Let’s Go Back to Gas Lamps
Earlier today I almost had a brain aneurysm. I was sitting in the offices of an important health care facility when the subject of electronic medical records (EMR) came up. What I heard uttered out of the mouth of a highly talented and solidly experienced health care professional made me realize just how bogged down in the 20th Century our health care industry has become:
What do we do if the computers go down?
Now this is an obvious concern. But it occurred to me that this line of reasoning is a deep-seated logos in the health care profession. I wanted to ask this person what the facility would do if the electricity would fail. I’m pretty sure I would hear “Well, our backup generators would kick in.” Why hasn’t this kind of acceptance of electric backup grown with respect to other kinds of technology? If we all followed this person’s logic, why wouldn’t we just go back to using gas lamps in hospitals?
What is the source of such fear? Why is our health care system so behind in the proper management of health information? Do we even know what are the economic and social opportunity costs of using paper for the majority of our health information?
A PAPER DRAGON BY THE FLAME
According to some studies, less than 10% of health care facilities in the US employ health information technology (HIT). 90% of of the health information is on paper! Is it 2008? Is this the 21st Century?
I know there are many reasons for the delay: federal and state regulations, privacy concerns, reliability, cost, etc. These are all major considerations. Something tells me, though, that even if these concerns were addressed an allayed, there would remain perhaps the single largest Dip our health care industry would have to get up and over: culture.
Social media geeks are all coked up about Twitter and FriendFeed and many other white lines on the web, but what could be more geeky than healthcare? I’ve worked in the ICU and the technical geekiness required to safely titrate a vasopressor or manage ventilator settings is far more wicked than anything on the web. If health care workers can learn these gadgets to save lives and restore the sick to wellness, what gives? Why such a gap in using health care data with as much comfort as using Google or any other informational interface?
THE OPPORTUNITY COST OF GAS LAMPS
We live in a time when cost containment is being addressed by folks who aren’t thinking about the consequences of their decisions. Refusing to reimburse facilities for Hospital-Acquired Complications (HAC) is admirable and understandable. Ultimately, however, facilities will need to start documenting care for the primary benefit of payors instead of patients. Those facilities that rely on paper to document events, in turn, will place the burden of this kind of documentation on health care workers.
When does this deadly game end? When will the body count be sufficient for this Pagan God of cost efficiency? The opportunity cost of paper documentation is quality care. Period. The right ideas in the wrong heads are always dangerous.
If our health care system is still burning gas lamps in an age of light bulbs, how blind our we getting? Time for some eyes to open up. The dusk is coming and the lamps are buring low.
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Policy-Compliant Healthcare Fail
Just like any roadway, the healthcare system needs signals that work. Too many signals and the system arrests. Too little and everything crashes. It’s important to build a system of healthcare that anyone can use safely. It doesn’t need to be complicated. It just needs to work. So why might our system have so many jams and fails?
After seeing this video that Seth Godin shared on his blog, I started thinking about what might be wrong with how we provide healthcare. So many rules have to be followed that I think we end up breaking them right onto each other. When you watch this video, consider how our healthcare system builds policy-compliant accidents:
If you have ever worked in a corporate environmnet, you completely get this video. Painfully, it’s dead-on with the fundamental problems of complex organizational behaviors. Governmental organizations often operate with as much derrangement.
So my question about Healthcare Fail is this: if corporations and governments operate healthcare the same way as the geniuses designing the stop sign in the video do, just who or what is the right choice? It’s easy to say “the free market works”, as the political Right claim, or “healthcare should be free for everyone”, as the Left claim. Honestly, I don’t think either of those claims make any sense these days. I wish one of those claims were true. It would make our problem easier to solve. Simple-mindedness is not simplicity.
As the costs of healthcare increase inversely with the quality provided, our public discussion focuses more on Universal Healthcare initiatives. Unfortunately, I think that our emphasis on cost has largely gotten us into trouble. It’s as if Werner Heisenberg’s uncertainty principle is meliciously at work: the more we try to batten costs down, the higher they fly.
Rather than focusing on cost, we aught to focus on the value provided to patients and the community. Once the public understands what really goes into providing quality healthcare, then we might have a chance at a benefiting from a system that is neither the result of Capitalist Fail or Socialist Fail.
Our health is too important to hand over to corporations or governments. We need another kind of organization altogether, a totally novel way to provide quality care. I wish I had a name for it. For now let’s call it the Godinizaiton of Healthcare.
Godinize the Healthcare System
Part of the problem with the economics of healthcare is that we try to satisfy every conceivable end-point. It’s important that healthcare involves regulatory controls and well-conceived designs. If every intersection involves convoluted stop signs built to comply with everybody’s rules, we will have nothing but very reliable policy-compliant Healthcare Fail.
Policy-compliance is not a goal of healthcare: healthcare is the goal of healthcare.
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Twitter, HIPAA, Privacy and Freedom of Speech
Twitter will get you fired, fined or sued. Well, it will if you’re a health care professional who doesn’t follow the rules set down by the federal government and patient bills of rights. Here are some thoughts on how to Twitter safely in the clinical care setting.
WHAT HAPPENS ON TWITTER STAYS ON TWITTER…AND SUMMIZE AND…
Permission-based processes, whether you know it or not, have been a central dogma of medicine and nursing for many years. Acquiring informed consents or refusals has always been a right of patients, whether or not it was properly acknowledged by practitioners.
Twitter is a remarkable tool for broadcasting the latest advances in medicine or nursing. It’s also a way to establish an ambient intimacy within a community. Unfortunately, it has opened up a publicly viewable portal into the effluence of private patient information. What happens on Twitter, stays on Twitter…and Summize and FriendFeed and Disqus and ping.fm and Google’s cashes forever and ever and ever. Oh, and right on that PowerPoint slide which the plaintiff’s attorney ginormously projects onto a court room wide screen.
HIPPA IS DEFECTIVE LEGISLATION. BUT I FOLLOW ITS RULES.
Patients have a right to privacy when receiving care. That’s just common sense. Unfortunately, there have been legislative attempts to regulate how providers ensure patient privacy and information security. Those steps are honorable. Their execution, however, is matter for another blog post. Suffice it to say, HIPAA is not the optimal solution to the problem of patient information security.
HIPAA (Health Insurance Portability Accountability and Accountability Act of 1996) is one of those legislative examples of fighting the right war with the wrong means. Again, I won’t get into the merits of fighting HIPAA, but I’ll emphasize that until the act is properly amended, health care professionals are well advised to comply.
Why? Here are just two civil and crimianl penalties for non-compliance (Source):
- fines up to $25,000 for multiple violations of the same standard in a calendar year (ouch!)
- fines up to $250,000 and/or imprisonment up to 10 years for knowingly misusing individually identifiable health information (yikes!)
I’d hate to see any doctor or nurse lose their job, get fired or sued by a patient for violations that are easily avoided.
If you’re a health care provider and you plan on using Twitter or a similar tool to open up the world to what happens in the clinical setting (and I applaud you), here are two questions to ask yourself:
- Would I want my care to be broadcasted to who-knows-whom?
- Even if my name wasn’t mentioned, would I want my care to be on TwitterVision? If I do, did I sign a fully informed consent?
FREEDOM OF SPEECH
So, how could health care providers use Twitter to express their freedom of speech while protecting the information safety of patients? Here are some off-the-cuff suggestions:
- Be fictive with cases if your Twitter feed is on a public time-line
- Get permission, in writing, from patient’s or patient representatives
- Understand the ways in which protected health information privacy rights can be violated
- Remember that patient privacy is a part of patient safety
- Think about the purpose of a Tweet
- If you don’t have a real purpose to Tweet, don’t update
- Look at your license, recall that oath (I know corny, but it’s better than staring at a jail cell wall for 10 years)
I understand the excitement over using Twitter in a clinical setting (hey, I’m one of the advocates of Improvement through Health 2.0). But I don’t want that excitement to lose its luster in the wake of avoidable violations.
I’m not a big fan of HIPAA but I follow its rules. And so should you if you want to keep your license and practice the artful science of being a Jedi. Twitter’s awesome. But I’m not going to endanger my patient’s dignity and safety over it. All that, it ain’t.
Perhaps our first Tweets about the state of health care aught to be made about a wider discussion about how to simultaneously protect patient privacy and health professional sanity. HIPPA may be a stupidly constructed work of legislative ignorance, but it has the enforceable power to fine and jail you. Tweet Smart.
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Bloggers Wanted: Why You Should Volunteer for a Hospital Blog
Of the billions of bloggers out there (albeit most with an average readership of 1), how many talented ones would be willing to volunteer their time to help out a community hospital with its blogging?
As I’ve discussed in the last post, hospital blogging can be a costly project. The opportunity costs of blogging can be huge (time spent on research or improving operations). But: the opportunity costs of not blogging can be even bigger (not showing off your knowledge base and expertise or establishing community trust and authority).
So to help the community of hospitals (large and small), one possible route is to solicit help from the community of bloggers. The blogosphere a disparate and often talented community. It includes soccer moms, engineers, web designers, doctors, politicians, forest rangers, comics, and a whole assortment of other resourceful individuals. Many of them also have other skills pertinent to business and process management.
I’m willing to bet that there are plenty of bloggers (some amateur, others experienced pros) who would be delighted to offer their services to community hospitals. There’s really no University of Blogging per se. And no one company that stands out to fill the role of uber-consultant. So hospitals interested in looking into blogging or other Web 2.0 projects could reap handsome rewards by reaching out to the blogging community.
Why would bloggers volunteer their time, even it would be for an hour per week? Here are some off-the-cuff benefits to volunteer hospital-blogging:
1. Boost traffic (slightly) to their own site (as appropriate)
2. Help enhance their reputation and authority
3. Develop another blogging “voice”
4. Build their brand (or resume if that’s what they want)
5. Expand their horizons
6. Offer a chance to become evangelists for healthcare technology on the web
7. Enhance their value to other bloggers
8. Network with other bloggers
9. Change the mix of their daily grind
10. Gain a sense of participating in a noble cause.
I hear people laugh and offer a lot of (understandable) sarcasm at the idea of bringing blogging and other social media to hospitals. That’s fine with me. As long as they have ideas for improving healthcare. And understand what it is that I’m driving at.
Cynicism is not skepticism.
Cynics put down the truth. Skeptics lift it up.
For you folks who find it a nutty proposition, please argue with any of the ten items I listed above. If you reject them all, would you just do me a favor and offer your own lists for improving healthcare. People are suffering. They could use your help. You’re brighter than me, so radiate your brilliance!
For those of you who believe in the values of hospital blogging let me know why you think volunteer blogging makes sense. Do you think it’s a realistic proposition?
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