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Sam says...

A lot has been said about the impact of technology on HealthCare and how 50,000 HealthCare IT jobs will be created as part of the healthcare reform debate.

Let me share an example of the reality of what is occurring due to the utter lack of transparency coming from D.C. around HealthCare reform.

Healthcare organizations are planning to run lean in 2010.  While the quality and quantity of care will continue to be emphasized and of paramount importance, the much touted impact on HealthCare IT is a different story. 

Capital expenditures are being scaled back to the absolute critical projects – and even there hard choices are being made. Maybe you can wait another year for new hardware or the next version of software.

New HIT jobs are being scaled back or eliminated directly; the money, rightfully so, goes towards clinical service and quality first. Maybe you can just buy a third party product, if you can get a pricebreak.

Healthcare Organizations just don’t know and simply cannot divine from the offal of entrails they are being thrown from D.C. as to what the impact to their bottom lines are going to be – and keep in mind, most of them struggle to stay in the black, and what profit is made is typically reinvested, not sent to line any pockets. Further many of these organizations genuinely emphasize quality care of their customers (aka patients!).

Gone is the talk of decoupling insurance, patient choice, portability standards and tort reform, replaced instead with an obfuscated miasma from the swamp that is already having a negative impact on that which can bring about efficiencies – information technology.

If healthcare organizations, even healthy ones, are scaling back on IT now, what, one wonders will occur when it finally becomes a reality?

 

Filed under: HealthCare IT

Sam says...

In the process of designing and prototyping our Operational Data Store (ODS) for our Enterprise Products, we’ve noticed a couple of things that we expected but (vainly) hoped weren’t there.

First, a good number of our HL7 messages don’t follow documented standards closely. Most importantly, there are Z-segments (custom messages) in all sorts of places in a message instead of where they should be. This means our integration implementation has to be smarter and more defensive in handling these messages, such that the message transactions continue to flow when an unexpected or unanticipated message is consumed.

Second, we are replicating a lot of data with our HL7 messages. Say you change a zip code on a registration screen. You get the entire screen of data, not just the change, replete with whatever customized Z-segments. This means we’ll have some extra heavy lifting to do when consuming messages.

The key points here are two fold.

First, this is no one person’s fault – no one did a bad job – people work to their level of awareness.  What it does indicate is that HIT hasn’t evolved. We’re still making the same mistakes we’ve been making for the last few decades, and that is inexcusable.

Second, this only reinforces why HL7 and standard don’t ever belong in the same sentence.  It doesn’t matter than one vendor’s HL7 specifications may adhere to the standard, such as it is, the problem is that the HL7 message is too easily hijacked.  Z segments should be the exception, not the rule and they certainly shouldn’t cause a problem when it comes to consuming the message nor require defensive coding to accommodate it.

The only way this is going to be solved is if an alliance of HIT-centric entities, not vendors, not the government, work together to force industry adoption of standards and practices that are common place across most enterprises else. In short, HIT needs to evolve out of its current calcification by having the people that feel the pain the most do something about it

For our project needs, we knew these would be problems, we planned and allocated for them. For anyone else embarking on similar ODS or Data Warehousing projects in HIT – caveat emptor, a standard isn’t always a standard in HIT.

 

Filed under: HealthCare IT

Sam says...

Fair warning, this is more of an internalized discussion written down, appropriate caveats on misinterpretations apply.

While I feel that American Exceptionalism is being apathetically eroded into guilt-ridden mediocrity, this post is going to focus on the beginnings of a sort of depressing epiphany that I’ve stubbornly fought against for the better part of my nearly 2 decade career in computing, far preferring a bloody head over what I, personally, deem an ethical compromise of commitment.

Until now.

Based on personal observation and comparison of peer experiences, exceptionalism is neither encouraged nor rewarded in corporate computing.  I’m sure the odd corporate computing environment exists out there where this may not be the case, but a very odd duck it will be.

HealthCare IT, regardless of talks of reform and funding, sadly suffers from the same issue that cancerously gnaws at the heart of ingenuity and innovation in corporate computing, but writ larger.

Unfortunately, HealthCare IT seems to have further devolved into purchasing disparate solutions and cramming them into weak integration platforms, repeated ad infinitum with insufficient focus on first, defining the problem, then designing the solution, before creating or purchasing or integrating anything. The tumor has spread to the extent that few things seem possible without the intervention or resources of a third party vendor, from defining the need to delivering the solution to supporting and training.

We’ve achieved 100% de facto outsourcing! The counterpoint of course is that you have a body of knowledge workers who have been robbed of the opportunity to gain the knowledge they need to replace that vendor mentality.

Healthcare organizations: the consultants you want are the ones who will not sell you a single license or product until they have helped you define the problem and design the solution; expect to pay for their time.

Fundamentally, this is no one person’s fault, per se, nor should this be seen as an assignment of blame, but rather a general reflection that, for all the books, talks, discussions, groups, whitepapers and consultants, corporate computing will remain mired in a necrotic momentum that seeks to continue to survive instead of thrive and grow, learning the same wrong lessons from each ancestral generation and imparting it on to each successive descendant generations in situ. What mold-breaking successes that do come, stagnate and seem to not develop into behavior that can be consistently repeated.

In considering root causes, there is one key, very lacking, cornerstone. Accountability - the accountability that speaks to a pride in ownership and a desire to excel, to step up instead of cleave to the accepted status quo, in particular by those very same computing professionals. This isn’t just a management problem, this isn’t just a business problem.

There are many understandable, wholly justifiable reasons, mostly rooted in fear and lack of support, as to why this doesn’t occur. While the parable of the tortoise and the hare teaches that slow and steady get’s you there, I have to wonder if what’s missed is that the hare likely only lost the race once, then learned a valuable lesson and modified its behavior. That tortoise is welcome to that singular gold medal, hanging lonesome on its mantle, it’s only true testament that it lead to another’s success, another who wears shades from the overpowering brilliance of its accolades.

Now replace speed with accountability in the above story. Dig deeper and realize the other lesson here is that a lesson was learned and applied.

The lesson learned for me has been that it’s not for me to expect nor to demand, except in myself and those I lead, mentor or raise, a level of accountability that I hold myself to.

For me the this leads to my epiphany. I have defined myself by my work for the better part of two decades, the cornerstone of which is accountability – from which I am convinced all other things such as delivery, flows. I can no longer afford to do so, largely for my own sanity but also because of the perception this sets.  While I take at least half of the responsibility in setting that perception, it appears that the balance of the half remains looking for a home. Sound familiar? Yes, there’s accountability (or lack thereof) again.

So, where the balance of my career in corporate computing is involved, it would appear that a reset of expectations is called for and the balance to be sought is contentment, not satisfaction nor happiness.

The sub-conclusion here is that as risky as entrepreneurial endeavors’ are it would appear that my happy professional place is there, which leads me to considered thought on my future professional growing exercises. I’m still ruminating on that; been there, got the t-shirt(s), if I’m unwilling to return to that fertile ground …

Certainly, I will not allow qualities to neither suffer nor erode, instead, they will enjoy a tighter scope!

There is comfort in this, in a way; it’s the self-inflicted globe off Atlas’ shoulders. There’s certain liberation in looking forward to not being defined by work and expelling those same energies into other avenues too long neglected.

While this still has legs to run around and finish baking, I can honestly say that I am breathing easier now than I have in years.

I will, however, shed a tear, but not for myself, but rather for the endurance of mediocrity where it already existed rather than the desperately needed elevation of excellence.

The loss here, is not mine.

Filed under: HealthCare IT

A new study out the Agency for Healthcare Research and Quality (AHRQ) suggests that by excluding consumers from the broader implementation of health information technologies, the medical community is marginalizing themselves and prolonging the time it will take to reach high levels of consumer adoption. Just another reason to add to the list of flawed approaches/perspectives on information technology among health professionals, though quite possibly the one issue that if addressed effectively could make all of the other impediments to ubiquitous adoption of highly advanced IT systems evaporate in the face of overwhelming consumer demand.

Filed under: health care IT

A new survey released by the Massachusetts Medical Device Industry Council (MassMEDIC) and Cambridge Consultants, a technology product design and development firm, finds that a patient-centered and coordinated approach to healthcare could save billions of dollars. The survey also indicates care coordination will reduce wasteful spending in defensive medicine, inefficient claims processing, medical errors and emergency room services.

http://www.healthcareitnews.com/news/survey-connected-health-could-cut-healthcare-costs-40-percent

It makes little sense to me that the current debate in DC about health reform presupposes that the health care business is fundamentally unsustainable, as it has yet to adopt many of the most widely recognized enhancements in operational efficiency that have redefined nearly every other information intensive industry in America since the early 1990's. If 40-percent of costs can be trimmed without totally overhauling the system, which would leave 1/6th of our economy to exist in a vacuum for several years as we wait to see if our blind overhaul worked, I think this must be allowed to play itself out as it did in every other market. If any policy measures are useful at this stage in the modernization of health care, they are gradual, incentive-based measures that would help break-through barriers created within the medical community by undefined guidelines and a perception that such innovative activity would involve too much risk. Several programs launched through the stimulus package were a good start, but will be much less consequential if too much is done too soon by politicians focused not on patient care, but rather on their personal legacies.

Filed under: health care IT

Sam says...

I'll link here to a page which contains an email conversation, cleaned up and colored, of an email discussion between me and (apparently) a liberal around, well, many a topic.

We'll call her Miss Informed Liberal and I've colored her emails orange.
Call me Concerned American and I've colored my emails green.
Aside from some spelling corrections, I've left the content alone.

Read it from the bottom up.

The most telling part for me was the largely defensive, partisan tone she took and the lack of factual references or refutation of my references with facts of her own. Strikes me as a typical response from a liberal. To be fair, the conservatives also have their fringe, but I at least try to stay factual.

In as much a healthy shouting match is, in moderation, a necessary part of a healthy debate, it's also critical that what you are shouting is at least factual.

Ad Hominem attacks are never acceptable.
Enjoy ...

Filed under: HealthCare IT

The Obama administration is encouraging broader use of electronic records in the United States with the aim of reducing medical errors, eliminating redundant testing and saving money overall.

The $787 billion U.S. economic stimulus law signed by President Barack Obama in February, 2009 included $19 billion to promote adoption of health information technology such as electronic medical records.  With the push in automation, home health providers will have to make a choice in choosing the right software vendor that will meet their needs.

Unfortunately, almost all Home Health 'solutions' are more problematic than they are solutions.

There are vendors that target the smaller home health agencies by offering low-priced 'solutions' built with outdated technology that has surpassed its developer's end-of-life' notice and became a patch work of old and, some what, modern technology.  It's like buying a shiny computer with outdated spare parts that are hard to find because they are no longer being manufactured.  Would you trust your confidential patient records in such instability and uncertainty?  Would you compromise your confidential data?  Surprisingly, many agencies are unknowingly heading down this path...and they are paying for this 'technology'!  Does the cost-savings really outweigh the risks?

Then there are the 'big' software vendors who are raking in big bucks in offering costly and lengthy training sessions just to learn how to use and maintain their 'solutions'.  Installation and implementation could take 4 to 6 months - sometimes even more.  In the Home Health industry, time and money is not a luxury.

Some vendors boast offering 24/7 customer support - does it really require 24 hours, 7 days a week to support a 'state-of-the-art' solution?  The more stable and intuitive the solution, the less support it should need.

Because agility is an important factor in survival, the ideal solution is one that can be accessed anytime, anywhere, with the proper security to protect patient records.  With home health agencies being forced to be more efficient, the ideal solution should not require any specialized training such as complex installations and updates.  Many home health agencies cannot afford to have an in-house IT staff so the ideal solution must be virtually maintenance free. Furthermore, to get the clinicians on board and minimize resistance, the user-interface must have the look and feel that they are already accustomed to - paper forms.

Filed under: Healthcare IT

Healthcare ITNews reported:

The global hospital information systems market will climb past  $35 billion by 2015, according to a new forecast by Global Industry Analysts.  The United States represents the largest market in the world.

Healthcare around the world is finally seeing the importance of electronic medical records (EMR).  The Asia-Pacific region (excluding Japan) represents the fastest growing hospital information systems market, exhibiting a compounded annual growth rate of 11.5 percent over the next few years, according to analysts. Despite being a smaller market in terms of revenue, the Asia-Pacific promises excellent growth opportunities for hospital information systems, they said.

According to the report:

The growth of the emerging health informatics market is high in countries such as Australia, China, Thailand, Malaysia, India and the Philippines. Emergence of a fast-growing healthcare industry in the Asia-Pacific region augurs well for the future of the global market.

The world is taking significant steps toward enabling healthcare that's safer, more efficient and better connected.  We, as individuals, must do our part in taking better care of ourselves.  Until then, Clinical & Management Solutions, Inc. will continue to help healthcare providers in providing the best care possible.  The best place to start is at home - the Home Health Care industry's focus is to keep patients out of the hospital.

Filed under: Healthcare IT