Thursday, September 2, 2010

The Elephant (HIT) Inside the Boa Constrictor (Government)

When it comes to physicians failing to adopt and install electronic records, I think of the Saint-Exuperty’s story of The Prince, in which a boa constrictor is trying to digest an elephant.

The story says, “"Boa constrictors swallow their prey whole, without chewing it. After that they are not able to move, and they sleep through the six months that they need for digestion."

With electronic health records, this metaphor holds true. But it going to take five years, probably a decade if you count the last five years, for the boa constrictor, government, to digest the elephant. It may have byten off more than it can chew.

In a piece in The Health Care Blog, “ Beyond Meaningful Use: Three Five-Year Trends in the Uses of Patient Health Data and Clinical IT,” David Kibbe, MD MBA, a Family Physician and Senior Adviser to the American Academy of Family Physicians, and Brian Klepper health care market analyst and a Founding Principal of Health 2.0 Advisors, Inc., describe the essence of the digestive problem.\

All or Nothing

“Finally, we have a Final Rule on the Medicare and Medicaid EHR incentive programs. The rules and criteria are simpler and more flexible, and the measures easier to compute. But they are still an “all or nothing” proposition for physicians, who will have to meet all of the objectives and measures to receive any incentive payment.

Three HIT Trends

They then go on to describe three trends likely to take place over the next five years.

"1. The expanding uses of structured health data using XML. EHR vendors, HIE companies, consultants, and other middlemen are used to making fortunes on one-off health data interfaces between an EHR and sites of care (e.g., hospital) or service (e.g., lab)."

"2. Point-to-point sharing of health data, securely, over the Internet. Local and regional health information exchanges are proliferating, but they still face the problem of communicating beyond their own boundaries."

"3. Platforms+modular apps+network services. Almost everyone is familiar with this model: it’s the iPhone app store and the Android Market. It’s the use of the Internet without as much dependence on the web browser, with multiple mobile devices for platforms, and with the emphasis on replaceable apps and re-useable technology that offers up data from many sources simultaneously."

This is the kind of technocratic language most physicians, particularly those in marginal small practices, find hard to swallow and digest. This physician indigestion process reminds me of two other elephant metaphors.

The Elephant in the Room

Before resigning in frustration as the first “HIT Czar,” David Brailer observed in a 2005 in a New Times Times interview , “The elephant in the living room is what we’re trying to do is the small physician practice. That’s the hardest part, and it will bring this effort to its knees if we fail.”

The Blind Men and The Elephant

The second metaphor is the Blind Men and the Elephant. Our health care system is an elephant. Everyone feels the elephant’s parts differently. Doctors hanging on to the tail feel the system is an encircling rope, purchasers touching the leg feel it is an immovable tree, plans holding the trunk feel it is a squirming snake, and government officials riding on the head feel it as a global positioning satellite devices, capable of controlling the direction of the elephant.

What concerns me is what will come out the distal end of the boa constrictor once the digestive process ends.


obat herbal said...

menghilangkanbintikbintikkutildikelamin jualobatkutilkelamin menghilangkanbintikkutildikemaluan

herbal medicine said...

obat wasir racikan herbal dan pengobatan penyakit wasir dan cara mengobati penyakit wasir dan obat herbal penyakit wasir dan obat wasir ambeien dan cara menyembuhkan ambeien atau wasir dan obat wasir ampuh dan cara menyembuhkan wasir dan obat herbal wasir dan cara mengobati ambeien dan obat herbal wasir dan obat ambeien ampuh merupakan solusi pengobatan herbal dari denature indonesia

lionelmessi10 said...

kenapa keputihan tidak normal dan mengeluarkan nanah obat kutil herbal di kemaluan cara menghilangkan kutil kemaluan secara alami tips menghindari kutil kelamin tips menghilangkan kencing nanah cara mengobati kelamin keluar nanah obat alam tradisional kencing bernanah obat kutil di kemaluan pria obat kemaluan keluar nanah Obat Ambeien Ampuh Tradisional Resep Obat Wasir obat alami untuk gejala wasir Mengobati Wasir Secara Alami Obat ampuh atasi wasir Obat herbal efektif menyembuhkan wasir Obat untuk kelamin laki laki keluar cairan nanah Obat kemaluan keluar nanah atau gonore Obat cairan nanah keluar dari alat kelamin Mengapa kencing sakit dan keluar cairan nanah Mengapa kencing perih dan keluar nanah Mengapa nanah keluar dari kelamin Obat untuk kutil di sekitar bibir vagina Obat kencing nanah manjur menghilangkan benjolan kutil di vagina wanita

najwa said...

Menghilangkan Kutil Di KelaminJika penyakit ini terus dibiarkan maka gejala juga akan terasa menyakitkan. Mengenai proses munculnya, kutil pada pria ini bisa hadir dalam bentuk datar atau berukuran besar dan berkelompok. Ciri yang paling umum dari kutil kelamin ini adalah bentuknya yang menyerupai kembang kol. untuk cara pemesanana silahkan kunjungsite kami

obat kelamin keluar nanahDan kondisi ini dapat semakin parah dan kemudian menimbulkan berbagai macam komplikasi seperti peradangan sendi dan infeksi jantung. Hal yang seperti ini dapat dicegah dengan mengenali gejala awalnya, sehingga penyakit ini tidak bertambah parah. untuk cara pemesanana silahkan kunjungartikel kami

Mengobati Kutil Pada Kelaminentu saja kita agak seram membayangkan hal ini jika terjadi pada kita, tapi setidaknya cara ini memang terbaik karena dilakuka dengan bersih dan efisien. untuk cara pemesanana silahkan kunjungartikel ini

Obat Kutil Di Kemaluan WanitaHal inilah yang menjadi penyebab kenapa akhirnya banyak penderita yang mencoba berbagai solusi pengobatan herbal dan semacamnya. untuk cara pemesanana silahkan kunjungklik disin

Artikel Lain