Rants & Musings

Patient Experience: “You can leave your shoes on”

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One of the best parts of my day is when it is announced that consultants are being released back in to society.

As one who flies frequently I have become attuned to what I can do to shave seconds off the gauntlet of passing through security.  I no longer bring a gallon jug of Old Spice in my luggage, and I try to remember not to wear cufflinks that I cannot reattach to my shirt without having to request assistance of a fellow traveler.

As such, and thanks to our friend the underwear bomber, I begin to disrobe the moment I exit my taxi.  On Wednesday at O’Hare I was wearing little more than my freckles as I made my way to TSA’s Death-Star chamber.

“You can put your shoes, and everything else back on,” the agent told me.  I and the other semi-nude people around me wondered if this was some kind of trick.  Would they Taser me the moment I stepped into the chamber still wearing my belt and my dignity?

It turns out they were testing a new way of screening people.  Someone had created a new user experience.

My taxi driver, a man named Ron of Ron’s Taxi, had also created a new user experience.  From what I could tell about Ron he had only been in the US for a brief time. He barely spoke English but I understood he had been driving a cab for most of his life.  I handed Ron my credit card and he slid it through the thing-a-majig that was attached to his phone.  Thirty seconds later he handed me his phone and asked me to enter my email address so the application could send me my receipt.

I share these two instances because they made a very positive impact on my user experience and because there are still a lot of people riding the That Will Never Work Here train.  One VP of strategy even went so far as to comment that rather than innovating hospitals we should effect to bond more with their patients as a way to bring down readmissions.

Now, I like a good bonding experience as much as the next person, but I tend to think of it as a rather poor metric for measuring did we or did we not bond.  Instead of asking a patient if the reason they did not follow their discharge orders was because we did not bond well, perhaps we need to get to the point where patients and prospective patients can carry their favorite hospital around on their iPads just like customers and prospective customers do with Amazon.

When deciding how to reinvent how we approach patients it is too easy to get sidetracked by subordinate clauses around things like HCAHPs.  Why are there thirty-two questions?  Why not thirty-one or thirty-three.  Let us not be led astray by an ounce of fact.

Everything You Need To Know About Patient Experience

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Which of the following statements are false?

  • Forty-eight percent of us believe aliens have visited the earth
  • Thirty-four percent of us believe in ghosts
  • One percent believes the earth is flat—“I put a post in a hole and adjusted it until it was level. That means the earth is flat.”
  • Eighty-to ninety percent of hospitals CEOs believe improving patient experience is one of their top three objectives in the next three to five years.

I can believe the chair next to me will support my weight, but unless I actually sit in the chair merely believing is not worth anything.

Hospitals would have us believe that what is important to consumers of healthcare is that the product—healthcare—is the same as the process of interacting with it or buying it are one in the same, or their belief that process has nothing to do with it.

Take flying for example.  Airlines want us to focus on the product, getting us from Point A to Point B.  They do not want us to focus on the fact that they will charge you if you use your flotation device, your flight will be late, and that they have packed more people into the plane than were in your high school.

My hospital has a website, let’s move on.

The US economy has developed a dependence on digital performance, including the twenty percent tied to healthcare.  Healthcare, hospitals in particular, have developed a digital illiteracy, independence, or naive indifference on all things digital and on all things related to process.

Believing that because your hospital has a website means it understands the impact the digital world should play in its business model is like believing that reading Oliver Swift gives you keen insight into what it is like to be an orphan.

The C-Suite needs to understand that technology is not the same as digital; in fact they have little in common.  In a hospital technology equates to cost—to back-office functions, to supply-chain, to why ICD-10 may be a disaster, and how it is possible to spend three hundred million dollars on EHR and see productivity take a nose-dive.

Digital is different.  It is not some emergent trend.  Please do not stop reading here even though many will disagree with what follows.  Digital is Amazon and eBay, but not in the way most people think about them.  It has nothing to do with CDs, movies, or laptops.  It has nothing to do with what they sell or the price at which it is sold.  It has everything to do with the process by which customers act with what is being sold.

The process, the processes are everything.  They are everything that the processes within a hospital are not, everything that the health exchange is not.  The processes are:

  • Intuitive
  • Easy

And the processes are intuitive and easy because they were designed to be that way.  We are not talking about tweaking things.

The less you understand about the importance of having a remarkable digital presence the less likely you are to have one.  Hospital executives may understand it least of all.  The poorer your understanding, the poorer the delivery of your product is, and the poorer its perception is in the marketplace.

And to make a bad story worse, by the time your hospital gets it your competitors will have already passed you by.

We are not talking about being better at what you are—the grammar is poor but the intent is not.  The discussion that your customers are begging for, the discussion they expect is about your hospital becoming what you are not.

And what does being what you are not look like?

In less than three years every hospital process, every single nonclinical function that is performed today by nonclinical employees will be performed by your patients and by prospective patients.  Every process will be performed without waiting and without error and without much cost.  It will performed digitally and on a device and at a time of the person’s choosing.

Your customers will carry your hospital around in the purses and briefcases.  And that is how I define improving patient experience.

Reinventing Patient Registration

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Healthcare, whether at the largest hospital in the country or at the smallest doctor’s office, begins with the same business process—waiting.  And the bigger the institution the more likely they are to repeat that process during your stay.

To me the registration process reminds me of how I feel when I fly into a city and the pilot, who a second ago was patting himself on the back for an on-time arrival then says that we have to sit on the plane because our gate is not available.  The airline, who scheduled the flight, has known for a month that this plane would be arriving at this time on this day and would be parking at the occupied gate. 

The hospital has the same a priori knowledge.  Someone at the hospital knew what time each patient would be arriving because the hospital employs the gatekeeper.  They know it so well that most patients can call the hospital days or weeks in advance of their scheduled appointment and be told the exact time and location of that appointment.

Let’s agree to do this—it’s pretty far out on a limb, but that is where the fruit is.  Let the patients schedule, admit, and register.  Please don’t say that can’t be done. It is more accurate to say it has not been done.  To those who will say it’s too hard to do, grammatically they should be saying it’s too difficult to do, other industries do it, and a lot of very profitable clinics, clinics with very high patient experience ratings do it.

Create a mobile application that allows me to open it on a tablet at a time of my choosing.  Using the app I view appointments for my doctor or lab and book it.  The app tells me what I need to do prior to arrival.  I enter my insurance information and complete any online forms, perhaps even providing an electronic signature.  The app gives me some form of bar-code that I store on my device.  And when I arrive at the hospital I display the bar code on my device, and hold it up to the hospital’s scanner.  The scanner completes the registration process, displays where I am to go along with accurate directions about how to get there, and even prints out my wrist band.

That allows the hospital to reclaim the waiting room area and get rid of all of the outdated copies of The Economist and Highlights magazines.

The Ten Commandments of Patient Experience

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According to social media mavens, people are a lot more likely to read your blog if the title includes phrases like the five best, the six most, and seven things you should never do.

Hence, the ten commandments of patient experience.

When I began commenting about improving patient experience I drew comparisons of a hospital’s business processes to those in the hospitality industry, and I was liberal with my use of the word customer instead of patient.  Readers used to throw metaphorical tomatoes at their monitors.  Over time that angst subsided, was replaced by indifference, and most readers began to accept the notion that having a heretic in their midst was the new steady-state.

Few have accepted the notion that most hospitals ought to at least augment their patient experience focus to include what happens outside of the hospital—prior to admissions and after discharge, and fewer still are paying any attention to the largest group of stakeholders—non-patients.

After all, patient experience for non-patients is a non sequitur.  Or is it?  Most people who are discharged change their status; they change from patient to prospective patient.  For them to become a patient again, to be treated for something new or to undergo a new procedure, the hospital must acquire them. 

The unique thing about prospective patients is that all of them reside outside of the hospital.  If your patient experience focus is entirely within the hospital you have no idea what experiences those people have and whether or not those experiences are even satisfactory, a poor benchmark by anyone’s standards.

What are those unmeasured and unreported experiences?  They include access in all of its forms.  Scheduling, admissions, second opinions, billing, complaints, labs, and discharge.  They happen online and on the phone. 

And, if they do not happen well, they will not happen again.  Those people, whose experiences of trying to do business with the hospital are poor, will go somewhere else.  Those people, the hospital’s assets with a lifetime value of between $180,000 to $250,000, will move that asset to another hospital.  They are the same people who cost less to acquire as patients than do the ones who are not even looking at your hospital’s website or calling the switchboard.

Anyway, back to the commandments.  There is only one—

A remarkable experience for every person every time on any device.

Patient Experience: The Impotence of Being Earnest

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The impotence of being earnest, or should I have written importance?

Four down; contumelious soccer coach—Uday Hussein

It appears the Los Angeles Dodgers are going to offer one of their pitchers, Clayton Kershaw, a ten-year, three hundred million dollar contract; roughly equal to one-fifth of the value of the entire team.  Thirty million dollars a year.

In the five years he has played, he has averaged fifteen wins a year. So let us say the Dodgers offered all that money, two million dollars a win, in the hope that he will duplicate those numbers over the next ten years.

Will the expenditure justify the result?  As it turns out, there are many, many pitchers who will win about twelve games every year.  Pitchers nobody has heard of, pitchers who do not cost even close to thirty million dollars a year.  So, what are the Dodgers really paying for?  They are not paying two million dollars per win for fifteen wins.  A lot of pitchers could get the Dodgers twelve of those wins for a lot less money.

Whether they know it or not the Dodgers are going to bet ten million dollars a win for three extra wins each year, wins thirteen, fourteen, and fifteen—wins that the no-name twelve-win pitchers may not achieve.

One hundred and sixty-two games a year.  A three hundred million dollar contract.  One fifth of the value of the organization.  To get three additional wins a year.  Three out of one hundred and sixty-two.  The contract could affect about two percent of the games, assuming the pitcher wins those games.

The contract could also affect all of the games.  How?  What if, as it turns out, the Dodgers spend so much money on that one player to try to lock down those additional three wins that they do not have the money to spend on the other twenty-four players to get the other wins they need?  Is it possible that the other twenty-four players could have an impact greater to or equal to the three games for which they were willing to spend ten million dollars each to win?

Taken to the extreme, if the Dodgers spent no money on the other players they will have accomplished nothing.  Their effort to win a World Series, to improve the total experience of their fans will have been for naught.

The Dodgers’ important, earnest effort to improve may prove to be impotent.  The impotence of being earnest.

Failing to see the forest through the trees.  Keeping so focused on the doughnut so as to miss the hole, or perhaps the whole—as in picture.

HCAHPs and patient in experience.  One-in-the-same.  That is certainly how hospitals view the entirety of patient experience, singularly focused on the trees rather than the forest.  So focused on the trees that they have become experts on tree bark.

Each year hospitals spend a lot of money on data about patients’ “experiences”.  They spend a lot of money hiring coaches.  What are they trying to buy?  They are trying to buy a tenth of a point here or two tenths of a point there.  Trying to raise a score from 7.27 to 7.37.  There are no guarantees that the score will go up.

What then is guaranteed?

  1. Raising patient experience scores is not the same thing as raising patient experience.
  2. Spending all of your resources to win three of one hundred and sixty two games puts your organization at risk.

So, from a hospital’s perspective what should you be doing to increase patient satisfaction, how should you allocate scarce resources to improve everyone’s access?

Today, everybody is playing on the same kickball team.  Everyone busies themselves with the realm of what’s possible.  Operational blindness.

Innovation can only happen outside the box.  The box is the hospital’s four walls.  Put all of the functionality of the hospital on the web.  All of it.  Back office.  Access.  Billing.  Discharge.  Scheduling.  Admissions.  Claims.

How Can Reinventing Patient Experience Decrease Readmissions?

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As I was going up the stair, I met a man who wasn’t there.

Then I read an article espousing the ROI of EHR.  I leave it to you to decide if these two activities are one in the same.

I also read an article on reducing readmissions in this month’s HealthLeaders, Readmissions: The Big Picture.  Perhaps it is because my synapses do not work the way they were intended to work, but the first thing that came to mind for me was How could Patient Experience be reinvented to help contribute to the goal of reducing readmissions?  Could deliberately coloring outside of the lines help to solve a real problem?

It absolutely can.  One reason patients readmit is because of their failure to comply with their discharge instructions.  They do not do what they are supposed to do, they do not do it with the frequency with which they are supposed to do it, or they do not understand what to do, who to contact, how to contact them or when when something goes akimbo.  And worst of all, nobody at the hospital knows anything about these failures until the patient is readmitted.

Many of us have been discharged.  I remember the discharge process as the only thing standing between me and the front door.  I would have nodded to anyone and signed anything to be home and to have the hospitalization behind me.  I would read the fine print once I was paroled, once I had a real television remote in my hand, not some off-white three-channel device that was tethered to the hospital bed.  Is it possible that more than a handful of patients feel this way?

Since you cannot give patients a test to confirm they understand their instructions prior to discharging them, and you have no control of patients once they leave, is the situation hopeless?

Patient experience continues once patients are discharged.  Or it could.  Post discharge, most patient experiences—and family experiences—consist of calling the hospital for a variety of reasons; understanding discharge instructions, scheduling a follow-up appointment, scheduling a lab, understanding a bill, filing a claim—reasons very similar to those encountered by patients before they are admitted.  Unfortunately, the people being called may not know the right answer to any of these questions.  Unfortunately, the line may be busy; it may be after hours, or during the lunch break.  Access 8 a.m. until 6 p.m.

They call the hospital.  How well did that work?  If the answer is not well, they may be on their way to having a very poor experience.  If it concerns their discharge instructions they may be on their way to being readmitted.

Here’s how we can tie reducing readmissions to patient experience.  It is not complex, it does not require and MD or a PhD, and it is not really all that innovative unless innovation means looking at solving the problem in a way that differs from the way solving problems is normally looked at.

It is all about access, two-way access.  Two-way access between the hospital and the patient.  Digital and mobile access.  Twenty-four by seven.  I know you do not do it this way, and the natural reaction to this idea is that some of you will have a long list of reasons why this cannot be done or why it will never work at your hospital.  It won’t work for people who do not want it to work, or who may not have the skills. One invalid excuse for it not working is not because it cannot be done.  It can, someone just has to tell someone to make it happen.

Let us take a non-natural reaction, just for a minute.  I envision the following—this is not exhaustive, it does not come from hours of research.  It is just a back-of-the-napkin idea that I would like your opinion as to whether it is worth another napkin or two.

What if the complete discharge summary, and everything patients needed to do, could be available to the patient and the primary care provider in real-time, at the time of discharge?  What if the patient’s behavior and compliance could be recorded, tracked, and reported?  Online access.  Perhaps on an iPad type of device.  Let’s use me as an example, me, the guy who was in too big of a hurry to get discharged to pay attention to my instructions.

Now that I am home I read the instructions.  I register on the website using some form of secure ID that pulls up what I need.  I read about my medications—what they are for, when I have to take them, possible side effects.  I discover that I can track my recovery progress on the site, enter when I take my meds, record when I may have exercised or gone to therapy, perhaps enter what I ate, my blood pressure, and weight. 

Maybe my wife logs in and helps me schedule an appointment, therapy, or a lab. If I schedule a lab the site tells me my instructions prior to having the lab work done, and I provide an electronic signature to confirm my understanding of those instructions.

If I have questions I use the online chat function, or I submit a question that will be replied to within an hour.

My primary care provider can access my progress.

This is certainly not an exhaustive list of tasks, and it deserves more consideration than the twenty minutes it took to write this post.  However, if you pair the idea of decreasing admissions and increasing access, and do so using user-centered design to create an intuitive user experience you may be surprised by the results.

What Does Remarkable Patient Experience Look Like?

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My mother would tell me, if a good idea goes in one ear and out of the other there must not be anything in its path to block it.

Procrustes—nicknamed the stretcher and the subduer—was an hotelier, well sort of.  Procrustes’ problem was his bed, his iron bed.  He told his invited guests that he only had one bed, and like Goldilocks, it turns out that his bed was always either too short or too long.  I should let you know that Procrustes’ actually had two sizes of bed.  That way he could ensure himself that his bed would never fit his guests.

He was not a very good host as his tendency towards sadism demonstrated.  Once a person agreed to spend the night Procrustes’ task was to make sure his guests fit the bed.  Those guests who were too tall were shortened; the shorter ones were stretched.

Something defined as Procrustean produces strict conformity by ruthless or arbitrary means.

Iron beds. HCAHPs.  Strict conformity by ruthless—CMS penalties—or arbitrary means—thirty-two questions that do not begin to cover the breadth of a person’s experiences with a health system.  Approaching it this way may make it seem everything is in harmony, and hospitals know they are all being held hostage to the same standards, no matter how wanting or abridged those standards may be.

For those who enjoy movies, one of my favorite lines comes from The City Slickers—we don’t know where we’re going but we’re making really good time.  Aren’t we though.

What if CMS added a 33rd question to HCAHPs?  The question asked of the patients—“What percentage of the time were all of the lights in your room working?” Indeed.  Here’s what I think would happen.  Press Ganey would sell you your data telling you just how many lights were not working.  The Studer Group would offer coaching services about fixing the lights, and your hospital would form a committee to figure out how to raise your scores.

When it is spelled out like this it is easier to see the fallacy of confining yourselves to the responses of thirty-two survey questions as the sole determinant of how people perceive your hospital. Why not use twenty-nine? Why not one hundred and eight?  Is every hospital identical?  Can all of the important experiences be so nicely bundled and wrapped with a bow?

Of course they cannot.

Think about access.  Patient access.  Family access.  Physician access.  HCAHPs do not address access.  Is that because access has no bearing on the experience and satisfaction of patients and prospective patients?  If access has a bearing, one might argue it has even a greater bearing than lights that always work, bathrooms that are always clean, noiseless hallways, and smiling staff.  If people cannot access the hospital using the time and means of their choosing then it is not easy for them to do business with it.

Access should be scored as follows—A remarkable experience for every person every time on every device.  Remarkable is easy to score.  The score is binary, it was or it wasn’t.  you do not put an initiative in place to take your remarkableness from a score of 7.23 to 7.33.  you put an initiative in place to take it to remarkable.

Where does your hospital score on access with regard to being remarkable?  What is your hospital doing to improve it?

Patient Experience: Why is it like Greek Mythology, and why is that bad?

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The pastor was teaching on the book of Leviticus, more specifically the part where lepers had to shout the warning “unclean” as they passed people on the street.  I had a client once who tried to induce me to yell the same warning when I passed people in his office.  Sometimes instead of consulting the idea of being Willy Loman looks pretty good.

Sometimes we decide something cannot be done and our only supporting argument is because they have never been done—meaning we have tried to do them.  Some things are difficult, some are nigh on impossible, and some are impossible.  (I usually try to accomplish two or three things before breakfast.) Greek mythology tells us of Sisyphus, a deceitful ruler who was punished by being forced to roll a giant boulder up a hill, only to watch it roll back down, and to repeat the task forever.

Here is an example of a Sisyphean task.  Place you back against the wall of whatever room you are in.  Your task is to reach the other wall, and every step you take cuts the remaining distance in half.  No matter how many steps you take you will always have half as far to go from the distance of your prior step.

We all have our boulders.  Endeavoring year after year to raise HCAHPs scores and to achieve survey ratings of one hundred percent is healthcare’s Sisyphean task. There are returns, diminishing returns, and no returns.  Is the best scoring the one that places your organization in the fiftieth percentile?  What is the business benefit of being rated first or second?

Children teach us that there is a fallacy created by using superlatives and in measuring perfection.  They begin arguments with phrases like you always and you never.  These arguments are easily rebutted, for all you need is to find the exception, the instance where the tautology does not hold.

There are grossly diminishing returns earned from trying to hit benchmarks around always achieving a goal because you can prove the negative by finding a single false occurrence.

A month ago I was in Los Angeles.  The only thing I recall with certainty is that I stayed in a Marriott, and that the Marriott charged me twenty-nine cents for checking why my message light was lit, a message they left me welcoming me to the hotel.  I do not recall the floor my room was on, the side of the hall on which it was located, whether the employees always smiled, whether the bathroom was always cleaned, the noise level of the room, nor the color of the carpeting. Five months from now I will not be able to remember the name of the hotel.  Can you recall these details from your last trip?

It would be silly of anyone to ask me these things six months later.  If I am in a good mood I might invent positive scores.  If I am in a bad mood, who knows how I would score the questions.  I would certainly discourage the Marriott from taking my input too seriously, and I would caution them from investing any resources trying to change their processes based on my invented responses.

Riddle me this, then why does that seem to be the model under which everyone in healthcare operates, trying to hit Sisyphean standards?  People are asked to score their recollections about something that happened six months ago, that happened when they were in pain, bored, and taking medication.  For them to score their experience of the hospital the most favorably they have to say that something favorable happened one hundred percent of the time.  That is, the hospital was never noisy, the bathroom was always clean, the pain was always managed, and everyone always smiled.

Superlatives.  The wrong measure of success.  The wrong measures of patient experience, retention, and referrals.  Let’s face it.  Hospitals will have noise and employees will have bad days—and the patients know it.  So why then put all of your patient experience eggs in only one basket?

Patients have expectations, prospective healthcare buyers have expectations.  And yet nobody ever asks them about what expectations they have and nobody tries to design experiences around those expectations.

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As an industry we are led to believe that we have our arms around patient experience simply because we are measuring and responding to survey responses, buying data, and hiring coaches.  The questions, and their resulting weights, were developed without ever speaking to a patient let alone speaking to hundreds of patients or prospective patients.

The point is that nobody knows what kind of experience patients and prospective patients expect of any of the contacts and interactions people have with a hospital.  We do not know because we have not asked.

We do not know what people expect to be able to do when they go to a hospital’s website to make a purchase of healthcare.  Clearly people go to a hospital’s website with some purpose in mind.  They expect to accomplish something.  There are dozens of things they would like to accomplish but nobody knows what they are because nobody has asked them.

This is real Patient Access:

I selected twenty hospital websites to see what I could accomplish using their site.  My tasks were simple; view available appointments, actually schedule an appointment, reschedule an appointment, schedule a lab, complete the pre-admission process, learn how to file a claim, issue a complaint, use online chat, download my personal health records, receive a clear explanation of my bill, understand what my procedure will cost me, get information about a second opinion.

Most hospital websites read like reading a Wiki:

I could not accomplish any tasks on any of the sites I visited. I could however get information about the hospital’s board, learn how to make a donation, find out about what hours the gift shop is open, get directions, read the hospital’s blog, “like” the hospital, learn what awards have been given, and learn about the history of the hospital.

People go to the web because they know they cannot get the information they need by calling the hospital.  Then they learn they cannot get what they need from the web.  Where do they go?  Who knows?  The only thing we know for sure is that their expectations about their experiences are not being met.  They also know that nothing is being done about it.

One final thing I did not see on any of the hospital websites I visited was the hospital’s HCAHPs score.  Why is that worth noting?  It is worth noting because if HCAHPs mattered to those buying healthcare, if hospital’s believed HCAHPs are an actual reflection of what patients think of their experience, the scores would be posted front and center.  HCAHPs are not important to patients.  HCAHP scores are not included in marketing letters; they are not posted on billboards, or spoken of on NPR commercials.

Meeting expectations determines whether people will buy healthcare from your hospital.  Improving HCAHP scores determines whether or not your hospital will be fined.

Improving HCAHP scores and improving patient experience are two very different goals.  Only one increases revenues.

The Patient Experience Expectation Gap

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“Dinner is warm, it’s in the dog.”

Let’s see what we can somehow tie this to patients; I couldn’t resist using the title. The phrase came from my friend’s wife. She’d said it to him after he and I came home late from work one night, he having forgotten his promise to call her if we were to be late. Apparently, she hadn’t forgotten his promise. We walked into the kitchen.  “Dinner’s warm—it’s in the dog.”  She walked out of the kitchen.  I think that’s one of the best lines I’ve ever heard.

Turns out that he and his wife had expectations about how everything would play out.  Turns out their expectations were different.  Satisfaction has more to do with meeting expectations than with actual experiences.  It all comes down to Expectations. In healthcare it comes down to patient expectations.

PEM can be a number of things; Patient Experience Management, Patient Equity Management, and Patient Expectation Management. In this instance, we are discussing the latter. One could argue as to whether the expectations were realistic—and he did argue just that—only to learn that his wife considered the realism of her expectations to be a critical success factor.

Expectations are set, and they will either be met or missed.  The further ones’ experiences are from their expectations the lower is their satisfaction.  I call this the Expectation Gap.

The thing to remember about the Expectation Gap is that in order to measure it you need to know people’s expectations.  And the only way to know their expectations is to ask.  Having people from IT and marketing sitting around defining the expectations of patients and prospective patients is courting disaster.

Each time expectations are missed, the expectation bar is lowered. Soon, the expectation bar is set so low it’s difficult to miss them, but miss them we do. What happens next?  Patients leave. They leave and go somewhere they know will also fail to meet their expectations.

People would rather give their money to someone who may disappoint them than somebody who already disappointed them.

Is the National Healthcare Information Network Our Bridge to Nowhere?

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Scientists turned on the largest machine ever made, the Hadron Collider. It’s a proton accelerator. This all takes place in a donut-shaped underground tube that is 17 miles in circumference.

Fears about the collider centered on two things; black holes and the danger posed by weird hypothetical particles, strangelets, that critics said could transform the Earth almost instantly into a dead, dense lump. Physicists calculated that the chances of this catastrophe were negligible, based on astronomical evidence and assumptions about the physics of the strangelets. One report put the odds of a strangelet disaster at less than one in 50 million, less than a chance of winning some lottery jackpots—what they failed to acknowledge is that someone always wins the lottery, so negligible risk exists only in the mind of the beholder.

If I understand the physics correctly from my Physics for Librarians mail-order course—and that’s always a big if—once these protons accelerate to something close to the speed of light, when they collide, the force of the collision causes the resultant mass to have a density so massive that it creates a gravitational field from which nothing can escape. The two protons become a mini black hole. And so forth and so on. Pascal’s triangle on steroids. Two to the nth power (2ⁿ) forever. Every proton, neutron, electron, car, house, and so on.

The collider could do exactly what it was designed to do. Self-fulfilling self-destruction. In actuality, if the collider does exactly what it was designed to do we will never know it because there will be no ‘we’.  Technology run amuck. Let’s personalize it. Instead of a collider, let’s build a national healthcare information network capable of handling millions of transfers a day. What are the rules of engagement?  Turn on the lights and let’s see how it functions.

Let’s say we need to get anybody’s record to anybody’s doctor.  That’s overly simplistic, but if we can’t make sense out of it at this level, the national healthcare information network is doomed.  The number of possible permutations among doctors and patients, although not infinite, is bigger than big.  Can you see what can happen? Strangelets.  The giant sucking sound you’ll hear will come from ARRA and stimulus money as it is pulled in to the black hole.

So what has the thought leadership done to fight the strangelets? It created healthcare information exchanges (HIEs)—mini national networks.  Not only does their plan have them repeating the same flawed approach, they are relying on embedding the same bad idea, and doing it using hundreds of different blueprints.

I thought we had this thing called the internet that you transfer data securely from any point to any other point.  Based on recent news stories I am willing to be that the NSA may have an idea or two about how to tap into somebody’s healthcare data without having to build a national healthcare information network.