You provide the caption, I am not that foolish
I think the only criteria 4 years from now will be interoperability. It will decide who collects stimulus money. My opinion–I think meaningful use and certifiable will be moot points because it won;t be possible to implement anything that doesn’t work.
Not sure what that does for those who have apready implemented.
Margaret Thatcher said, “Anyone who finds themselves on public transport after the age of 26 must consider themselves a failure.” There’s probably some sort of corollary for anyone twice that age that spends part of every day writing to imaginary people on the web and believing it makes a difference. The good news is that I don’t hear the voices as much as I used to–sometimes you just have to end with a preposition.
When I write I like to pick a side and stand by it instead of standing in the middle of the road where you can get run over by the traffic from both sides. Likewise, I don’t look for consensus around an idea. Consensus is the process of everyone abandoning their beliefs and principles and meeting in the middle. When was it decided that meeting in the middle is beneficial? So, achieving consensus about a problem is nothing more than that state of lukewarm affection one feels when one neither believes in nor objects to a proposition.
Having this approach to solving business problems tends to yield a high number of critics. I don’t mind critics; those are the same people who after seeing me walk across a swimming pool would say that my walking only proves that I can’t swim–which if you’ve seen me training for the triathlon wouldn’t be far from the truth. I rather enjoy it when someone offers a decidedly personal attack on something I wrote if only because it means they can’t find a legitimate business principle on which to base their argument. I love the debate, and I don’t expect anyone to agree with me just because I say it is so, although if one or two of you did that would be nice.
In trying to promote a different way of looking at the EHR decision, I’ve learned that it’s not possible to lead from within the crowd. The as-is was created by history, by followers. The future will be created by someone who believes it can be done better. I believe firmly in the notion that implementing an EHR without understanding your specific business problems need is like trying to cure a cold with leeches.
My best – Paul
I’m having one of those days where it feels like I just fell of the turnip truck and I don’t even like turnip.
I have an idea–ok, quit laughing. I am sure somebody somewhere has expressed this idea, however, I haven’t heard it expressed. That, in and of itself, should probably tell me something about the quality of the idea. It’s way too simple to be executable.
Expressing it in the form of a question, it comes down to this:
Instead of rebuilding the entire healthcare system one bandaid at a time, why not build a program for uninsured like we do for elderly? Heck, why not add them to Medicare/Medicaid?
Has this been discussed somewhere?
My best – Paul
I was invited to share some thoughts on OpenEHR, please also share yours. Nobody will ever accuse me of being a technologist—there are those among us whose expertise is the application of technology, so if I hurt myself trying to convey an opinion, I trust you will correct me. On my best days I see myself as an ideaist, which according to Google makes me unique as they don’t think the word exists. Maybe that’s why I can’t see my own shadow.
If there are two camps, those who want to see EHR up and running, and those who want to see it running on their own software, in my opinion, OpenEHR is in the former.
Understand, I am not suggesting OpenEHR is any of the following. However, If correctly implemented and deployed, I think stretching the current OPenEHR model could be used in conjunction to:
Got carried away.
Now, good arguments can be made to explain away each of these. There’s always a long list of reasons why things can’t work. That’s the easy list to draft. If instead of suggesting why this couldn’t work, what would happen if we argued in the affirmative, to see if this is at all possible?
If it turns out that it’s not, I’ll take the 5th on my lack of technology expertise.
Are there things I should be doing on a nice Sunday instead of tossing out counterfeit intellectual chum over FIOS?
Sure, however my children are in Colombia for six weeks visiting their grandmother–the country, not the school–I can’t remember the last time the house was this quite. Already did my run, and pretended I could swim. Got Rachmaninoff floating through every room in the house. Somebody needs to yell, “Step away from the computer.”
My wife is in DC for the weekend–you really don’t care about any of this, do you? A guy weekend. Home alone, or home lonely–this is my 12-step program, you have to invent your own. Wearing those boxers with all the holes–stop laughing. The perfect weekend for football, but there are no games. It will probably all come down to a Clint Eastwood festival with cigars, body counts, and scratching. “Are you feeling luck today?”
I was excited to learn yesterday that a Harvard psychiatrist and teacher reads the bolg. However, now I’m afraid that these little missives could wind up as case studies in Abi-normal psych 101–so you think you know healthcare?
Once again you’ve gotten me off track. On a personal note…
We are all consumers of healthcare. We are it’s customers. Without us healthcare doesn’t exist. Rule number one in any business–Never reform the customers.
Missed that one, didn’t they? Here’s my thought on this–the audience took a collective sigh, and many of those at the back of the theater were seen sneaking away.
What is one of the most important factors for individuals when it comes to healthcare? You may disagree, but I think it comes to choice. The patient having the right to choose. The right to exercise some control, even if it isn’t real. I think a lot of the uproar about reform has to do with people not wanting to lose what little control they have.
It’s difficult to believe you even have the right to assert yourself when you think your life may be on the line. Laying in the back of the ambulance I knew I wasn’t having a stellar day. Those who say your life passes before you are wrong, what passes before you is the life not yet lived.
From the back of the ambulance, one has more control over who is going to cut their hair than they have over who is going to do their heart. When you’re flat on your back, the perspective is that the only things that may be left is your right to choose.
That’s a tad too somber for a Sunday, so let’s all fast forward.
The Term Death Panels is so negative, let’s agree to call them, “Are we going to vote you off the planet panels?”
Why can’t we all just get along?
This is where the battle win be won or lost, not in the NEJM, not on Meet the Press.
Presidents are almost omnipotent. They can; invade Grenada, go the the moon, and let GM fail. Some things require the support of the UN, some things happen in the dead of night.
The one thing presidents and Congress are learning is that you don’t mess with a mom being able to take her child in for treatment for an ear infection, even if that’s not what you’re doing. Right wingers, left wingers, middle wingers. The last time the country was so united on a single issue may have been when we jointly decided disco was dead–I still have my platform shoes.
A large majority are united; the informed, the uninformed, and the illinformed; united for many different, valid, and imagined reasons. That’s why this won’t pass. The message fgot away from them, and they won’t be able to get it back. They wanted a discussion, and they got it. It’s way past having to do anything with the facts of reform. It has to do with each person believing that no matter what their circumstances, their personal health is in jeopardy.
Have you noticed that there is not a single instance on TV of Joe or Janet the Plumber rallying behind reform and extolling the virtues of reform? Why? Because is’t not seen as being virtuous.
We’ve gotten it out of the think-tank stage and into the realm of Oprah and People Magazine. Thinking and good judgement have left the building.
My best- Paul
I’m just asking, but when push comes to shove, that’s what we’re talking about, isn’t it? Is that the one-page PowerPoint summary slide?
If so, doesn’t that push total entitlements to around 50% of the budget?
Let’s say for a moment that that’s the plan. If the real driving force behind the reform push is to make quality care available to those who don’t have it, do that. Let the government build a program for that segment, just like they did with Medicare and Medicaid.
Is it not easier to design a program for 45 million people than one for 350 million?
crayon physics
There are those who may suggest I am not a fan of healthcare. I love healtcare–it saved my life twice, really. I’m still a young guy, and I am grateful to be able to use the phrase, “My oncologist and my cardiologist” in the same sentence. I want others to be able to do the same.
Anyway. I think that what the administration needs right now is a good scandal, something salacious. Something to get this off the front page. What are the chances they–the ubiquitous ‘they’–will find some way to vote this through in the dead of night or while we’re all out shopping. Maybe we need a good wag-the-dog scenario. Who haven’t we attacked lately? I hear Greece is lovely this time of year.
With no disrespect meant to anyone, well maybe just a smidgen, we spent more time studying Travel-Gate and who killed Vince Foster than it took to write the entire reform legislation–I think it was the butcher with the candlestick in the library.
Does anyone know who wrote the pages? How come we aren’t asking questions of them instead of the talking heads?
This little muse, like most of my others, will be written using reverse Rube Goldberg logic—I just thought of that, but it seems to fairly represent how my synapses seem to fire. For those who don’t feel like googling—not sure what tense of the google verb that is—Rube is the person noted for making highly complex machines to perform the simplest of tasks.
There are things I can’t answer, and sometimes it makes me more than a little cranky. Like the other night. I am attending a board meeting for a non-profit. The organization is a youth sports association—soccer, softball—sports. There are sixteen of us. Adults. We meet more often than the US Cabinet Secretaries—I’m unsure about the capitalization, but it passed Word’s threshold. We manage a budget, which if divided amongst the board members, would pass for petty cash in most firms.
Big issues, big decisions. The meetings make me want to drill holes in my own teeth as was done to Dustin Hoffman in the movie, “Marathon Man.” We now have an agenda for each meeting. That was a huge effort. In my year on the board, we have never had a ‘no’ vote, not one; not even a ‘maybe.’ I’ve been tempted to vote no on several occasions just to see if anyone is paying attention.
So, Tuesday night we spent an hour trying to agree if I should be allowed to write a plan for the organization (on my own time); a few goals, and a few tactics to help offset out declining membership. I was going to call it a strategic plan, but we both know that would be unfair to the work ‘strategic.’ Sixteen adults. More than 64 years of college sitting at a warped Formica table who looked like we were trying to reach an agreement on the relationship between string theory and why the Chicago Cubs haven’t won the Series in a hundred years. They knew I was upset, but they couldn’t understand why, which upset me further—or is it further upset me? One of those split infinitive things. Have your editor call me.
So, here’s the punch line. This simple—simple may have multiple meanings in this sentence—group of people arguing minutia over such mundane affairs foretells the problem. I wanted to figure out how to squeeze the word mendacities into the sentence to go for a bit of alliteration, but it didn’t fit.
Do you see where I’m headed with this? Here’s the Rube Goldberg part. If grownups can’t pull together on simple things, pull together in a way that almost guarantees they will make a sound decision, how can they be expected to do so in much more complex matters like healthcare reform and EHR? Nobody is in charge, nobody is the decider. Can you name the person? Can you even name what it is nobody is in charge of? (Sorry for the preposition.) I can’t. Congress. A thousand pages in one house, a thousand in another. What’s a few thousand between friends? Do those people understand the issue? Not.
We have reached the point in the reform discussion where in the “Wizard of Oz” the Wizard instructs Dorothy to, “Pay no attention to the man behind the curtain.” The finish line is so blurred that we wouldn’t recognize it if it sat next to us at dinner.
EHR. There are valid business reasons for implementing EHR. Washington made me do it is not one of them. Stimulus money isn’t either. No standards. Plenty of intermediate stops along the way to a national network. The technology exists today to remove the middle man. The technology exists today to build one national EHR system instead of building thousands of them and then trying to give them the Elmer’s treatment—that’s glue, not Fudd.
EHR. Who will lead? I guarantee it won’t be vendor led. Steve Jobs told his people to build a phone with no buttons. Don’t you wish you were a fly on the wall in the coffee room listening to the reactions to that mandate?
EHR. What’s needed? A mandate. And a leader. A decider would also be nice. To the ninety-plus percent who haven’t attained EHR enlightenment—stage seven—you may be the lucky ones.
I could be wrong about this—I was wrong on a Tuesday once—but within the next five to seven years I think we will have a national browser-based EHR that relegates the current EHRs to something akin to microfiche. So, if you’re in the process of building, acquiring, or implementing a nine figure fiche system, stop. Please. Ask yourself if you understand the business problem you think an EHR will solve. If so, go forward with caution.
If not, click your heels together three times and repeat after me, “Go Cubs.”
Pale Rhino Consulting 