Battle of the ages; A growing divide in healthcare IT; High expectations and hacking
The IT age
I just read your article “Battle of the ages” and had to comment about how appropriate it is.
As I head into my “senior years,” I’m reminded of a customer/friend, now retired, who once told me that a good organization generally has three layers of managers: the Older Person (seasoned veteran, been-there-done-that, tried-it-before, don’t-move-my-cheese-easily guy, survivor of the wars), the Middle Person (somewhat seasoned, still has a few original thoughts and ideas, with only a few battle scars) and the Junior Person (youngster, full of vigor, has new ideas every minute, must-try-these-now type, with no battle scars).
The OP tempered the other two with wisdom, proofs, ROI arguments and so on, all the while passing on what takes sometimes years to get: experience. The MP listened carefully to the OP, forced through some new ideas and played the system with coaching from the OP. The JP learned from this and even had some ideas reach the top, and was rewarded without battle scars needing to be inflicted.
Pete Carletti
Branford, Conn.
To your health
Regarding “A growing divide in healthcare IT”: Claims that applying electronic health records (EHR) and related IT would significantly reduce healthcare costs and errors, and improve quality, are largely false, for many reasons. First, rapid advances in non-IT technologies that have improved outcomes via less invasive techniques and more effective pharmaceuticals have driven increasing costs, not lack of computers. There is no reason to expect changes in this dynamic. Indeed, advances in the broad area of genomics and proteomics will raise expectations and costs.
Second, the differences between EHRs and computerized physician order entries are greater than the similarities. Poorly designed interfaces create more problems than they solve, and at considerable expense. Third, EHRs cannot yet scale as required, as the U.K.’s National Health Service and Kaiser now realize after spending billions of dollars.
Fourth, multiple vendors deliver multiple incompatible solutions to a public problem, thereby engendering massive future expenses for integration and other overhead. Fifth, simple kinds of IT, such as bar-coding instruments and consumables used in the operating room, can significantly reduce errors.
Sixth, changing the procedures and the culture of healthcare delivery to double- and triple-check information and decisions during handoffs can reduce errors significantly without IT. Seventh, while more information may help the federal government reduce the vast local and regional differences in care, it won’t do much for patients despite all the rhetoric about market mechanisms. This is simply because most people lack the knowledge to make medical decisions and in any case, they don’t have the time. That’s why doctors spend so much time learning their trade. If providers were forced to put all medically relevant information online, they would spin it just the way all corporations that compete do.
Eighth, no amount of IT will change the fact that Americans embrace unhealthy lifestyles and expect the healthcare industry to fix them when their bodies succumb. This was less a problem before quadruple bypasses and organ transplants because before such expensive medical advances, people just died. We need to live healthy lifestyles and focus on preventative healthcare and use technology more cost effectively. This will involve taxing substances that cause health problems, including trans-fats, sugar and industrial chemicals, so that the true long-term costs are dealt with more rationally.
Tom Shillock
President
M2 Consulting
Portland, Ore.
Self-protection is key
Regarding Mark Gibbs’ Backspin column, “High expectations and hacking”: We have bred a society of folks who do not know how to protect themselves — folks who think you can legislate morality and insist that some kind Big Brother protect them.
I personally believe in tough solutions at times. Every once in a while a bulldozer is less pain than tweezers or death by a thousand cuts.
The argument that the solutions are too complicated is ridiculous. Even the expense (assuming you cannot manage to implement totally free solutions) is overrun by the savings realized by eliminating wasted manual spam management, rebuilding one’s smoking mess and other currently necessary activities. So we tear down the (dysfunctional, more dangerous because it isn’t really reliably invulnerable, costly, useless) current “protections.”
My head says Gibbs’ solution will not be allowed. The problem is that the commercial side (everything from PC sales and net infrastructure to all of business communications) probably will not tolerate the short-term issues. I believe there will be a period during which the Net will grind to a crawl under the weight of elevated crack/hack foolishness. Many people’s personal (zombie) computers will be totally unusable, until these people get their protection in place. The rest of us will suffer through that period as well.
Do we need the equivalent of a reverse scarlet letter? By that I mean technology that prevents routing your packets without provable armoring. Does such technology exist now? I think so but I am not sure. Or rather than preventing, how about we revisit the idea of preferential routing — this time for armored folks willing to prove their armoredness? Or we can have open season on unarmed sheep.
Brandon Sussman
Webster, N.H.
