HIMSS 11 Thoughts

In my recent blogs I have been addressing the lack of office efficiency and automation within the health care industry as compared to other industries that have been dealing with "global competition" for decades. I recently had the opportunity to attend the HIMSS 11 Conference in Orlando and was delighted to find numerous examples of signs of change signaling, to me anyway, that the healthcare industry is finally entering the twenty-first century.

While visiting with EMR software providers it was clear that they too envision a world with appointments being held on time in an effiecient modest office setting. I have previously mocked this industry as to the number of secretaries, or more the politically correct "office personal" a doctor requires and I am pleased to see that this waste and added on cost is going to evaporate at some point soon. Items like bills, personal information and test results can be emailed to you. Some systems allow the patient to have an username so one can view his or her health record and test results online. These new systems even allow you to post questions to your Drs office and make appointments online. You can also maintain your personal information if you like.

Later in the conference, I came across several outsourcing companies looking for third party vendors to be representatives for their services. Some of these companies are setup to provide outsourcing of the complete set of office functions before and after the patients encounter, including scheduling, EMR, coding, billing, collections etc…. A number of these outfits were foreign, as in India, and I thought to myself "yes, healthcare is now facing global competition". For sometime now I have visioned the perfect small office as being one that would include one office person, one nurse and the outsourcing of all other office functions to someplace far away. In this way the doctors could be doctors and the office would be efficient, friendly and effective.

Lastly, being an old software/hardware hack I enjoyed seeing the various technical devices coming into the market from other industries. Items like a wristwatch for elderly that also acts as a phone, locating device, heart rate monitor and even has a blood pressure device so that these statistics can be monitored 24/7.

In closing I would recommend to anyone who has an interest in the healthcare industry that they attend the next conference if at all possible. I for one found it exciting, educational and enlightening.

Thoughts about EMR standardization

Being a newbie to healthcare informatics I sometimes find myself making pre-assumptions about the state of the art in healthcare IT. A few months ago I began the process of learning what the EMR is today, its past and its future. Through my readings I came to realize that for as long as the EMR concept has existed it has not yet been fully standardized and I wondered, why that is. Why is it that this data structure is not completely defined and regulated by our government whom is spending an incredible amount of money and resources to bring the healthcare system into the 21^st century?  Why has this not been done prior to mandating that all physicians begin to use an EMR? Is the government, once again, putting the cart before the horse?

My original position as to why the EMR is not yet completely standardized was very critical of both the healthcare industry and our government. Having had some time to enlighten myself in regards to the complexity of the problem, industry environment and its current state I now find myself understanding the current state and even in agreement with its lack of complete standardization at this point in time. In a recent article posted on medcitynews.com Dr. David Blumenthal, the National Coordinator for Health Information Technology, was quoted as saying:

“There is a raging debate in the computer science world, which I have only lifted the lid on because I’m not a computer scientist, but it goes basically like this: Do we want a world where somebody sets very detailed standards for what computers have to do in order to create interoperability? Or do we want a world that’s a little bit more like the Internet, where a minimal set of standards was created and an enormous, vibrant competition and spontaneous growth occurred?”

I would have to side with the latter view. Not only will there be spontaneous growth but also that spontaneous growth will allow for the evolution of a much better solution than one developed by committee. Furthermore by allowing the solution to evolve there is the opportunity for financial success by many rather than just a few. Not to mention innovation of unforeseen solutions.

In closing, I now am in support of an evolving EMR which will be allowed to grow and adapt as nature dictates. I now support an EMR solution that is never completely standardized and will always possess a fuzzy definition in certain areas.

Automation in healthcare, now where's the competition?

In my latest blog I expressed my frustration and bewilderment in regards to the lack of efficiency in the health care industry. I alluded to my dismay as to the fact that as a whole, the health care industry is decades behind other industries in the use of process improvement philosophies and machine automation in the workplace.

About a week ago after drinking my morning coffee, I assumed my customary position in my reading laboratory as one may call it and came upon an encouraging article in the September issue of IT Solutions. The article was titled "Automation appreciation" and summarized the implementation of an entirely automated medication delivery system at a hospital somewhere in Ohio. The article inspired me to recall experiences I had in working to automate inspections of automotive and airline parts in the early 90’s at various plants in the US. It gave me hope that health care is awakening from its paper dependent existence and that opportunity to participate in this enlightenment may just be around the corner. The article provided examples of where improvements were made and not. It summarized the discovery and implementation process the facility experienced and shared some insight as to what more could be accomplished. It even went so far as to provide recommendations in a "lessons learned" section for others whom are considering such rollouts to learn from. Wow, I gasped, my first engineering project manager used to have a "lessons learned" meeting every Friday prior to taking the team to the watering hole for some end of week relief. Now I am reading about "lessons learned" in a healthcare magazine and I wonder why it took so long.

Since that day I have made a point to spend 30 minutes every morning "Googling" for more cases of the use of both workflow improvement techniques and machine automation in health care settings. I have been encouraged that there is hope for the healthcare system just like back in the late 1980’s when the big three auto-makers were being clobbered by the lean and mean Japanese empire. These three companies became sluggish and fat in waste from years of easy profits. However, they rose to the challenge and by the late 90’s were competing once again with the best. I see similarities in the potential savings in the current health care system to the aging auto industry. The US healthcare industry needs to be pressed into finding these improvements in order to not only save our US citizens money but to also provide for a better product.

It occurs to me that what the US healthcare system really needs is some good old fashion global competition to make it sharpen its iron and trim its fat. So, I now wonder when will the US healthcare industry be exposed to the "global market" like the rest of us. Is this just around the corner? Why has this industry been allowed to practice isolationism? When no others have. Later.

Wonders of Healthcare Inefficiencies

Many of us, myself included, have often wondered why it is that when you go to a Dr. you have to make an appointment only to find yourself waiting, sometimes for more than an hour, to have your pre-scheduled appointment. Since I was a kid, I have also wondered why a Dr. needs SO many secretaries. My fathers accounted didn’t have one, his lawyers was part-time, he himself was a mechanic, ran his own Standard Oil station with 4 bays and he never had one. He also was the contracted mechanic for not only the local AT&T service center which had over 100 vehicles but also supported the county vehicles.  He did his own billing, collections, scheduling, HR all without a secretary. Why was a Dr. so much different? It seemed to me as a kid and still to this day that it was a combination of inefficiency and ego.

Growing up it would have been unacceptable for me to be a mechanic. I was groomed to be an engineer of some sort period and that was that. I received my bachelor’s degree in something called Engineering Mathematics and Computer Systems, which nobody really knew what that meant. Later it was updated to simply Computer Engineering. Starting with my very first employer, year 1984, an aerospace and defense systems company I have been sent to process improvement training countless times, this included Six-Sigma, Lean Engineering etc... you name it, I’ve been exposed to it. This was due to the global competition environment in which the companies were in. If one wanted to ensure himself a raise or promotion one had to not only do his job but also participate in making the company better and leaner. Leaner meant “fewer employees” or “man-hours” to get the same job done.

In the late 1980’s and early 90’s most engineering design companies, research and development outfits,  manufacturers and  even the construction industry went paperless.  Six Sigma and Lean Engineering became global philosophies. Throughout the 80’s, 90’s and early 2000’s engineering and manufacturing has been optimized and downsized ten times over. This has created better, safer and less expensive products for societies to enjoy. For an example, just look at the automotive industry. Detroit used to make the entire car all in Detroit, from raw material to finished product. Today, it subs out most of the work, finds “cool “ parts from almost any other industry and has been also decimated by foreign completion which has completely different manufacturing standards, employee laws and environmental rules. It is a wonder that Detroit even makes a car today. We find car plants springing up in places like Columbia S.C. which has no major natural transportation anywhere geographically near it. However, I am still walking into the Dr. for my appointment greeted by several secretaries and an hour long wait. I find my records incorrect or they cannot find them, along with errors in my “paper” billing, continuously.  At my last appointment I requested them to email me my statement and the expression I received made me feel like I was from a time 100 years in the future. This is accepted or at least seems to be by us as a society.

Now we face something called “Obamacare”.  Since, I like everyone else have no idea what this means, do I agree with it, NO. But, if it requires Dr’s to become more efficient and lean like the rest of us, good, let’s make sure that part is not thrown away. Why is it that it is just in the last three years or so that the healthcare industry has become aware of workplace philosophies like Six-Sigma and Lean Engineering. Motorola developed Six-Sigma is the 70’s. Why is it that programs like Medicare and Medicaid continue to fund this overweight decrepit industry with taxpayer monies?  We as a society have been leaned and optimized now so that 10% of us cannot find work, while even more, like me, are what is called under employed. At the same time the healthcare industry has continued to grow and construct museums as offices and workplaces. It is time for this to end.