Saturday, August 18, 2012

UR xactly who I thought U were!

I wondered what I was going to blog about this week and what kept coming to my mind was someone's comment a while back about how presumptuous the title of my blog was.

I initially titled it as a theme on the first impressions that we make on others peoples lives. It was a play on how we behave in the business world, driving around town, or at the grocery store that determines the "characteristic impression marks" that we leave on those that are watching us. Some are watching consciously; and some unconsciously. I know that when I see someone's behavior (positive or negative) it affects me in some way throughout the day. 

It by no means means that first impressions determines who you are. Who knows, possibly you could just be having a bad day, a giddy day, or just had a life changing experience that alters your behavior. But at the essential core of your being, you are who you are; or "I yam what I yam and tha's all what I yam." *

I spent a few hours filtering through a provider data base to prepare for an outreach marketing message and was amazed how there is going to be a major effort to get a Master Patient Index (MPI) developed and maintained. 

How would an Health Information Exchange (HIE) determine a John Smith vs. a Jon Smith, or a J. Smithe? Or if there is a William Sydney or Sydney William? What would happen if a clerk misspelled my name or my email address? I am very appreciative that there are algorithms out there that will help process the other related personal information so that the community can determine the exact person - because in the area of health information exchange, it needs to be surgically precise. 

Thus the reason that clinical providers always verbally ask your name, birth date, address, and medical procedure, after checking your ID and visually making sure you are who you are. Primum non nocere (first, do no harm).

In the next few months, I am looking forward to getting a absolute, clear understanding of this process so that by next year this feature will be available. It is going to take a lot of work and a lot of effort but I believe that if HIEs can build this correctly, it will last for generations.


Sunday, August 12, 2012

There Is A Time For Everything . . .

I want to write about my concept of time; the time that it takes for things to get done, time that we have on Earth, time for processing our thoughts, time for understanding and forgiveness, time to work and time to play. 

In our society we want everything NOW: the microwave doesn’t pop popcorn  fast enough, Keurig doesn’t know how big a cup of coffee I want (which button do I press?), and the HIE isn’t built yet. What’s up with that, “Why aren’t you guys done yet?"

It takes time to build something that everyone wants and will use, but the problem is only a few really knows what they want and how they are going to use it! 

I don’t think I am alone in this. I recently traveled to the beautiful city of Portland (in July it was 82 degrees, without a cloud in the sky) to discuss how electronic health information was going to be exchanged technically between the states. We also discussed how the information from one state was going to be legally treated if it came from another state. To a certain extent this already happens now. If a doctor needs information from another doctor in a different state, they tell their staff to get it. The staff has to:

  1. asks the patient for the doctor’s information in the other state;
  2. research the doctor’s contact info on the internet;
  3. phone the physician;
  4. describe the patient, the problem, and the specific information needed;
  5. exchange fax numbers and the information is faxed. 
  6. - Done.

Sounds simple doesn’t it. So, why are we finished? 

It is because within each of these steps, there is a complex sub-steps that needs to be addressed. Added to that, the time that it takes to get it done can drag on for weeks due to missed calls, voicemail, and jammed fax machines. We are all humans and we forget, or rather, we get consumed by a avalanche of tasks that, what was on our mind a few days ago, gets pushed aside by what is critical and in front of us at that moment. 

And that is why Health Information Exchange (HIE) is important. It has to efficiently get the vital medical information that is needed to treat the patient at the point of care.  

But the long term goals of analytics, auto population of data, and synchronization of quality reimbursements will take time. I’m not saying that we should push that aside and let the the immediate issues take over this important vision. But what I am saying is that we need to meet the needs of what is happening now, demonstrate success, and encourage adoption.

To me (and this is my opinion), the community needs to put in the effort to make this happen and push adoption. Let’s put our energies into working together to help the immediate need become efficient. That means:

  • work for a common goal - help the provider;
  • create efficentices - combine policies so that there is commonality between organizations
  • and unify the message so that the provider doesn’t become lost in all the programs that is supposed to help him (really?).

The Hawaii Governor just signed a Bill that unifies the numerous state laws to fall under the federal health information protection act. It took a lot of work and support to get this accomplished and it’s just one small tactic to do the above three bullets. 

Well, enough of my update. Time to play.

“I know that there is nothing better for men than to be happy and do good while they live.” -Solomon

Friday, August 3, 2012

Health in Hawai‘i


Since my two years in Health Information Exchange (HIE) I have been extremely blessed by the many opportunities I have been given exposure to each day. I have meet extremely, embracing, intelligent and caring people all focused on doing public good. What really strikes me is how extremely complicated organized health care is and how we as individuals deal with the many intricacies.
When I was growing up I used to watch Marcus Welby, M.D. (for you young whipper-snappers, google it) with my beloved grandmother and was sooo amazed at his demeanor and bedside manner. When I was a little older, I watched shows like M*A*S*H and St. Elsewhere and I was amazed at all the relationships that went on. Honestly, I was looking for the gore and realism in those shows; as well as the entertaining comic relief but was introduced to the politics revolving around the relationships. By the end of the hour everything wrapped up nicely and I stayed tuned for next week’s episode, fully satisfied by the loss of brain activity that was zapped by the TV set.
Now that I am up to by eye-balls, drowning in analytics, reporting, and developing programs, I am amazed at how physicians get through their day. They are the true champions that crawl through the muck of payment reimbursements, Medicaid regulations, malpractice risk, and just regular business operations – oh and by the way, have to take care of all of us sick people. I admire their dedication to their profession and sacrifice their own health, time with their families, and embracing the unrelenting change that is supposed to “help” them. Well, I’m sorry to say that I’m a part of that change.
But change is inevitable. It is how we plan the change and solicit input to the ideas that craft it. We also have to provide our creative assessment and innovative ideas that, not solve, but deal with problems. I say deal because for big problems you never will solve them, and for little problems, if you think you solved them – there is always another problem related to it; usually much bigger. But the fact of the matter is that you have to change and if we all work together and share ideas, then change becomes understandable, embraceable, and sellable.
These are not new problems “History merely repeats itself. It has all been done before. Nothing under the sun is truly new. 10 Sometimes people say, “Here is something new!” But actually it is old; nothing is ever truly new.”* It’s just the way we handle ourselves and how we relate to each other. If we go into a meeting with a heavy burden on our shoulders of a monumental task that seems impossible to resolve, then our minds are already set that it won’t be resolved. We focus on picking on the faults and barriers of the gargantuan (Kill Bill reference) problem and wallow in our misery. Rather, let’s focus on the small tasks that can be resolved, keeping in mind that it may bring revelation to how to deal with the next bigger problem, which no doubt will come.
In the end, when it is all said and done, it’s the impressions that we leave our children that will help them deal with the continuing problems that, unfortunately we with all of our character flaws, all will never solve.  But we can come close!!

* Ecclesiastes 1 New Living Translation (NLT)