DOCtalk by Dr. Gregg 4/1/13

Sunny Side Up? Nope. Scrambled.

I’ve started to see that the world healthcare information technology is just one big pile of scrambled eggs – metaphorically speaking, of course.

Consider the metaphor: scrambled eggs are an amorphous conglomeration of congealed albumen and yolk, nutritive albumin protein and embryo all swirled up into one, often incompletely cooked, goo. Scrambled eggs often have lots of other non-egg-related matter thrown in – like ham, or onions, or cheese, maybe some spices or a little milk – all swirled together and intermingling haphazardly.

Now, compare and contrast time:

Consider the cooked egg world’s opposite – the sunny side up egg. It also may be incompletely cooked sometimes, but it is a structural antonym to its scrambled cohort. It has the lovely yellow yolk nestled serenely in the center, caressed and protected by the surrounding proteinaceous white. The two components are discrete, yet complementary. Together they make the dish, but their borders are well-defined.

Either scrambled or sunny side up eggs can be cooked fully or served up with just a touch of “slime” left. Some folks prefer the drier, “well done” type while some of us are happy with a little remaining mucusy texture. (I admit it sounds less appetizing when written as such.)

Now, metaphor hop back with me to the world of HIT:

Look through the multitude of realms which HIT involves or touches: healthcare, technology, legislative, financial, legal, and more. All of these can be further broken down into subgroups such as mHealth, telehealth, inpatient, outpatient, e-patient, privacy and security, insurance and billing, regulatory, education, etc. Each of these can be subdivided even further into things like mobile apps or client server tools, real-time or store-and-forward, acute care or long-term care, primary care or urgent care, empowerment or engagement, HIPAA or data sharing, and so on and so on and so on.

There is nothing about MU or HITECH or HIT (or, perhaps, even US healthcare in general!) that comes even close to a sunny side up, well-defined and harmonizing balance of distinct collaborative elements. It’s a mishmash. It is one giant pan full of goo and goop and value-add ingredients all churning about and “intermingling haphazardly.” And, it’s anything but fully cooked; there’s a slew of slime.

I know lots of well-intentioned folks are busy trying to get some regulations and some standards into place to help define and refine the hootenanny of interplaying elements in the enormous HIT space. And that’s probably good. But when I look around the massive HIT frying pan, I’m pretty sure we’re going to have to be happy eating our “eggs” scrambled for quite some time – and with plenty of mucus.

It’s been said that you can’t put toothpaste back in the tube. You actually can, but it’s a major pain in the tukhus. Similarly, it’s pretty near impossible to unscramble your eggs.

If the good folks trying to regulate and standardize are trying to regenerate sunny side up HIT eggs from our current scramble…well, doubtful. If they’re trying to harmonize the ingredients…well, that’s probably possible.

Of course, we could always throw away the current batch and start – more gently – with some new, fresh “eggs.”

(Yeah…right.)

From the trenches…

“The world is wrong side up. It needs to be turned upside down in order to be right side up.” – Billy Sunday

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).