Progressives tout California Health care "success"

[birdog1960]

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.

 

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.

 

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.

 

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.

 

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.

 

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.

 

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.

all very interesting stuff. supports my theory that most people are fundamentally good. we'll make a progressive of you, yet. a right leaning progressive probably, but a progressive nonetheless.

 

the hemingway imitations in notes aren't primarily about style. they're about the difference between a note that immediately paints a vibrant picture of a patient and her problems in a few sentences and one that conveys almost nothing in 3 pages of computer template generated, cookie cutter vomitus. every colleague i discuss this with does the same thing on such notes: reads the first sentence to obtain demographic info then skips to the end to see the impression and plan. even this is usually woefully inadequate because this is usually free form and most docs hate typing.

 

the bright side is that ehr's are moving the system closer to single payer. small practices can't afford them and are thus joining mega groups and systems. this advances ACO's and integrated delivery systems. it's a blunt, rude, impersonal, inefficient and often hated implement but it is surely advancing us towards that endpoint. now, if we could get the ehr systems to actually communicate with each other....

Edited July 11, 2013 by birdog1960

[B-Man]

Asked and Unanswered

 

From Karl Rove’s piece about Obamacare in the Wall Street Journal:

.

. . in June, the administration and an allied nonprofit, Enroll America, described how hundreds of thousands of community organizers will sign up seven million uninsured people for health coverage, once registration for subsidized insurance starts Oct. 1.

 

Then on July 2, the administration dropped a bombshell, delaying the employer mandate for a year.

Even Democrats were taken aback. Iowa Sen. Tom Harkin, one of the law’s authors, was quoted in the New York Times saying, “This was the law. How can they change the law?”

 

It’s almost a Fox Butterfield moment — how can the administration send its shock troops out to give away “health care” and then disrupt the mechanism that in part is supposed to pay for it? — a contradiction that isn’t a contradiction when you stop to think about it. Or, to put it another way, for the Cloward-Obama administration, bankrupting the system’s not a bug, it’s a feature.

 

 

But back to Senator Harkin’s question: “How can they change the law?” Easy, senator: Because there’s no one to stop them. Now, what are you and your congressional colleagues going to do about it? Besides nothing, I mean.

[birdog1960]

http://www.buffalonews.com/apps/pbcs.dll/article?AID=/20130710/BUSINESS/130719892/1003 "it's a win-win". well, yeah, it would be if that touted socially responsible employer, wegman's ,didn't employ part-time to full-time workers at a ration of nearly 4:1 even before the ACA affects them.

[Doc]

Since Romneycare was the model for this, costs will continue to increase, not decrease. Also the CBO estimates that 30M people will still be without coverage. Considering it was 50M before, and that number was artificially high, this is becoming an even bigger CF than before.

[B-Man]

Dr. Milton R. Wolf: OBAMACARE’S PANICKED DEMOCRATS.

 

Poor Democrats. An election looms and their Obamacare train wreck is deservedly being called the worst law in American history. Voters hate it, and why shouldn’t they? The Democrats’ promises — that patients could keep their doctors and current insurance and that the law would reduce premiums, lower the deficit and create millions of jobs — have been exposed as outright lies. Now a central tenet of the fundamentally flawed law, the employer mandate, is collapsing. What ever will Democrats do?

 

 

 

 

 

 

Megan McArdle: The Employer Mandate: A Necessary Impossibility.

 

“For obvious reasons, the Obama administration did not want to tell folks that if they needed subsidies, they would be given access to a handful of HMOs. Nor that they would go onto the exchanges and be told to print out a paper application they could send to their state’s Medicaid office. That law would never have passed Congress, or the public.”

 

 

 

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Edited July 11, 2013 by B-Man

[IDBillzFan]

http://www.buffalone.../130719892/1003 "it's a win-win". well, yeah, it would be if that touted socially responsible employer, wegman's ,didn't employ part-time to full-time workers at a ration of nearly 4:1 even before the ACA affects them.

 

What's this I hear? You're not happy that companies are complying with the rules of ACA?

[DC Tom]

Since Romneycare was the model for this, costs will continue to increase, not decrease. Also the CBO estimates that 30M people will still be without coverage. Considering it was 50M before, and that number was artificially high, this is becoming an even bigger CF than before.

 

And the Democrats will blame the Republicans, because Romneycare was the model...

[Magox]

http://www.buffalone.../130719892/1003 "it's a win-win". well, yeah, it would be if that touted socially responsible employer, wegman's ,didn't employ part-time to full-time workers at a ration of nearly 4:1 even before the ACA affects them.

It's a "win-win" for the employees, however it's a lose-lose for the US taxpayer and federal debt.

[DC Tom]

It's a "win-win" for the employees, however it's a lose-lose for the US taxpayer and federal debt.

 

But it would be a win for the taxpayer and debt if the Republicans would sit in the back of the bus like they're supposed to.

[Jauronimo]

It's a "win-win" for the employees, however it's a lose-lose for the US taxpayer and federal debt.

EMRs should offset most of that debt. Right?

[Magox]

EMRs should offset most of that debt. Right?

You are going to have to forgive me for the question, what is an EMR? Electronic Medical Record?

[B-Man]

You are going to have to forgive me for the question, what is an EMR? Electronic Medical Record?

 

You are correct.

 

and once everyone is enrolled in Obamacare and hooked up to the big database.............we will save billions.

 

 

 

 

 

 

we were promised..................

 

 

.

[DC Tom]

You are correct.

 

and once everyone is enrolled in Obamacare and hooked up to the big database.............we will save billions.

 

 

 

 

 

 

we were promised..................

 

 

.

 

Because in the entire history of IT, the two things computers have saved are paper and money.

[Jauronimo]

You are correct.

 

and once everyone is enrolled in Obamacare and hooked up to the big database.............we will save billions.

 

 

 

 

 

 

we were promised..................

 

 

.

Yes, we were promised. Efficiencies through EMRs and system integration were going to offset "free sh%t for everyone" and preventative care was going to eliminate ailments such as old age.

[DC Tom]

Yes, we were promised. Efficiencies through EMRs and system integration were going to offset "free sh%t for everyone" and preventative care was going to eliminate ailments such as old age.

 

...because the Declaration of Independence lists "life, liberty, and the pursuit of happiness" as inalienable rights...and an inalienable right to life means the government must guarantee our right to not die.

 

(Yes, that's an actual argument I read.)

[Magox]

I should have known Jauronimo was being facetious. Damn you Jauronimo! Damn you!!!!!!!!!!!!!!!

[birdog1960]

EMRs should offset most of that debt. Right?

i don't think anyone ever imagined that. they imagined more cost effectiveness and quality data along with more oversight and control over costs and waste. but mostly they're just part of the trojan horse.

[Jauronimo]

i don't think anyone ever imagined that. they imagined more cost effectiveness and quality data along with more oversight and control over costs and waste. but mostly they're just part of the trojan horse.

If no one believed it then why was it peddled so aggressively? Are you accusing Obama of blatantly deceiving the American people?

[birdog1960]

If no one believed it then why was it peddled so aggressively? Are you accusing Obama of blatantly deceiving the American people?

i've said all along that the aca is a work in progress. ehr's are as well but also part of the overall plan. just my opinion.

[IDBillzFan]

Because in the entire history of IT, the two things computers have saved are paper and money.

 

That actually made me laugh out loud.