Tuesday, November 8, 2011

Which Health Reform Hole Do You Inhabit?

You cannot dig a hole in a different place by digging the same hole differently.

Edward de Bono, MD (1933- ), The Use of Lateral Thinking

In a hole there lived a hobbit. Not a nasty, dirty, wet hole, filled with the ends of worms and an oozy smell, nor yet a dry, bare, sandy hole with in it to sit down on or to eat: it was a hobbit hole, and that means comfort.

J.R.R. Tolkien (1892-1973), The Hobbitt, There and Back Again(1937)

November 8, 2011 – Yesterday I had a conversation with R. Lee Heath, the inventor who developed the portable automatic cardiac defibrillator. Heath said he liked my analogy of a health reform horizontal landscape punctuated and punctured by a series of disconnected vertical holes with specialists and true believers at the bottom of each hole.

Two Observations

Heath made two profound observations:

One, government does not innovate, individual entrepreneurs do. Government cannot manage failure; seldom abandons a project; does not gamble with its own money; measures its success in good intentions, not results; grows too big to fail, too influential to stop; can’t go out of business; prints money to keep on going; and is propped up tax payer money. With entrepreneurs, the opposite applies.

Two, government have been concentrating on physician offices as the primary hole to be filled but the biggest hole in primary care is the ER, where patients go for primary care when ill or injured and where Emergency Care Services teams deliver them to be evaluated and treated.

Emergency Medical Services (EMS)

Emergency medical services (EMS) are emergency services dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency.The use of the term emergency medical services may refer solely to the pre-hospital element of the care, or be part of an integrated system of care, including the main care provider, such as a hospital.

When an emergency occurs, prompted either by a 911 call or a call by the patient, relatives, or neighbors, the first department, the police, emergency technicians, nurses, and an ambulance descend upon the scene, at a total cost of $2000 to $4000 to someone – the patient, Medicare, the insurer, or the city – for evaluation and transport.

Intersection of Private and Public Holes

The emergency situation is where private and public holes intersect. Heath says software he acquired from the United Kingdom, where care is much more efficient, saves more lives, and is less costly than in the U.S., can be used to connect the holes.

The software allows emergency personnel, most often a nurse, immediately help set priorities by which the patient needing critical care can be directed immediately to the ER, or if requiring less urgent care, can redirected to primary care clinics or urgent care centers. The result is lives saved and costs saved and better quality care.

To bolster his case, Heath sent me a 15 page article by Fire Chief Dennis Murphy (retired), Director of Design and Development for the Mobile Healthcare Network, The paper, entitled, “Mobile Integrated System of 24 Hours Services for Emergency and Non-Urgent Injuries and Illnesses,” says that by retraining emergency personnel and teaching them to use the software for a quick appraisal, the U.S. could save $4.4 billion a year.

According to Heath , this system, guided by data-based software setting priorities, is an example of the use of synergistic thinking by an individual entrepreneur to isolate, integrate, and conceptualize an idea to connect the holes in our current system.

This story led to me compose this bit of doggerel.

Which hole in the health reform landscape do you live in?
Where do you feel most comfortable in your cozy den?
Do you live in the specialist hole,
Where everything is neat and in control?
Do you live in primary care hole?
Which everybody says connecting holes is the goal?
Do you live in the collectivist’s hole,
Where government possesses a compassionate soul?
Do you live in an entrepreneur’s hole,
Where you believe markets should set the toll?
Well, we ought to use IT to connect each hole,
With integrated roles for every mole.
At the bottom of every hole lives a holey mole,
Who lives in comfort, professes, protects, and partitions himself from other moles in other holes and from public-private partnerships.

Tweet: Software-guided integrated emergency medical response teams, could save the $4.4 million a year, and produce more appropriate, better care.


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