Health 2.0 Philadelphia
Posted by Paul Roemer on February 25, 2010
The new meetup.com group is up and running.
There is a distinction between the business of healthcare and the healthcare business. The first is more about managing the dollars and cents, and the latter is about delivering outstanding care. Many argue that the business of healthcare operates under an 0.2 business model. I believe that moving the business model to a 2.0 model by correctly deploying healthcare IT will benefit the business, the physicians, and the patients.
My vision is to make this group a place where local healthcare executives come to learn and exchange ideas in a non-threatening forum.
The purpose of the meet up is to network, exchange ideas, and learn from subject matter experts. I hope we can agree to make the meetings something of value as opposed to a forum for selling the products and services of some of the members.
Please think about joining us or sharing the link with someone.
http://www.meetup.com/Philadelphia-Healthcare-Technology-Health-2-0-Philadelphia/
Possibly related posts: (automatically generated)
This entry was posted on February 25, 2010 at 2:45 pm and is filed under Rants & Musings. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site. Edit this entry.
Rants & Musings
May I borrow your pen?
Have I written recently I’m not a fan of technology for unless someone knows what business problem they intend to solve? It’s not so much that I have anything against any of the technology or any particular technology or EHR vendor, it’s more that I think many are misjudging what the technology will do for them, what they have to do to it, and they forget to ask themselves how to best address the problems.
Whatever do you mean? Thanks for asking—here’s an example. When the United States first started sending astronauts into space, they quickly discovered that ballpoint pens would not work in zero gravity.
To combat the problem, NASA scientists spent a decade and $12 Billion to develop a pen that writes in zero gravity, upside down, underwater, on almost any surface including glass and at temperatures ranging from below freezing to 300C.
The Russians used a pencil.
Have a meeting about how to best plan for and implement EHR in your hospital. One rule, all discussion should involve process, not technology. Try first to reach consensus about what to do, then look at how to do it. You may find out that all you need is a pencil.
Does reform need to be reformed?
The following is the comment I posted to,
Kent Bottles: Is It Really Impossible to Control the Cost of Health Care in the U.S.?
Kent, your narrative should be mandatory reading for all those in Washington whose vision of reform stands in stark contrast to the piece. Then, before they are allowed to propose or vote on their vision, they should be forced to explain why their vision doesn’t address these issues.
In my non-luminary opinion, here’s where I think the reformists have failed. The notion of spending funds that don’t exist, to fix things that may not be broken, without fixing those that are could only come from Washington.
Permit me to over simplify things to make a point. When I look at healthcare, I see a three legged stool; pharma, the payors, and the providers—the three P’s. Not exactly in a pod, each working to their own benefits and operating under different business models—models which are in conflict. For example, many hospitals operate as not for profits, which conflicts with the for profit sectors.
I believe the present reform effort will increase the conflict. Why? Because the legislation is siloed—it looks a lot like the word ‘soiled’ which might also be part of the problem. The legislation does not seem designed to address healthcare as in integrated industry. The way reform is positioned, each nudge that is put to one leg of the stool will cause a reaction, an unfavorable one, to the other legs. It is a little like doing an experiment, changing multiple variables at once, and hoping for the best.
Two sides of the stool, the payors and pharma, have behemoths running the show. Among the behemoths, the business models in pharma are quite similar and the same holds for the payors.
I think it is important to distinguish between the business of healthcare (the dollars and cents) and the healthcare business (the clinical side). The provider segment is highly fragmented. There is no behemoth provider cartel. The business of healthcare, is the side most in need of reform. Each of the thousands of providers operates under their own business model. None of these businesses was designed to be interoperable—I do not use this term in the same sense being used by the ONC and CMS.
The business of healthcare, with all of its inefficiencies, is designed to operate within its four walls and across a limited geographical radius. The long term goal of healthcare reform, I believe, is to make the provider side appear as one giant services provider. Just because consolidation sort of worked for steel, the airlines, and the automotive industry does not mean it will work for delivering healthcare.
My final comment has to do with the payor side of healthcare, and I’ll start by acknowledging that this one is more than a little provocative, one for which I have not thought through a workable solution—I’ll leave that to those of you who aren’t grasping for metaphorical tomatoes to throw. I could be convinced to skip the rest of my comments if for a moment I thought that the business model of the payors was—let’s cover everyone who needs care for a fair cost. Ignore for the moment that my statement is naive.
We know that on a small scale it is possible for people to self-insure, to meet their needs without having to rely on payors. I’ll frame my final comment with a question—where is the value-add to healthcare from the payors?
Here is my issue with the current model. You want to go to the movie, you hand me ten dollars for an eight dollar ticket, and I pay the movie theater on your behalf and pocket the two dollars. In this instance I am merely the middle man, I manage the transaction. The theater gets no marginal benefit, and you get no marginal benefit.
Not complex enough? Let’s say someday millions of people want to go to the movies and a ticket will cost them eight dollars. Anticipating that, everyone pays me a dollar a day so that when the time comes they can go. On that day, I pay for movie tickets for those who want to go, pocket the difference, and I keep the money for those who don’t go.
In my small mind, that’s how I view the payor leg of the stool. I think the payors relish reform. I think the more they complain about how badly this will hurt them the more they may like it. It reminds me of the Uncle Remus story in which Brer Rabbitt pleading with Brer Bear and Brer Fox not to throw him into the briar patch.
What industry wouldn’t be salivating if they could find an additional thirty or forty million customers overnight? What if you could charge them a monthly fee and make the co-pay so high that you might not have to cover major medical claims? Does this sound absurd or does it sound a little like the mortgage banking industry? Fess for no service. I am not saying that this will happen in every case, but I do not think one can argue that this will never happen.
Circling back to how to reform reform. From my vantage point, the most advantageous reform idea would be to force multiples of payors to compete in every state. Competition could do wonders for cost control.
A final thought. Earlier this year a House committee passed legislation on “can’t fail” businesses. The Financial Services Committee voted on an amendment that would let regulators dismantle a firm, limit mergers and acquisitions, and force an end to activities deemed systemically risky. The financial industry opposed the measure, as part of legislation to overhaul Wall Street rules. This could be another opportunity for the camel—Washington—to get its nose further under the healthcare tent. There is nothing that limits the legislation to financial services. Call me a cock-eyed pessimist, but what is there to prevent Congress from deciding that the payors need to be dismantled, thereby ushering in a federal payor model? That would give them two legs of the stool. What if…?
Who is minding your patients, your equity?
Did I mention that I like to sing? No? Don’t tell anyone, but I just downloaded some Tom Jones to my MP3 so I can belt out a rendition of Delilah while I’m running—I only do this when I’m certain nobody is around. This doesn’t quite foot with my college collection of albums from Pink Floyd, Genesis, and Queen.
Then there was the time I was on a date at a roller rink. I was probably dressed in a pair of tight fitting bell-bottoms, an equally tight fitting rayon shirt unbuttoned to who knows where—hold the laughter. My almost shoulder length hair half-hid a puka shell necklace.
It may be important to know that although I had ice skated, I had never roller skated. There are a few not so subtle differences between the two. Most notably, the sadist who designed the roller skate must have thought it amusing to place a large round rubberized wheel on the front of the skate in much the same position as a car bumper. I have no idea what is supposed to do. What it does do is stop you on a dime, especially when you have no intent of stopping.
Let’s see if we can tie some of this together. I’ve never felt that I actually needed to know how to do something in order to develop my own unsubstantiated delusions of adequacy—that probably explains why I’ve been consulting all these years. Anyway, back at the roller rink.
Barry Manilow’s “I Write the Songs” was being piped overhead through speakers the size of a dishwasher. Feeling much too confident for my abilities, I dragged my date to the floor. We stood side by side. I grasped her hands in a crisscrossed fashion like I had seen skaters do on television. After circling the rink for half a lap—watching my feet the entire way—I thought I should further dazzle her by singing. I should point out that it is difficult to sing and simultaneously watch your feet, a fact I didn’t learn until I was airborne. This takes me back to the rubber wheel on the front of the roller skate. We crashed to the floor and quickly took out the next thirty or so couples who were following us. It looked like a conga line run amuck. For the next hour or so it seemed like everyone in the rink pointed at me as though they were trying to warn others to stay away.
I haven’t sung any Manilow since that fabled night. Maybe it has something to do with the fact that times change and tastes change. Now I listen to groups like Dashboard Confessional and Great Lake Swimmers. I still interface with those closeted Manilow fans. Gone are the bell-bottoms and platform shoes, replaced by micro-fiber trousers, Droids, and Cole Hahns. My collar-length hair has a more monastic cut.
I’ve aged, so has my generation. Aged to the point where they now have the power. Those people own the decision making process in most hospitals. They may be the people calling the shots in yours. How can you tell if the person wearing the eighties polyester is one of them? Walk past her humming a few bars of Mandy or Copacabana, or something from The Captain and Tennille, and see if she hums back.
Is your Patient Equity Management (PEM) strategy is as dated as the double knits? Or did I get ahead of myself; does your hospital even have a PEM strategy? Odds are that there is no PEM strategy, no PEM group or executive.
Hospitals are quite good at managing their assets. I bet your hospital has someone who can tell you how many chairs, televisions, beds and bed pans you have. Assets. We count them because we don’t want to lose them. That is how businesses are managed.
In today’s dollars over their lifetime the average person in the US will spend more than $600,000 on healthcare. Patients. Assets. They are a big part of your hospital’s equity base.
Who is minding your patients, your equity? I don’t mean the doctors and nurses. Who is responsible for making sure discharged patients return to you the next time they need a hospital? Who manages that relationship for the hundreds of days between hospital visits? Probably nobody; at least nobody in your organization. Wanna’ bet somebody in the hospital on the other side of town is studying how to turn that $600,000 patient into one of theirs?
In case you’re wondering, the episode at the skating rink was our last date.
Patient Relationship Management & Patient Equity Management
Here’s a link to my deck on the above. I’d like to read your thoughts.
http://www.slideshare.net/paulroemer/good-CEM-deck
In accordance with the prophecy « Healthcare IT: How good is your strategy?
Counting me, there were six of us; college spies. Maybe that is a grammatical error; we were spies who happened to be in college. Well, maybe that%u2019s a half-truth. We were co-op students with rather high security clearances, working at a place in the DC area which made the type of things of which Nancy Pelosi would deny having any knowledge. I was a mathematics intern–not a bad step on the rungs of the career ladder given that the dean of my math department had tried on more than one occasion to get me to change majors. Everyone I worked with had at least a PhD in math. At least I had enough firing synapses to know I would never be their intellectual peer.
During the summers, we six would report at one of the complex’s gates, flash our badges at the marine guards, make our way past the military weapons testing facilities, and head to our basement offices. At lunch time we would break out our briefcases, and take out our tools of the trade–Frisbees, bag lunch, sun tan oil (this was in the days before anyone could spell SPF, pure Hawaiian Tropic.) Within minutes we would be stripped down to our cutoffs, running across the field where the helicopters landed, and dripping with sweat. After lunch we would help draft differential equations whose aim was to read target signatures sent from one of our missiles at a Soviet or Chinese aircraft. Not a bad gig if you can get it.
That was then. Now we are aging adolescents clinging woefully to rapidly fading images of summers past, whose idea of getting wasted is drinking multiple espressos. Gone are the days where we could abnegate responsibility. We matured, at least a lot of us. We have learned pretending you know what you are doing is almost the same as knowing what you are doing. We have accepted it to the extent that we act like we know what we are doing even if we do not and, we do it.
Pretending is a skill. Guys do it all the time, secretly hoping no one will notice. People who answer your hospital phones do it too. Sometimes patients will settle for an answer; any answer. It is sort of like bluffing in Trivial Pursuit–you bluff with enough confidence, your opponent may not even check your answer. For some patient questions, there are three states of being; not knowing, action and completion. The goal is to move as rapidly as possible from the first state to the third. If the patient proves to be a problem, the patient care rep should finish each sentence with the phrase, In accordance with the prophecy.
Of course, if face-to-face interaction proves to be too much, you can always tighten up the dialog. For example;
RING….
*click*
Welcome to the Patient Care Hotline.
If you are obsessive-compulsive, please press 1 repeatedly.
If you are codependent, please ask someone to press 2.
If you have multiple personalities, please press 3, 4, 5 and 6.
If you are paranoid-delusional, we know who you are and what you want.
If you are schizophrenic, listen carefully to the little voice until it tells you which number to press.
If you are manic-depressive, it does not matter which number you press. No one will answer.
If you are delusional and hallucinate, please be aware that the thing you are holding on the side of your head is alive and about to bite off your ear.
Thanks for calling.
In accordance with the prophecy
Counting me, there were six of us; college spies. Maybe that is a grammatical error; we were spies who happened to be in college. Well, maybe that’s a half-truth. We were co-op students with rather high security clearances, working at a place in the DC area which made the type of things of which Nancy Pelosi would deny having any knowledge. I was a mathematics intern—not a bad step on the rungs of the career ladder given that the dean of my math department had tried on more than one occasion to get me to change majors. Everyone I worked with had at least a PhD in math. At least I had enough firing synapses to know I would never be their intellectual peer.
During the summers, we six would report at one of the complex’s gates, flash our badges at the marine guards, make our way past the military weapons testing facilities, and head to our basement offices. At lunch time we’d break out our briefcases, and take out our tools of the trade—Frisbees, bag lunch, sun tan oil (this was in the days before anyone could spell SPF, pure Hawaiian Tropic.) Within minutes we’d be stripped down to our cutoffs, running across the field where the helicopters landed, and dripping with sweat. After lunch we’d help draft differential equations whose aim was to read target signatures sent from one of our missiles at a Soviet or Chinese aircraft. Not a bad gig if you can get it.
That was then. Now we are aging adolescents clinging woefully to rapidly fading images of summers past, whose idea of getting wasted is drinking multiple espressos. Gone are the days where we could abnegate responsibility. We matured, at least a lot of us. We’ve learned pretending you know what you’re doing is almost the same as knowing what you are doing. We’ve accepted it to the extent that we act like we know what we’re doing even if we don’t and, we do it.
Pretending is a skill. Guys do it all the time, secretly hoping no one will notice. People who answer your hospital phones do it too. Sometimes patients will settle for an answer; any answer. It’s sort of like bluffing in Trivial Pursuit—if you bluff with enough confidence, your opponent may not even check your answer. For some patient questions, there are three states of being; not knowing, action and completion. The goal is to move as rapidly as possible from the first state to the third. If the patient proves to be a problem, the patient care rep should finish each sentence with the phrase, “In accordance with the prophecy.”
Of course, if face-to-face interaction proves to be too much, you can always tighten up the dialog. For example;
RING …RING …
*click*
Welcome to the Patient Care Hotline.
If you are obsessive-compulsive, please press 1 repeatedly.
If you are codependent, please ask someone to press 2.
If you have multiple personalities, please press 3, 4, 5 and 6.
If you are paranoid-delusional, we know who you are and what you want.
If you are schizophrenic, listen carefully to the little voice until it tells you which number to press.
If you are manic-depressive, it doesn’t matter which number you press. No one will answer.
If you are delusional and hallucinate, please be aware that the thing you are holding on the side of your head is alive and about to bite off your ear.
Thanks for calling.
My latest piece on healthsystemCIO.com
I was wondering how CIOs would approach the implementation of EMRs if they had never heard the term Meaningful Use. The more I thought about the question, the more I felt it merited discussion. If I were a CIO, I would not let these outside regulatory influences dictate my strategic decision making. As a member of the executive team, my responsibility is two-fold; to facilitate and improve patient care, and to contribute to the business as an advisor, someone whose actions positively impact the bottom line.
Some CIOs have been forced to abdicate their responsibility and to approach EHR as order takers. Sometimes the CEO/CFO/COO creates a directive mandating EHR. That said, their guidance may end. In other, more problematic cases, it doesn’t, and they also supply the name of the EHR vendor that must be used. The worst reaction to this pressure is to not challenge the issue of whether your organization will attempt to meet Meaningful Use. The concept is much more novel than it may appear.
What if Meaningful Use didn’t exist? Many hospitals undertook EHR without any hint of the fact that MU was coming — coming with money, penalties, and constraints. Many completed the implementation only to learn that to meet MU they are not done, far from it. In fact, they have just begun modifying their implementations, and paying big time for those changes.
Those who started EHR early did so under the notion that their efforts were working in concert with an established set of business goals. This is the right way to operate. Remember, EHR is voluntary — really. By default, that makes meeting MU voluntary. There is no hidden directive that states all those who implement an EHR must meet MU. Not meeting it may subject your organization to penalties, and these should be factored into your ROI calculation.
Let’s assume you have, or are going to implement, an EHR system. For large providers, it is difficult to develop a business argument for not having EHR. Now assume that MU does not exist. We already have seen examples of how having MU impacts HIT strategy, how would not having to plan around MU impact your EHR and HIT strategy? What other projects would be at the top of your list? What initiatives could you own if you did not shuffle resources away from your preferred strategy simply to chase MU? Instead, would you be addressing patient and physician churn? Implementing managed services opportunities? Aligning workflows? Developing a social media platform?
There is nothing wrong with assessing what you would be doing to support your hospital if there were no Meaningful Use. You can and should undertake that assessment and calculate its ROI. Then, instead of having a lone MU ROI, you have something else against which to compare it.
healthsystemcio.com » Blog Archive » What Would You Do Without MU?
Paul Roemer, Managing Partner, Healthcare IT Strategy
I was wondering how CIOs would approach the implementation of EMRs if they had never heard the term Meaningful Use. The more I thought about the question, the more I felt it merited discussion. If I were a CIO, I would not let these outside regulatory influences dictate my strategic decision making. As a member of the executive team, my responsibility is two-fold; to facilitate and improve patient care, and to contribute to the business as an advisor, someone whose actions positively impact the bottom line.
Some CIOs have been forced to abdicate their responsibility and to approach EHR as order takers. Sometimes the CEO/CFO/COO creates a directive mandating EHR. That said, their guidance may end. In other, more problematic cases, it doesn%u2019t, and they also supply the name of the EHR vendor that must be used. The worst reaction to this pressure is to not challenge the issue of whether your organization will attempt to meet Meaningful Use. The concept is much more novel than it may appear.
What if Meaningful Use didn%u2019t exist? Many hospitals undertook EHR without any hint of the fact that MU was coming %u2014 coming with money, penalties, and constraints. Many completed the implementation only to learn that to meet MU they are not done, far from it. In fact, they have just begun modifying their implementations, and paying big time for those changes.
Those who started EHR early did so under the notion that their efforts were working in concert with an established set of business goals. This is the right way to operate. Remember, EHR is voluntary %u2014 really. By default, that makes meeting MU voluntary. There is no hidden directive that states all those who implement an EHR must meet MU. Not meeting it may subject your organization to penalties, and these should be factored into your ROI calculation.
Let%u2019s assume you have, or are going to implement, an EHR system. For large providers, it is difficult to develop a business argument for not having EHR. Now assume that MU does not exist. We already have seen examples of how having MU impacts HIT strategy, how would not having to plan around MU impact your EHR and HIT strategy? What other projects would be at the top of your list? What initiatives could you own if you did not shuffle resources away from your preferred strategy simply to chase MU? Instead, would you be addressing patient and physician churn? Implementing managed services opportunities? Aligning workflows? Developing a social media platform?
There is nothing wrong with assessing what you would be doing to support your hospital if there were no Meaningful Use. You can and should undertake that assessment and calculate its ROI. Then, instead of having a lone MU ROI, you have something else against which to compare it.
Tags: Blogs, Paul Roemer
This entry was posted on Saturday, February 20th, 2010 at 3:28 PM and is filed under Acute EMR, Ambulatory EMR, Meaningful Use. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
Do you believe Meaningful Use is best for you?
The area was cordoned off with yellow crime scene tape. Crime scene investigators searched the trampled grass, careful so as not to disturb the evidence. People and horses craned their necks to watch. The lead investigator knelt and retrieved a small piece of shell with a pair of tweezers. It looked like the dozens of other pieces they had already collected. The yolk was congealing at the base of the wall.
On the other side of the wall, a rookie patrolman noticed shoe imprints in the wet earth.
“Humpty-Dumpty was pushed,” he yelled to the lead investigator.
Humpty-Dumpty didn’t fall. Even long held beliefs can prove false. Not everything is the way it seems. Just because you believe something is true doesn’t make it so. Ask the Flat Earth Society; ask the people think the moon landing was faked. Sometimes it just requires a little more thought.
Sometimes you need to be the needle in the haystack. There’s not much value in being the hay.
Just because everyone believes chasing Meaningful Use is the right thing to do doesn’t make it so. This is not a cause and effect relationship. The belief seems to be that meeting the standards set by the CMS is the best metric for determining the value of your EHR. Wrong. They are only the best metric for determining if you will be receiving incentive money.
Believing something doesn’t make it true. Ask the person who pushed Humpty-Dumpty.
Pale Rhino Consulting 