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President Obama: Don't Spend Money on Epic

Posted on: 1.3.2009 10:37:13 AM Posted by Suresh Gunasekaran

I received the following news update through many colleagues and RSS feeds that I use….

(Begin story)

The Boston Globe (1/1/09, Wangsness) reported, “As Barack Obama prepares to spend billions on health information technology as part of his plan to revive the US economy, some specialists are warning against investing too heavily in existing electronic record-keeping systems.” In fact, David Kibbe, a “top technology adviser to the American Academy of Family Physicians,” and Bruce Klepper, a healthcare market analyst, highlight “the challenges confronting Obama's proposal to digitize an enormous and fragmented healthcare system” in “a recent open letter to the President-elect.” Klepper argued that “current systems are expensive, cumbersome to use, and cannot easily exchange information about patients' health histories and treatments among different hospitals, labs, and doctors' offices.” And, although “Obama and many health policy analysts support a large investment in electronic health records,” Klepper and Kibbe advocated for spending “the bulk of” the package on “simpler and cheaper technology.” (End story)

(Begin rant)

Klepper and Kibbe do a great job of stating the obvious: current systems are expensive, cumbersome to use and cannot easily exchange information. Exactly; if they were perfect and cheap, everyone would have them and the President would not need to buy us all an EMR.

The real question at the heart of this open letter is far more interesting than their contrived recommendation. If President Obama does invest a great deal in healthcare information technology and much of the money is directed at the EMR space, will it spur investment from new players or will this be the chance for some of the monoliths of the industry that have gotten us this far to accelerate their move to more nimble solutions?

(To read the posting in its entirety, visit www.healthcare-informatics.com/suresh_gunasekaran.)

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I Quit! Actually I need a Raise …

Posted on: 1.5.2009 7:06:37 AM Posted by Tim Tolan

It's the classic scenario where the candidate is very much engaged in the search process, shows up for all of the requisite interviews and completes each and every task along the way that we require as part of our search process. I mean we really invest a significant amount of time in vetting candidates and do whatever we can to ensure that we have demonstrated all of the reasons we feel a particular candidate is qualified and should be seriously considered for the job. The offer finally makes its way to me and before I send the offer to a candidate I always present a verbal offer to make sure I communicate all of the details verbally in advance of just sending the document via e-mail or overnight mail. It gives me a chance to gauge the candidate's reaction to the offer and their immediate response is usually a fairly good indicator of their willingness to accept the offer - or not.

(To read the posting in its entirety, visit www.healthcare-informatics.com/tim_tolan.)

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It's Not My Job!

Posted on: 1.12.2009 3:07:39 PM Posted by Neal Ganguly

I recently visited a friend in the hospital on discharge day. Knowing a thing or two about the challenges that the discharge process poses, I struck up a conversation with the nurse and the physician about how things worked in their facility. It was a lively discussion that ended up focusing on the medication recon-ciliation process, and the problems with obtaining accurate information on ‘at-home’ medications. As one might expect, the nurse and physician both disagreed on who should be responsible for the process. They each felt that the other should be responsible, but ultimately agreed it should be the pharmacy's problem, since there was no pharmacist in our discussion.

As I listened to them go back and forth, it struck me. Why isn't this the patient's responsibility? Have we become so completely disconnected as a society that we do not even feel the need to know and understand the medicines we take to improve our lives? Sure, some people take a lot of medications. How hard is it to carry a list? In fact, my thoughts went beyond medication lists, to nursing documentation, order entry, etc. All areas where compliance is often an issue and technology is blamed.

I asked the debating clinicians this question, and then asked folks back at my hospital as well. They agreed that the patient should know, but also blamed technology by arguing that the information existed in various computers - why should they have to enter it again? There should be an interface.

And there it was: the interface. It is the magic bullet for end-users everywhere, the technology that would solve all the problems and do all the work. It got me thinking about all of the interfaces that are running in hospitals, and the many more that are being requested. Managing the growing tangle of interfaces is increasingly nightmarish for hospitals. Without real standards, how can it improve?

(To read the posting in its entirety, visit www.healthcare-informatics.com/ganguly.)

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5 Ways to Become a Lean, Mean, Budget Machine

Posted on: 1.26.2009 8:50:33 AM Posted by Pete Rivera

1. Take stock of what you have. As in any survival situation, you start by analyzing what tools you have available to make it through the next few months. You can check strengths and weaknesses, find out what systems are reaching its lifecycle replacement, and what partnering opportunities exist to develop and SLA or an ASP solution. What makes sense to do yourself and what needs to be farmed out?

2. Realize that you cannot continue the Status Quo. Thinking that you can continue to operate the same way you always have is a sure way to run aground. Making changes to business processes is often like parking a supertanker; it's slow and you can't do it alone.

3. Cut meetings; no seriously, cut meetings! Try this at your next “Standing Meeting.” Count the attendees, guess each person's salary, add all the salaries and divide by the amount of time the meeting will take.

4. Payment Variance: move it up on your priority list. Chasing variances or write-off policies has an immediate ROI. If you have a basic information system that cannot balance receivables against payor contracts, then you are giving your services away. Healthcare's law of diminishing returns state: the larger the institution, the more likely to write off a debt. If you have to ask yourself if it's worth chasing down the debt, then you must not be having budget problems.

5. Analyze your system maintenance costs. Figure out what systems should finally be sunset, what are you paying maintenance on, and is it yielding an ROI. You may have to do this by module, by interface and vendor. Look at how you're using a managed care application/module for instance, and analyze against how many contracts it is maintaining.

(To read the posting in its entirety visit www.healthcare-informatics.com/pete_rivera.)