Many of you opened your email this morning, trying to figure out what the current state of affairs is. In your inbox, you found requests for information, instructions on what needs to be done or maybe a fire or two to put out. Email isn't your problem, but it is a symptom of the larger illness.
Your practice/hospital/office has departments that do various things: reception, billing, human resources, maybe a lab. You may even have a way for a couple of these departments to communicate with each other. Sure, when a practitioner orders a test, the lab is probably notified, the test run and the results entered somewhere. That is only one question out of dozens, or maybe hundreds that need to be answered. Yes, we now know that Patient X has a total cholesterol measurement of 247. Who administered the draw? What kit was used for testing and who was the tester? What equipment was used and how old was it? What is the average lifespan of that particular piece of equipment? Where was the draw done? Where was the test done? How much power was consumed and rent paid on the facilities the tests were conducted in and how do they compare with other facilities? How does all that affect the accuracy of the test itself?
I don't know the answers to these questions any more than you do. I don't even know how the total cholesterol test is conducted or on what equipment. That isn't the point. The point is that we don't know. If you walk into your local watering hole, ask the owner/manager what his or her food and labor costs are as percentage of sales revenue. That manager will be able to tell you off the top if his or her head, without sending an email, calling anyone or any other action. Labor cost will be between 30 and 35% of sales and food will be 28-35% of sales. That bar owner knows the cost of every head of lettuce, loaf of bread and bottle of beer. If he or she doesn't, the venue will go out of business. Sure, running a bar restaurant isn't nearly as complicated as running a hospital. ...or is it?
A bar or restaurant has raw materials coming in the back door. A bar or restaurant has technicians that make the products and provide the services. A bar or restaurant has patients, er, patrons who walk in the front door looking to consume the products and be provided the services. I am completely unclear on how that is different from what your practice or hospital does. I am also completely unclear on why we can't have a simple point of sale system, like a bar or restaurant that tracks every bottle of beer and head of lettuce.
This reminds me of the classic psychology test given to groups of youngsters. One group is given two ropes and two boards and the instructions to cross a room without touching the floor. Predictably, they either tied the boards to their feet or tied the ends of the ropes to the ends of the boards and 'skied' across. A second group was given one board and one rope. Just as predictably, the tied the rope to the board but then walked across the room, one foot on each end of the board using the one rope to hold the one board to the bottoms of their feet. The second group solved the same problem in half the time and consumed half the physical resources. The moral of that story is that the solution to any problem will expand to consume all available resources.
Back to bars and practices, we don't have children and rope we have administrators who don't understand what is going on or how the processes and materials all fit together to produce the product, making decisions on what the best ways to get things accomplished are. Thinking is hard, researching that particular question is beyond probably most of us, so we buy a bunch of expensive equipment and hire a bunch of expensive people to run it and we get some result, right, wrong or indifferent. We don't know and we don't care. We had a job to do and we got it done. When we need some of the other dozens or hundreds of questions answered, we call Accenture or Deloitte and pay them $200 per hour to 'integrate' our systems. Sometimes, and yes I've seen this happen, the 'integration' is a bunch of offshore resources copying and pasting data from one system to another. Forever. At $200 per hour. Literally.
Flash forward (or not) to 2016 and healthcare is consuming about 20 cents of every dollar produced by the United States economy. The juggernaut of healthcare has expanded to consume all available resources. Like the first group of children, administrators just throw resources at a problem until it is overshadowed by a larger problem. If the hospital or practice isn't making money, jack up the prices. Nobody is minding the store. ...or restaurant.
The solution is to run your practice like a restaurant. Mom and pop do it with paper or with Excel (There really is a restaurant across the street from my office named Mom's). Smart owners and chains use a Point of Sale (POS) system that can literally track everything that goes into or comes out of the restaurant and how much is used for each dish or drink. When we are getting eight shots out of a bottle of Jägermeister, we have a problem and we KNOW it.
So how does your practice manage all this data? Do you know all the inputs and outputs? Do you know the total cost for that cholesterol test? Can you track the work output of any given employee over any given period? Do you have one system that does everything like a bar's POS or do you have hundreds or thousands of boards and ropes laying around for your practice to strap to their collective feet? So you didn't do the due diligence, and don't worry nobody else did either, demonstrably, and you went and bought some accounting system because a guy you play golf with likes it. You bought some human resource management system that may or may not track time cards for hourly employees, you bought this and you bought that and none of it works together, so you can't tell what the cholesterol test costs. Joe Bar Owner knows EXACTLY how many shots are in a bottle of Jägermeister and how many s/he is getting and what percentage of his sales go into buying the bottle, pouring and serving and all the other little details of running a restaurant.
Running a large hospital is no different from running a bar except in scale. You can't run a hospital (or maybe any practice) on paper or Excel. Worse, you shouldn't try. People are not meant to sit around and fill out spreadsheets all day. As doctors, you should know that better than anyone. At Sentia, we have been designing and building software in a holistic environment for decades. Ok, its only TWO decades but that is still decades, We have automated entire businesses to the point that the owner just clicks the "Send Bills" button at the end of the month. Not just once, not just twice, but many times. So what we have is basically the POS system for your practice. Soon, we will have automated the entire health insurance industry and if your patient has our coverage, simply documenting your patient encounter with our software will submit the claim and pay it automatically. Sentia's EMR is completely free to your practice, has no installation and requires no servers for you to buy. No moving parts. No medical coding, no fighting with the insurance over coverage (you will know what procedures are covered and for how much, before they are performed), no billing, nothing but the things you need to do to take care of your patients and eliminating the things the insurance company forces you to. For your patients, it eliminates almost the entire cost of providing the service of insurance.
Sound nice? CALL US and let's set up a demonstration.
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Friday, I'm cleaning out my inbox and come across this from John Lynn's EMR and HIPAA. Anne Zieger states that the Medical Group Management Association condicted a study that found that the average physician-owned multispecialty practice spends $32,500 per year on health IT.
While that only equates to about $7 per encounter, it adds up quickly. The American Academy of Family Physicians calculated that the average group practice physician sees 93.2 patients per week. So that's $650 per week, or $32,500 per year. The median per capita income in the United States in the same period was $28,851.21. That means that the average practitioner employs about 1 1/8 guys each just to keep the EMR up and running. Even worse, this study doesn't include hospitals who spend hundreds of millions of dollars EACH for an EMR installation. To add insult to injury, this does not include the approximately 1/3 of healthcare dollars that insurance companies are wasting managing data that could be managed automatically.
If you've been keeping up with Sentia Health's blog you know where we are going with this: Start a new insurance company that vends the EMR capable of completely documenting the patient encounter and showing the practitioner what is covered as the encounter is documented. Then we perform our magic in the background and issue payment immediately for services rendered. Sentia Health has already developed this EMR.
While Sentia Health's solution doesn't eliminate this $32,500 worth of health IT costs, it does significantly reduce it. Most of you have either set up, or paid to have set up, a secure home network and the machines you use to access it. That same kind of network is all the practice would need to use Sentia Health's EMR. I received a little chrome book for my birthday that is extremely handy, has a super long battery life (it would last all day in a practice) and has a minuscule cost. It would be perfect for using Sentia's EMR.
I'm going to posit that we are getting close to cutting half of the cost of healthcare here at Sentia. When you factor in the no cost use of Sentia's EMR, the ability to create questionnaires, the ability to email your practitioner, the ability to schedule appointments online and soon, even telemedicine and doing it all for $10 per month, I'm pretty sure that we are getting close to cutting half the fat from the system.
$32,500 per year or $120? Again, It's not quite that simple, but it's not too much more complicated either. My personal health insurance bill is $465 per month. I would sure like to see something around $250. What would your health insurance cost be with that kind of reduction?
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You can't use open source for enterprise applications. There it is, I said it. Open source has no database. The keystone, the sine qua non, the linchpin of enterprise development is the database. Don't yell NoSQL, that is a joke perpetrated by people who don't understand how databases are supposed to work, don't shout MySQL that is a nightmare comparable to Access just without the slick user interface and without the reporting tools.
I get this bug from the latest post "A Consulting Firm Attempts a Transition to Open Source Health Software" by my buddy Andy Oram over at EMR and HIPAA.
There is really only one reason to use open source software in the first place and that is its price: free. Yup, its free and worth every penny. You don't have a database, you don't have support, you don't have any reasonable expectation of having developers who even know what they are doing. We make that bold and inflammatory statement because they don't know about databases. In a related post a couple of weeks ago, we detailed why there is no such thing as big data. The conclusion was that the open source guys had gotten behind Hadoop and noSQL becuase they were something that Oracle and SQL Server don't have. Then we told you why running procedural code (Java, Row by agonizing row or RBAR processing, the way NoSQL and Hadoop jobs work) was an amazingly inferior way to do things. You are already here, go look at the article, I'll wait.
So yes, the open source guys have proven that they don't have the first clue what they are doing with these big, new, buzzword 'technologies' that do things the way they were done in the bad old days (the 60s) on mainframes requiring astounding amounts of processing power to even work. They are building solutions that are looking for problems. Flash forward to 1979 when Larry Ellis introduced Oracle and we enter the modern age of computer programming. I might even say that everything since then has just been window dressing or transportation to and from the database.
So, dear reader, do you want to go back to the bad old days of bell bottoms and horrible music, or do you want to come with me into the modern world of software design? We noted above that the the one attractive thing about open source was its price. Actually, it isn't free. The people who produce this open source software don't do it from the kindness of their hearts, they want money, just like everyone else. They market their products like drug dealers. Sure, the first snort is free, but then they have you.
So let's examine free. If I want to build open source stuff using Linux and Apache and all that, I can go to Arvixe and get Cloud based hosting for exactly the same price they charge for Windows. And Windows comes with SQL Server. Where they get you is in the support. They already know that you don't know what you are doing so you call your open source vendor and ask a question. There goes a couple of hundred dollars, and they don't have the ability to document and eradicate problems with the software.
Conclusion: Once again, you are barking up the wrong tree. There is no advantage to going Open Source and several huge drawbacks. We here at Sentia Health have done the homework, have done the due diligence, and understand the things that need to be understood. What we as a population need is a standard for healthcare. We have that standard. It's done. Come see for yourself.
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I am running around doing the daily last Wednesday, Rotary in the morning, quick workout, write my little epistle to you, dear readers, Lions over lunch, when I met one Kent Newtown, PE. Kent spent his professional life in the town I grew up in and have returned to. The more I talked to him, the more excited I got. He referenced a book I read several years ago called "The Goal" by Eliyahu Goldratt. "The Goal" demonstrates the Theory of Constraints (TOC) with a series of vignettes illustrating one manager's quest to improve his employee's productivity.
That doesn't seem to have a lot to do with Health Information Technology (HIT) until you look at it a little deeper, and have someone smart like Kent explain it to you and literally give you an executive summary of both a book "Necessary But Not Sufficient" and 7 hours of presentation by Mr. Goldratt.
In the presentation Mr. Goldratt explains that
- Technology can bring benefits if and only if it diminishes a limitation and
- Long before the availability of technology we developed modes of behavior, policies, measurements and rules to help us accommodate the limitation
If we want to be successful with the implementation of new technology, we must find the things that helped us live with the old limitations and change the rules to take advantage of the new methods.
In this blog you have heard me preach about Bob Cratchit and Jacob Marley and how nothing has really changed since 1843 except that Bob Cratchit XXXII doesn't get ink on his fingers when he works with his spreadsheets. You have heard me crow about how a small group of bright people came up with an industry changing car, the Mustang, and a cast of thousands in focus groups almost murdered the pony car eight years later with the Mustang II. This is precisely what Mr. Goldratt is talking about in his book and presentation.
Mr. Goldratt goes on to state that a client talking to a software provider should only care about
"....making sure my people have the data they need. Your computers, your software - I don't want to know about them. I don't want to hear about bugs. I don't want to hear about new versions. I don't want to hear about hardware. That's your headache. What I want are the end results; the information available when my people need it, where they need it and in the form they need it in."
Well said, Eli, well said. If you, Mr. Manager, are going to mandate all the technologies, processes and design patterns, apparently you know as much about it as we do and you should just develop the solutions yourself. As the President of Sentia Systems and Sentia Health, I can unequivocally state "that's fine with me." You all keep doing what you are doing and you will keep getting what you already have. That's the same thing you've had with Marley and Co. since 1843.
So what does that all mean for healthcare? Well, let's consider what 'rules' we have to change. Let's further assume that doctors know what they are doing and give the best care they possibly can. That leaves all the ancillary systems and protocols that practitioners use to get the job of dispensing care done. Enter Sentia Systems and Sentia Health. If you want me to solve your problems, the software is a black box, you input some stuff, you get out the stuff you need. In the case of healthcare, practitioners document care, and a check shows up. It costs the practitioner nothing, no medical coding, no billing, no EMR and its associated implementation costs, and it costs the patient about 1/10th of what they pay their current insurance company to do the same job. Health insurance companies make the process more complicated than it really is with all the little Cratchits and focus groups. We propose to do away with health insurance as we know it altogether, ditch the 'rules' that go along with health payments, and automate the entire process.
We've taken the Theory of Constraints and the holistic approach to designing solutions to the streets and are actually building software that automates entire industries. In this case the healthcare industry, but Sentia Systems has several clients who have automated entire businesses. They literally click the button that sends out bills at the end of the month and that is it. Work complete.
Go buy "Necessary But Not Sufficient." Understand why Bob Cratchit XXXII doesn't have ink stained fingers but still does nothing different that his Great^31 Grandfather did in 1843. Ask for better.
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