Progressives tout California Health care "success"

[KD in CA]

Weren't electronic patient records an important part of the ACA?

 

Not those IT guys.

[birdog1960]

Not those IT guys.

no, actually just those IT guys. EHR's in my view aren't primarily about improving patient care. they're primarily about oversight and billing. they're primarily about proving what providers including hospitals did or didn't do and whether they're entitled to reimbursement. they're also about measuring quality. unfortunately, i understand their necessity. but claiming that they've transformed patient care is a quantum leap. they may not have improved it at all.while were at it, where are the really big players in the EHR biz? where's apple for instance? microsoft? there's obviously plenty of money in it. why were we left with the winners among a group of losers in the run off to be the big providers of EHR's? maybe oc can help us here.

Edited July 8, 2013 by birdog1960

[B-Man]

Careful, strong opinion to follow, some posters should have their smelling salts ready.........lol

 

 

Cloward-Obama

By Michael Walsh

 

By now it’s abundantly clear that there is not an honest bone in the Obama administration’s body; as Mary McCarthy said of fellow traveler Lillian Hellman, “every word she writes is a lie, including ‘a” and ‘the’.” Everything with these people is a bait-and-switch, and nothing more so than their “signature achievement,” the Patient Deflection and Unaffordable Care Act, better known as Obamacare.

 

From the start, it was clear that the “health care” law had nothing to do with health care. It barely had anything to do with insurance, although it was “sold” to a minority of the American people — but to a majority of their elected representatives in the Democratic party — as if the two are somehow related. Rather, the act was a naked power grab by the federal government, rescued from its blatant unconstitutionality by the timely intervention of Chief Justice John Roberts, who buckled to administration pressure and discerned a “tax” in the emanations from a penumbra wrapped inside a riddle behind the Sphinx’s left ear. Even with itself, it was dishonest from the start.

 

And so the White House has pulled its now-shopworn thief-in-the-night act, not once but twice: first with its by-the-way “delay” of the employer mandate for a full year, and now with its don’t-ask-don’t-tell approach to the eligibility requirements for Uncle Suger’s subsidies in the state exchanges. “Stated income” may be no good in the mortgage market any more after it crashed the system, but apparently it’s good enough for the Obama bureaucracy, whose faith in the honesty of the mendicant citizenry is touching if historically misplaced.

 

This all may be due to the bumbling incompetence of an administration long on ideology, bristling with hostility, short on intellectual diversity, and absolutely devoid of a moral compass, but I don’t think so. I think it’s exactly what they’ve hoped and planned for all along: that the faster they wreck the system, Cloward-Piven-style, the faster they’ll get to the “single payer” (i.e., you) mechanism they’ve wanted all along. And then we, too, like all those East Bloc countries where I spent so much time from the 40th anniversary of the Dresden firebombing in 1985 in the old DDR to the 1991 coup attempt against Gorbachev in the old USSR, can say: At least we have “health care.” Freedom, not so much, but you can’t effect “fundamental transformation” with breaking a few shibboleths.

 

The larger issue is what’s compelling a sizable swath of the political class to constantly insist that things are “broken” and that they must be fixed right this minute, especially in the Senate (the supposedly more deliberative body), where soulmates like Chuck Schumer and John McCain rush around with their hair on fire, pushing “health care” reform and discerning ominous undocumented shapes lurking in the shadows. When a used-car salesman tells you have to take his manager’s just-for-you deal right now, a sensible person walks away. In Cloward-Obama America, we continually reelect such hucksters to Congress. And nothing ever changes, including the fierce urgency of change.

[DC Tom]

no, actually just those IT guys. EHR's in my view aren't primarily about improving patient care.

 

Funny, I thought I'd asked "Weren't electronic patient records an important part of the ACA?" I didn't realize I'd asked "Weren't electronic patient records an important part of birdog1960's view?"

[OCinBuffalo]

Disclaimer: Not that I expect birdog, or most of you to read this, but, it is not only fair, but accurate, and dare I say: insightful? So why not write it, even it if it falls on idiot/deaf ears?

 

yeah, what did all us folks actually trained in medicine do before all you invaluable IT people came around and saved us?

Quite literally? With so many of you saying "I'm a doctor" and pretending that means you know not just something, but everything, about IT design, construction, integration and MANAGEMENT, and the various other disciplines we use, which often take just as much study, and just as much "interning" to master, as your work? And, when we actually do bring these to the problem, you fight us right up until the point that you are embarassing yourself, then you slink off and refuse to participate...because it's not "your idea"? (When in reality, my design doesn't work, unless it is 100%: your idea. But, the ego is blinding...)

 

Add to that nurses saying things like "I know my patients", when doing so is to claim ominpotence, or at the very least, insomnia, since college. Add to these the facts that the weakest consultants I have ever seen operate in your industry, that 90% of the code/architecture I've seen is atrocious, and most importantly: that I have consisently found that Health Care is where the incompetent/scared of their own shadow IT/health care managers hide?

 

It's a tossup for whom exactly is more responsible for holding your industry back. There is more than enough blame to go around, birdog.

 

You could have saved yourselves, years ago, had you all been able to get your egos out of the way of the projects that were necessary, and hire the people that were necessary. Example: I've now met 5 doctors/wannabe Bill Gates...with complete server racks in their basement/office/office basement. I'd estimate an average of ~$30k of equipment per guy, all ready to go, and not one of them with the first F'ing clue how to build the software they need. (I thought the last guy was going to cry when I told him what "the cloud" actually means)

 

But...the hardware proves they know what they are doing, right? No, they don't, which is how I came to be standing in their basement, next to their kid's toys. I am the panic button that gets pushed when the hubris comes crashing down. But, please understand, that's been the story many other places too.

 

The upside? Nobody can say you guys don't care. But caring is not a replacement for proper standards and practice. You only get that from guys like me.

hell, we aren't even needed, right? just use diagnostic programs, treatment algorithms and robots for surgery, right?

This is the polar opposite of what is required, what I think, what I do, and what I plan to do. Hilarious.

 

In fact, it is this very thinking that is the root of so much idiocy in health care. Clinical software, which, in other industries would correctly be called "quality assurance", should never, ever, have been allowed to drive things like reimbursement or used as a replacement for operations software. This is flat out illogical. Other industries have operations software, you do not. CRM software is not the answer here either. Care planning/clincal plans, without proper operations software, is like preparing a battle plan, but going into the battle with all the radios turned off, no real time information, ignoring how the plan went, whether the planned work was done, and more importantly how we did with the unplanned work, and then, preparing the next battle plan, and repeating the process.

 

That is precisely what health care does today, and then, when called on it? They talk about the F'ing patient. (Imagine Walter Sobchak, conducting the choir, but instead of "their gonna kill that poor woman", it's "we have to be patient-centered". )

 

I have news: basing your business process on an unpredictable standard, which changes constantly, is inconsistent from one to the next and whose flavors may or many not even show up this month? That is the opposite of a standard. People aren't widgets(u starting to see why applying your screed, to me, of all people, is hilarious?). Using the patient as the core design pole is the height of idiocy. Your business process is what you do, therefore, it must be based upon and measured by, what you do. The patient may effect what you do, but it is an input, a variable, it is not the equation, and should never be the core of the architecture.

 

Put simply: you don't learn how to hit a baseball based on the pitcher. You learn how to hit by focusing on the fundamentals. You start with where you feet go, and then move on to your knees, etc. You improve your hitting by doing the same. As the pitchers get "better", and start to throw curveballs, again, you focus on what you do, and learn new fundamentals to deal with it. Most health care organizations do not learn or operate this way.

 

At no time does the pitcher define what you are doing, or your improvement of what you're doing. It's merely an input. While you adjust what you are doing to the input from the pitcher, you don't try to come up with a different batting stance, swing, etc. per pitcher, or per pitch. This is precisely how we ended up with a bazillion ICD 9-10 codes, and within that design concept, there are actually too few. Are you feeling me on any of this? Do you get how stupid this all is? Do you get WHY and HOW I have already proven how stupid this all is?

 

Any health care organization that is trying to hit, based solely on the pitcher(patient, state regs, Joint commission, whatever), will fail.

um, well, NO! essentially no one believes we are anywhere near this point. how did we ever manage patients without you? (hint -many of us had great outcomes with paper charts). Do you actually have data that supports the contention that IT has improved patient outcomes as an independent variable? i've seen some negative data. my impression is that the jury is still out...but i'm sure in your narrow, biased, self congratulatory mind, it's a slam dunk.and if you objectively believe that tasker "schooled me" on lawyers from what is documented in this thread, then your opinion is worthless...but most here already knew that.

Clearly what I wrote above not only invalidates this idiocy, what you've written here merely underscores the veracity of what I'm saying..

 

Frankly, health care is the only industry I've worked in where IT has been allowed to be this bad, for this long. There are many reasons why.

 

Edit: #2 = Answer to why no Apple, Microsoft, etc.:

Chief among them is bad profit margins, which keep the elite away, bad attitudes (doctors and nurses saying things like "my job is more important than anyone else's, so that means I don't have to be a manager or a leader, or even try"...so why should Apple or Microsoft want to bother?...before I got into this, I had an E&Y partner screaming at me on a plane not to do it, and come work for him, because "Health care is nothing but A-holes who refuse to learn"), and constant meddling from the insurance/pharma companies and the unions/government.

 

Again, there is enough blame to go around. One thing is certain: if you can't tell me what you did today, how it went, by patient, and what it cost, literally, by patient, not financial accounting nonsense, and the same thing tomorrow, then the rest of what you have to say is irrelevant. This is because, by definition it cannot be based on fact, or anything that is actually relevant to determining how health care is performing as an industry, a group, or an individual.

 

Or, put another way: It's impossible to get a handle on health care costs, if you don't know what they are.

 

Edit: It's hilarious that birdog's posts actually agree with mine at a high level at least, however, he doesn't actually know why EHR's aren't the answer, does he? Maybe he will if he chooses to read the above.

Edited July 9, 2013 by OCinBuffalo

[DC Tom]

Disclaimer: Not that I expect birdog, or most of you to read this,

 

You got that much right.

[B-Man]

Obamacare Exposed

 

By Ramesh Ponnuru

 

My latest Bloomberg View column discusses six truths about Obamacare revealed by last week’s delay of the employer mandate.

Fifth

, the law’s problems aren’t simply the result of Republican sabotage, as many of its supporters say. It is an odd defense of a law — especially one that most people oppose — to say that it would work well if only the country were uniformly behind it. And last week’s delay undermines this defense.

The administration simply flinched from the economic consequences of the law; Republicans had nothing to do with it.

 

 

 

.

Edited July 9, 2013 by B-Man

[IDBillzFan]

Obamacare Exposed

 

By Ramesh Ponnuru

 

My latest Bloomberg View column discusses six truths about Obamacare revealed by last week’s delay of the employer mandate.

Fifth

, the law’s problems aren’t simply the result of Republican sabotage, as many of its supporters say. It is an odd defense of a law — especially one that most people oppose — to say that it would work well if only the country were uniformly behind it. And last week’s delay undermines this defense.

The administration simply flinched from the economic consequences of the law; Republicans had nothing to do with it.

 

I find it increasingly amazing that anyone in their right mind...anyone at all...can still believe this law is a good idea.

[Nanker]

"If you like your current healthcare coverage - you can keep it!"

"It will provide HC for 30,000,000.00 Americans who do not now have it."

"It will LOWER healthcare costs for (almost) all Americans."

"It will REDUCE the deficit."

"Employers will be required to provide HC insurance for all their employees."

"Insurance companies will be required to cover all pre-existing conditions without increasing premiums - for anyone."

"Parents can keep their unemployed children on their policy till they (the children) are 26."

(Of course they'll continue paying higher premiums to cover their generally healthy kids for an additional five years - but hey, it's THEIR money.)

What's not to like?

Did I miss anything?

[birdog1960]

Disclaimer: Not that I expect birdog, or most of you to read this, but, it is not only fair, but accurate, and dare I say: insightful? So why not write it, even it if it falls on idiot/deaf ears?

 

 

Quite literally? With so many of you saying "I'm a doctor" and pretending that means you know not just something, but everything, about IT design, construction, integration and MANAGEMENT, and the various other disciplines we use, which often take just as much study, and just as much "interning" to master, as your work? And, when we actually do bring these to the problem, you fight us right up until the point that you are embarassing yourself, then you slink off and refuse to participate...because it's not "your idea"? (When in reality, my design doesn't work, unless it is 100%: your idea. But, the ego is blinding...)

 

Add to that nurses saying things like "I know my patients", when doing so is to claim ominpotence, or at the very least, insomnia, since college. Add to these the facts that the weakest consultants I have ever seen operate in your industry, that 90% of the code/architecture I've seen is atrocious, and most importantly: that I have consisently found that Health Care is where the incompetent/scared of their own shadow IT/health care managers hide?

 

It's a tossup for whom exactly is more responsible for holding your industry back. There is more than enough blame to go around, birdog.

 

You could have saved yourselves, years ago, had you all been able to get your egos out of the way of the projects that were necessary, and hire the people that were necessary. Example: I've now met 5 doctors/wannabe Bill Gates...with complete server racks in their basement/office/office basement. I'd estimate an average of ~$30k of equipment per guy, all ready to go, and not one of them with the first F'ing clue how to build the software they need. (I thought the last guy was going to cry when I told him what "the cloud" actually means)

 

But...the hardware proves they know what they are doing, right? No, they don't, which is how I came to be standing in their basement, next to their kid's toys. I am the panic button that gets pushed when the hubris comes crashing down. But, please understand, that's been the story many other places too.

 

The upside? Nobody can say you guys don't care. But caring is not a replacement for proper standards and practice. You only get that from guys like me.

 

This is the polar opposite of what is required, what I think, what I do, and what I plan to do. Hilarious.

 

In fact, it is this very thinking that is the root of so much idiocy in health care. Clinical software, which, in other industries would correctly be called "quality assurance", should never, ever, have been allowed to drive things like reimbursement or used as a replacement for operations software. This is flat out illogical. Other industries have operations software, you do not. CRM software is not the answer here either. Care planning/clincal plans, without proper operations software, is like preparing a battle plan, but going into the battle with all the radios turned off, no real time information, ignoring how the plan went, whether the planned work was done, and more importantly how we did with the unplanned work, and then, preparing the next battle plan, and repeating the process.

 

That is precisely what health care does today, and then, when called on it? They talk about the F'ing patient. (Imagine Walter Sobchak, conducting the choir, but instead of "their gonna kill that poor woman", it's "we have to be patient-centered". )

 

I have news: basing your business process on an unpredictable standard, which changes constantly, is inconsistent from one to the next and whose flavors may or many not even show up this month? That is the opposite of a standard. People aren't widgets(u starting to see why applying your screed, to me, of all people, is hilarious?). Using the patient as the core design pole is the height of idiocy. Your business process is what you do, therefore, it must be based upon and measured by, what you do. The patient may effect what you do, but it is an input, a variable, it is not the equation, and should never be the core of the architecture.

 

Put simply: you don't learn how to hit a baseball based on the pitcher. You learn how to hit by focusing on the fundamentals. You start with where you feet go, and then move on to your knees, etc. You improve your hitting by doing the same. As the pitchers get "better", and start to throw curveballs, again, you focus on what you do, and learn new fundamentals to deal with it. Most health care organizations do not learn or operate this way.

 

At no time does the pitcher define what you are doing, or your improvement of what you're doing. It's merely an input. While you adjust what you are doing to the input from the pitcher, you don't try to come up with a different batting stance, swing, etc. per pitcher, or per pitch. This is precisely how we ended up with a bazillion ICD 9-10 codes, and within that design concept, there are actually too few. Are you feeling me on any of this? Do you get how stupid this all is? Do you get WHY and HOW I have already proven how stupid this all is?

 

Any health care organization that is trying to hit, based solely on the pitcher(patient, state regs, Joint commission, whatever), will fail.

 

Clearly what I wrote above not only invalidates this idiocy, what you've written here merely underscores the veracity of what I'm saying..

 

Frankly, health care is the only industry I've worked in where IT has been allowed to be this bad, for this long. There are many reasons why.

 

Edit: #2 = Answer to why no Apple, Microsoft, etc.:

Chief among them is bad profit margins, which keep the elite away, bad attitudes (doctors and nurses saying things like "my job is more important than anyone else's, so that means I don't have to be a manager or a leader, or even try"...so why should Apple or Microsoft want to bother?...before I got into this, I had an E&Y partner screaming at me on a plane not to do it, and come work for him, because "Health care is nothing but A-holes who refuse to learn"), and constant meddling from the insurance/pharma companies and the unions/government.

 

Again, there is enough blame to go around. One thing is certain: if you can't tell me what you did today, how it went, by patient, and what it cost, literally, by patient, not financial accounting nonsense, and the same thing tomorrow, then the rest of what you have to say is irrelevant. This is because, by definition it cannot be based on fact, or anything that is actually relevant to determining how health care is performing as an industry, a group, or an individual.

 

Or, put another way: It's impossible to get a handle on health care costs, if you don't know what they are.

 

Edit: It's hilarious that birdog's posts actually agree with mine at a high level at least, however, he doesn't actually know why EHR's aren't the answer, does he? Maybe he will if he chooses to read the above.

well, i'm shocked and i did read it. and much of it i agree with, especially the part about if it isn't my idea it won't work. that must be why it doesn't work!!! i can't think of a single medical IT product available that was primarily designed this way or works this way. if they were, we wouldn't see abbreviations for tests, diagnoses and treatments that are never used in medicine (just one example). we'd have systems that could parse information in notes routinely and collate them into the proper lists. and we wouldn't have so much keyboard data and note entry. almost every doc over 40 became a master of dictation in his training and career. that should be the primary data entry method. it's not. so yeah, some docs are luddites, many, if not most docs are arrogant but the IT people have generally dropped the ball repeatedly and there's more than enough justified criticism to go around.but to the original point, if the big players aren't here due to low profit margins and you are, how does that advance your thesis re generalists vs specialists in IT? microsoft and apple have a rep for paying well. they employ generalist IT people. presumably they're well paid. but if the profit margin in med IT is low isn't the pay disparity between a generalist working for a big player and a specialist working for a lower food chain org likely to be relatively low, at least in comparison to medicine?

[B-Large]

had an older gentleman come in for a medicare wellness exam recently. i explained that it was a new benefit of the ACA to which he made some disparaging comment. i explained that it was optional and we could deal only with ongoing issues if he preferred. nope. let's do the wellness exam...strange when ideology and reality meet.

 

Its all about perspective really. If you have a pre-exisiting condition you see the obvious advantages of the ACA even in lieu of the disadvantages. If you have never considered going it alone and always relay on employer group plans, railing in the ACA is great for the dedicated partisan to talk about and ride bets on its rough implemntation and fall short on set goals.

 

Repealing the ACA doesn't terrify me, in fact, I am not convinced the Bill should have been comprehensive, instead should have addressed urgent pieces of the problem like covering the people who desire to be covered, etc.... but what terrifies me is 1 party who wants to repeal has no plans t replace it with anyting- that to me is more terrfiying that the monolith ACA

[KD in CA]

but what terrifies me is 1 party who wants to repeal has no plans t replace it with anyting- that to me is more terrfiying that the monolith ACA

 

So way too much and way too expensive gov't is better than too little? Now THAT mentality is what's truly terrifying.

[B-Man]

but what terrifies me is 1 party who wants to repeal has no plans t replace it with anyting- that to me is more terrfiying that the monolith ACA

 

We have had this discussion several times.

 

Your statement that the GOP wants to repeal, but has no "replacement" is disingenuous.

 

There are multiple, more direct, less intrusive plans that have been propose by Republicans, and democrats over the years that could instituted.

 

.....................and it wouldn't take six years for them to start......................lol

 

 

.

[birdog1960]

Its all about perspective really. If you have a pre-exisiting condition you see the obvious advantages of the ACA even in lieu of the disadvantages. If you have never considered going it alone and always relay on employer group plans, railing in the ACA is great for the dedicated partisan to talk about and ride bets on its rough implemntation and fall short on set goals.

 

Repealing the ACA doesn't terrify me, in fact, I am not convinced the Bill should have been comprehensive, instead should have addressed urgent pieces of the problem like covering the people who desire to be covered, etc.... but what terrifies me is 1 party who wants to repeal has no plans t replace it with anyting- that to me is more terrfiying that the monolith ACA

the perspective i see all too often is that if lots of other people that are not getting care now, suddenly start getting care, there will bew less care and more waiting and inconvenience for me. therefore, it's bad...except for the parts that benefit me. those are good. yup, perspective.

[B-Man]

 

Great news: White House knew all along ObamaCare implementation impossible

 

Surprised by the recent waivers from the Obama administration on the Affordable Care Act? Get ready for more, writes Margot Sanger-Katz at National Journal, because the employer mandate is far from the only piece of ObamaCare that’s not ready for prime time. In fact, it might be easier to select the few components that might be ready for the implementation target date than to number those that won’t:

If you’ve been reading all the Obamacare stories lately, you might get the impression that the administration has just realized it will not be able to implement the massive health reform as designed.

 

It has known for months.

 

As far back as March, a top IT official at the Department of Health and Human Services said the department’s current ambition for the law’s new online insurance marketplaces was that they not be “

a Third-World experience

.” Several provisions had already been abandoned in an effort to simplify the administration’s task and maximize the chances that the new systems would be ready to go live in October, when customers are supposed to start signing up for insurance.

 

In April, several consultants focusing on the new online marketplaces, known as exchanges, told

National Journal

that the idealized, seamless user experience initially envisioned under the Affordable Care Act was no longer possible, as the administration axed non-essential provisions that were too complex to implement in time. (Read

the story for some examples and commentary

.) That focus has intensified lately, as officials announced that they would

not be requiring employers to cover their workers

next year or states to

verify residents’ incomes

before signing them up for insurance.

 

“There’s been a focusing in not on: ‘What is the full ACA vision?’ but: ‘What are the pieces we have to get running by October 1?” said Cindy Gillespie, senior managing director at McKenna Long and Aldridge, who is working with states and health plans.

 

Remember the impossibly-complicated flow charts produced by ObamaCare opponents to demonstrate the folly of the ACA? At the time, proponents of the bill insisted that those were just scare tactics designed to irrationally frighten voters from the benefits of change.

 

Now, though, it’s the ACA’s supporters producing similar flow charts to demonstrate why they can’t meet their deadline:

 

Functions ........maze , I mean, map, at link

 

“Bear in mind,” Sanger-Katz notes, “this chart is supposed to simplify and explain.” It comes from a consultant group assisting in the process of getting states to create the exchanges that will interface with the IRS, HHS, and other federal agencies. What it does explain is the mess that the ACA created, and how the administration cannot make it work more than three years after its passage.

 

Another point to bear in mind: this is the Obama administration’s signature accomplishment. For the past five years, they have had no higher priority than to make this work, which at the time of passage they claimed would be nowhere near as complicated as their critics claimed. Now they can’t even make the key employer mandate work after three years — three years in which employers and their employees have been forced to adjust to it by taking on more expensive insurance or cutting hours to their staffs.

 

 

 

http://hotair.com/archives/2013/07/09/great-news-white-house-knew-all-along-obamacare-implementation-impossible/

[DC Tom]

 

 

 

 

 

http://hotair.com/ar...ion-impossible/

 

First...that's not a "flow chart", that's more what the feds call an "architectural overview".

 

Second...as federal "architectural overviews" go, that's clearer than most. Half the ones I see don't even have arrows. ("What's this system? What does this do? Does this actually talk to any other system? Does it do anything at all? What? You 'don't need arrows' because 'we're agile' and 'it's in the cloud'? Shut your !@#$ing piehole, you !@#$ing monkey.")

[B-Man]

First...that's not a "flow chart", that's more what the feds call an "architectural overview".

 

Second...as federal "architectural overviews" go, that's clearer than most. Half the ones I see don't even have arrows. ("What's this system? What does this do? Does this actually talk to any other system? Does it do anything at all? What? You 'don't need arrows' because 'we're agile' and 'it's in the cloud'? Shut your !@#$ing piehole, you !@#$ing monkey.")

 

Thanks for the laugh Tom, I think that I've been to a few meetings like that.

 

 

.

[OCinBuffalo]

well, i'm shocked and i did read it. and much of it i agree with, especially the part about if it isn't my idea it won't work. that must be why it doesn't work!!! i can't think of a single medical IT product available that was primarily designed this way or works this way.

Wait, you didn't expect me to leave the Fortune 500, just so I could bring you something somebody has already done that sucks, or something else that is equally inferior, all lame-dick rehashed with few new added features, did you? Does that even kinda sound like me?

 

I spent years in feasibility study, performed properly, before I left. I determined what was needed after testing tons of different hardware and software against the very long(imagine ), granular and specific set of requirements I created. I spent F'ing hours and hours on nights and weekends in hospitals and SNFs, smelling the poop, seeing the gunshot victims come in, and observing. That's before I wrote a single line of code. The notion that I haven't spent time in hospitals = hilarious.

if they were, we wouldn't see abbreviations for tests, diagnoses and treatments that are never used in medicine (just one example).

Why do I need to control what you call things? I couldn't care less. Our stack = call ALL of it what you want, and this can be done per user, per department, and completely changed over and over, as many times as you/others want: no consequences, no data conversion, and all of this can be resurrected at any time.

 

But, it's not just limited to terms, you design the ENTIRE process of how the "thinger"(you name it) you build works, from end to end, with only a few basic, experience-based rules to keep you from hurting yourself. It's like gun safety: too many rules is counter productive. If you want more rules, we can build them, but you own them. (There is a hell of a lot more to this than just this stuff) A wise doctor could actually end up making money on this deal, because he could charge others for some or all of his "thinger". Or, a group of docs could all be birdogs, share everything they do, and have little parties where they tell each how moral they are for sharing, and talk about squash. I do not care.

 

(Edit: I also do not care if you have parties and charge each other for use of your thingers, consenting adults...etc. )

 

The reason that you find what you hate elsewhere is specific to the underlying data model that was used to create the software. I can explain in detail, but, it's merely: inferior.

we'd have systems that could parse information in notes routinely and collate them into the proper lists.

Si Senor. (Always wanted to use that, the right way) Now you've described a core concept of our transactional storage facility(sorta). You've also kinda backed into one of our workflow concepts.

 

But actually, consider this: what if the "proper lists" were infinite, and also user defined in any level of granularity? Of course we'd have the lists for "corporate"/standard purposes, but, if you just wanted to do your own thing, and study your own thing, or, get the hospital/nursing home to give you "your own thing" data? It's actually easy, for us, without causing major disruption of process/testing/implementation costs.

 

In fact I've filled a doctor's custom data "order" like that in .5 hour, and that was PT rehab along with nurses responding to doctor's order crapola, delivered remotely, and delivery timing was purely rule/data-driven. The PTs and RNs spent under a minute in making the adjustment, because they've designed every aspect of their respective systems, the same as you.

 

So no, we don't text you every 5 minutes with the irrelevant, whether you want it or not(see Epic's relatively recent $750k mobile software project debacle...or Epic FAIL as it were. ) That is what happens when you ask maintence workers to suddenly become architects and project managers.

and we wouldn't have so much keyboard data and note entry.

How about 0 keyboard and note entry, other than doing your login(and that's only because HIPPA says we have to + Meaningful Use = 2 factor authentication)?

 

Health care is the single most quantifiable industry I've ever been in, period. Consider: everything is big, medium, small, that presented 1, 3, 25 times, etc. Consistent, sporadic, rare. Etc. The only reason you all think you're Earnest Hemingway, and that your notes are wildly valuable pieces of prose that must be saved for posterity?

 

You grew up in paper. Notes are a function of the limitation of paper, as a vehicle for communication, and, the Hemingway thing. I cut out all the reasons why I am right. If you want them, just ask. But I will tell you now: Argue with me all you want, when you get done, I will prove the need for notes to be a myth, and a hindrance to doing this better.

almost every doc over 40 became a master of dictation in his training and career. that should be the primary data entry method.

I had a specially designed browser responding to voice commands on mobile device and doing stuff with our first RC...in 2003(that browser went nowhere = IBM stikes again). As I say often: I don't care how you enter the data, as long as you do it, correctly, and stop making excuses for not doing it. Rather than leaving you to it, I take away your excuses, and, "correctly" is defined by you, so if you don't do it right, you only have yourself to blame.

 

We create the conditions for you to find a way to make it work for you. That's how we do it. That ain't how GE/Cerner/McKesson/etc does it. They find a way to have you buy what they have on their shelf.

so yeah, some docs are luddites, many, if not most docs are arrogant but the IT people have generally dropped the ball repeatedly and there's more than enough justified criticism to go around. but to the original point, if the big players aren't here due to low profit margins and you are, how does that advance your thesis re generalists vs specialists in IT?

Well, here's where I am going to sound like you: I made a self-sacrificing choice to get into this because I knew I could make a difference. Really. A real consultant is attracted to the biggest/riskiest problems, because boredom is worse than death. A kitty gets his 8-5 job at IBM. Not many 20-somethings are going to miss good drinking time to hang out in a poop and desperation-infested inner city hospitals or nursing homes on a Friday night.

 

I've met 2 guys out of a 1000+ in health care that made that same choice. Almost all of the other 998 wouldn't last an hour where we come from, because they couldn't bill for that hour, because nobody would pay for that hour.

 

How some health care software was developed: 6-8 nurses in their focus group, 10 docs in theirs, etc. This approach works great, if you are one of those nurses or docs. Everybody else: the shaft. Health care is not manufacturing, so, no, that requirements gathering approach, that produces that form that those 6 nurses like is not going to make sense to other nurses. In manufacturing, a form similarly designed will make a lot more sense from one group of factory foreman to another. The job is different. We aren't simply reporting on what the machine did and what we did as a result, the combinations of which are finite, and where the process is the only thing. No, in health care we are reporting what we did in repsonse to a patient, the combinations of which are infinite, and where the patient(WRONGLY) is the only thing.

 

How the rest was developed? Docs/Ph.D nurse clowns, who've never taken a single IT class in their life, setting themselves up as project managers and technical architects(which they patently are not), hiring programmers(that they don't know how to hire or...manage ), writing specs(that they don't know how to write), and designing DBs(that they don't know how to design), and creating UI based on nothing other than: it makes sense to them.

 

This is because most of these companies were started by the untrained, inexperienced, bottom of the barrel. In the 80s, the real deal was making billions coding for Wall Street. These guys were making thousands coding for St. Mercy General.

 

Again, you can't expect very many janitors to suddenly show prowess as architects and project managers. You can't expect people who learned the job from Barnes & Noble, to be on par with me. I've been too well-trained, and far too many elite people have spent too much time(for which I owe, which why I train kids just as hard) on me to expect that.

microsoft and apple have a rep for paying well. they employ generalist IT people. presumably they're well paid. but if the profit margin in med IT is low isn't the pay disparity between a generalist working for a big player and a specialist working for a lower food chain org likely to be relatively low, at least in comparison to medicine?

No, no and no, and as many more no's as are required.

 

The generalist in IT works in India, if he has a job at all anymore. You don't hire a "programmer" like we once did, for the long haul, and train him/her as you go along, system to system. Now, you hire a javascript programmer with some json for the server stuff. You hire a Jquery guy for the UI. You hire another guy who only does DBs, and only if he has both SQL and NoSQL, etc. All specialists, but all of them are cross-trained as well. Thus, you expect that they will leave for more $ in 3 years max, and that is fine, because you may not want/need them by then. Relevant IT is becoming less about hierarchy and generalists, and more about small groups or...guilds? of master craftsmen.

 

This doesn't include the Drupal, etc. people, or the implementers of somebody's accounting package. Put simply: is the guy who grabs the metal out of your trash a generalist? Neither are they.

 

Hospitals don't have a rep for paying well, or, paying at all sometimes. I had to come up with a business model that could provide the high level IT stuff that I was doing elsewhere...for a price that health care could afford. I then had to come up with the stack that could be run within that business model. That's because: my interest here is in solving the problems. If somebody comes along and drops F U $ on me for the firm, that's fine, as long as it allows me to solve the problem.

 

Apple/Microsoft have no motivation for doing that. Their interest is solely in making $, with the least amount of North Korea Health Care attitude as possible.

Edited July 10, 2013 by OCinBuffalo

[IDBillzFan]

Bring it.

 

The House of Representatives will take up a bill that would stop the Department of the Treasury, including the Internal Revenue Services, from implementing and enforcing the provisions of Obamacare. The bill, authored by Georgia Republican Tom Price and co-sponsored by 114 other House members, is just two pages long and claims its purpose is to "prohibit the Secretary of the Treasury from enforcing the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010."

 

Let's see how many Democrats want to step to the mic and support the IRS these days after already screwing up their careers by ramming a detested ACA down America's throat.

[DC Tom]

The House of Representatives will take up a bill that would stop the Department of the Treasury, including the Internal Revenue Services, from implementing and enforcing the provisions of Obamacare.

 

Or they could just wait for the administration to stop them...