Patient Relationship Management (PRM)-why men can’t boil water

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There was a meeting last week of the scions of the Philadelphia business community. The business leaders began to arrive at the suburban enclave at the appointed hour. The industries they represented included medical devices, automotive, retail, pharmaceutical, chemicals, and management consulting. No one at their respective organizations was aware of the clandestine meeting. These men were responsible for managing millions of dollars of assets, overseeing thousands of employees, and the fiduciary responsibility of international conglomerates. Within their ranks they had managed mergers and acquisitions and divestitures. They were group with which to be reckoned and their skills were the envy of many.

They arrived singularly, each bearing gifts. Keenly aware of the etiquette, they removed their shoes and placed them neatly by the door.

The pharmaceutical executive was escorted to the kitchen.

“Did your wife make you bring that?” I asked.

He glanced quickly at the cellophane wrapped cheese ball, and sheepishly nodded. “What are we supposed to do with those?” He asked as he eyeballed the brightly wrapped toothpicks that looked banderillas, the short barbed sticks a matador would use..

“My wife made me put them out,” I replied. “She said we should use these with the hors d’oeuvres.”

He nodded sympathetically; he too had seen it too many times. I went to the front door to admit the next guest. He stood there holding two boxes of wafer thin, whole wheat crackers. Our eyes met, knowingly, as if to say, “Et Tu Brutus”. The gentleman following him was a senior executive in the automotive industry. He carried a plate of freshly baked chocolate chip cookies. And so it went for the next 15 to 20 minutes, industry giants made to look small by the gifts they were forced to carry.

The granite countertop was lined with the accoutrements for the party. “It’s just poker,” I had tried to explain. My explanation had fallen on deaf ears. There is a right way and a wrong way to entertain, I had been informed. Plates, utensils, and napkins were lined up at one end of the counter, followed in quick succession by the crock pot of chili that had been brewing for some eight hours, the cheese tray, a nicely arrayed platter of crackers, assorted fruits, a selection of anti-pastas, cups, ice, and a selection of beverages. In their mind, independent of what we did for a living and the amount of power and responsibility we each wielded, we were incapable of making it through a four hour card game without their intervention.

I deftly stabbed a gherkin with my tooth pick. “Hey,” I hollered “put a coaster under that glass. Are you trying to get us all in trouble? And you,” I said to Pharmacy Boy, “Get a napkin and wipe up the chili you spilled. She’ll be back here in four hours, and we have to have this place looking just as good as when she left.”  I thought I was having the neighborhood guys over for poker; I was wrong. So was each of the other guys. We had been outwitted by our controllers, our spouses. Nothing is ever as simple as it first appears. We didn’t even recognize we were being managed until they made themselves known.

Who’s managing the show at your shop, you or the patients?  The answer to that question depends on who owns the relationship, who controls the dialog.  If most of the conversation about your organization originates with them, the best you are doing is reacting to them as they initiate the social media spin, or try to respond once the phone started ringing.  It’s a pretty ineffective way of managing.  It’s as though they dealt the cards, and they know ahead of time that your holding nothing.

There are times when my manager isn’t home, times when I wear my shoes inside the house—however, I wear little cloth booties over them to make certain I don’t mar the floor.  One time when I decided to push the envelope, I didn’t even separate the darks from the whites when I did the laundry.  We got in an hour of poker before I broke out the mop and vacuum.  One friend tried to light a cigar—he will be out of the cast in a few weeks.

Be afraid. Be very, very afraid.

Patients are issuing RFPs for healthcare services

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The following is my latest post for healthsystem CIO.com.

If a patient fell in the woods and nobody heard him, so what?

I’ve spent a lot of time trying to understand what a patient is worth to a hospital over a period of let us say five to ten years. Simply put, what is the ROI of a patient?  Apparently, no one has answered this question. If they have, the answer is well hidden.

Why are hospital marketing departments continuously searching for new patients when they already have access to a ready supply of past and current patients?  It will always be much cheaper to retain those patients, than to try to acquire new ones.

Patients are both customers and consumers. Unless the patient is in the back of an ambulance being driven to the nearest hospital, as I was the night I had my heart attack, the patient can choose which hospital to purchase services from.

Choice. If I wish to “hire” a healthcare procedure, how might I go about doing so?  This concept of a customer hiring a product or service comes from Harvard’s Clayton Crhistensen.  It flies in the face of how businesses, hospitals included, normally view their business.  It employs a pull model, driven by patients (customers), rather than pushing services down to the customers.

The entire healthcare provider model is being turned on its head and the only people who do not acknowledge it are those running the hospitals.

Hospitals replicate each other’s services instead of making themselves unique.  They sacrifice and outsource their highly sought, low margin services to other organizations that are able to quickly raise the profitability of those same services.

Let us examine this notion of hiring a service from a more easily understood example.  If I want to “hire” a large HDMI flat-screen television I issue an RFP (Request for Proposal) to the market.  I do not walk into Best Buy and see what they have to offer and repeat this process across several chain stores.  I go to the web, input my hiring criteria, obtain information, and evaluate my options. Through social networking, I force vendors to submit their RFP responses to me.

For some reason the large provider business model continues to operate under the premise that healthcare can treat people who research options before making a purchase as an anomaly.  They approach patient acquisition as though they still have the keys to the car, having their chief marketing officer authorize the installation of billboards touting their urology expertise, believing incorrectly that this type of direct marketing will offset patients’ ability to choose their own provider.  Look at your numbers.  Does that approach appear to be working?

Of course not.

Patients want to hire healthcare services the same way they want to purchase breakfast cereal. Patients want to own the hiring decision.

When I had my heart attack eight years ago, I wasn’t able to choose among hospitals. I could not tell the ambulance driver, “My insurance does not cover this hospital.” I could not tell him, “I’ve heard good things about the cardiology department at hospital ABC.”

After being treated, I issued an RFP for cardiovascular services.  I did considerable research and decided to hire my cardio services from Penn Medicine.  I now hire all of my cardio services from Penn, and my decision had nothing to do with which organization was covered by my insurer.

The large provider business model is being disrupted. It is being disrupted by prospective patients—consumers of healthcare and customers.  Providers will be faced with patients who hire their services under two new models; “pay as you go” and “pay for performance.”

When you have a few minutes, Google your name-brand hospital. You’ll get thousands of responses. Almost all of them have been initiated by current and prior patients.  Many of the responses will not convey a positive message.

The healthcare market is changing to a patient-driven model. But nothing the C-suite is doing acknowledges that shift. Large providers fail to recognize the fact that patients are doing the hiring, that patients are issuing RFPs. No hospitals take a business approach to maximizing the life time value of a patient. In fact, no hospitals can even tell you the lifetime value of a patient.  Yet the lifetime value of an individual patient is probably seven figures.

Instead, the business strategy of most hospitals is to replicate the business strategies of their competitors.  Few hospitals appear to operate strategically.  They operate against budgets because that is how their boards measure them. If the hospital next door buys a machine that goes “ping,” hospitals feel the need to purchase the machine that goes “ping,” even though it adds no value to their bottom line.

Whether or not hospitals acknowledge it, patients are now driving the business model. Each patient, or prospective patient, is an asset—not the MRI and not the machine that goes “ping.” Each patient/asset may be worth more than a million dollars.

Hospitals need to get beyond the magnificence of their own credentials. Prospective patients do not care about marketing or billboards. Patients, especially informed patients, are narcissistic; they care about themselves, not how providers market their services.

There is one thing, and only one thing, about patient experience management that the C-suite needs to understand. Patients are learning to hire healthcare from among a range of options. If you want them to hire you, you have got to give them a reason to buy. Being like the hospital next door is not enough.

I am convinced IT can play a substantial role in providing former and prospective patients the information they need to drive the hiring process to their organization.  It is a combination of churn management and patient experience management, and the experience which has to be managed starts before the patient hires its provider.

 

Pigeon Project Management Office (PMO)

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I just finished stacking two cords of wood, much like a squirrel getting ready for a long cold winter. My feet were doing the “Boy is it cold dance” in an effort to keep the blood circulating.

As I was picking up the scraps, my eldest picked up a piece and placed it in his backpack. When I asked him what he would do with it he told me he was going to carve it after school. His statement brought back boyhood memories of hours of whittling, an activity done if for no other reason than to get from one minute to the next. Grab a stick and whittle it away until there was nothing left.  What next? Grab another. The weight of the pocketknife felt equally good in my hand as it did in my pocket.

When is the last time the thought of whittling crossed your mind? Probably been a long time. It’s an activity meant for idle minds and hands, or minds that should be idle.

Speaking of idle minds, there are times I find myself questioning what value so and so brings to the party. Do you do that?  “Why is she in this meeting?”  You know who I mean. You’re sitting there trying to get your work done and all of a sudden, some Mensa wannabe with more idle time on their hands than a Lipitor salesman at a BBQ cook-off, makes an aerial assault on your cubicle like a pigeon on a Rodin bronze.  Drops in and changes the rules of the universe, at least your universe.

This happens more often than is documented on large healthcare IT projects.  People set new courses and define program rules that may have nothing whatsoever to do with the project’s charter or scope.  You do have a written charter and scope in the project office, don’t you?  If not, it’s easy to see how new directions and rules can be given a certain specious authority.

What’s the best way to handle this situation? Often these management Mensas are nervous about a lack of visible results and they need to report on something.  They may feel the need to be doing something, something resembling leading.  They don’t mean to interfere, and they believe that their little forays into the world of super PMO (Program Management Officer) will actually add value. You tell me, are they adding value, or are they preventing the team from sticking to the scope? There’s that irritating scope word again.  The next time you see one wandering aimlessly through the rows of cubicles, hand that person a pocketknife and a nice piece of balsa wood.  Although their efforts won’t add any value to what you’re trying to accomplish, at least it will get them out of the way for a little while.

The effect of healthcare reform on others

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Somebody had to do this, so it may as well be me.  Sometimes to bring clarity to issues, it helps me if I dumb-it-down.  Which got me to wondering, how would the whole healthcare reform debate play out with Mother Goose?  Here’s what I was able to learn from my interviews.

Jack & Jill went up the hill, Jack fell down, and learned Mother Goose’s insurance wouldn’t cover him because he’s not a real boy.  Having recovered, Jack was soon found not so nimbly jumping over the candlestick.  His charred wooden body is being sanded in an effort to heal the burns.  Not only is Jack not a real boy, he’s also not a candidate for Mensa.

They sent the Little Old Woman who lived in the shoe home with a can of Desenex because her AARP insurance had expired and Medicare told her she already used her share of the money.  Afterwards, she was interviewed by Planned Parenthood for an episode of “I didn’t know I was pregnant.”

And remember that tuffet upon which Little Miss Muffet sat?  It wasn’t the spider who frightened her away, it was the deductible she’d hay to pay to cover the rash she got.  She tried sussing out her own treatment using social media on WebMd.

Jack Sprat could eat no fat, but he forgot to disclose that when he completed his insurance application.  He now suffers anemia anonymously as his not so lean wife left him.

How about Peter Peter Pumpkin eater?  All that fiber blocked his colon—a little personal prevention could have saved him a lot of time posed in the Thinker position.

Mary and Little Bo-Peep had a little mutton for dinner which after having sat on the counter all day produced various toxins which were absorbed into their bloodstream.  This resulted in them being rushed to the Mother Goose Clinic with a case of food poisoning.

Simple Simon met a pieman who knew nothing of pasteurization.  Simple is sitting three seats away from Mary in the waiting room.  The Clinic has been unable to locate either of their records on their EHR which cost in excess of one hundred million dollars.

Old King Cole called for his pipe even though he had a severe case of sinusitis.  CVS was out of Z-packs, and home he went with just a tin of Prince Albert.

All the king’s men tried to make a meal out of Mr. Dumpty.  Several were to learn later that one can get Salmonella from eating a raw egg that had been tromped on by horses.

Pat-a-cake.  The baker’s man, not one for washing his hands before pattying his cakes, caused Tommy to be seen by an internist.  Apparently neither real men nor cartoon men wash there hands.

The Butcher, the Baker, and the Candlestick-Maker, were being treated for nontuberculous mycobacterial disease for poor hygiene having been found bathing together.

It was reported that Georgie Porgie who’d been kissing girls had made them cry when they discovered they had contracted the herpes simplex virus.  Their mother, embarrassed by the turn of events, reported to the school that her twins were out with the H1N1 virus.

The Three Blind Mice were found to have stitched themselves together after unsuccessfully trying to sew back on each other’s tails.  It was later discovered that the tails had been cut off by the Farmer’s wife with the Butcher’s knife.  The mice are suffering from septicemia.  The Crooked Man and Yankee Doodle are trying to ascertain why the Farmer’s Wife and the Butcher were later found hiding in the barn.  The Farmer’s wife is being treated with Effexor on an out-patient basis for clinical depression.  The Farmer was not available for comment.

It’s believed that Willie Winkie is suffering from a plantar wart after running through the town in just his nightgown.  Uninsured, he tried removing the wart with the knife he’d borrowed from the Butcher, only learn the knife had been recently use to amputate the tails of some handicapped mice.

Old Mother Hubbard, a spinster of questionable repute, upon learning that there were no bones in the cupboard for her dog Hannibal, began to get hungry herself.  She settled for a meaty broth, and fava bean soup, and a nice Chianti.  Polly was seen putting on the kettle.  The SPCA continues to look for Ms. Hubbard’s dog.

Is the term “Payor” healthcare’s oxymoron?

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One of the great things about fall is that as I prune back the vestiges of my virtual garden I am able to collect basketful upon basketful of overly ripe metaphorical tomatoes, perfect for tossing at aberrant analogies and inappropriate idioms.

It’s a curious time.  We give away money to the middle class and rich so they can upgrade their BMWs on the backs of the poor.  The feds market that idea as though that pittance will either jump start the economy, or to hide the fact that that the administration has managed to budget for a nine trillion dollar deficit gap over ten years.

By now we know there are no quick fixes, no magic formulas for fixing the economy.  Finding a formula that works will be more difficult than learning how to neatly fold a fitted bed sheet.

“Is it the essential paradox of the age of Obama that we have to destroy the village in order to save it, bust the budget in hopes someday we’ll balance it?” Nancy Gibbs, Time, September 9, 2009.

“It takes an idiot to raze a village.” Paul Roemer, today.

Congress is trying to decide what the final bill will look like without ever having read the first draft.  How will we know when they have something that makes sense?  Do we watch the Congressional chimney to see if the smoke is white or black?  Does that mean we have a bill, or is it simply that the chef burnt the Peking Duck?

Then there are the payors.  Get me started, or don’t.  We all know that one of the driving factors for reform is the behavior of the payors.  A friend asks—for full disclosure I note that she is one of “them”—why do people view health insurers differently from auto, life, or home owners insurance.  She was serious.

Here’s my take on the answer.  If the health insurance firms provided life insurance they’d be exhuming the deceased and trying to prove they weren’t dead.  Car smashed, get a check.  House leaks, get a check.  Die, get a check.  Need surgery.  Not so fast.  Let’s see if you’re covered for that.  If not, whew.  If yes, let our doctors decide if you really need the surgery.  It won’t cost you a minute of your time as our doctors don’t even need to examine you.  You see how this plays out?

It happened to me after my heart attack, albeit with my disability payor, sort of the evil step sister of the health side.  My doctor put me on six months disability, naturally, the payor declined to pay.  There doctor, who never examined me decided I was fine, at least that’s what their letter stated.  How do we know these doctors even exist?  Have they ever been seen in the daylight?

Most Americans don’t believe that insurance companies are interested in helping people.  They like us fine when people are payors.  They are much less fond of us when people become patients.  It’s a simple matter of flow theory.  As long as the flow of cash is in-bound, all is well.  When people move to the dark side, from payors to patients, payors have no patience.

Is there anyone who believes that there is a single payor in the country whose mission statement says anything about doing all we can to help those who need us?  Of course not.  Payors have claims adjusters.  What is their role?  It’s certainly not to adjust the payment higher.

Do payors incent their employees to pay out as little as possible?  I believe they do.  Do payors penalize or retrain people who pay out too much?  I believe they do.  Do they design the claims and dispute process so as to make it so cumbersome on patients and doctors that parties give up prior to settling?  I believe they do.

I believe the payor business model is not much different from that of tobacco companies.  For years tobacco firms claimed there was no public evidence to support the fact that nicotine was addictive.  It turns out they buried the evidence.  Payors claim they are not bad actors.  Some claim the moon landing was faked.

I am a firm believer that pictures can sometimes convey more than mere words.  To me, this link explains a lot about what’s wrong with healthcare.

http://www.youtube.com/watch?v=Z7Forzj5-O0 Start playing at 6 minutes and 40 seconds.

Patient Relationship Management–why patients and hospitals collide

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When universes collide, or is universi the plural? Not that is matters. I was watching NOVA.  The show focused on the lead singer of the Indie group The Eels.  The show walked through the singer’s attempt to understand was his father had done for a living.  His father was a physicist, in fact he was the person who came up with the notion of colliding universes. Colliding universes has something to do with quantum mechanics and cosmology—did you also wonder what makeup had to do with particle physics? In its rawest meaning, parallel universes have something to do with the notion of identical worlds living side-by-side, with no notion of each other, with differing outcomes from similar events. Got it?  Me either.

I’ll try to illustrate if for nothing else than my own attempt to understand. Let’s say I’m concurrently teaching my two sons to play two different card games, Poker and War. Poker, albeit a game of chance, is heavily rules-based—when to bet, when to fold, when to raise. On the other hand, War is purely a game of chance. The poker player likes rules and order. The one playing war—he’s seven—likes to win, and will do what is required to bring about that outcome. Each one plays independent of the other, using the tools at their disposal to direct the outcome of the game in their favor. They are oblivious to the goals and tactics employed by the person sitting beside them. Parallel universes.

What if we allowed these two universes to collide, to come into conflict with one another? For example, let’s say I have them play each other and I re-deal the cards, giving one the cards he needs for a poker hand, and the other the cards to play war. I then instruct them to play one another. The poker player becomes focused on the rules, and the one playing war has a laser focus on one thing—winning. The poker player quickly caves, knowing that he is engaged in a futile endeavor. This does not bother the other one whose only focus was to win.

Imagine if you will—sort of Rod Serlingish—two other games going on simultaneously, one team whose sole focus is winning, the other whose focus is on the rules. For the rules-based team there is no winning. The best they can ever hope to do is to measure up to the rules by which they are judged. Millions have been spent on technology to help ensure that adherence. Adherence to the rules will be monitored, recorded, reported, and measured. The rules-based team’s ability to continue to play the game will be based solely on how well they follow the rules. Now imagine that the universes in which these two teams are playing collide and these two teams play their separate games but against each other. One team having never been told how to win, never been instructed to win, never even given permission to win. The other team’s only purpose is to win.

This is a nonsense game. One we play every day.  One team is the hospital’s patients the other team is the employees who are tasked with patient customer care, patient relationship management (PRM).  The patients are focused on winning, those tasked with customer care or PRM are not permitted or equipped to win.

It’s possible for these two groups to change the outcome, to take away the nonsense.  To make that happen, the rules must change.  PRM can be very effective provided that it is designed to help the patients “win”, designed to facilitate favorable outcomes for patients.  The trick to changing the outcome is that the hospital must understand that a win for the patients in most cases is also a win for the hospital.

 

The EHR wore Prada: Stilleto Change Management

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I just returned from the Prada show in Milan. Not really—that was the opening line from a piece on NPR. Apparently this year’s runaway hit on the runways has to do with high heels, with the emphasis on the notion of high.

The following comes from the UK Telegraph: The girls looked like rabbits trapped in the headlights; their faces taut and unsmiling, their eyes wide with fear and apprehension. Were they about to undertake a parachute jump? Abseil down a 1,000ft mountain? None of the above. All they were doing was trying to negotiate the catwalk at Prada during this week’s Milan fashion shows in shoes that were virtually impossible to walk in. At least two models tripped and fell on to the concrete floor; others wobbled and stumbled, teetering and tottering, clearly in agony, and all the while their minds were fixated on just one thing: reaching the sanctuary and safety of the backstage area without suffering a similar fate.

According to the NPR reporter, the heels are so high that regular people—women people that is—can’t seem to walk in them without falling. This problem has led to the creation of an entirely new micro-industry. In L.A. and New York, there are classes to teach ladies how to walk in very high heels without hurting themselves. These classes are being offered through dance schools that couldn’t fill their dance classes—they are now booked solid.

Tell me this isn’t the same as trying to walk and chew gum at the same time. Multitasking. Now before I make fun of some thirty year-old that has to relearn how to walk, let us turn our attention back to those dancing—cum—walking schools. From a consultant’s perspective what makes this story interesting is that those businesses saw a need and re-engineered a part of their operation to meet that need, sort of like we’ve been discussing regarding the impact EHR and reform can have on your organization.  With the implementation of EHR, many things will change.  If they don’t require change, you probably wasted your money on the EHR.  What’s important is having a plan to define the change and manage it.  Rework work flows, remove duplicated processes and departments.

Now I’m going to go saw the heels off my wife’s shoes before she hurts herself.

 

EHR: How to purchase an EHR

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Are you really going to where that?  Do these pants really make my…

Did you ever have one of those non-halcyon days when you felt the need to ask someone “Did a house fall on your sister?”  Try to stay with me, it will come to you.  Enough about falling houses Toto.

I sought the counsel of a friend before heading down this path, and I’ve decided to choose the road less traveled anyway.

I may have written that I have observed differences between men and women.  You too?  Here are a few examples from my side of the gated compound.

  • We are willing to make mistakes as long as someone else is willing to learn from them
  • A good excuse is almost as good as getting it right
  • Good intuition will often make up for a lack of any facts
  • We refine our personality flaws, for without them we may not have a personality
  • Peter the Great heard the voices too

I regret that I am unable to share my list about women, for I am a coward.

While shopping the other day, I noticed that women shop for clothing differently from men.  For women, shop is a participatory verb—whatever that is—involving all twelve senses, for men it’s something we’d rather do online while watching the game.  From what I’ve observed, in fostering the she-conomy women:

  • Do their homework—what’s in, what’s not, what’s on sale
  • View shopping as a competitive sport, for some, a blood sport
  • Try on things, often more than once
  • Buy something they may need in case they someday find some other thing they may need that may go with it
  • There is no rule about having too many shoes—buy in volume
  • There is no rule about having too many black shoes

So, let’s see if we can segue beyond this jingoistic tractate on one to something more in line with the lofty subscription fee you paid for this site.

Permit me to employ two definitions which help me keep my ideas cogent.

  • IntraEHR—EHR statements that relate mostly to the healthcare provider
  • InterEHR—EHR statements that relate mostly to the movement  or transport of the EHR record from point A to point B

EHR and shopping.  Can one be at one with this duality?  How can one not be?  From having spoken with a number of healthcare providers about their IntraEHR selection, my take on a lot of the process is that more often than not there is no process.  It’s a lot like watching men shop.  It’s over and done with without much reasoned or substantiable—I was afraid I’d have to invent this word but I found it on Google—thought.  Over and done with, now back to the game.

Maybe EHR scholars will one day be able to trace speed buying of IntraEHRs back to that whole Neanderthal hunter gatherer thing in the Pleistocene epoch.  Sort of a think fast on your feet or you’ll be eaten approach to software selection—an awful metaphor, however CNN ran a feature with that title, so it has some legitimacy.  Maybe the hospital’s executive committee will be able to trace the hastily made IntraEHR purchase back to a lack of a plan, the lack of business requirements, and the lack of an adequate request for proposal RFP.  Maybe your successor will figure it out.

For those who haven’t contracted for their IntraEHR, it may be better to approach this like a woman.  To those who are women—you should know who you are—you are probably already approaching it that way.

Now, where did I leave my black pumps?  And no, I am not going to finish my thought about the pants.

How healthcare reform could be made to work: Fantasy Healthcare

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What if we create fantasy-healthcare.com?  It could work a lot like fantasy football.  Annual registration fees must be paid prior to the fantasy draft, and may be paid at healthcarefantasy@paypal.com. Participants will have to participate in the annual draft from the pool of available doctors and specialists, and will be limited to two specialists per person, five for a family.  The same process will apply for selecting a hospital.  If your choice is no longer available when it’s your turn to draft, you may submit another bid, or offer to trade with another member.  Each trade will cost you one thousand Healthcare Points.  Additional points may be purchased at the Public Option web site, www.we’vegotyoucovered.com .

You may purchase fantasy insurance to protect your fantasy-healthcare investment.  In the event your doctor is sued or retires, you have the right to pick one of the doctors provided they are in the same or lower price category. For those who are concerned about the possibility of disputes, we have created www.fantasyhealthcaredisputes.com.  You and your provider submit your arguments online, and the winner will be notified on-line.  Additionally, we’ve added a new feature this year to help you understand your medical costs and bills, www.fantasyhealthcaremath.com.  Join now, or take the chance that there may not be any doctors left within a three-hour drive from your house.  Good luck

Revising patient interactions via social media and CRM

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For those who don’t have time for 140 characters, or who don’t have much to say, I’ve created an alternative, smidge.com. The Urban Dictionary defines a smidge as a small amount of something, short for smidegeon.

This will revolutionize the interaction between patient/customers and the healthcare provider. We all know how annoying customers can be. Why should providers continue to enable bad behavior? They call, fax, email, and tweet. Enough already.

It’s time providers show a little backbone, show the customers who’s in charge.

Here’s how smidge.com works. Each time a customer interacts with you, give the patient their smidegeon account. Explain to them that this is their private way to communicate with you. It’s instantaneous, totally secure, and it operates 7 x 24 x 365. No more navigating IVRs, no more being placed on hold, no longer will they be transferred to another agent, never again will they be monitored for quality control purposes. Let the customers know that anytime they want to smidge, the world is theirs.

Explain to them that you are doing away with archaic forms of interacting; closing your call centers, throwing away your fax machines, and deleting your presence on the web. What are the advantages to your firm? They’re almost too many to document. Think of the capital savings. No more IT expenditures to support those millions of whining customers. No more CSRs complaining about not being allowed to browse the web, or about not getting their mid-morning break.

And now for the best part. In order to minimize bandwidth and storage costs, each smidegeon only allows the user to use each letter of the alphabet one time, meaning the largest smidge can’t exceed 26 characters. The longest message one could get is, “The quick brown fox jumps over the lazy dog”.  That being the case, there will no longer be any justification for the customer complaining that your company didn’t resolve their problem.The roles will be reversed. The upper hand will now go to the company.

How? Let’s look at an example. The patient wants to smidge the following change of address information, “We are moving on October 13 to 1175 Harmony Hill Road, Spokane, Washington. Please forward our bill.” Since smidges don’t allow numbers, we’ve already simplified the message, and the ease of entry. Now, if we translate the message into a correctly formatted smidegeon, we get the following message, “We ar moving ctb Hny l d Spk f u b d.” Now, how can you be expected to understand that kind of nonsense? If you can’t understand it, how can your patients possibly blame you