Saturday, February 28, 2009

Chumming the Sharks

Did you happen to catch the Mythbusters episode where, off the coast of South Africa, they chummed a shark feeding ground at breakfast to see if a dolphin could deter these ravenous beasts from chowing on a helpless little seal? (Don’t fret, PETA people, both the seal and dolphin were manmade.) The fake seal was always chomped within seconds without its mammalian mate, but whenever it was in the water nearby, the incredibly real-looking robo-dolphin was 100% effective keeping the sharks at bay.

Well, I waste your time discussing a T.V. show because I see an ominous analogy.

As you well know, Obama has now set his signature to the Grand Economic Stimulus Package promising over $19 billion dollars to healthcare info tech (not to mention the 100-some billion for CMS, et al.) Even before the pen hit the paper, you could see the HIT waters churning with the frenzied maneuverings of all the “sharks” scurrying to see their version of healthcare digitization fed. Since the signing, the “seas” have been virtually bubbling with their voracious intrigues. (Imagine what’s happening behind the scenes if we can see this much commotion above the surface!)

Me? I feel like one of thousands of helpless little seals swimming along, looking for my buddy Flipper to keep my fur firmly affixed to my hide. The giants of this sea – big centers, big RHIOs, big HIEs, big insurance, big EHR/technology vendors, and big governmental groups – are all thrashing about, stirred by the perceived problem-solving chum of the Obama bucks.



Here I sit, in my little town, in our little community hospital, knowing full well that virtually all of the solutions the sharks are promoting are oriented toward the big boys in the big cities in the big centers. All the while, they ignore that nearly 70% of the NHIN will be comprised of small communities, their associated small hospitals, and their affiliated docs. We, the seals of the U.S. healthcare information technology world, desperately need a dolphin to help us avoid becoming the aftertaste of the sharks.

Maybe Barry (did you know Barack was called ‘Barry’ in college?) and company could be our dolphin. We don’t need all the HIT bells and whistles the sharks are selling, just a little seal’s basic model. A truly end user-oriented, patient-centric but community driven solution, a little “HIT Mini Cooper” - if you will - for the MAJORITY of us, instead of one of those sharky Rolls Royce or Humvee big center/HIE/RHIO/CHIN thingies.

I have a plan for such a system which, for a relatively small chunk of the Stimulus Stash, we could implement for some 70% of the country and …

Aw, crap…did I just sprout big teeth and a dorsal fin?


First posted on http://www.histalkpractice.com/
, February 28, 2009

Up Next: “Official Grunt-in-the-Trenches Complete U.S. Healthcare System Overhaul and National Health Information Network in Five Easy Steps Disruptive Innovation Package




Thursday, February 5, 2009

Go Big by Thinking Small


I don’t know about you, but this whole economic meltdown has me worried. I’m worried for my family, for my little local hospital, for my little rural community, for my practice and the families we serve, for the future of healthcare...


OK? ‘Nuff said about my anxieties. On to a solution or two. (I hate whining. That’s for depressing, “poor me” chats over a beer or three. As the testosterone-laden male I am, I want to know the problem, sure, but mostly I want to know how we go about fixing it. So, now, where’s my toolbox?)

Speaking of my tools, history is one of my greatest wrenches. Utilizing the lessons hard won from days gone by, I believe you avoid silly missteps and can tighten up many a loose nut which you might otherwise miss. (Please hold your “loose nuts” comments until the end.) I also believe many “advanced” minds often overlook the power of historical context and reference.

Currently, I am praying daily that the new Obama administration folks don’t neglect their history lessons as they approach the absolutely monumental challenges before them. Recent HIT efforts/failures and the Great Depression can provide clues to some serious answers for our current healthcare, environmental, and even economic woes, if we heed their warnings.


With this in mind, I’d like to offer them an absolutely brilliant solution designed to:
1) Deliver the 70% of the population currently being ignored by most HIT project;
2) Enable the NHIN goal for all Americans, utilizing a tool we already have;
3) Minimize the impact of more technology upon the already strained electrical power grid;
4) Provide jobs and lower healthcare costs;
5) Stimulate PHR participation while providing a tax break to all, and;
6) Eliminate all forms of STDs from the entire planet.

Yes, just stretching it a bit on that last one, but drop dead serious about the rest. Kidding? Nope. Not even a little. While the naysayers out there will poo-poo such grandiose proclamations, if the rest of you will willingly suspend disbelief for a moment, I will explain, very succinctly, after two short points.

First, small communities and their associated community hospitals provide care for some 70% or so of the U.S. population. They have been virtually ignored by the past 25 years of HIT development. They’ve been awaiting the trickle down from big medical center/large regional/big money projects. It has been along, boring wait with no brass ring in sight. And now, the global economic crisis threatens them even more.

Second, the big boys and their big money mindsets are notoriously neglectful of the little people. Their big projects often don’t provide down-scalable answers that work well for smaller markets. However, as many a grassroots phenomena illustrates (recent evidence: Obama campaign,) starting with an answer from the little folks can absolutely engender big, even huge results for everyone.

Consider this:
1) Begin to build the national health information database using a system we already have. If they’re already planning to provide a tax break, build in an incentive for extra bucks for those who opt in and provide some basic demographics and maybe allergy history to a national healthcare database. Why not use the IRS? Who has more info on everyone already? (OK, CIA aside.) They already have a national electronic input forum; all you’d need is something similar to the check box they use for donating a dollar to the presidential campaign.
2) Develop a small community HIT mindset. Start with a system designed for the end user, a basic EHR/PHR combo that provides end user satisfaction and doesn’t try to compete with the big boys doing everything for everybody. Push this inward toward the hospital and outward toward the community at the same time allowing everyone in the community to go through the growing pains together. People are empowered by, and engaged with, their communities; use this to provide mass motivation to all of a given community’s doctors, hospitals, and individuals – all together, all at once. Patient-centered, but community-driven.
3) Use open source as much as possible. Save taxpayer dollars. (Sorry, all my HIT vendor friends.)
4) Associate green technology with HIT deployment. Every new computer component in every doc’s office, home, or hospital is going to add to the already overburdened power grid, not to mention add to electric bills we all have trouble paying. Offer incentives to add a solar panel or micro wind turbine for each new system, residential or commercial. It may not lower your heating costs, but it could offset any increase in power consumption.
5) Use small business incentives to develop small community employment to deploy, train, and service these new technologies. Provide jobs for people to help us ‘technologize’ healthcare, contain our energy demand, and create the real NHIN from the grasses’ roots up.

Think about it. If President Obama wants to spend $50,000,000,000 on healthcare information integration (I prefer that term to HIT as it places the focus more appropriately) over the next five years, how about this? The U.S.’s 2,000 or so small communities and associated community hospitals could start a basic whole community system for around 2-3 million dollars each (we’ve drawn up such a system.) Let’s say 5 million to be safe, so that’s 5 Mil times 2,000 totaling 10 billion dollars to achieve the foundation for a full 70% of the NHIN goal. Sure, it’d be the early Honda Civic version, but small towns don’t need Rolls Royces. (And, if you remember, the first Civic, more or less a box on wheels, turned into a pretty nice little sedan over time.) This still leaves 40 billion bucks for the big boys to squander...er, I mean use.

Large problems need gigantic answers. But that doesn’t mean it has to be from or for the giants. Little guys, in little communities, eventually all working together can generate huge solutions.

Don’t just throw money at the big boys. Go big by thinking small.



First posted on http://www.histalkpractice.com/, February 5, 2009.

Up next: Stone tools still work...or, maybe, sharks.