Thursday, October 21, 2010


When I still had fewer candles on my birthday cake than teeth or toes or even ears, I was introduced to the concept of pencil and paper – well, initially, it was crayons and paper. I have only the foggiest of recollections, but I’m told it was a similar introduction scenario to the classic “Fish Meets Water.” Pretty soon, the walls next to my crib – once I had mastered the art of the tape dispenser – were covered with masterpiece piled upon masterpiece. My thoughts, expressed graphically, flowed as freely as the breeze. (I was going to say “as freely as the urine within my diaper,” but maybe only other pediatricians would think that semi-amusing.)

A few additional teeth later, I was introduced to the slightly more difficult chore of organized and standardized pictograms known as “letters” and two of the three “Rs.” It took a while, and I had a more spongey-esque brain, but within less than a year or so I was a’readin’ and a’writin’ to my little heart’s content. And, of note, the ROI hasn’t been matched by anything else in my life except perhaps the art of breathing (which was also pretty easily mastered.)

Time travel out of the Stone Age and here I am with a staff that has just spent over five years (and their boss who has spent oodles of dollars in the process) finally starting to feel pretty comfortable with a much less standardized and drastically less organized part of the “healthcare information management” system. And, now, that part of the system – our EHR of choice – is getting shut down.

Not that our particular EHR is bad or that it doesn’t meet certification criteria or anything that would imply it was not up to HIT snuff, not at all. It’s actually very technologically savvy, often called a very “sexy” system by HIT folks in the know. No, it’s just that the whole, bigger picture HIT schema is about as well thought out as Saddam’s claim of WMDs.

Virtually no standardization exists in HIT, not even something as simple and as helpful as a standardized way to display laboratory data (which, for all you tech-heads out there looking for a great idea to incorporate into your next version, is something that would really, actually help providers deliver better, faster healthcare.) Far too much emphasis has been placed upon the data capture for the Inscos or the profit margin of the vendors and far too little has been given to the actual users of the tools.

And, now – especially now that there are HITECH chum-churned waters filled with every size EMR-sales-shark you can imagine threatening that if you don’t get on board right away, the boat’ll be gone and you’ll be paddle-less up Poop’s Creek – now we’re all being told we have to learn to use these typically less than elegant tools that are often cumbersome and non-intuitive – STAT. To borrow (and then bastardize) a nautical phrase, in many quarters it’s “Providers be damned; full steam ahead!”

Add to this the almost almighty power of the HIT vendor executives (quite often more MIT Sloan’ers than Harvard Med-ites) making shareholder or financial positioning decisions which may empower the bottom line while castrating the clinician and you have a situation likely to end with a medical navy full of provider pirates all running around, as I am right now, shouting “Arrrrrggggh!!!” all day long rather than the standard, and gentler, “Say, ‘ah’” …or maybe, “bend over,” depending upon your specialty.

That’s it! I sorta feel like a proctologized pirate these days. (And, by a fellow Rotarian…double Arrrggh!)

From the swarthy trenches, matey…

“Even pirates, before they attack another ship, hoist a black flag.” – Bela Kiraly