The Wit and Wisdom of HIStalk

Sorry for this big article that's sucking up your bandwidth to load. It's just that I had occasion to need to re-read some old HIStalk stuff and I was saddened. There's so much cool stuff in the archives here, but unless you use the Search function or click the previous months, you would never know about it. Like a sad, childless, middle-aged woman who calls her cats her children and dresses them up for Christmas, these articles are my babies, conceived with sweat and toil instead of ... well, anything else. And I do have a wife and kids, just in case that cats reference was too creepy.

Anyway, since tons of HIStalk readers are relative newbies, I thought, what the hey, let's drag out some of the wit and wisdom accumulated here in the last year and a half and give it the light of day one more time. If you don't like it, just read the new stuff and I'm happy.

Hospitals

• It's shameful that our industry is still debating bar codes and electronic order entry. Thank goodness hospitals don't run FedEx, Wal-Mart, or online companies. They would still be using clipboards and typewriters.
• Has any for-profit hospital company ever kept all of its executives out of jail?
• You can't keep a hospital open unless you run it like a business, but you can't run it like a business because turning away patients who can't pay is unacceptable.
• Most of modern medicine outside of surgery and vaccinations consists of recognizing something seen before and having a cool-sounding name for it. No cures, no definitive causes, just "hey, there's that weird heart thing again."
• DC's Greater Southeast Community Hospital keeps its license for now after widespread problems and preventable deaths. Is that good news?
• [On the heroic measures taken to save a 24-week gestation preemie weighting 10 ounces] The baby's doing fine despite weighing no more than a can of Campbell's soup at birth (and not Chunky, either.) Ironically, nearly 30 "fetuses" older than that are aborted each day in the US (21 weeks' gestation and older.)
• Hospitals with mammoth IT budgets and speaking circuit CIOs don't seem to be raising the bar on persistent profits or improved patient outcomes.
• That's my conclusion on healthcare information systems. If you're already a great organization, they have the potential to make you a little bit better. If you're so-so, don't get your hopes up.
• We can install advanced clinical systems, but just don't try to get a decent cable TV picture or Internet access into a hospital room.
• Does throwing together a bunch of unrelated hospitals instantly create a "health system" or just a mess?
• Every 20 bed hospital hung Regional Medical Center on its name in the 1980s as though encouraging the locals to mistake it for a world-class facility.)

CPOE

• Ever notice that these Davies winners are often using old technology applications? I think that says something about process vs. product (something those 40% of hospitals doing CPOE projects should keep in mind.)
• The fool's gold of CPOE-as-the-solution continues to beckon the naive, who speak bravely of mandating CPOE while failing to enforce existing policies that would improve patient safety immediately, such as not allowing illegibly written orders or unapproved abbreviations.
• Despite incessant rag coverage, alluring vendor propaganda, and well-intentioned but wildly simplistic Leapfrog mandates, virtually no hospitals are doing anything close to computerized physician order entry.
• Hospitals keep opening their slim checkbooks under the starry-eyed delusion that they're ready for "clinical transformation," hoping beyond hope that those bitchy docs will line up like docile sheep to take the place of the unit secretaries who enter their orders today.

Physicians

• I'll believe how victimized doctors are when I walk through their reserved parking lot while they're having free lunches in the hospital cafeteria and see a line of Hyundais.
• Stop the presses: 9 out of 10 docs prefer specialty drug reps instead of general drug reps. To which I'll add my own personal research: 10 out of 10 prefer hot blonde chippies bearing checks for "honoraria."
• As a society, we seem to want doctors to wear $1,000 suits and drive BMW's and make us call them Doctor instead of Bob or Joe because somehow we feel like we're bending the ear of a big shot, not just some technician. We like their feeling superior to us and living far more luxurious and interesting lives than we'll ever have. Once you put them up on the pedestal, it's hard to get them back down.
• How do you tell a salaried physician from a community-based one? Answer: you can't get the community doc to attend meetings and you can't get the salaried ones to STOP attending them.
• I don't care what docs spout about higher calling and helping humanity, 90% of them would run like napalm was coming down if they had to practice their healing skills for less cash and ego-stroking.
• You would be shocked at how much doctor "pharmacology" comes from the cute little heads of those drug company Kens and Barbies out there building eRelationships.
• In other words, all that doctorly scientific curiosity and thirst for knowledge to help patients goes away completely when you stop bribing them. Ruminate on that when you find that your $200 prescription is $40 in every other country.
• I was on the floors this week and a doc strides purposefully by, resplendent in an impeccably starched lab coat and stethoscope (although he could have been a psychiatrist for all I know since all those guys wear 'scopes like generals' stripes.) He goes to the nursing station sink and gives his hands a five-second quick rinse: no soap, no scrub. Now he must have gotten into God knows what to wash his hands publicly in the first place since docs rarely do. Keep that in mind when you're signing that $20 million CPOE check: these guys will kill patients with nosocomial infections before they'll wash their damn hands! You think they're going to enter orders just because it's the right thing to to?

Government HIT initiatives

• I've never understood why veterans have their own domestic healthcare system, but other than paying taxes to support it, what do I know?
• Only the government and consultants combined could botch things this badly.
• We're being shamed into change by the least innovative, least efficient, and most bureaucratic organization in this hemisphere: the US Government.
• VA spent $500 million (!!!) on the DSS) and it was written by two VA employees while still working there. Thank goodness it's their money and not mine ... oh, that's right, it's our tax dollars being incinerated.
• It might be cheaper to just hand out money on streetcorners to people who look poor.
• So how is that different from the crappy applications the rest of us can buy from vendors, other than the vendors don't have tax money available to rewrite their stuff? And of course those federal agencies hire their own docs, generally not very good ones, who do what they're told instead of whining and complaining like the prima donna businessmen we community hospitals get.

Non-IT professional involvement in IT

• They hate the idea of working for IS because we require a lot more planning and support than just "look at what I created" as the veil is dramatically lifted for all to behold and they move on to the next fun project.
• Why have your budget squeezed because IT costs are "too high" when departments have mini-IS groups that are never questioned?
• Access or Excel is their hammer and everything looks like a nail to them.
• Not many of these "I'm not just a doctor, I'm Bill Gates" systems can be successfully deployed and supported, although they usually have few interesting design elements. The problem with the software industry is that it seems so easy, like good cooks who somehow think they'd be great restaurateurs.

Nurses

• 80% of patient care is directly influenced by nurses, often via skillfully planted recommendations that allow doctors to believe they thought of it themselves.
• For my money, you don't want a nurse who's too good with computers when you're sick because she'll be screwing around on the system instead of paying attention to your whining and demands.
• When you get right down to it, a hospital is still a clean building with nurses. Everyone else is supporting cast, even if their salaries make them believe differently.
• Nurses clean up the vomit, hug the babies, keep doctors from killing patients, give the drugs, do the Code Blues, and comfort the families. All the rest of us are hangers-on who look like deer in the headlights on the rare occasions when we stray into an actual patient care area where human triumph or tragedy is unfolding with a nurse at its center.

Company and product names, marketing

• Bridge Medical is owned by AmerisourceBergen, another of those merged companies too indecisive to choose a real name.
• The Philips product line has one of those "hell let's just make something up" names: Vequion. Sounds like an alien planet.
• These guys are like doctors: they're afraid to write something you can understand for fear you won't respect them for being understandable.
• I would have been concerned that this ASP's website was created with FrontPage and Adobe GoLive and also has the company's name spelled wrong on the window title.
• I've read the press release and still can't tell exactly what the product is, so they must have great marketers.
• Does any vendor NOT have a product or product line named Insight?
• Boston's CareGroup licenses RelayHealth's webVisit for its PatientSite portal. Do you suppose it embarrassed both parties to realize that their too-cute "leave out the spaces between two words so we don't get sued" collided with a vengeance on both their company and product names?
• These two document workflow firms deserved to co-market products based on their names alone: Xythos and Dralasoft. Sounds like a wedding announcement for a couple of Trekkies.
• Convoluted name for a spam filtering product: mycomPRO(TM) mailMAX II. I've created names like that when trying to clean my computer keyboard.

Programming

• Like telephone operators, programming went from being highly skilled and highly paid work to a clerical function. Eventually, it will be as obsolete as making a living as a "word processor."
• This is one case where it didn't get any better when it went offshore.
• Old, awful products looked compelling at the HIMSS exhibition hall of long ago. Vendors never came out and said, "This product sucks, but buy it anyway so we can afford to build a better one."
• Honest to God, this smug superiority over programming tools is asinine. Do artists sneer over each other's choice of brushes? Why should you as a user, CIO, or anything in between care what language the vendor wrote it in when you'll never see the source code anyway?

Companies

• [On a Johnstown, PA high-tech corridor] If they can get high tech types to work there, more power to them. I'm betting they flee like another flood's coming once the government money runs out.
• They also prominently feature some stock-photo zombies on their web page. At least it isn't the usual Internet-Godcam view of someone taken from a ladder so that their head's as large as the rest of them.
• I like product guys who get their hands dirty and speak proudly of how cheap they are with the company's money, not a bunch of Ivy League pukes who want to build a resume and a bank account and move on.
• Their technology is hardly smile-for-the-Computerworld-picture buzzware.
• Eclipsys has a Chairman Emeritus, a Chairman, a President and CEO, six Regional Presidents, four Executive VPs, another President, seven Senior VPs, and six run-of-the-mill VPs. Mucho dollaro for a company not making any of it
• Installers aren't the best and the brightest. They're the best and brightest willing to spend most of their lives away from home.

Hospital CFOs

• CFOs are skeptical about having CIOs run IT. You would think two professions that are characterized as humorless, analytical, and button-down would get along just fine, but for whatever reason, they don't seem to.
• Whomever controls the money controls the strategy and tactics. Did you ever see a hospital that underspends on the finance department or their technology needs? Me neither. Somehow those finance guys always get the best offices, the latest laptops, and the least scrutinized budgets of all hospital departments. They're CEO-wannabes without the personality, leadership, and compassion.
• They can't imagine how Florence Nightingale or Mother Teresa got along without having a bean-counter whispering in their ears.
• I sometimes think CFOs are interchangeable bean-counters who are convinced that the real business of a hospital is cash flow, bond proceeds, and accounts receivable. Armies of directors, auditors, accountants, and controllers are the elite troops. All those nurses and patient care people are hamburger flippers.
• They love asking the unasked questions, getting involved in IT operations that aren't any of their business, reminding you of that COBOL class they took in 1972 or their computer science minor before their CPA, and creating their own mini-IS organizations.
• Where [CFOs] are least necessary and most stupid is when they confuse themselves to be IT professionals.

HIT conferences

• Neophyte attendees might wonder why healthcare IT is so far behind other industries when looking over the phalanx of Oxford-shirted reps confidently showing cutting edge technologies and promising earth-shattering results.
• I'm also struggling with how to describe it [the HIMSS annual conference,] sort of like a tiny figure at the bottom of the Grand Canyon who is overwhelmed by its sheer size and place in the universe.

Politics

• [On Jeanne Patterson’s run for Congress] If Gopher from "The Love Boat" and the less-talented half of  "Sonny and Cher" can become Congressmen, I wouldn't rule it out.
  

Lawsuits

• The "deep pockets" system of lawsuit Lotto is perhaps the most ludicrous of all American inventions.
• I guess there's just no death that's not wrongful in some way.
• Stay off I-75 since it will be full of lawyers trying to get their faces in the trough.
• Obviously the first thing anyone should do who is unhappy about anything is get a lawyer to sue everyone who has failed to make you happy.

Publications

• The "articles" are simply the filler that keeps the vendor ads from touching each other. Don't expect a tell-all expose' or a critically honest editorial that would enrage an advertiser.
• It occurs to me that most of what passes for "news" in our industry is glorified press releases.
• Other than the usual incessantly sophomoric punning that this rag's headline writers just can't resist, they make clinical systems seem so simple and those of us in healthcare IT seem so stupid for not just buying the great systems that are out there.
• All the Davies Award winners are using warhorses like Invision and TDS that are far older even than 20 years. Modern Healthcare wants you to believe that isn't possible. Why? Because Modern Healthcare and its peers make money selling ads, not from sending you your free copy.

NHII, David Brailer, etc.

• I'm glad we're moving along, but let's keep our wits about us, OK? Particularly once the election is over and maybe our poster children get pushed back to the kid's table.
• Attendees at the meeting (folks who can get time off and travel money for that kind of affair, certainly not me) apparently have stars in their eyes, gushing and fawning over the politicos like Monica Lewinski under Bill Clinton's desk.
• Please, everyone, don't get irrationally exuberant like you did over CPOE and some of those half-baked consultant ideas your hospitals went for a few years back.
• John Hammergren's remarks from the "reactor panel" at the Brailer party known as "Secretarial Summit on Health Information Technology," (unfortunate acronym) adds a hip reference about how MP3 players revolutionized music, yet docs write orders by hand. Next thing you know he'll be cranking up a Kazaa-downloaded copy of 50 Cent at the shareholder's meeting. Anyway, he agrees with everything Brailer said, not too shocking since it means more McSystems to be sold.
• Of all the technology that could be implemented, their foot-dragging on barcoding has cost too many lives already. Maybe Dr. DB should put the heat on these clowns since they're making more money than anyone else in healthcare. They can decode the human genome but can't figure out how to put a 30-year old printing format on a label? Please.

Technology’s Role in Patient Care

• Patients could care less if we used chisels and stone tablets as long as we reduce the ED turnaround time and keep friendly, caring nurses at the bedside (which some hospitals with the gadgets can't do.)
• A bad carpenter doesn't build a better house just because he gets himself a new hammer.
• I guarantee that quality, outcomes, and cost is completely unrelated to systems used. Get a research grant and prove me wrong -- I dare you.

HIStalk

• [On HIStalk advertising] This is another of my filthy capitalist pig, Gordon Gekko, dot-com-nineties ideas to keep me in a style that I'm not accustomed to, but would probably enjoy. Now I'll be sorry I slammed all those products .... naaaah.
• I've got more diarrhea of the word processor than Stephen King.
• At least with HIStalk you get sarcasm and some take-it-or-leave-it opinion without those cute pun-slinging headlines crafted by underachieving liberal arts majors.