness. The father of one of the guys was the CEO of the second or third largest petroleum company in North America. We stayed at his ranch, a 12 bedroom log cabin in the middle of Nowhere, Montana, which is about 20 miles west of Next to Nowhere, Montana.