DOCtalk by Dr. Gregg 2/17/12

HIMSS, Mine & Ours

HIMSS

Not heading to HIMSS this year is a real drag…and, then again, maybe not so much. There are things I’ve grown to enjoy and people I’ll greatly miss seeing, but there are definitely both pros and cons to HIMSSing:

Things sadly missed:

• Real human-to-human, sans digital intermediary, connecting with friends and cohorts I don’t get a chance to see often.
• The “Ooo and Ahh” factor of all the glitz and showmanship that is HIMSS.
• The after-hours parties, especially HIStalkapalooza (and wearing my HIStalkapalooza sash.)

Things gladly missed:

• The morning after the after-hours parties (and the additional sleep deficit in my already miniscule sleep bank account.)
• Sore, oh-so-sore, feet (regardless of the choice of shoe fashion.)
• The guilt factor of knowing I’m helping to contribute to the gigundo national healthcare tab. (All that money comes from the same eventual place.)

MINE

At HIMSS, you’ll be hearing a new rallying cry coming from the e-patient folks: “Give Me My Damn Data!” You’ll be seeing them all over HIMSS this year. They’re looking to make some patient-empowered waves and I think they have the drive and chutzpah to do so.

The people (from around the world) who are driving this “e-Patient Spring”, like those over at the Society for Participatory Medicine, are some very active, very socially engaged, and very assertive folks. As with any social movement these days, they are taking advantage of Internet-enabled collaboration tools to promote their message(s). As with any social movement these days, they will not easily be denied their voice given the ease with which social connecting can now be accomplished.

Their basic cause is that they want to be considered a part of their healthcare, not a receivership nor a tangential. They want access to their own health data and they want providers who listen, discuss, and partner with them in their healthcare. (It is their health and healthcare system, after all.)

OURS

Considering both the HIMSS-related world and the just cause of the e-patient advocates, I feel a little bit caught in the middle. And, I’m not flying solo in my self-pity. I’ve heard similar sentiments from many colleagues. It really feels as if we providers are sometimes seen as the both the meal ticket and the root of all evil. Let me explain.

HIMSS razzle dazzle is exciting – and not meaning to rain on anyone’s parade-to-come in Vegas next week – but when I look at all the money spent there, I know where they get that money. When I look at the enormous facilities that Extormity Healthcare and others have built, I know where they get the financing. When I see all the faces of the pitchmen and pitchwomen who tout their HIT tools as the must-have to provide quality care and decrease healthcare costs, I know where they get their salaries. Ultimately, it’s all from patients and providers (some of it routed through the tax system.)

HMOs stepped into the healthcare lunch line some years back, promising to lower healthcare costs. They didn’t, but they sure made some millionaires and built some really large glass and steel high-rises to help manage all that “cost containment.” HIT vendors sometimes evidence a similar mojo.

On the patient engagement front, it makes a lot of sense and is, I think, an inevitability. But when I have to see so many patients per day just to pay all my costs, I have that nagging inner voice which reminds me that I don’t have the luxury of talking with them as much as I would prefer: I’m paid by volume. And that really sucks. I try to spend quality time, but if I’m sometimes too brief, it isn’t by desire.

Honestly, I think most docs, primary care docs especially, would prefer to spend more time discussing, explaining, and engaging with their patients. Heck, almost every one of us got into this field to try and help people. Of course we want to engage with our patients! But if you knew how many primary care medical practices, especially us small guys, are running in the red more and more each year, you wouldn’t be surprised by our seeming lack of time to chat. I want to chat more and engage more, but I don’t want to be doing it in a bread line or soup kitchen.

Considering the costs of technology adoption to the (rightful) desires of patients seeking more of a partnership in their healthcare, and — when you include the slimmer and slimmer reimbursements we’re given (and the still possible 27% SGR reduction, even if it’s now postponed 10 months) — it is starting to feel pretty durn tight in this little provider box. Sorta reminds me of that scene in Indiana Jones where the spiked walls and ceiling are closing in: closer, and closer, and closer…

To be clear, I have no desire to see HIT vendors nor HIMSS disappear. I love HIT and think it is one of the smartest moves medicine has made in years. HIMSS is a terribly fun 30,000-person party! And who doesn’t love a good geeky party now and again?

To be just as clear, I have no desire to withhold healthcare data and absolutely think engaged patients are the best patients. I have no desire to return to the days of paternalistic healthcare.

So please, as you hoist an IngaTini or as you raise awareness of the empowered patient, remember we’re all in this together. No part of this joint effort can survive without the health — both physical and financial — of the other: patients, HIT facilitators, and providers.

From the trenches…

“Boy, if this damn room would stop rolling around maybe I could find some place to be sick!” – Helen North (in “Yours, Mine and Ours” from 1968)

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).