DOCtalk by Dr. Gregg 3/26/14

Is Being OK OK?

In the fields of healthcare and technology, perfection is essential. In healthcare, anything less may get you sued. In the tech world, if it doesn’t get you sued, you certainly won’t be in business for long if your tech offerings are filled with glaring flaws. (Imagine how long you’d keep using your iPad or smart phone if it remained annoyingly glitchy.)

Contrast this with the popular mantra, “Don’t let perfection become the enemy of the good.” This is such a perfectly human sentiment; it recognizes both our penchant for overthinking and our inherent inability to ever be truly perfect.

Whether you’re OK with “OK,” “O.K.,” “ok,” or “okay,” being OK implies acceptability. It implies good enough. It implies sufficiency. It implies decent. But, is it OK in healthcare IT to be OK?

Trying to make everyone happy is quixotic. It’s never going to happen. Someone won’t like how you did this, or they won’t like how you said that, or they just won’t like your approach. Thus, you just know that all of your best efforts are, at some point with some person, going to fail. Despite all the minutia minding and detail addressing, someone will be displeased with you.

In healthcare, you try to do your best. You try to address your customers’ needs as best you can, try to make sure to “do no harm,” try to attend to the pertinent details, all while hoping that payment reform and insurance requirement changes and federal or state regs will allow you to keep trying to serve your patients…and pay your bills.

In the land of HIT, it’s pretty much the same. There’s no health IT vendor on the planet who has 100 percent customer satisfaction. No matter how good your tools are, no matter how cutting edge your designs, no matter how responsive your tech support, someone somewhere is going to find fault. (I must admit that sometimes I’m one of them!) No HIT vendor anywhere does everything well…despite what their marketing folks may say.

When I look at EMRs or EHRs, one of the most important things I look for is a sufficient number of “happy factors” that make my overall user experience pleasant enough that I can overlook the missed or poorly addressed elements. Honestly, there haven’t been that many systems that engender a feeling of “Oooo…this is cool” often enough. Many have some of those moments; few have enough of them.

When HIT consulting, I try to stress the end user experience to the vendors, even while understanding their resource limitations and developmental timeframe restraints. Vendors can spend all of their resources trying to make each little detail perfect. But, there are so many darn details in any EHR/EMR, that I’m sure even Epic doesn’t have the resources to attend to each one completely, despite its Fort Knox of cash and (not so) small city of employees. Top off all the medical minutia with the seemingly endless requirements for MU, ICD-10, PCMH, ACO, HIPAA, P4P, PQRI, and a laundry list of other acronyms requiring attention, and it’s easy to see that the details demanding developer deliberation are virtually limitless.

Is it possible, then, in either healthcare or health IT to decide that good enough is good enough? Can you be OK with being OK?

You can. I’m certain of it. (Frankly, I don’t see any other option most days!) And, OK is good. You may not be able to “please ‘em all,” but if you strive for perfection and achieve OK-ness, that’s really an accomplishment. Humans are not, almost by definition, perfect. You can sometimes be great, sometimes be not-so-great, and overall be perfectly OK. You take your best shot each day and hope you hit somewhere in the good part of the old Pareto’s Principle (80/20 Rule.)

The hard part isn’t achieving perfection. That’s a pipe dream. The hard part is learning to be OK with being OK, even as you still strive for more. You always want to try for perfect, but you have to be able to see that less than perfect can still be good.

Good.

Fine.

OK.

Psychiatrist Dr. Thomas Harris once told us that we’re all OK in “I’m OK – You’re OK.” Even if you don’t agree with his overall approach, the sentiment stands: it’s just fine to be OK, in healthcare IT or anywhere. Just be a grand OK. Be an exceptional OK.

OK?

From the trenches…

“I’ll lean on you and you lean on me and we’ll be okay.” – Dave Matthews

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).

DOCtalk by Dr. Gregg 2/19/14

HIMSS 2014 – “DON’T FORGET THIS JUNK” LIST

Every February, I pull out my handy dandy HIMSS checklist. You probably have a similar list of your own, but there might be a few things here that are worth adding to yours, in case you’ve overlooked them.

My Official HIMSS 2014 – “DON’T FORGET THIS JUNK” LIST

• Tennis shoes – Remember your solemn oath: “I promise my feet that I will never again run the HIMSS triple marathon on somewhat carpeted concrete in hard sole shoes.” (And, God, please bless the women that do it in heels.)
• Dr. McGinty’s Amazing Hangover Cure and Spot Remover
• Deodorant (Remember that guy last year… ew… don’t wanna be him.)
•  Ibuprofen (and plenty of it)
• Extra cell phone battery and multiple chargers/cords (More power!)
• Hand sanitizer (You know why.)
•  Dr. McGillicutty’s Amazing Energy Booster and Blemish Cream
• Business cards (Remember, lots of folks still use them despite all our digital wizardry.)
• Lint remover brush (Nobody needs to know you have a dog.)
• Breath mints (Remember that gal last year… ew …don’t wanna be her.)
• Hair trimmer/scissors (Think “nose and ear hairs.”)
• Dr. McDougal’s Amazing Anti-Flatulence and Static-Reducing Powder
• Sunscreen (It may not be toasty, but it is Florida and you’re leaving snow-laden and gray-skied, frigid and frosty, it’s still-winter-here-in-the-“New Arctic”-Ohio.)
• Preparation H (You never know and plane rides can seem like forever.)
• Stamps (It may be old-fashioned, but it’s really fun to get a postcard. Make someone else smile and send a few… especially the funny ones, like with an alligator biting off a girl’s bikini.)
• Your tickets (Duh.)
• Dr. McGuinness’ Amazing Anti-Belch and Shoe Shine Liquor
• Triple Antibiotic Cream (Remember that guy with that rash last year?)
• NSA-approved list of safe text and email terms (No need to stir up any trouble.)
• Personal and heavily-encrypted MiFi wireless hotspot (No need making it easier than you have to for the hackers.)
• Noise-reducing ear buds (The kind that block noise and unwanted sales pitches.)
• Dr. McDonagall’s Amazing Bullhockey Detector and Battery Booster
• Humility (God knows there’s not much of that to be found at HIMSS.)

From the trenches…

"I’m not a list person.” – Joan Jett

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).

DOCtalk by Dr. Gregg 2/5/14

City Geek, Country Geek

I’m a pretty lucky guy. Every once in an azure moon, I get the pleasure of hosting someone from “The Big City” here in little Nowhere, Ohio. From big deal technology folks to EHR C-suiters to other IT and healthcare muckety mucks, I’ve had the good fortune of getting to chat with some top shelf folks here in our de-city-fied environ.

The visits are almost always fun and the conversations enlightening. Whether it’s the ambience and atmosphere of the nearby “Red Brick Tavern” (dubbed the “biker bar” by one of my more enjoyable visitors) or the local flavor of “Ronetti’s” which has perhaps the best cheeseburger, fried bologna sandwich, and “Super Sub” this side of Cholesterol County, the friendly chats and shared insights seem to flow with ease when “big” folks take time to share of themselves here in Smallville.

I was graced with another such visit this past week from a longtime pal. We’d given a talk together several years ago where we looked at EMR myths; it was the MOST fun talk I’ve ever enjoyed giving. He came by to spend the day talking all things geek and just getting away from his day to day.

The latter was actually the main inspiration for his visit; he’s the CMIO for one of the nation’s top specialty hospitals and seemed to feel that a day “in the trenches” might be a nice getaway from his multi-problem, multi-committee, multi-pressure work life. He thought it might be good for his psyche to step outside of his institutional realm, to spend some time in the small-practice-make-a-decision-implement-decide-and-move-on world of a solo practice.

I was happy to have him come, though not just because he’s one of the most genuine, friendly, funny, and intelligent people I know; also because it’s fun for me to hear about the large scale side of HIT, from an insider’s perspective – but relaxed, sans board meetings or convention halls. No sales pitches. No corporate protectionism. Just HIT nerds sharing nerdian experiences.

Despite the bad weather and accumulated snow, he made the trip and we spent a wonderful day with only limited interruptions from phone calls or urgent texts. We talked all kinds of geek – from building electronics as kids to dealing with the politics and pressures in our very different domains of healthcare and HIT to comparing the issues of Extormity EHR with those of “Minormity” EMR. We discussed the goods and bads of EHR vendors we’ve known as well as the struggles they face. We discussed family pressures and how they impact on our HIT decisions. We discussed mobile tech and wearable devices. We discussed HIT past and HIT future. It was pure digital doctor geekdom and it was a blast!

I’m not going to expose any of the scandalous nor even the more mundane comments we shared. That isn’t my focus in writing (though some of them might be well worth a headline or three!) What I really want to share is how enlightening it can be to step across the digital and healthcare divides, how spending some time away from your healthcare or IT constructs can be both broadening and restorative.

It’s almost like Neo leaving his Matrixian, computer-generated reality. (At one point I swear I heard Morpheus saying, “Welcome… to the real world.”) Hearing how someone else deals with the same issues of your everyday domain that are similar, but oh so different, is just fascinating, especially when it’s an agenda-free discussion seeking nothing but insight and a little camaraderie across the divide.

I can’t say for sure what my friend took away from our visit, but I can say that it was soulfully reinvigorating for me. While I still prefer my entrepreneurial trench with its day-to-day survival challenges, my view of the world received a shot of bigger picture re-clarification.

We all have our little cubicles. Some are much bigger than others, but they’re all confining, particularly upon our perceptions. If you have a friend or colleague who sits in a different cubby than you, I highly recommend taking time for such a viewpoint renovation visit. It’ll do your HIT spirit good.

From the trenches…

“Better beans and bacon in peace than cakes and ale in fear.” – Aesop

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).

DOCtalk by Dr. Gregg 01/22/14

Has HIT Jumped the Shark?

Watching the world of HIT of late, I’ve been wondering if it may have “jumped the shark.” You know what that is, right? It’s the phrase coined by Jon Hein (Howard Stern Show) after an episode of the TV show “Happy Days” where Fonzi (the coolest, black leather-jacketed, semi-tough tough guy on the planet at the time) was shown on water skis jumping a shark. Gimmicky stuff, for sure, used in an attempt to keep the show’s audience, and revenues, intact. The term denotes the moment in the life of a TV series where quality begins to decline, but has since broadened in usage. It generally denotes when something – a tool, a brand, an offering, a design – has begun its descent from wondrous to woeful.

Is it fair to derogatorily tag HIT with this? Perhaps not, especially when there are definitely some folks are out there doing some pretty amazing things in the HIT space. One really cool example is the stuff Dr. Patrick Soon-Shiong is doing with his bazillions of dollars tying disparate systems together and creating true change in the status quo. And there are several pretty cool newish EMRs/EHRs as well as improving patient portal and PHR-type tools.

However, in the mainstream of HIT, many of the big systems and players seem to have been so redirected by the needs to meet criteria of regulatory design – you know the culprits: Meaningful Use, ICD-10, etc. – that the lovely innovation that once bubbled throughout the industry doesn’t percolate much at all these days. The excitement that used to be almost palpable in HIT seems faded, like it’s become less about innovation and more about institutionalization.

I’ve been looking around at EHR/EMR systems quite a bit lately, checking newer offerings and revisiting older systems I haven’t seen for a while. What I’ve seen has been, by and large, depressingly similar to what I saw ten years ago. Outlook-y systems. Windows 95-y systems. Excel spreadsheet-y systems. There are some that have moved the needle for user experience, but most older systems still look and feel…well…older.

User interfaces in many of today’s more well-established systems look much the same as they did ten years ago, despite all that’s been learned about optimization of the user experience. Workflows and process management are similarly stagnant. There’s almost an attitude of “well, if it’s working enough for our many users, we don’t need to worry about it.” But, this doesn’t mean it’s good.

It may be heretical to mention this as we approach the 2014 HIMSS extravaganza. Despite my sense that there may be some shark-jumping going down, HIMSS rolls on bigger and grander than ever. The mega-bucks are flowing and the shows will be glowing. You’d have no hint that anything was less than lovely in the land of HIT.

But, even Happy Days lasted another five years or so after Fonzi waterskied over a shark. It isn’t a death knell, but it definitely isn’t a sign of good things to come. Once a shark gets jumped, the effort to maintain the prior luster is like applying Bondo to a rusted Roll Royce: its former glory is behind it without some serious restoration.

I’m sure the HIT show will roll on for years to come, but maybe we need some new writers.

From the trenches…

“I think the phrase ‘jump the shark’ has jumped the shark.” – Linda Edelstein

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).

DOCtalk by Dr. Gregg 1/6/14

Why Does Simon Practice?

Simon – Dr. Simon Princewalleter – is a small practice, primary care provider who works diligently every day, often seven days a week. He keeps his own books, but has an accountant advisor and an outside billing company. He has three staff members who he loves and who seem to appreciate him. (He loses sleep on numerous payday eves worrying that he won’t have enough to meet their payroll.) He efforts to keep current on standards of care and evidence-based guidelines. He takes his own after-hours calls, tries to offer quality online tools for his patients including a nice website and an attractive patient portal, and uses a good electronic medical tool for all his patient records. He tries to keep up with governmental and insurance company rules and regs, maintains HIPAA watchfulness, and protects his digital patient data. He spends many hours doing things for which he was never trained.

He is going into debt to stay afloat.

Why does Simon continue this struggle? Why not sell out to an ACO or join a group? Why does Simon practice?

Simon, it appears, is part of a dwindling breed. He loves his practice, his staff, and his patients. He thinks he provides a value and services that are unique. He likes being entrepreneurial despite the challenges and mounting pressures. He likes being a small practice doctor, with all that entails. He isn’t convinced that a regular paycheck and institutional guidelines would ever provide the warm sense of satisfaction he gleans on his own.

But, he knows that he cannot continue to watch debt mount. He struggles to find new resource avenues. He provides some consulting services which, while detracting from his family time, help keep the lights on and the family fed. He looks for ways to see more patients that don’t entail cutting value and patient care quality. He considers innovative options for increasing practice revenues through digital services offerings. He trims staff benefits though he despises the necessity.

Why does Simon continue to struggle when the “security” of a group might be so much cozier?

Simon loves being innovative. He loves seeing what needs to be done and then defining creative ways to accomplish the job. He loves making decisions and seeing where they lead. He doesn’t mind when his decisions are wrong; he just decides on what needs to be done next to make it better. He likes his mom-and-pop shop ways.

As witnessed all over the country, though, he knows moms and pops are fading from the landscape. Corporate conglomerates have the clout and the monies to push moms and pops aside or, all too often, just steamroll them into oblivion.

He sees the conglomerate writing on the healthcare wall. Simon knows he may not be able to avoid the centralization of healthcare. It may be inevitable that he will one day become subsumed by the healthcare Borg.

Why does Simon continue to buck the trend and keep his individualist ways?

Simon isn’t arrogant or excessively proud. He’s just trying to do a good job and provide the best he can for those for whom he cares, whether patients or staff or family. He also knows that something deep down inside him would probably get lost if he sold out to a corporate structure. He believes strongly in the American ethos of the pioneer spirit upon which his country stands so proud. He thinks innovation, even micro-innovation on a micro-scale such as his little practice, has a value and an intrinsic worth that can never be replicated in an institutional setting. He believes he can make a difference – perhaps a small difference, but nonetheless an important difference – by being true to the values he holds dear. He believes his best is brought forth in his entrepreneurial realm.

Why does Simon practice?

Simon loves what he does, he loves those for whom he cares, and he thinks he has found the best way to repay all that he has been given by being the best “him” that he can be: a small practice doc trying to do what’s right, delivering personal care the best way he can – for as long as he can.

From the trenches…

“We must free ourselves of the hope that the sea will ever rest. We must learn to sail in high winds.” – Aristotle Onassis

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).