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The Big Birds of Health Care

For the first time in this election campaign Mitt Romney came up with a useful “zinger”. During the first Presidential debate Romney suggested that we should examine our various expenditures and ascertain if the item we spend taxpayers money on is “important enough to borrow money from China”. Unsurprisingly, the first thing that came to Romney’s mind was a public service providing small children with education on racial diversity and basic literacy skills. And although, we are not directly borrowing money from China to pay for things, it wouldn’t hurt to go through our expenses, including the many small and apparently insignificant ones, and see if there’s anything we can do without. It actually may be less painful to make a thousand additive little cuts than to locate one large silver bullet that is certain to cause commensurately large pain. Of course, such exercise would be fraught with controversy, since what may look frivolous to one party, could look worthwhile to another. But ...

Opportunity for HIT Vendors to Do Good

Yesterday, I found an email from Health and Human Services (HHS) in my inbox highlighting a new initiative where the “Obama Administration and Text4Baby join forces to connect pregnant women and children to health coverage and information”. The goal of this partnership is “to promote enrollment in both Medicaid and the Children’s Health Insurance Program (CHIP)”. Having more babies and children obtain insurance coverage is obviously a worthy endeavor, and if it can be accomplished by simply sending informative text messages to pregnant women, even better. Of course having insurance coverage doesn’t always translate into having access to an actual doctor, particularly for Medicaid enrollees. In an unrelated coincidental turn of events, it just so happened that I have had the recent opportunity to spend time with large numbers of Pediatric practices, most of which were small independent practices in middle-class suburban areas. The main goal of these conversations was to elicit doctors’...

The EHR Non-User Interface

Every time someone publishes an article or a paper or a blog post that has anything remotely to do with Electronic Health Records (EHR), there is usually a flurry of reactions in the comments section, now available in most publications, and these always include at least half a dozen anonymous statements, usually from clinicians, decrying the current state of EHR software, best summed up by a commenter on THCB : “It is the user interface stupid!... It has to be designed from the ground up to be an integral part of the patient care experience”. Can’t argue with that now, can you? Particularly when coming from a practicing physician. And why argue at all? The user interface in any software product is the easiest thing to get right. All you need to do is apply some basic principles and tweak them based on talking to users, listening and observing them in their “natural habitat”. Having done exactly that, for an inordinate amount of time, and being aware that most EHR vendors were engaging ...

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