In 2007, I wrote about the experience of flying in my post Unfriendly Skies. In the past 4 years, the domestic flying experience has gotten worse.
Two weeks ago today, I was in Japan at Narita airport for my flight back to Boston. The check in and security lines were extremely long. Although I had 1.5 hours before my departure, it was clear that getting to the plane on time would be challenging.
I asked the customer service staff at All Nippon Airways (ANA) for their advice. Immediately, they assessed the situation and escorted me to a check in window for a boarding pass. (Note that I was flying the lowest cost economy possible, not business or first class). The check in person then left her post to escort me to the crew line in security and walked with me through the screening process. During X-ray scanning, the Japanese security staff noted I was carrying a handcrafted broom that violated their security guidelines because it could be used as a "nightstick" weapon. They paged an ANA baggage carrier who wrapped my broom and checked it on the spot. I arrived to my gate on time, but unfortunately my departure was delayed 45 minutes because ANA wanted to accommodate a late arriving plane with numerous connecting passengers.
During the flight to Los Angeles, ANA called ahead to my connecting flight on American Airlines to give me the best chance to make my tight connection.
When I arrived at LAX, ANA staff escorted me to Customs/Immigration and gave me a special "expedited" sticker to ensure I could bypass lines and delays. It worked flawlessly.
I walked out of the Tom Bradley International terminal and then walked to the American Airlines gates at Terminal 4. I might as well have walked into the 9th circle of Dante's Inferno.
Immediately, the American Airlines staff were hostile and uncaring. They told me I'd never make my flight and sent me to the back of a long customer service line. Shortly thereafter a single mother with 4 young children was sent to the same line and began crying in despair because she was going to miss her flight. A truly unpleasant American Airlines staffer told her "I know what you're going through and I cannot help you, just stand in line", as if a 25 year old male understood the challenge of being a single mother with 4 children. I escorted her to the front of the line explaining to everyone else that she and her children needed their help. We got her onto her flight to Shanghai. I missed my flight and was told by American Airlines that all Boston flights were so overbooked that I had no hope of getting a flight until the next day. They would offer me a $5.00 discount on a hotel room…
Let's see - in Japan, caring people walked me through the process to ensure success. In the US, I was hassled, ignored, impeded, and overbooked. My flight to Boston took 30 hours including an overnight stay at a motel near LAX.
There is truly something wrong with an industry that sets policies and hires people who are customer hostile. I will amend what I said in 2007. I will try as hard as possible to limit my travel to international carriers that want my business, while using teleconferencing instead of domestic travel. When I'm asked if my domestic travel experience met my expectation, my only response can be - it landed and I guess I'm thankful for that!
Thursday, August 18, 2011
Wednesday, August 17, 2011
The August HIT Standards Committee meeting
The August meeting of the HIT Standards Committee (the 28th meeting of this FACA) was a milestone in parsimony. As you'll see, we approved a set of vocabulary recommendations and public health standards that represent harmony as well the fewest number of standards possible for the intended purpose.
Since April, we've been working hard on Summer Camp. At our September meeting, we'll wrap up all that work and hand off the finished standards recommendations to ONC for regulation writing.
Per our Summer Camp plan, the August meeting included final recommendations on vocabulary standards for quality measures, final recommendations on all public health transactions, preliminary recommendations on patient matching, and preliminary recommendations on transport/security standards. We also heard from the Standards and Interoperability Framework team about their work and the Implementation Workgroup on their review of Certification Criteria.
This was a powerful meeting, discussing the standards that so many people have been working on for the past decade - one vocabulary standard for each class of data used in quality measures, one approach to public health transactions, one approach to transfer of care summaries, one approach to laboratory results, and a building block approach to data transmission that supports the portfolio of health information exchange options.
We began with the final recommendations from the Clinical Quality Workgroup and Vocabulary Task force on vocabulary standards. Per the marching orders we gave them, they selected one vocabulary standard for each domain - problems, medications, allergies, labs etc. SNOMED-CT and LOINC are the default vocabularies used whenever possible. The committee approved these recommendations by consensus with 2 caveats
-the Implementation Workgroup will be charged with ongoing review of the implementation burden of using these standards in a variety of settings
-the September meeting of the HIT Standards Committee will include discussion of a transition plan for those vocabulary standards required for Stage 1 that are being retired/replaced in Stage 2.
Marc Overhage presented best practices for patient matching, identifying the metadata that should be standardized in patient records and health information exchange. These recommendations are complementary to the metadata standard recommendations in the Advanced Notice of Proposed Rulemaking, enabling stakeholders to optimize a patient matching strategy as needed for their applications using best practices and evidence from industry experience.
Chris Chute presented the recommendations for public health standards - one HL7 2.51 implementation guide for surveillance, one HL7 2.51 implementation guide for immunizations and one HL7 2.51 implementation guide for reportable labs. The optionality specified in meaningful use stage 1 was eliminated and the end result is simple un-ambiguous implementation guides for public health.
Dixie Baker presented the preliminary recommendations for building blocks that support data exchange in both "push" and "pull" models. The key innovation in Dixie's work is the process for reviewing existing standards for appropriateness, adoption, maturity, and currency.
Jitin Asnaani from ONC presented the S&I Framework update including Certificates, Lab Results, Transitions of Care, and Provider Directories. These will be reviewed and hopefully turned into guidance for ONC in the next few months.
Finally, Judy Murphy and Liz Johnson presented their work on certification criteria.
A remarkable meeting from a world class team. I'm proud to be a part of it!
Since April, we've been working hard on Summer Camp. At our September meeting, we'll wrap up all that work and hand off the finished standards recommendations to ONC for regulation writing.
Per our Summer Camp plan, the August meeting included final recommendations on vocabulary standards for quality measures, final recommendations on all public health transactions, preliminary recommendations on patient matching, and preliminary recommendations on transport/security standards. We also heard from the Standards and Interoperability Framework team about their work and the Implementation Workgroup on their review of Certification Criteria.
This was a powerful meeting, discussing the standards that so many people have been working on for the past decade - one vocabulary standard for each class of data used in quality measures, one approach to public health transactions, one approach to transfer of care summaries, one approach to laboratory results, and a building block approach to data transmission that supports the portfolio of health information exchange options.
We began with the final recommendations from the Clinical Quality Workgroup and Vocabulary Task force on vocabulary standards. Per the marching orders we gave them, they selected one vocabulary standard for each domain - problems, medications, allergies, labs etc. SNOMED-CT and LOINC are the default vocabularies used whenever possible. The committee approved these recommendations by consensus with 2 caveats
-the Implementation Workgroup will be charged with ongoing review of the implementation burden of using these standards in a variety of settings
-the September meeting of the HIT Standards Committee will include discussion of a transition plan for those vocabulary standards required for Stage 1 that are being retired/replaced in Stage 2.
Marc Overhage presented best practices for patient matching, identifying the metadata that should be standardized in patient records and health information exchange. These recommendations are complementary to the metadata standard recommendations in the Advanced Notice of Proposed Rulemaking, enabling stakeholders to optimize a patient matching strategy as needed for their applications using best practices and evidence from industry experience.
Chris Chute presented the recommendations for public health standards - one HL7 2.51 implementation guide for surveillance, one HL7 2.51 implementation guide for immunizations and one HL7 2.51 implementation guide for reportable labs. The optionality specified in meaningful use stage 1 was eliminated and the end result is simple un-ambiguous implementation guides for public health.
Dixie Baker presented the preliminary recommendations for building blocks that support data exchange in both "push" and "pull" models. The key innovation in Dixie's work is the process for reviewing existing standards for appropriateness, adoption, maturity, and currency.
Jitin Asnaani from ONC presented the S&I Framework update including Certificates, Lab Results, Transitions of Care, and Provider Directories. These will be reviewed and hopefully turned into guidance for ONC in the next few months.
Finally, Judy Murphy and Liz Johnson presented their work on certification criteria.
A remarkable meeting from a world class team. I'm proud to be a part of it!
Tuesday, August 16, 2011
The Role and Future of HIT in an Era of Health Care Transformation
Today I'm at George Washington University's "The Role and Future of HIT in an Era of Health Care Transformation Symposium" serving as moderator of a panel discussing the barriers and enablers to health information exchange, including the impact of PCAST Work.
We began the day with an introduction from Dr. Alfred Hamilton, assistant professor, The George Washington University School of Public Health, and Dr. Ward S. Casscells, professor of medicine and public health, The University of Texas Health Science Center at Houston. Drs. Hamilton and Casscells organized the conference so that stakeholders and policymakers could discuss barriers and enablers to creating a connected, learning healthcare system.
Paul Egerman, retired CEO/software entrepreneur, educated the group about the PCAST report's main ideas - accelerating interoperability through the use of a universal exchange language (UEL) and a data element access service (DEAS). Reviews of the report thus far have raised policy and operational feasibility concerns, suggesting pilots and an incremental approach to implementing its ideas. The Office of the National Coordinator has released an Advanced Notice of Proposed Rulemaking containing the PCAST-related metadata recommendations from the HIT Standards Committee. As a next step, PCAST ideas will be tested using CDA R2 headers to identify the patient, the provenance of the data, and privacy flags, ideally in the PHR to EHR data exchanges described below.
Dr. Stephen Ondra, White House Office of Science and Technology Policy, presented an overview of the impact that interoperability and data sharing will have on healthcare systems, providers, healthcare purchasers and patient advocacy groups. He noted that HIT is not a goal in itself but is a critical foundation for health reform efforts. The Obama administration has recommended a portfolio of approaches rather than one size fits all health information exchange. Choices include query/response "pull" (Exchange type), directed "push" (Direct type) and consumer based viewing (Blue Button type).
Dr. Farzad Mostashari, national coordinator for health information technology, discussed how interoperability and data sharing support the stages of meaningful use. He identified the issues we've all been diligently working on - standards, governance, architecture, creating trust, and sustainability. He thanked the HIT Policy and HIT Standards Committee for their hard work- an average of a meeting every other day for the past 2 years. He noted that our policy drivers are quality, safety, efficiency, public health, and patient centeredness while protecting privacy and security. He emphasized the use cases with early wins - laboratory report exchange, e-prescribing, and patient summary sharing. He suggested the need for bold incrementalism - balancing innovation with the reality of implementation cost and timing. The recent debt ceiling negotiation illustrates that we cannot afford to pay for more healthcare quatity, instead we need to pay for quality and value. Healthcare IT is foundational to new reimbursement models and needs to be available for every stakeholder, large and small.
I had the opportunity moderate a panel discussion of policy and technology enablers and barriers to healthcare information exchange. Participants included
*Dr. Farzad Mostashari
*Dr. Stephen Ondra
*Ms. Christine Bechtel, vice president, National Partnership for Women and Children
*General Douglas Robb, joint staff surgeon, Office of the Chairman, Joint Chiefs of Staff, the
Pentagon
Major themes of the dialog included
*Consumers can be effective stewards for their own summary data and care plans, but there needs to be standards-based, easy to use, automated interfaces between EHRs and PHRs before there will be significant adoption of PHRs. One easy way to do this is a certification criterion for every EHR and PHR to support the Direct specifications, enabling providers to send patient summaries to any PHR without requiring custom interfaces. PHRs need to be more than just passive containers for data. Ideally there will be an ecosystem of applications which enable patients to seek second opinions, obtain personalized educational materials, and enroll in clinical trials using their PHR data.
*Although HITECH incentives are great in the short term, the best way to foster healthcare IT adoption in the long term is to ensure it supports workflow, saving time and bringing value-added services to providers, payers, and patients. John Rother from AARP noted that online appointment making, referrals, and medication renewals have high value to patients. Such transactions are not typically offered by standalone commercial PHRs.
*The culture of healthcare needs to be changed so that providers and patients expect healthcare information exchange at every patient encounter. A culture change will create market demand for healthcare information exchange. Patient and provider trust in the data integrity and privacy of healthcare information exchange is a pre-requisite to culture change.
*Healthcare reform will create incentives for health information exchange, since payments for wellness will require community-wide care coordination and decision. support. The Patient Centered Medical Home is likely to become an electronic medical home that receives all data about patients from labs, pharmacies, hospitals, specialty practices, and home care devices.
*There needs to be innovation in care models, services, and technologies. Although the government can catalyze innovation, the private sector will need to fund ongoing efforts, since grants are only short term and are not a sustainable business model.
The audience was very engaged in the discussion and there will be a whitepaper summarizing the conference. A great meeting. Thanks to Drs. Hamilton and Casscells for organizing it!
We began the day with an introduction from Dr. Alfred Hamilton, assistant professor, The George Washington University School of Public Health, and Dr. Ward S. Casscells, professor of medicine and public health, The University of Texas Health Science Center at Houston. Drs. Hamilton and Casscells organized the conference so that stakeholders and policymakers could discuss barriers and enablers to creating a connected, learning healthcare system.
Paul Egerman, retired CEO/software entrepreneur, educated the group about the PCAST report's main ideas - accelerating interoperability through the use of a universal exchange language (UEL) and a data element access service (DEAS). Reviews of the report thus far have raised policy and operational feasibility concerns, suggesting pilots and an incremental approach to implementing its ideas. The Office of the National Coordinator has released an Advanced Notice of Proposed Rulemaking containing the PCAST-related metadata recommendations from the HIT Standards Committee. As a next step, PCAST ideas will be tested using CDA R2 headers to identify the patient, the provenance of the data, and privacy flags, ideally in the PHR to EHR data exchanges described below.
Dr. Stephen Ondra, White House Office of Science and Technology Policy, presented an overview of the impact that interoperability and data sharing will have on healthcare systems, providers, healthcare purchasers and patient advocacy groups. He noted that HIT is not a goal in itself but is a critical foundation for health reform efforts. The Obama administration has recommended a portfolio of approaches rather than one size fits all health information exchange. Choices include query/response "pull" (Exchange type), directed "push" (Direct type) and consumer based viewing (Blue Button type).
Dr. Farzad Mostashari, national coordinator for health information technology, discussed how interoperability and data sharing support the stages of meaningful use. He identified the issues we've all been diligently working on - standards, governance, architecture, creating trust, and sustainability. He thanked the HIT Policy and HIT Standards Committee for their hard work- an average of a meeting every other day for the past 2 years. He noted that our policy drivers are quality, safety, efficiency, public health, and patient centeredness while protecting privacy and security. He emphasized the use cases with early wins - laboratory report exchange, e-prescribing, and patient summary sharing. He suggested the need for bold incrementalism - balancing innovation with the reality of implementation cost and timing. The recent debt ceiling negotiation illustrates that we cannot afford to pay for more healthcare quatity, instead we need to pay for quality and value. Healthcare IT is foundational to new reimbursement models and needs to be available for every stakeholder, large and small.
I had the opportunity moderate a panel discussion of policy and technology enablers and barriers to healthcare information exchange. Participants included
*Dr. Farzad Mostashari
*Dr. Stephen Ondra
*Ms. Christine Bechtel, vice president, National Partnership for Women and Children
*General Douglas Robb, joint staff surgeon, Office of the Chairman, Joint Chiefs of Staff, the
Pentagon
Major themes of the dialog included
*Consumers can be effective stewards for their own summary data and care plans, but there needs to be standards-based, easy to use, automated interfaces between EHRs and PHRs before there will be significant adoption of PHRs. One easy way to do this is a certification criterion for every EHR and PHR to support the Direct specifications, enabling providers to send patient summaries to any PHR without requiring custom interfaces. PHRs need to be more than just passive containers for data. Ideally there will be an ecosystem of applications which enable patients to seek second opinions, obtain personalized educational materials, and enroll in clinical trials using their PHR data.
*Although HITECH incentives are great in the short term, the best way to foster healthcare IT adoption in the long term is to ensure it supports workflow, saving time and bringing value-added services to providers, payers, and patients. John Rother from AARP noted that online appointment making, referrals, and medication renewals have high value to patients. Such transactions are not typically offered by standalone commercial PHRs.
*The culture of healthcare needs to be changed so that providers and patients expect healthcare information exchange at every patient encounter. A culture change will create market demand for healthcare information exchange. Patient and provider trust in the data integrity and privacy of healthcare information exchange is a pre-requisite to culture change.
*Healthcare reform will create incentives for health information exchange, since payments for wellness will require community-wide care coordination and decision. support. The Patient Centered Medical Home is likely to become an electronic medical home that receives all data about patients from labs, pharmacies, hospitals, specialty practices, and home care devices.
*There needs to be innovation in care models, services, and technologies. Although the government can catalyze innovation, the private sector will need to fund ongoing efforts, since grants are only short term and are not a sustainable business model.
The audience was very engaged in the discussion and there will be a whitepaper summarizing the conference. A great meeting. Thanks to Drs. Hamilton and Casscells for organizing it!
Monday, August 15, 2011
The Importance of Corporate Culture
Can one person make a difference in a large organization?
Absolutely.
Although many modern executives operate under such regulatory constraints that they have infinite responsibility but limited authority, a single person can create a corporate culture that impacts everyone's work experience.
What do I mean by creating the corporate culture?
While flying back from Japan, the in flight magazine on All Nippon Airways featured an article about Zappos' corporate culture noting that the CEO has created an environment which emphasizes fun, creativity and happiness in the workplace. Happy employees deliver great customer service without needing micromanagement or clandestine monitoring of every conversation.
When evaluating leaders we often think of characteristics such as vision, interpersonal skills, commitment to quality, staff engagement, financial acumen, ability to raise money, and domain expertise.
However, we rarely consider their impact on corporate culture. It can make a huge difference.
In my professional life, I've had two dozen bosses, each with a different style, approach, and culture.
Here's a few questions to ask about your culture
1. Do you arrive at the office every day thinking about the joy of success or the fear of failure? Are you supported such that a negative outcome is a learning experience that results in policy or process change to improve the organization rather than blaming the person who caused it?
2. Is communication open and transparent, or guarded and reserved?
3. Do managers share accountability and see their role as enabling your success, or are they pugilists who punish unmet goals by screaming louder?
4. Do you have clear expectations for the work you do and clear metrics for success?
5. Is loyalty and trust valued? Is hierarchy respected or is your authority undermined by senior executives who work around you? Would you trust your boss to hold your rope?
6. Do staff feel respect and admiration for their colleagues such that there is a family-like atmosphere in which people will go the extra mile for each other?
7. If someone impedes the work of others through passive aggressive behavior or scheming for their own self interest, is it tolerated?
8. Is everyone empowered to make a difference? Are policies and procedures clear so that they know how to make a difference?
9. Are all emails/communications asking for guidance answered promptly?
10. Do you feel positive energy about the possibilities ahead when you wake up each day or does each day end in a tailspin of emotional exhaustion?
Throughout my career I've worked in positive cultures and negative cultures. I do whatever I can to create a positive culture in the organizations I oversee. It's not always possible to create a positive culture within a larger organization that has a negative culture, but we should all try.
May you always work in a positive culture and if you do not, have the wisdom to seek a better place!
Absolutely.
Although many modern executives operate under such regulatory constraints that they have infinite responsibility but limited authority, a single person can create a corporate culture that impacts everyone's work experience.
What do I mean by creating the corporate culture?
While flying back from Japan, the in flight magazine on All Nippon Airways featured an article about Zappos' corporate culture noting that the CEO has created an environment which emphasizes fun, creativity and happiness in the workplace. Happy employees deliver great customer service without needing micromanagement or clandestine monitoring of every conversation.
When evaluating leaders we often think of characteristics such as vision, interpersonal skills, commitment to quality, staff engagement, financial acumen, ability to raise money, and domain expertise.
However, we rarely consider their impact on corporate culture. It can make a huge difference.
In my professional life, I've had two dozen bosses, each with a different style, approach, and culture.
Here's a few questions to ask about your culture
1. Do you arrive at the office every day thinking about the joy of success or the fear of failure? Are you supported such that a negative outcome is a learning experience that results in policy or process change to improve the organization rather than blaming the person who caused it?
2. Is communication open and transparent, or guarded and reserved?
3. Do managers share accountability and see their role as enabling your success, or are they pugilists who punish unmet goals by screaming louder?
4. Do you have clear expectations for the work you do and clear metrics for success?
5. Is loyalty and trust valued? Is hierarchy respected or is your authority undermined by senior executives who work around you? Would you trust your boss to hold your rope?
6. Do staff feel respect and admiration for their colleagues such that there is a family-like atmosphere in which people will go the extra mile for each other?
7. If someone impedes the work of others through passive aggressive behavior or scheming for their own self interest, is it tolerated?
8. Is everyone empowered to make a difference? Are policies and procedures clear so that they know how to make a difference?
9. Are all emails/communications asking for guidance answered promptly?
10. Do you feel positive energy about the possibilities ahead when you wake up each day or does each day end in a tailspin of emotional exhaustion?
Throughout my career I've worked in positive cultures and negative cultures. I do whatever I can to create a positive culture in the organizations I oversee. It's not always possible to create a positive culture within a larger organization that has a negative culture, but we should all try.
May you always work in a positive culture and if you do not, have the wisdom to seek a better place!
Friday, August 12, 2011
Cool Technology of the Week
While in Japan last week, one of my lectures focused on emerging privacy and security issues. I highlighted the fact that increasingly sophisticated malware can breach every defense we put in place and that our best strategy is early detection when prevention fails.
Such an approach works well when the risk for damage is minimal. But what happens when the malware infects a medical device such as a smart pump or pacemaker? The risk of harm is far more dire than data integrity and includes physical harm up to an including death.
Sound far fetched?
This article illustrates that many of the command and control systems used in medical devices have inadequate security protections.
Hacks and malware aren't cool, so my cool technology of the week is a plea to the medical device industry - you need to engineer new devices with hardware level safeguards that impose sanity checks on the commands being given. Use encryption to protect all data transmissions and data at rest. Set limits on the minimum and maximum amounts of insulin that should ever be injected into the patient. Assume that hackers will penetrate and take control of the device.
We need your innovation now and that will be very cool.
Thursday, August 11, 2011
Our Lives Together
Monday, August 8 was my 27th wedding anniversary. My wife Kathy and I met at Stanford on September 1, 1980, so we've been together for 31 years. That means that we've spent two-thirds of our lives on this planet together. We've been collaborators, soul mates, homeowners, parents, and friends together. For three decades, our relationship has just worked. Here's why.
My entire life has been math/science/engineering - digital, white and black, linear, orderly, and left-brained.
Kathy's entire life has been the visual arts/humanities/creativity - analog, splashes of color, wabi sabi, Victorian clutter, and right-brained.
Our talents are entirely different, our approaches complementary, and we never compete on any level.
In our 20's we were vigorous hiking partners and built a home together.
In our 30's we focused on raising a young child.
In our 40's we created stability by planning for the future, caring for our parents, and preparing our child to leave the nest.
In our 50's we're likely to travel, create, and tend our garden together.
In our 60's and beyond we're likely to create a Japanese inspired wilderness retreat to serve as a home base between experiences around the world that are part of our work lives, volunteer lives, and personal lives.
We've evolved together and continue to expand and refine our relationship every day.
When I read literature from the scientific and lay press about the "seven year itch", it makes me realize that needs change, people change, and relationships need to change over time if they are going to last.
In your 20's you're likely at the peak of your physical life with more endurance, strength, and biological resilience than any other era. You can climb mountains and if you fall you bounce.
In your 40's, you're likely to be at the peak of your mental life with more experience, intellectual agility, and intuition than any other era. You can climb mountains, but if you fall you break. You're more likely focused on your 401k than your surfboard.
In your 60's you're likely to be at the peak of your financial life with more savings, more earning, and stability than any other area. If you've kept up your workouts and managed your diet, you can climb mountains, but if you fall, you shatter. You're more likely to be focused on supporting your children and aging parents, than thinking about a bleached blonde in a red convertible (unless you're a Congressman…)
If you and your partner are perfect for each other in your 20's, you may not be perfect in your 60's unless you adapt to your changing bodies, changing needs, and changing abilities together.
Kathy and I have been able to do that.
We've always treated each other as equals - there has never been a superior/subordinate aspects to our home lives, work lives, or family lives. Our division of labor is not cast in stone, it remains fluid based on the schedule and needs of each day. We share housework, we share parenting responsibilities, and we support each other's career.
Of course, we've had stress, anxiety, joy, sadness, and conflict along the way, that's life. But we've been able to weather the challenges, relish the successes, and treat each other fairly along the way.
This month we become empty nesters as our daughter begins her college life at Tufts on August 31. The house will seem quieter, the schedules will change, and our roles will need to evolve again as we focus more time on each other and our careers while our daughter becomes increasingly independent. It's another risky time for relationships.
But we'll navigate the transition, overcome the sense of loss, and plan our future together.
Given human life expectancy, we're likely to live another 31 years (I'm using Japan rather than US because our diet and lifestyle are distinctly Japanese). That means that Kathy and I are only halfway through our life together.
Happy Anniversary, Kathy. The second half of our time together will be even better than the first. I love you and always will.
My entire life has been math/science/engineering - digital, white and black, linear, orderly, and left-brained.
Kathy's entire life has been the visual arts/humanities/creativity - analog, splashes of color, wabi sabi, Victorian clutter, and right-brained.
Our talents are entirely different, our approaches complementary, and we never compete on any level.
In our 20's we were vigorous hiking partners and built a home together.
In our 30's we focused on raising a young child.
In our 40's we created stability by planning for the future, caring for our parents, and preparing our child to leave the nest.
In our 50's we're likely to travel, create, and tend our garden together.
In our 60's and beyond we're likely to create a Japanese inspired wilderness retreat to serve as a home base between experiences around the world that are part of our work lives, volunteer lives, and personal lives.
We've evolved together and continue to expand and refine our relationship every day.
When I read literature from the scientific and lay press about the "seven year itch", it makes me realize that needs change, people change, and relationships need to change over time if they are going to last.
In your 20's you're likely at the peak of your physical life with more endurance, strength, and biological resilience than any other era. You can climb mountains and if you fall you bounce.
In your 40's, you're likely to be at the peak of your mental life with more experience, intellectual agility, and intuition than any other era. You can climb mountains, but if you fall you break. You're more likely focused on your 401k than your surfboard.
In your 60's you're likely to be at the peak of your financial life with more savings, more earning, and stability than any other area. If you've kept up your workouts and managed your diet, you can climb mountains, but if you fall, you shatter. You're more likely to be focused on supporting your children and aging parents, than thinking about a bleached blonde in a red convertible (unless you're a Congressman…)
If you and your partner are perfect for each other in your 20's, you may not be perfect in your 60's unless you adapt to your changing bodies, changing needs, and changing abilities together.
Kathy and I have been able to do that.
We've always treated each other as equals - there has never been a superior/subordinate aspects to our home lives, work lives, or family lives. Our division of labor is not cast in stone, it remains fluid based on the schedule and needs of each day. We share housework, we share parenting responsibilities, and we support each other's career.
Of course, we've had stress, anxiety, joy, sadness, and conflict along the way, that's life. But we've been able to weather the challenges, relish the successes, and treat each other fairly along the way.
This month we become empty nesters as our daughter begins her college life at Tufts on August 31. The house will seem quieter, the schedules will change, and our roles will need to evolve again as we focus more time on each other and our careers while our daughter becomes increasingly independent. It's another risky time for relationships.
But we'll navigate the transition, overcome the sense of loss, and plan our future together.
Given human life expectancy, we're likely to live another 31 years (I'm using Japan rather than US because our diet and lifestyle are distinctly Japanese). That means that Kathy and I are only halfway through our life together.
Happy Anniversary, Kathy. The second half of our time together will be even better than the first. I love you and always will.
Wednesday, August 10, 2011
Healthcare is Different
I'm often asked why healthcare has been slow to automate its processes compared to other industries such as the airlines, shipping/logistics, or the financial services industry.
Many clinicians say that healthcare is different.
I'm going to be a bit controversial in this post and agree that healthcare has unique challenges that make it more difficult to automate than other industries.
Here's an inventory of the issues
1. Flow of funds - Hospitals and professionals are seldom paid by their customer. Payment usually comes from an intermediary such as the government or insurance payer. Thus, healthcare IT resources are focused on back office systems that facilitate communications between providers and payers rather than innovative retail workflows such as those found at the Apple Store.
2. Hiring and training the workforce - Important members of the workforce, the physicians delivering care, are seldom employed by the hospital. This is rare if not non-existent in any other industry. It's as if Toyota built a factory that anyone can use but does not hire or train the workers who build cars. If someone wanted to create a Toyota with wings and an outboard motor, they would have the freedom to do it.
3. Negotiating Price - Reimbursement no longer is based on a price schedule hospitals and professionals can control. It is based on a prospective payment model such as DRGs that someone else designs and dictates. Where else in the US do prices get dictated to a firm?
4. Establishing referral relationships - We cannot market services to those who control our patient flow due to Stark anti-kickback regulations. In other industries, you can build relationships, offer special incentives, and arrange mutually beneficial deals to develop your referral business. In health care, it's illegal even when unilaterally funding an action would make things easier for both parties and the patient.
5. Standardizing the product - In most industries, the product or service can be standardized to improve efficiency and quality. In health care, every person is chemically, structurally, and emotionally unique. What works for one person may or may not work for another. In this environment, it is difficult to standardize and personalize care in parallel.
6. Choosing the customer - In most other industries, you can chose with whom you do business. Not so in health care. If you have an emergency department, you must provide treatment even if the customer has no means to pay.
7. Compliance - Data flows in healthcare in increasingly regulated. What other business, including the IRS, is required to produce, on-demand, a three year look back of everyone who accessed your information within their firm.
As I noted in my recent post about the Burden of Compliance "the more complex a health system becomes, the more difficult it becomes to find any system design that has a higher fitness."
We are successfully automating healthcare workflows, motivated by HITECH incentives and the requirements of healthcare reform. The 7 characteristics above have required vendors to create full featured software applications and organizations to create complex rollout/funding models that take time. By 2015 we will be there and I will be proud of all we've accomplished, given that the constraints on the healthcare industry are truly different than industries which have been earlier adopters of technology.
Many clinicians say that healthcare is different.
I'm going to be a bit controversial in this post and agree that healthcare has unique challenges that make it more difficult to automate than other industries.
Here's an inventory of the issues
1. Flow of funds - Hospitals and professionals are seldom paid by their customer. Payment usually comes from an intermediary such as the government or insurance payer. Thus, healthcare IT resources are focused on back office systems that facilitate communications between providers and payers rather than innovative retail workflows such as those found at the Apple Store.
2. Hiring and training the workforce - Important members of the workforce, the physicians delivering care, are seldom employed by the hospital. This is rare if not non-existent in any other industry. It's as if Toyota built a factory that anyone can use but does not hire or train the workers who build cars. If someone wanted to create a Toyota with wings and an outboard motor, they would have the freedom to do it.
3. Negotiating Price - Reimbursement no longer is based on a price schedule hospitals and professionals can control. It is based on a prospective payment model such as DRGs that someone else designs and dictates. Where else in the US do prices get dictated to a firm?
4. Establishing referral relationships - We cannot market services to those who control our patient flow due to Stark anti-kickback regulations. In other industries, you can build relationships, offer special incentives, and arrange mutually beneficial deals to develop your referral business. In health care, it's illegal even when unilaterally funding an action would make things easier for both parties and the patient.
5. Standardizing the product - In most industries, the product or service can be standardized to improve efficiency and quality. In health care, every person is chemically, structurally, and emotionally unique. What works for one person may or may not work for another. In this environment, it is difficult to standardize and personalize care in parallel.
6. Choosing the customer - In most other industries, you can chose with whom you do business. Not so in health care. If you have an emergency department, you must provide treatment even if the customer has no means to pay.
7. Compliance - Data flows in healthcare in increasingly regulated. What other business, including the IRS, is required to produce, on-demand, a three year look back of everyone who accessed your information within their firm.
As I noted in my recent post about the Burden of Compliance "the more complex a health system becomes, the more difficult it becomes to find any system design that has a higher fitness."
We are successfully automating healthcare workflows, motivated by HITECH incentives and the requirements of healthcare reform. The 7 characteristics above have required vendors to create full featured software applications and organizations to create complex rollout/funding models that take time. By 2015 we will be there and I will be proud of all we've accomplished, given that the constraints on the healthcare industry are truly different than industries which have been earlier adopters of technology.
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