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Time Capsule: Hello, NAHIT? Wanna Buy My Dictionary for $29 Billion?

February 8, 2013 Time Capsule No Comments

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in May 2008.

Hello, NAHIT? Wanna Buy My Dictionary for $29 Billion?
By Mr. HIStalk


The New Oxford American Dictionary costs $48 and contains definitions of 350,000 words. What a deal! HHS just paid consultants $500,000 of taxpayer money to make up five healthcare IT definitions (being overachievers trolling for future engagements, the consultants threw in an extra one). At that rate, that $48 dictionary is actually worth just over $29 billion (shipping extra).

Furthermore, NAHIT (sorry, they apparently prefer the authoritarian-sounding “The Alliance,” according to the Web site) didn’t even get real definitions for its (your) money. Your sixth grade English teacher would be horrified to see, for instance, that the definition for electronic medical record starts out with “An electronic record …” That’s not a real definition, even if it did cost $83,000. If it were, the dictionary entry for civil war would be, “A war that is civil.”

Consultants can’t say, “Have a nice day” without gravely presenting a PowerPoint and an executive summary, so the handful of one-sentence definitions is buried in a 40-page report that no one will ever read.

Note: it is law that every healthcare IT article written by dull reporters or unimaginative academics must start with one of two opening lines, either, (a) “In 2004, President George Bush called for every American to have electronic health records by 2014” or, (b) “In its landmark 1999 report To Err is Human, the Institute of Medicine said that medical errors kill 98,000 Americans each year.” Spoiler: this one goes with (a).

The report implies that the appalling lack of consultant-produced definitions was a matter of national importance, suggesting that the pesky term Health Information Exchange threw the entire United States government into a near-standstill by causing poor EMR adoption and public indifference to healthcare IT. Its conclusion is that, despite war and economic woes, all is again right in the federal world and the HIT pipelines are flowing. The definition deficit has been eliminated.

Give the criticality of the situation, what methodology did BearingPoint use to create the definitions? Since they’re consultants, duh, they “conducted a literature review” and then asked a few people, “Say, what do you think these terms mean?” and packaged it all up with a big invoice. Ca-ching!

Here’s a polite assessment of their work: at least the definitions won’t be contentious. Nobody would read them and argue (except non-CCHIT certified EMR vendors since the report says, in essence, that their CCHIT-certified brethren are EHRs and everybody else’s are EMRs, giving a nice, parochial nod to another ONCHIT pet project). The definitions, in other words, were plainly obvious, thereby throwing the whole “why did they spend all that taxpayer money” question right out into the open.

Here’s another negative beyond $500K of irretrievably lost funds. The cash went to perennial trough-lapper BearingPoint, which some lawmakers tried to ban from government work after its $472 million debacle, the CoreFLS ERP system at the Bay Pines VA in Florida. That project nearly shut down the hospital before it was mothballed for good in August 2004, having never advanced beyond disastrous beta testing. All has been forgiven, apparently, except for those VA folks who were fired or reassigned because of it.

Optimists would say that taxpayers usually fare much worse when Washington bureaucrats meet big consulting firms, so blowing only $500,000 is actually not a bad outcome. Here’s another: if you order in the next 30 minutes, I’ll sell you that dictionary for just $1 billion. Act now and, like BearingPoint, I’ll throw in a bonus definition: boondoggle.

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  • Brian Too: While I'm usually pretty forgiving about individual stylistic variations, I will say that I found Ed's final paragraph e...
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