Wednesday, March 13, 2013

EMR #2 ~ Solutions?

"Simplicity is the ultimate Sophistication." ~ Leonardo Da Vinci

Sophistication or Success?

Sophistication unlike success arises out of need, while success is borne of a difficulty.
The vagrant causal arrow seems to arrive from everywhere nowadays. Any “expert” who arrives at the mindfulness of a deeply flawed conjured idea, he or she becomes the author of the new cause celebre. This top-down, one-way dictates are flawed in execution even though the concept might have been sound at inception.

So let us go through a thought experiment.

What if?

What if we decided that sharing data between physicians, the hospitals and other healthcare facilities would be a boon to proper caring for a patient?

Ah yes. The logic in this is sound.

There is some potential for failure, especially if all the parties do not cooperate or the hospitals refuse to transmit their information, but then those are the inconsistencies of the human condition. Given enough time and little by little as the early adopters through their own trials and tribulations show success in regaling the virtues of this new form of a quicker communication, others might do some shoulder surfing and try their hand at it. In these early days, just like Lewis and Clark, the adopters would go through a sea of troubles, fits and starts, fortunes made and fortunes lost, before isolating all the potential pitfalls that might need remedy. The adapters, on the other hand, would get the benefit of usage while the early adopters would reap the rewards of their tribulations.

Lewis and Clark Trail

Now that makes perfect sense. Doesn’t it? It is after all the underlying principle of supply and demand. 

Like Apple’s iPad, no one needs one, but given its capabilities, everyone wants one. It arguably brings the world closer, integrates information faster and does not need a tether or a lot of weight to go with it. An innovation worth its tiny weight, a lot of bang for the buck! Now, Apple did not go to the Central Planners and through lobbying, ask that an iPad be mandated for every child, student, doctor or businessman, because the argument would go, “this would help in education and help humanity as a whole.” No they did not! They produced a product that needed little assist. It had value in it, all by its lonesome and today resides in millions of homes. Thank you very much!

So that brings me to the 50 some billion dollars that the central planners used as inducement for EMR, and created empires of software/hardware industries, “to create and sell the right widget to the hospitals and the doctors.” But their motive although explicitly expressed as being patient-centered turned out to be more for the benefit of the makers of the software and the industry that governs payments. The patient care itself was relegated to the sidelines because, “Oh the beauty of this is that predigested-Medicare-Approved-Verbiage for the appropriate level of care is already built into the glossary to populate the data, to reduce your interactive time (they did not say, “fills reams of digital data, all with one click”).

Opining from the cloudy realm of the ivory towers where everything is an evolving nebulous stream of dictum. And, without the benefit of success or failure from hardships and difficulties, is tantamount to the marginalizing of real intellect or need. Might I suggest that if the system had allowed for and indeed now shifts its gear into neutral, the intellectuals on the ground would create such a process to really incorporate excellence of patient care into this proposed paradigm. The contextual basis for this evolving paradigm would be a ground-up means and not the central planning top-down mentality of forced pseudo-intellectualism.

Hey give it a try! What have you got to lose? Except, maybe control. You Top dudes have failed in all aspects of managing this concept, except maybe in determining who is doing what in medicine, but that is a far cry from patient care, now isn’t it? Let the boots on the ground come up with their pride and joy. They will make sure when they have done their tinkering of trial and error, the product would be seamless and exist in the background without the prejudice of an intermediary obstruction between the physician and patient. All such electronic data would be hum-less, noiseless software, an invisible, recording of the physician-patient interaction and generating good and solid data for the benefit of the patients!

Thought experiment over!

Now lets dream…

The spirit's foe in man has not been simplicity, but sophistication." ~George Santayana

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