Rants & Musings

Innovation 101

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The world continues to revolve and to rotate, and yet some mornings, like today, I find myself asking why bother.

Moammar Gadhafi—the name does not even pass Word’s spell check which should tell him something about his popularity—dressed in his Michael Jackson garage sale Thriller outfits is discovering quickly that his Lawrence of Arabia shtick is about as effective as is Congress’ pretense at leading from behind.  Speaking of which, now that Congress are back from Nebraska’s beaches, maybe they can save the country.

What else?  Kim Kardashian is married—whew, I thought that would never end, Jimmy Hoffa has sworn off drinking tea party, and Chaz, minus some of the important parts will be appearing as a man on Dancing with the Stars.  I will be appearing as a giraffe on Animal Planet.

The country keeps getting curiouser and curiouser and where does that leave your business in an economy that has gone Byzantine?  It appears choices are somewhat limited.  Firms can wait until the unknown influencers become known, they can wait for Washington to sort out who’s on first, or they can decide to innovate.

When I think of innovation I think of it as follows: knowledge plus need equals innovation.  To renew or change.  From a firm’s perspective, before innovation can have application, questions must be defined and answered:

·         What is the need:

  • Declining market share
  • Uncertain markets
  • Poor economic conditions
  • New technologies causing obsolescence
  • Entering new markets

·         What knowledge is required

·         What can be renewed

·         What must be changed

Doing today what you were doing yesterday is not the picture of innovating.  It is the first day of the last days of your business.  Moving your production to China, or your call center to India is not innovative, it is cutting cost.  Anyone can cut costs, until there are no more costs to cut.  Then what?  The most effective way to cut costs is to turn off the lights and lock the door.

A manly dog?

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On weekends I put my mind on hold and write things that have nothing to do with business. If it gets either of us to smile it was a good use of my time.

A few years ago when I returned home from a 10k race in DC I discovered my wife had purchased a dog, a Bichon.  That may have been its scientific classification, but it looked a lot more like a feather duster.  She named it Lorenzo, after the name of the dog in the Wizard of Oz—I know that dog was named Toto, but telling her that was not going to correct the situation.  I learned she spent twice as much on the dog as I had on my first car.

I did not object—at least verbally—that her dog was about the size of an underfed gerbil.  We had a family of large turkey vultures living in the woods behind our house, so I often encouraged the dog to play outside and get some exercise.  My thought process was simple; perhaps one of the vultures would mistake the dog for a petit four.

Man-dogs should be big.  Big enough to go on runs, large enough to take up most of the bed, and require the use of a drool cup.  They ought not to be the size where one day you may find them inside the bag of your vacuum cleaner.  To be man’s best friend, they need to be friend-sized.  I do not have any friends the size of a throw-toy.  Lorenzo is sized more like something you would expect to find as the prize that comes with a Happy Meal.

What I did object to was taking the gerbil to Pets Mart for a haircut.  After all, the store was only a few miles from our house, and chances were I might run into someone I knew.  It was not healthy putting Lorenzo on a leash, as the weight of even the smallest leash could dislocate his shoulder.  It would have looked like I was walking a Q-tip, so I carried him into the store.

Face it, I was embarrassed, and concerned someone would see through the disguise I was wearing.  The store was full of manly dogs, most of whom were making fun of me.  A stunning blonde was being led down the dog toy aisle by a Great Dane.  I hid inside an eighty pound bag of puppy chow until she disappeared around a corner.

The dog stylist delivered the newly coiffed Lorenzo to me, pink ribbons affixed to his ears–the dog’s ears, not the stylist’s. I told the dog “either take off the ribbons or walk home.”

Turned out Lorenzo was a pretty good dog.  He died at the age of five.  Whoever created dog-year math was wrong on this one.  My first car, a Corvair, lived longer than that.  It’s not like we found him doing the back-stroke in the fish tank, but he was equally as dead.  It was not easy explain that to three children under the age of ten.  There were plenty of tears to go around, and photos of Lorenzo were taped as a eulogy around our house.  I mounted his collar in a small diorama box and placed it on my wife’s desk.

Well, taking on the role of Super-dad, I went out and adopted what appeared to be Lorenzo’s stem-cell clone.  I let everyone know that this time the dog would get haircuts at home, thereby eliminating the need for me to go skulking around Pets Mart.

The status of my lifetime membership in the He-Men’s club is being reconsidered by the membership committee of the Philadelphia Chapter.  To make matters worse, yesterday my client walked into my office and caught me listening to James Blunt.  I think it is time for me to quash the idea of going out to select new drapes.

10 Things Ever Man Should Know

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There remain a few things which separate men from the no-opposable-thumbs crowd, but they are in rapid decline.  These come to mind for me, please feel free to add your favorites.

  1. Fitted sheets.  If they were meant to be folded neatly, there would be instructions printed on the package.  They are folded when you buy them because they popped out of a machine that way; give me the machine and I will fold them.  Otherwise, that is why linen closets have doors.
  2. The reason grocery stores went from using paper bags to plastic is because men do not like to do things more than once—like making repeated trips to the car to carry in the bags.  The volume of a grocery cart is designed to hold an amount of food equal to that which a man can carry from the car in plastic bags in a single trip.  Things laying on the bottom rack of the shopping cart do not count in the trip equation—items like eighty pound bags of dog food, cases of soda, and bulk purchases.  If you are unsure if an item is to be counted against the one trip rule, do not purchase it.
  3. Housekeeping. No cleaning is required of any item whose height is one inch higher than that of your spouse—if it cannot be seen it cannot be dirty.  If the cord of the vacuum cleaner was meant to be coiled it would have a built-in coiler.  Your time would be more productive if you did not waste time coiling and uncoiling, a task with zero value-add.
  4. Standardized tests.  Answering questions with the same letter more than three consecutive times will cause your head to implode.  The days when you could score an 800 on the SAT simply by placing your name on the scoring sheet are over.
  5. There is nothing wrong with arguing, until you get to the point in the argument when you know you are wrong.  That part stinks.
  6. Men will communicate better when Microsoft develops a sarcasm font.
  7. If you don’t hear what someone says, and have to ask them to repeat themselves, that is okay—it is a Mulligan.  You get one Mulligan per conversation.  If at the end of the second telling you still have no idea what was said you are responsible to nod your head and act like you get it—this is what is meant by active listening.
  8. On driving.  If a car is attempting to move into your lane, and the driver is not using their turn signal, you are not obligated to let them in.  If the men in other cars notice this violation, it is permissible for the group of men to align their cars in a ‘moving pick’ formation to block the other car from entering or passing.  If the violating driver begins to signal you by using sign language, you are obligated to maintain the moving pick formation even if it means missing your next several exits.
  9. Friends never let friends wear Speedos.
  10. 10. There is no reason to know how to iron or sew on a button.  That’s why there are stores.

 

Healthcare IT: Musings of a drive-by mind

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It takes a lot of energy to dislike someone, but sometimes it is worth the effort. It is not easy being a consultant.  One client required that I shout “unclean, unclean” as I passed through the hallways.  Maybe that is why I leave newspapers scattered around the floor of my desk, so nobody can sneak up on me without me being able to hear them.

I have a knack for complicating simple things, but the voices in my head tell me that is better than simplifying complicated things.  Either way, I appreciate those of you who continue to play along.  Just remember, if you choose to dine with the devil it is best to use a long spoon.

You’ve probably figured out that I am never going to be asked to substitute host any of the home improvement shows.  I wasn’t blessed with a mechanical mind, and I have the attention span bordering on the half-life of a gnat.

I’ve noticed that projects involving me and the house have a way of taking on a life of their own.  It’s not the big projects that get me in over my head—that’s why God invented phones, so we can outsource—it’s the little ones, those fifteen minute jobs meant to be accomplished during half-time, between pizza slices.

Case in point—trim touch ups.  Can, brush, paint can opener tool (screwdriver).  Head to the basement where all the leftover paint is stored.  You know exactly where I mean, yours is probably in the same place.  Directions:  grab the can with the dry white paint stuck to the side, open it, give a quick stir with the screwdriver, apply paint, and affix the lid using the other end of the screwdriver.  Back in the chair before the microwave beeps.

That’s how it should have worked.  It doesn’t, does it?  For some reason, you get extra motivated, figure you’ll go for the bonus points, and take a quick spin around the house, dabbing the trim paint on any damaged surface—window and doorframes, baseboards, stair spindles, and other white “things”.  Those of us who are innovators even go so far as to paint over finger prints, crayon marks, and things which otherwise simply needed a wipe down with 409.

This is when it happens, just as you reach for that slice of pizza.  “What are all of those white spots all over the house?”  She asks—you determine who your she is, or, I can let you borrow mine.  You explain that it looks like that simply because the paint is still wet—good response.  To which she tells you the paint is dry—a better response.

“Why is the other paint shiny, and the spots are flat?”

You pause.  I pause, like when I’m trying to come up with a good bluff in Trivial Pursuit.  She knows the look.  She sees my bluff and raises the ante.  Thirty minutes later the game I’m watching is a distant memory.  I’ve returned from the paint store.  I am moving furniture, placing drop cloths, raising ladders, filling paint trays, all under the supervision of my personal chimera.  My fifteen-minute exercise has resulted in a multi-weekend amercement.

This is what usually happens when the plan isn’t tested or isn’t validated.  My plan was to be done by the end of halftime.  Poor planning often results in a lot of rework.  There’s a saying something along the lines of it takes twice as long to do something over as it does to do it right the first time—the DIRT-FIT rule.  And costs twice as much.  Can you really afford either of those outcomes?  Can you really afford to scrimp on the planning part of IT?  The exercise of obtaining HER champions and believers is difficult.  If you don’t come out of the gate correctly, it will be impossible.

Back to my project.  Would you believe me if I said I deliberately messed up?  Maybe I did, maybe I didn’t, but the one think I know with certainty is that I now have half-times all to myself.

The relationship of EHR to mobile health

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Why not see if we can muddy the waters even further?  Is this a true statement: EHR is to the N-HIN of HIT applications, as wireless health devices and their apps are to the HIEs?

The good news is that in the last two to three years more variety, flexibility, and adaptability have been demonstrated by these mobile devices and their related software applications than has come out of traditional healthcare systems since Mr. Gore built his first lockbox.

The bad news is that in the last two to three years…(ibid).

Healthcare IT meets Ben & Jerry’s

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The idea for this blog came about after reading a PowerPoint presentation by Doctor Alberto Borges.  All mistakes can be attributed to me.

When one is witness to the number of external influencers trying to shape policy on healthcare, reform, and healthcare IT, the best one can hope for is that hidden somewhere under the pile is a pony.

But let’s be real—the pony has suffocated.

While it is okay to point the finger of blame at the usual suspects—payors, lobbyists, and the lawmakers—let us not forget to ensure to point out the role paid by the healthcare IT applications vendors.

“Who me?” You ask.

Decrease costs, increase quality, decrease errors.  I did not invent these words; they are written on your websites.

Prior to 2008 the value of EHR vendors’ stocks plummeted.  Look at them now.  How does one explain the difference?  Can the gains be attributed to vendors having rewritten their applications?  New technological innovations?  If not, what else could it be?

Meaningful Use.  Meaningful Use tied to Medicare payments and a twenty billion dollar incentive to get providers to do something they otherwise would not have done.  Could life be any better if you are sitting in the EHR Tower’s corner office?

What if we think about the issue this way?  Let us suppose all of the leading ice cream manufacturers lobbied Congress to push for including ice cream machines in all new cars starting in 2012…silly idea, but then again, so is Meaningful Use.  Not only do the ice cream machines have to be installed, but they have to be able to communicate with one another.  That way, if I happen to rent a car, the ice cream machine in my rental will already know what type of ice cream I like to eat.

Now we already know that no car buyers and no car builders will think much of being forced to buy or make cars with pre-installed ice cream makers.  But, perhaps there is a way around that.  Maybe in some self-serving way the Cookies and Cream lobby can convince Washington of the merits of pushing through their agenda.

Time passes, and still the idea is not getting much purchase.  What happens next?  The ice cream manufactures get Congress to pass the Ice Cream Tech Act—ICTA.  And as part of the ICTA Act, Ben and Jerrys, Baskin Robbins, and Haagen Dazs convince our friends to offer the auto manufacturers a twenty-billion dollar rebate for building cars with built-in ice cream makers—ICTA Initiatives.

Now, why would the Ben’s and Jerry’s do this?  Good question.  They will do this because they know that without offering a large financial incentive the car company executives will not do what they want them to do.  Now to insert ice cream makers, you can imagine that the car companies will have to go way off message, will have to change their strategy, and will have to incur all sorts of costs that have nothing to do with selling cars.

And that brings us back to the start of this story.  There is a reason why EHR vendors needed to lobby Congress to put forth more than twenty billion dollars of lottery money, and that reason is healthcare providers would not be doing EHR the Meaningful Use way unless there was a monetary reason to do it.  There certainly is no business reason to do it.

And for the most part, if providers calculate an ROI on EHR, even factoring in the incentive payments, there is still no reasonable financial argument that can be made.  In fact, when the cost to meet Meaningful Use is factored in, the financial argument worsens.

So, what will happen?  Here is what we know so far.  The Meaningful Use deadlines draw closer, meaning there is less time left to get the incentive dollars.  Implementations of EHR continue to falter, be redone, and under deliver.  The result is that the purchase of EHR systems will slow, and many EHRs will be uninstalled.  When there is no time left to get the incentive dollars, only then will EHR implementations be driven by the needs of the providers, and the government will no longer be driving the process.

 

EHR: the wisdom of crowds

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According to National Geographic, a single ant or bee isn’t smart, but their colonies are. The study of swarm intelligence is providing insights that can help humans manage complex systems. The ability of animal groups—such as this flock of starlings—to shift shape as one, even when they have no leader, reflects the genius of collective behavior—something scientists are now tapping to solve human problems.  Two monumental achievements happened this week; someone from MIT developed a mathematical model that mimics the seemingly random behavior of a flight of starlings, and I reached the halfway point in counting backwards from infinity–the number–infinity/2.

Swarm theory. The wisdom of crowds. Contrast that with the ignorance of many to listen to those crowds. In the eighties it took Coca-Cola many months before they heard what the crowd was saying about New Coke. Where does healthcare EHR fit with all of this? I’ll argue that the authors of the public option felt that wisdom.  If you remember the movie Network, towards the end of the movie the anchorman–in this case it was a man, not an anchor person–besides, in the eighties, nobody felt the need it add he/she or it as some morphed politically correct collection of pronouns.  Whoops, I digress.  Where were we?  Oh yes, the anchor-person.  He/she or it went to the window and exhorted everyone to yell, “I’m mad as hell, and I’m not going to take it anymore.”  Pretty soon, his entire audience had followed his lead.

So, starting today, I begin my search for starlings.  A group whose collective wisdom may be able to help shape the healthcare EHR debate.  The requirements for membership is a willingness to leave the path shaped by so few and trodden by so many, to come to a fork in the road and take it. Fly in a new flock.  A flock that says before we get five years down the road and discover that we have created such an unbelievable mess that not only can we not use it, but that we have to write-off the entire effort and redo it, let us at least evaluate whether a strategic change is warranted.  The mess does not lie at the provider level.  It lies in the belief that hundreds of sets of different standards can be married to hundreds of different applications, and then to hundreds of different Rhios.

Where are the starlings headed?  Great question, as it is not sufficient simply to say, “you’re going the wrong way”.  I will write about some of my ideas on that later today.  Please share yours.

Now, when somebody asks you why you strayed from the pack, it would be good to offer a reasoned response.  It’s important to be able to stay on message.  Reform couldn’t do that and look where it is. Here are bullet points you can write on a little card, print, laminate, and keep in your wallet if you are challenged.

  • Different standards
  • Different vendors
  • Different Rhios
  • No EHR Czar

Different Standards + Different Vendors + Different Rhios + No Decider = Failure

You know this, I know this.

To know whether your ready to fly in a new direction, ask yourself this question.  Do you believe that under the present framework you will be able to walk into any ER in the country and know with certainty that they can quickly and accurately retrieve all the medical information they need about you?  If you do, keep drinking the Kool Aid.  If your a starling, come fly with us and get the word out.  Now return your seat backs and tray tables to their upright and most uncomfortable positions.

The Y2K Hurricane

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I imagine myself in a situation not too dissimilar to the one faced by George Washington as he had to write by candlelight about the time he chopped down Abe Lincoln’s cherry tree.  The power is out, has been for eighteen hours, and I am forced to write using the remaining power of my laptop’s battery.

The hurricane that wasn’t, or at least wasn’t as dire as had been foretold.  It was sort of like the Y2K problem, more of myth than of merit.

The children were nestled all snug in their beds—at least for a few moments—until the lights went out.  How they knew the power was out is beyond me since at least in theory, they were supposed to have been asleep.  Over a period of several minutes, one by one they made their way into our room, joined by our two dogs.  Thankfully, the hamster decided to tough out the storm in his cage.

The last tidbit of information we received prior to the blackout was that several tornados had been spotted in our area.  Just prior to nodding off, this news made me think that at least things would be a little interesting.  My wife was thinking the opposite as she nudged me awake.  “You can’t sleep.  What are you going to do?”  Her reasoning was that if she was worried the least I could do was stay awake and pretend I was worried too.

“About what?” I asked groggily. This is the same woman who during Tuesday’s earthquake had looked askance at my suggestion that we leave the building.

“The tornados,” she replied with all seriousness.

Pretty soon our bed resembled a gathering of the Von Trapp family, along with seventeen pillows and three sleeping bags.  “Maybe we should bring up some snacks,” piped our youngest son.  Soon, not only was our bed overflowing with uninvited guests, we now had to deal with the fact that we would be sleeping on crumbs, crumbs we could not see in the blackout.

Morning came without much fanfare.  Other than having to light the gas stove with a match to boil water for the coffee, all appeared normal.

The phones are out, as are the cable and the internet and the Wii.  The microwave does not work, and we cannot open the refrigerator for fear of letting out all of the cold air.  It is a lot like camping I explain to the children as they asked what they can do living in such primitive conditions.

“You have four hours of daylight to clean your rooms and get ready for the first day of school,” I replied as I thought about how quiet tomorrow would be.

My take on earthquakes and hurricanes

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America’s east coast immigrants must be having a confusing week—an earthquake on Tuesday and a hurricane.  I assume many of them turned to the news for survival tips and came away even more confused.

The bad thing about earthquakes is there is not enough time to respond appropriately, and by respond I mean to shop.  For some reason, we adapt better to natural disasters once we have our shopping done.  And for those who do not know what to buy, the local news teams are always on the scene showing people where to shop and what to buy when they shop.

Based on what I saw, it appears the three natural disaster survival items are milk, bread, and eggs.  While my neighbors were stocking up for the hurricane I was buying bags of road salt and a few snow shovels just to confuse them.

For some reason, when the sky or the earth opens in ways only God understands, our natural reaction to unnatural occurrences must be to find solace in making French toast—milk, bread, and eggs.  (There was nobody in line by the kiwis and pomegranates.)

Perhaps French toast is our down-market homage to the Brits’ strawberries and cream.

If the sill of your window is still above water this Sunday morning, open it a crack, and let me know if you smell the cinnamon and syrup.

EHR: Men Behaving Badly

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When I lived in Colorado my friend and I decided that instead of running during our lunch break we would sit in on an aerobics class. Our plan was to hide away in the back of the class, watch the ladies, and then head back to the office. No sweat—literally, that was also part of the plan. Our thought process was that if women and other lower life forms could do it, how difficult could it be? We were mainly manly men; excuse the use of alliteration.

Within ten minutes we had to peel ourselves from the floor, barely able to lift our arms and legs. What we’d viewed as an hour of simple stretching coupled with an hour of looking like mainly manly men had reduced us to a pair of whimpering sissy boys. We also learned that if you sit in the back of the class that in order to exit you had to make it past all of the ladies as you dragged your carcass from the room.

Fast forward a few decades. I went to an exercise class called spinning. Sounds a little like ballet. It’s a stationary bike. A large TV hangs on a wall. Once again the room is packed with non-males, including my wife. My take on it is that it’s a bike class for women who’d rather watch Regis and pretend to exercise instead of actually breaking a sweat. What the heck; I was already there, why not humor her. The instructor smirked at me when I asked her to tune the TV to ESPN. She inserted a CD of The Killers, cranked it all the way up, and we started pedaling. Pyramids, intervals, uphill, more uphills. Twenty minutes into it my water bottle was empty, my towel soaked. The ladies, including my wife, were chatting away as though they were walking the dog.

Not everything changes with time. Sometimes it is better to participate than to watch. Sometimes it’s better to watch. Sometimes, no matter how certain one is, one’s certainty is meant to be changed. Sometimes certainty is based on bad ideas. Like the certainty that comes from knowing, “We’re doing just fine, thank you very much.”

There’s a scene in Billy Crystal’s movie, City Slickers, where the guys are on their horses and one remarks, “We don’t know where we’re going, but we’re making really good time.”

What is that everyone holds with such certitude in healthcare IT? Is it the knowledge that even if EHR drops productivity by 20% it was still a good call? Is it that chasing Meaningful Use, even if it means forgoing supporting the business strategy is wise?