Life in a Little Trench or Supply Side HIT

A “grunt in the trenches.” That’s a term I’ve used to describe who, what, and where I and thousands of healthcare providers like me are, occupationally speaking. It is probably a different perspective than many you’ll see on these pages. Please allow me a moment to offer a few descriptive moments to sketch out that picture a bit more.

• I’m a solo pediatrician in a small town (pop. ~9,500) in the rural flatlands of central Ohio.
• I’m on call for neonatal emergencies and C-sections 24/7/365.
• I love living in and serving my small community; I’m the medical director for the county health department, a member of the town planning commission, a local United Way board member, a Rotarian, a member of the local hospital Foundation Board, and have a spot on our town’s Bicentennial planning group.
• In the last three years, my true “vacations” have totaled 3 days.
• Our busy little practice serves a rural populace: about 65% of our families are Medicaid.
• I locally host our EHR on two servers and am it locally as far as IT for our office.
• My three wonderful employees started off almost fully computer-illiterate. (OK, one knew how to turn a computer on, one didn’t, and one called the mouse a “duck.” Seriously.)
• I spent hours upon hours researching more than 200 EHRs, demoed scores of systems, and went into deep detail on the finalists before deciding upon an EHR for our office.
• Life in my trench includes traffic “jams” of six cars and friends who know me before I’ve ever seen them. It allows for a trip to the post office, a bank deposit, picking up a prescription from the pharmacy, grabbing a forgotten paper from my home, and being back to the office, literally, in less than twenty minutes. There are Scout meetings, sports, school functions, and homework. I insist upon family time and some (admittedly brief) down time.
• I don’t miss big city life in the least.

I’m not offering this description to glorify myself nor anything I do. Rather, I am a very run-of-the-mill, small community, primary care physician. There are thousands more like me out there, working hard to care for our communities and families. We have wonderful, fulfilling lives and enjoy our labors.

There is, however, something missing from our great little lives. We need inclusion in this great big HIT discussion going on. With very few exceptions, nobody’s talking about us – even though we serve the majority of U.S healthcare needs. Systems and plans are almost completely focused upon the Mayos, the Clinics, the HIEs centered around giant centers, etc. Doesn’t anyone care about all us little grunts out in the frontline trenches?

It seems most everyone’s focused on the big guys and their bigger pools of money. Even the purported Keynesian liberals in political power now seem to be counting on the “Trickle Down Effect” (or its precursor, the “Horse and Sparrow Theory” from the 1890’s) to spread HIT from the big centers to all us little guys. Last time it was the conservatives telling us grunts how well we’d all be served by supplying the big boys’ side and letting us little fellows feed off the crumbs that fell.

OK, so that was finance, not healthcare IT. I suppose it’ll work better this time.

First posted on HIStalkPractice.com, May 27, 2009.