The President's signature on the bill for Health Care Reform has not put a stop to the criticism, anguish and negativity that surrounds change in this country. It appears in this country we have to have a push that is top-down from the Presidential Office Suite to legislate change in this country. It is becoming a barrier to change that most people want. The kind of people who take responsibility for their actions and want to work in jobs they love providing competent work. Ordinary people who want jobs they love and want to support quality patient care and know how.
This is the profile of most people who put any form of digital media to work as part of their work practice, so they can build capacity to serve their clients with a view for quality performance. It is not the profile of a government bureaucrat operating to push EMR into "meaningful use" so people can take benefit of funds allocated from the America's Recovery Act.
It seems that in this country we cannot get away from mandating laws that perpetuate fear. We rely on politicians and lobbying group and corporations to make change. These economic decision makers end up spending billions of dollars per year on media, advertising and debate that perpetuates fear instead of leading change for health, environment and law.
The day Health Care Reform passed, I was still unable to put my frustration aside about health. It had nothing to do with the heated debate and force that surrounded Health Care Reform for years. My mental anguish had nothing to do with the long history traced back to Teddy Roosevelt, a Republican Activist, who first proposed US Health Care Reform.
The staff at Justmeans.com did an incredible job or coverage from all points of view, Sara Libby provided a history of the bill tracing it back to 1912 when Teddy Roosevelt was in office. Alisa Ulferts wrote about how the voices of hate, threat and ill will related to HCR made her feel ill, and Ano Lobo asked some tough question, e.g. will 50 states each interpret their way of implementing hcr and will the health of Americans' overall improve.
I found these events that coincided with the passing of the bill far more telling on what the challenge is ahead of us for health, environment and education in this country.
Jamie Oliver's First Episode of Food Revolution portrayed a reality in American culture where adults are so critical of change it stops it dead in its tracks. Then we have to own how our children are not raised to have good food manners and eat with proper utensils. Oliver has met with a layer of challenge he did not anticipate when he decided to create a revolution to change the diet of citizens of America's most obese town. He has to induce fear in people to gain their cooperation. Is this the American way? He had to take a family to the doctor's office who never go and have them hear from a doctor what they had done to their son's health by letting him eat whatever he wants.
The fight and battle to obstruct good nutrition in the schools after the health care reform bill was signed began this week. Politicians have begun to lobby to block Michelle Obama's School Lunch Campaign designed to give a message to families and school son the importance of passing a new bill authored by the Obama administration to allocate $10B on school lunches over 10 years to feed children with healthier food. Michelle's partner for this bill is Disney, who is assisting with building a public media to teach good nutrition to kids and their families. Disney is producing Jamie Oliver's Food Revolution.
We are now looking at more media and more government and more mandates ahead of us to put into action a series of laws that have mandated use of health care information technology.
At almost every home page today of any EMR company they are promoting a $44,000 rebate from this stimulus package for clinical practices to adopt "meaningful use" of electronic medical record pages into their practice. To embed images from the website of HIT companies promoting the purchase of EMR systems that display the stimulus package as motivation for purchase would position me as a person attacking a specific company. That is not my intention.
In my opinion there seems to be a systemic flaw in the marketing and promotion of EMR and HIT. The media does not instill any understanding of how health information technology can be adopted in to use to
1. improve the delivery of care to consumers;
2. simplify the task of processing medications, insurance claims and information requests;
3. create a system of tracking and formatting a record of patient health that will weave into a larger knowledge base of research and practice relevant information associated with a specific patients health needs can be accessed;
4. build a translational and evidence based practice of medicine so that clinicians and patients can find the best in practice research, clinical trials and new diagnostic procedures.
For many years, I have had a passion about the possibility of Health Care IT and found a dynamic that surrounds it similar to health care reform.
The Department of Defense, the Veterans Administration and Health and Human Services have spent billions of dollars through the years to develop and put into use thousands of health care information technology pilots that have failed to result in improvements of quality of care and access for patients. Last summer, Obama and Congress scrutinized numerous projects that associated with a price tag of $3M for each project to find out if the purchase and adoption of these technologies resulted in patient outcomes. By the end of the summer, the Obama administration stopped 48 VA HIT projects mid stream.
We can now speculate on the billions of dollars in projected expenses and the cost of ongoing operation for initiatives led by Dr. David Blumenthal, from the Office of National Coordination of Health Information Technology. These initiatives are generating scazillions of bits and bytes of information on how to format electronic medical records for meaningful use.
To date, I have not yet found any information or knowledge shared with the people this initiative effects and apply a sustainability management practice of Triple Bottom Line to Meaningful Use. The Triple Bottom Line is a term that was coined by John Elkington in 1994. The application of this financial leadership approach to integrating ethical and sustainable practice to industry finances has not yet come into common use within all sectors of health care. Some BioPharm companies have adopted its use into practice because of the growing interest to comply with Corporate Sustainable Reporting Practices that are being adopted into use by the 7700 compnaies associated with the United Nations Global Compact (UNGC).
UNGC has authored a set of principles and leadership practices that are inspiring the business associated with the UNGC to learn from the span of practices authored and facilitated by global non profit organizations and investment indexes on how companies integrate practices into company strategies that are responsive to the environment, health and social justice topical challenges of today. Sandra Waddock, the Galligan Chair of Strategy at Boston College's Carroll School of Management has authored a paper, Building the Infrastructure for Corporate Responsibility, that summarizes the thought leadership and provides tables and listing for all the monitoring organizations globally that can guide groups in achieving a system and ethic of reporting for the environment, health and social justice that could add benefit to the growing through related to "meaningful use."
To integrate this system of thought we would begin to see images in health care that report metrics of change that "meaningful use" to a Triple Botton Line practice reflected in these images.
Health Care Reform and the adoption of use of HIT has been motivated by the view that we can as a nation create a health care that
It seems to me that the vision of HIT and the values associated with the importance, do not have the power that can be derived from a message enclosed in a vision of Corporate Social Responsibility and Sustainability. I know that this method of thought, inquiry and learning could change the posture of conversation to generate change rather than re-enforce fear, debate and threat, hence paralyzing members of the legislature, government agencies and health care institutions and players from authoring a new leadership to lead change.
Health Care is so much more than health care. Health comes from the air we breath, the food we eat, the way we work and live in balance with our family and communities. Health grows out of a sense of belonging and learning a capacity to deal with the growing uncertainty of these times.
Maybe it is time for the experts in government, technology and science to alter their view a bit. To do this it will require convening groups of stakeholders that represent all groups who live in the strategic geography that any change initiative reaches out to. This would mean putting various people who represent the diversity of expertise and diversity of people in need of response that includes patients and advocacy groups, clinicians the the institutions where care is provided, employers, insurance companies, think tanks, professional associations.
In gathering these people, the convening teams will need to identify and draw on perspectives from "natural leaders" who work within these groups and have the energy to lead change and examine all that change implies from a strategy perspective that is translated into action with plans for resources, budget and engagement to deploy these plans of action.
Last week as I combed through my research, conversations with my colleagues in the world of Corporate Social Responsibility and listened to the reports in the media on health care reform, I began to conceive my own picture of what is meant by Meaningful Use.
As I have repeatedly written here, health is so much more than health care.
Please be patient with me while I set up shop.
I apologize Dr. Blumenthal for raining on your parade. For me, "meaningful use, and the current buzz that surrounds it. It all gives me the experience of finding myself in an "electrical storm" that is raining pellets you have to add to your list of what to do, before you can leave the office. On Friday evening a office manager in a Harvard Medical Area, forwarded me an email instructing her on how she would have to collect more demographic patient data so her office can qualify for the first $18K payment from the Federal Government. My first reaction to this email was to ask, "Why is she still in the office on Friday night at 7 PM, when I know the doctor she worked with that day, left work at 4 PM?"
I believe if "meaningful use is to become more relevant to health professionals and their patients, we need to expand our vision of building health technology that supports people at work, home and in the doctor's office. In the world of social media this can become a never ending story that inspires people who want to live life sustainably to chose access to the best technology, science, and lifestyles that give give us the best shot at a quality of living, no matter our health status from cradle to death.
Perhaps with the appointment of Dr. Don Berwick to Center for Medicare and Medicaid Services (CMS), we now will see a more educational approach to what we need in health care. Berwick like me is a Larry Weed, M.D. fan. For years, Larry Weed was the voice on the power of digital health and how it can enable quality decision making and support evidence based practice of medicine. Dr. Weed like any practical physician and health informatics specialist had vision and imagination that for some reason the politicians and medical bureaucrats want to obstruct. Sometime in the 90's the Rockefeller Foundation gave Dr. Weed a grant and in his early 80's he established PKC, which has the architecture for this work to expand into practice and provide an outreach that is viral with quality capacity.
Both Berwick and Weed's work is focused on supporting the physician to provide quality care and assure the best practice to any patient possible. That is quite different than coming into a practice and starting off your contact with a clinician proposing he can get $44K in the bank for adopting use of an EMR.
Please join me here to read more About the Story of Meaninfgul Use