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Intelligent Healthcare Information Integration 2/6/09

February 5, 2009 News 9 Comments

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 that 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 projects;
  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 a long, 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 form; 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.

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 an unstoppable force.

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

Dr. Gregg Alexander is a grunt-in-the-trenches physician and admitted geek. He runs an innovative, high-tech, rural pediatric practice in London, OH, and can be reached at doc@madisonpediatric.com.

Comments 9
  • Go to http://www.gpii.info to learn more about how a patient identifier can both protect patients’ privacy AND make information more accessible across systems.

  • …who already has all this data? THE INSURANCE COMPANIES. Why is it that all of the “national database” talk involves federal ‘incentives’ (which we know will be incredibly inefficient) or expenses to the physicians when Wellpoint, Medicare, and Medicaid can provide PHRs on 50% or more of the population tomorrow morning?

    I’m with you on the open source bit. I fear Obama money going straight to the pockets of the VPs at every major IT vendor.

  • Harmon, you ‘Mad Scientist’ you,

    The insurance companies may have the info, but I doubt they will be any more inclined to share the (information) wealth than competing cross-town hospitals. If not incentivized – or forced – by federal mandate, I don’t know many execs who can put healthcare’s big picture needs past short term corporate financial pressures.

    And, I agree. I lose sleep worrying we’ll waste all these promised fed dollars for healthcare just as the financial sector seems wont to do. (Anyone looking for a good deal on a brand new corporate jet?) — Gregg

  • Dr. Alexander – awesome that you know who Harmon Muldoon is. You know they republished all those books a few years back? I just read ‘The Big Chunk of Ice’ last week. Anyone out there with kids, especially boys, should know the Mad Scientists Club.

    Meanwhile…
    I agree with you 100% that the inscos won’t move without a shove. But, as titanic (no pun intended) and dangerous as they are, why would anyone find them harder to corral than a few hundred thousand docs and hundred million patients? If we can force HIPAA, CMS-1500, X12 (837/835/etc.) on the inscos, we can certainly force them to dump data, no?

    The clinical value of just claim data itself is invaluable. And, essentially, free. And we waste it every day.

    Given that it *should* (or, at least, could) lead to better health care and, therefore, reduce claims…you’d think they’d get a little interested.

    It may be naive, but I’d rather push around UnitedHealthcare than all the primary care docs in the world. If nothing else, I’d feel better.

  • I work for an insurance company, I was was astounded by how data is stored and shared. It is quite scary, not as efficient as one would hope. What is soo funny is how inscos are just like doctors. They don’t want to go electronic either. People have a weird obsession with paper. We spend more then 150K per year on paper data storage. These sheets never gets converted to electronic records, seriously. Paper in paper out. Not defending the insco at all, infact i would love to see electronic information to automate processes and have people handle exceptions. Just letting you know it is not nirvana on this side. I do wish it was.

  • The difference, Scary Times, is that the insurance companies definitely benefit from the inefficiency of paperwork, no? Paying faster is never in their interests, no matter what they say.

    If that were true, then so many of my clients wouldn’t be reporting post-Wall Street meltdown delays and policy changes 🙂

  • Well, Judas Priest, KK…can we really expect inscos to facilitate anything that reduces their stranglehold on healthcare? And, Harmon, insco lobbyists and legal eagles are probably waaaaay harder to manipulate than a bunch of disorganized medicos. Honestly, healthcare leadership has not impressed me much for some time in championing patient-centered policy reform.

    I’m still thinking an Obama-esque, grass roots, small project, small community, disruptive innovation-ish, replicable & scalable reform for ALL involved parties, together and at once, will refocus the true intention of healthcare info integration. (And, as alluded to, maybe with a few of those Obama bucks to actually end up with end-users, not middlemen and CEOs.)

  • You made me laugh, Gregg.

    No, we can’t expect the insurance companies to do anything short of what’s best for themselves and their stockholders in the next quarter. But given their massive, published profits over the last year or two, I don’t find many valid arguments against additional requirements, do you?

    I can’t disagree with your second point, but – and I don’t say this to be rude – the tooth fairy is a sure better story than your parents slipping you a quarter (or whatever the going rate is now). How can you possibly see your vision happening? Maybe I’m too cynical, I just see those same lobbyists steering any such reforms away from the best answers for all.

    My apologies for not actually saying anything with this note. Beware the Dogfish Head.

  • Dogfish Head? Does that place you in Delaware?

    “Valid arguments”??? As a primary care grunt, I’ve never noted any insco to be hamstrung by a lack of validity…or even logic.

    As for cynicism, I offer the sentiment of Robert the Bruce as spoken to his father, Robert de Brus, in “Braveheart”: “I don’t want to lose heart; I want to believe…” I doubt any pioneer ever championed any cause or blazed any new trail with anything less than some serious pie-in-the-sky-ness!

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