DOCtalk by Dr. Gregg 8/30/13

Take the Cannoli

“The Godfather.” What a classic film. Just chocked full of life lessons, some would say. Unfortunately, they’re not the life lessons most moms and dads would try to instill in their children.

You know, things like, “Violence is an acceptable solution to your problems,” or, “If you cross the family, you’ll get whacked,” or even, “It’s OK to spray grandpa in the face with pesticides.”

Watching it with my Sicilian wife the other day – yeah, that’s right; she’s “connected,” so watch your step, pally – a line popped out at me that rang a sad HIT bell. Rocco Lampone and Pete Clemenza are driving along with traitor-to-the-don, Paulie Gatto, toward Paulie’s unbeknownst whacking. Pete says he needs to “take a leak” and has Paulie pull to the side of a country road. As Pete whizzes, Rocco whacks. Paulie slumps over the wheel, minus some of his brain. Pete zips up and walks back to the car telling Rocco to “Leave the gun. Take the cannoli.”

They leave Paulie and the instrument of his demise for all to see. The message is clear: the Corleone family will not tolerate traitors.

But there’s more than this. Leaving the gun shows their confidence, their arrogance that they can’t be touched. Taking the cannoli adds the “this is all just a part of the job” flavor to the message.

“We whack who we want and we keep the sweets.” This appears to be the take home message that far too many of the HIT “family” have garnered from “The Godfather.” It is becoming ingrained into some vendors’ unwritten corporate philosophies and become part of their modus operandi.

Take, for instance, Practice Fusion’s recent opt-out approach to sending emails to patients, addressed as if having been sent from the patients’ own doctor or other healthcare provider and asking patients to review and rate their provider. Regardless of whether Practice Fusion notified their EHR users via email (I’ve signed up for their EMR – though I don’t use it – and never saw such an email) or whether they wrote about it in their blogs or forums, it seems many providers were unaware that these emails were being sent on their behalf. Thus, the real benefit of these emails is obviously not for the loyal PF-using providers; the real benefit of these ratings is for PF, i.e., the cannoli is theirs.

If this wasn’t a bullet to the head for the providers, why wouldn’t they use an opt-in system instead? Do they think they are wiser or more caring about the patients that these providers serve than the providers themselves? Do they really believe, as they said in response to one blogger’s (John Lynn) recent post about this, that they are the correct arbiters to administer a patient feedback program “designed to provide your practice with a controlled, quality channel for accurate patient reviews”? Who provides this control? Who insures the quality? Who judges which reviews are “accurate”?

Seems to me that PF is a Rocco and their providers are Paulies (though Paulies who hadn’t turned out their boss to any enemy). These PF loyalists took a shot from behind and PF walked away with a cannoli in the form of nearly two million reviews that likely helped bolster investor interest.

I’m oversimplifying, I’m sure, and I’m not intending to pick on PF. There are loads of examples of non-healthcare folks (and some from within our midst) stepping into the healthcare IT space, taking what they could get from it, and walking away with some seriously sweet green cannoli, i.e., cash, that is ultimately generated by the labors of healthcare providers.

To us providers, if you take our money, we are making an investment in you. If we commit to the use of your tools, we are establishing a trust with you. If you take our dollars, or our good faith, and walk away – whether by acquisition, merger, or business failure – you are leaving us in a lurch, often a very expensive lurch from which to “unlurch.” If you take our efforts and then profit from them while leaving us with naught but the “you did a good deed” pat on the back, you have essentially stolen from us.

There are numerous HIT vendors, healthcare websites, and other such Roccos that come to mind, but my mission is not to point fingers or even ask for any cannoli back. My motivation for writing today comes from the mere hope that my colleagues – doctors, nurses, PAs, NPs, etc. – will begin to see that all of our so-called “helpmates” in the HIT space are not always goodly intentioned. They may mouth off about serving the greater good, helping providers or patients, and facilitating improved care, but all too often it appears that C-suites are C-suites; they care more about the cannoli than the caregiver – or the cared-for.

We need to watch our backs…and our cannoli.

From the trenches…

“Leave the gun. Take the cannoli.” – Pete Clemenza, in The Godfather

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).