DOCtalk by Dr. Gregg 12/23/13

Dear Digital Santa

Dear Digital Santa,

First, thank you so much for all the digital presents last year. They were really fun and most of them lasted several months before the next version or a completely updated model was released.

For 2013, I have a rather different wish list. I know you told me when I sat on your lap last Saturday at the mega-mall that you didn’t think you’d be able to deliver on most of these, but I still want to put in my official request. (Anything you can do might make up for that weird tukas fondle you tried to say was an accident. Didn’t know what to make of that, Santa, but if you deliver on these, I’m willing to forego consideration of any formal charges.)

That said, I’ve formalized my list. I’d like:

· Tablet and smartphone firmware and software that can upgrade for as long as the hardware still works

· A smartphone app that makes calls from people on otherwise great smartphones sound good so you don’t have to keep straining to hear through muffled mush

· An EHR app that can take excessively long, typically templated EHR reports sent from other systems and extract the truly relevant material (often one third to one tenth the length of the original)

· A way to get EHR vendors back to developing based upon intuitive creativity, not just dictated criteria that may or may not actually make a difference in healthcare outcomes someday

· An HIT governmental hierarchy that doesn’t keep edging toward where almost all government hierarchies end up: excessive bureaucracy piled so high on top of initial good intentions that it smothers the very systems it was designed to assist

· Healthcare IT people and healthcare delivery people speaking a mutually recognizable language where neither is so acronym-heavy that it makes the other feel stupid

· Promises and delivery – neither too big or too small, but juuuust right – as the cornerstones of HIT

· Interoperability that’s about true interoperable interactivity, not buzzwords and sales hype

· A year without buzzwords and sales hype – and maybe a year without sound bites, too

· Throughout HIT-dom, less flash and sizzle, more real and worthy

· Healthcare folks, either HIT-related or just in general, with more fondness for getting work done than fondness for their own egos

· A pocket version of Watson

· Key software, like word processing, email, and such, with real support from a real company that doesn’t cost an arm and a leg, that doesn’t keep costing me ad infinitum, and that can reside on my computer instead of an NSA-accessed cloud server somewhere

· A special app for all my devices that sends a fatal – or at least momentarily heart-stopping – shock to any hacker or identity thief who tries to access with my digital world

· Peace on earth

I’d probably take the last one as a substitute for all of the others, though I might have to think about it for a while.

I know you’ll do your best, Santa.

With holiday love, from the trenches…

“The season wouldn’t feel the same without people going out of their way to be offended by nothing.” – Jon Stewart

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 12/9/13

Does Health IT Care?

The other day I received an email from an HIT-related buddy of mine. He’s perhaps the brightest bulb in the HIT chandelier that I’ve had the privilege to know. In the email he used a term (and I quote it here except for the full expletive) to describe the HIT space as: ”motherf…inginteroperableidioticbigdatatalkingpredictiveanalyticHITindustryoverpromising-underdeliveingdreamweavingdouchebags.”  (MFIIBDTPAHITIOPUDDWDBs, for short.)

This from the same fellow who I’ve heard detail many of the complexities of the intricate HIT realm, both operational and political with clarity, precision, deep insight, and well-considered reason. His less than enthusiastic stereotype was like pure “cognitive fodder” as I knew how well he understood those of whom he spoke.

His rather saucy turn of phrase set me to wondering: does health IT actually care, or are we all just a bunch of MFIIBDTPAHITIOPUDDWDBs?

I swallowed the notion, and found myself chewing on its cud.

I thought about people I know/have known throughout various HIT-related experiences. I thought about corporate HIT cultures I’ve witnessed. I thought about HIT entrepreneurs I’ve met. I thought about doctors and nurses and geeks and gadgets and sales guys and C-suites. I thought about myself.

I thought about the bright-eyed newbies with so much passion and spirit. I thought about wizened old HIT patriots. I thought about those within whom the spark burns brightly and those within whom there appears to be naught but char.

I thought about “good guys” who turned, or who maybe were just never as good as they first appeared. I thought about “bad guys” who later showed shiny silver linings.

I thought about waste cases and value props. I thought about soul suckers and salvationists.

I thought about advocates and champions. I thought about people who fought tooth and nail to retain their rights to paper-and-pen. I thought about those dragged kicking and screaming into digital-dom. I thought about futurists and Monday morning quarterbacks. I thought about the converted and the lost.

I thought about e-patients and insurers. I thought about privacy rights protagonists and datasharing dreamers. I thought about population health and personal genomics and biomedical informaticists. I thought about my wife and sons and how all this HIT stuff must seem to them.

I thought about times when I’ve over-promised and/or under-delivered. (C’mon…we’ve all done it.) I thought about big HIT dreams that evaporated like so much smoke. I thought about personal HIT predictions that came true and those that now appear idiotic.

I thought a lot about things I’ve read on the pages of HIStalk sites.

Once I’d thought a while about all of this, and more, I realized that my buddy was spot on – and spot off. We are all MFIIBDTPAHITIOPUDDWDBs. And, yet, I’d wager that the vast majority of us also truly care, that we’re honestly trying to make healthcare better through HIT.

Maybe not all the time. Maybe not every effort. Maybe some motivations are not always so high-minded. Maybe some of us have less of a silver lining than others.

But overall, across the HIT board, across all the ups and downs and goods and bads, through all our human foibles and personal peccadilloes, I think it’s safe to say that HIT cares.

When we’re not being MFIIBDTPAHITIOPUDDWDBs, that is.

From the trenches…

“I tried to think, but nothing happened.” – Curly

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 11/22/13

Big Data, Self-Care, and a DeLorean

Feeling bored the other day, I decided it was time for a road-time trip. Thus, I pulled out the DeLorean, threw a stale grilled cheese into the Mr. Fusion, cranked up the flux capacitor, hit 88 MPH, and headed off again to the future. (I won’t say when, because I don’t want to scare folks. Let’s just say it’s sooner than you might expect.)

After exiting the space time continuum, I decided to drive over to my doctor’s office to see what had become of healthcare. Sadly, it had been replaced by a Walmart. (I noticed an amazing number of Walmarts on the way there, by the way.) Noticing a caduceus logo now featured just below the main sign, I pulled up and walked in.

A big “Wal-Care” sign was prominently positioned just inside the entry with the caduceus logo to its right. I turned in to see an array of kiosks and cubbies occupied by people tethered to digitalia and discoursing with holographic talking heads floating eerily in space above each counter. I noticed one real, white-coated person walking around and went up to make some inquiries. Her lab coat had “Dr. Cammy” embroidered above the right breast pocket.

“Dr. Cammy,” I started. She turned and smiled. “Might I ask you a few questions?”

Her smile grew larger. “Oh, my, yes!” she exclaimed with a rather mixed expression of surprise and joy. “I get so few questions these days. How can I help …” She stopped mid-sentence. “Wait…I know you…you’re that guy, that doc with the DeLorean,” she said with both pronouncement and query.

I smiled, sheepishly. “Guilty,” I say.

“So, you’re actually here from 2013, right?” she asked.

“I am,” I acknowledge.

“I’ll bet you’re curious about all this,” she said as she swept her left hand across the room.

“You’re very insightful,” I say.

“Thanks. You know, I don’t get to use my insight much anymore. Healthcare has changed so, so dramatically. I’m more custodian than caregiver, it seems. After the ‘BD&W Meld,’ the self-care appsets sort of took over, relegating docs to more monitor than mentor roles. Well, that’s true for those docs who could continue to find work anyway. I read somewhere that the majority of displaced doctors appear to have ended up selling either Amway or Mary Kay.”

“Whoa, whoa, whoa…a little fast for me,” I interrupt. “Doctors are disappearing? Self-care apps took over? And what’s this ‘BD&W Meld’ you mentioned?”

“Oh, I’m sorry,” she apologized. “That’s right. In your day, doctors were still pretty revered, weren’t they? Well, they were sometimes. All that has really changed, let me tell you. How can I condense the events…? OK. OK. I know. Remember when everybody used to go to the doctor when they were sick?”

I nod.

“Well, now that there are so many self-care appsets and devices available– and so cheap – that people go to themselves, so to speak, instead of someone else when they’re ill. They can scan and measure and examine almost anything, right from home,” she exclaims, a little bit sadly. “It doesn’t leave a whole lot for healthcare providers to do.

“For folks who don’t have the latest and greatest tools at home, they can come here and use one of our Wal-Care kiosks. It doesn’t even cost them anything, as long as they make a minimum in-store purchase.”

“Hmmm,” I ponder, trying to look less shocked than I felt. “What if they need surgery or chemo or radiation treatment or some such?”

Dr. Cammy looked around the room to see if anyone needed her. They did not. She sighed, just a smidge, and continued, “Well, between personalized genomics, robotics, Big Data, and Sir Watson, there’s far less need for ‘real’ doctors to get involved. People don’t get nearly as much invasive care anymore, not like in your day. When they do need some form of procedure, heck, sometimes they can schedule it themselves, show up, have the procedure, hang out in auto-post-op a bit, and head home without even seeing a live person.”

“Um,” I stumble, “you mention ‘Sir Watson.’ Who is tha… wait… no… you don’t mean ‘Watson,’ the IBM computer, do you?!”

“Yeah,” she chuckles. “Can you believe it? Good old England’s Queen Latifah III, herself, knighted Watson a couple of years back. It made all the news threeds. The first non-human in history to receive knighthood.”

“Threeds?” I say quizzically.

“Oh, right. You didn’t have those yet. Threeds are ‘3-Ds.’ It’s how most content is delivered anymore. Like those holographic talking heads all these people are talking with,” she said as she pointed across the room.

I think I see the connection and ask, “So then, is that the ‘BD&W Meld’ you mentioned? Big Data and Watson? Or should I say, Sir Watson?” My smirk leaks out a bit more than I intend.

“Yep, sure is,” she admits. “When they finally figured out that they could take all that mega data folks were collecting – which was mostly just sitting on a gazillion different servers doing nothing – and feed it to Watson, things went bananas. Watson just sort of looked like the Second Coming to some, spewing out all these connections that no one had ever even dreamed existed. He literally changed the world, even more than Saint Jobs. That’s how it earned its royal dubbing, even though some folks in healthcare thought it more an Antichrist than a savior.”

My mind was reeling. Big data had finally found use, but its use put providers out of business? People could now take their healthcare into their own hands – and devices? Walmart had become the major primary care player? Watson was now a ‘sir’? Jobs a saint?

“Dr. Cammy, I feel sort of faint,” I admit, feeling the wooziness all the way to my toes.

“Oh,” she says with disappointment. “Kiosk 7,” she directs.

From the trenches…

“The future ain’t what it used to be.” – Yogi Berra

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 11/4/13

The Nightmare After Halloween

My youngest son wanted to watch Tim Burton’s oddball Halloween/Christmas animated movie “The Nightmare Before Christmas” on Halloween night. We did. Little did I know it would the harbinger of dreadful things to follow.

I awoke the following day, sipped coffee, caught up on email (again learning that Barrister J. Tongai had $20 million ready to send to me for safekeeping), and readied for what seemed like any other day at the office. I should have heard the ominous music begin to swell on my life’s soundtrack.

When I arrived at the office, everything looked normal enough. The staff’s good morning greeting sounded routine and pleasant. The lights were on and the cichlids were silently swimming in our waiting area aquarium.

However, when I rounded the corner into our main work zone, I stopped dead in my tracks. Everywhere I looked I saw piles of paper! Charts and chart notes, faxes and physical forms, school notes and sticky notes, letters and legal papers – all strewn about in some monstrous organizational pattern which I had long ago forgotten.

I’m not ashamed to say I shrieked, just a little.

My office manager, Maggie, looked up and asked, “You OK?” I silently trembled, minimally shaking my head. “What’s wrong?” she again queried me. Still dumbstruck, I felt myself fall back a half step, almost losing my balance before catching myself by grabbing a counter.

The rest of the staff now noticed and turned to see what was up, still acting as if nothing was amiss. The horrified look on my face must have been evidence enough, for they all said, almost as if scripted and in near harmony, “What’s the matter?”

I shook my head again, quickly, trying to stir some words from my throat. I let out only a small whimper at first, but was able to find my tongue shortly thereafter. “What the hell is going on here?” I asked with more of a plea to my voice than I intended.

“What do you mean,” asked Kim, my salt-of-the-earth nurse.

“Where on God’s green earth did all this paper come from? Where did those charts come from? Why is this place such a chaos of wood pulp?” The questions rolled out in a near singular sentence.

The staff all looked at each other with eyes that bespoke their befuddlement (and possible curiosity about my sanity.) “What do you mean?” questioned Kim yet again. “We thought we had cleared through a lot of the stacks from yesterday. This looks good compared to how it looked an hour ago.”

I could feel my knees begin to buckle. I looked about. All I could see were piles upon piles. There were lab results in piles, consultant notes in piles, radiology readings in piles, patient phone call messages in piles, prescription requests in piles, unsorted faxes in piles, charts upon charts in piles. Piles and piles of paper, everywhere.

Then I noticed: no computers! The desktops were gone. The laptops were gone. The tablets were gone. The high end scanner was gone. The insurance card scanner was gone. The credit card scanner was gone. The patient touchscreen registration portals were gone. No digital anything anywhere my eye could see, save the fax which was busy spewing forth ever more paper.

It took only a moment before the full weight and meaning of this fell upon me like a load of wet cement: I had lost virtually all connectivity! (Except for the fax machine, though it’s paper and ink consumption only served to deepen the impact of the moment.) My lab interface was gone. My immunization registry connection was gone. Our online scheduling was gone. Our secure patient email was gone. Our barcode scanning and supply chain management was gone. Our digital referral capacity was gone. Our website was gone. Our HIE interface was gone. OUR EMR WAS GONE!

“NOOOOO!!!” I screamed in absolute horror. “This can’t be happening! What’s going on here? This is unthinkable! No. No. No…”

Maggie arose and grabbed me by the arm, leading me to a chair. She sat me down and said, “Dr. A., you seem a little more off today than normal. Why don’t you take a minute to sit and maybe take a few deep breaths? You just sit there and we’ll bring you a cup of coffee. Barb, get Dr. A. a coffee,” she directed. “I’ll grab your stack of charts from yesterday so you can finish them up while you compose yourself.”

She reached over and lifted a stack of twenty some charts about a foot and a half tall from the morass of chart piles. As she turned to carry them over to me I jumped from the chair and ran screaming bloody murder toward the door. I didn’t see the PDR sitting on the floor before my foot found it and sent my head into the wall.

When I awoke, I was snuggled in my bed with my smart phone alarm just beginning to buzz.

Rubbing the sleep from my eyes, I made a promise to myself to never, ever again watch The Nightmare Before Christmas, son or no son.

From the trenches…

“I am the shadow on the moon at night. Filling your dreams to the brim with fright.” – Oogie Boogie in The Nightmare Before Christmas

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 10/21/13

HIT Adoption Signs: Top Ten, Bottom Ten

Everybody and their brother seem to have jumped on the “Top Ten List” bandwagon these days. From the archetypal nightly comedic lists of Dave Letterman to the overly-used, attention-grabbing lists of Cosmopolitan magazine to The Huffington Post’s “Top Ten List of Top Ten Lists” (for heaven’s sake…really?) people just seem to flock to listed material. Thus, I created a couple of my own for HIT adoption.

I was going to go with the typical top ten thing, but it seemed the bottom ten also had a certain draw. I think you’ll see why.

Top Ten Things You Like to Hear After HIT Adoption

1) From your staff – “OMG, this EHR has made my job so much better.”

2) From your non-techy staff – “I would NEVER go back to paper.”

3) From your referral colleagues – “Your EHR generates really beautiful, easy-to-read reports.”

4) From your spouse – “It’s so nice to have you home every night at a decent hour.”

5) From your child – “Dad and mom always make it to my soccer games.”

6) From your accountant – “You paid off your EHR investment really fast. Great ROI!”

7) From your IT buddy – “This is a really well-designed piece of software.”

8) From your EHR vendor – “We just completed the interface to your local HIE. No charge.”

9) From your patient – “Doc, I just love your new patient portal! It is really useful.”

10) From yourself – “I can’t believe I waited so long to do this.”

And, now, on the other end…

The Bottom Ten

1) From your staff – “This EHR stuff sucks. I quit!”

2) From your spouse – “You’ve become unbearable. I’m leaving you for your lawyer.”

3) From your children – “Who are you?’

4) From referral colleagues – “Your chicken-scratch handwritten notes were more useful than those obnoxiously long, templated notes you burden us with now.”

5) From your accountant – “You paid how much for this?!”

6) From a young patient – “Mommy, how come doc never looks up at us anymore when we visit?”

7) From a patient – “Since you’ve gone electronic, I recognize you from the back better than I do from the front.”

8) From your EHR vendor – “Your product has been sunsetted.” Or, “We’re bankrupt.”

9) From yourself – “Bankruptcy doesn’t look so bad.”

10) From your lawyer – “Sorry about the spouse-stealing thing. See you in court.”

From the trenches…

“I didn’t care whose name was on it; I just wanted to get in that Top Ten.” – Terry Melcher

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).