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Readers Write 9/24/08

September 24, 2008 Readers Write 28 Comments

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Why Sarah Palin is Relevant to HIT
By Wilma Pearl Mankiller

I found it amusing that so many people took Inga’s comments about Sarah Palin and bangs and Botox and turned it into something political. I agree with the readers who think HIStalk isn’t the right forum for politics. We get plenty of that from every cable news channel every night.

That being said, the Sarah Palin story is relevant to our little healthcare technology world. There are some excellent women leaders in our industry, but men far outnumber the women in the top spots. With Palin, we see a working mom who has a realistic chance to be the #2 “guy” in the country. This makes her story relevant, interesting, and inspiring for those of us who have struggled to advance our careers while also balancing our family lives.

Years ago, when I was first newly pregnant, I went to dinner with my husband, a male co-worker, and the co-worker’s high-level executive wife. All but my husband worked for HIT vendors. At that dinner, I recall the wife warning me that no matter how much my husband claimed he was going to help carry the weight, some things would always fall to the wife/mother. At that time, I was young and naive and didn’t fully comprehend what she was telling me. All I really understood was that she and her husband had successfully raised three great kids and she managed to rise through the professional ranks at the same time. I aspired to be like her.

Fast-forward a few years. I supposed I can say that for the most part I achieved what I had hoped for: kids, a nice house, enough money, and some time as an executive. I suppose some would say I had it all. Perhaps I did. But the reality is that getting it “all” can include a few things you never expected or wanted, such as:

  • Tears, while sitting in the parking lot of my son’s daycare the first time I dropped him off.
  • The discomfort and inconvenience of expressing milk in airplane bathrooms and rental cars.
  • Resentment, from both men and women who felt it was unfair that they had to pick up the slack for me while I was getting paid time off just to hang out with a baby.
  • Frustration and guilt, for cancelling product demonstrations because I had a sick child at home who needed me.
  • Ambivalence, when removing my name from promotion consideration after learning I was (unexpectedly) pregnant again.
  • More ambivalence when I asked for lesser job with lesser pay so I would no longer have to travel.
  • Guilt and self doubt when others questioned (judged?) my career advancement decisions and my commitment to being a mom (and for some reason, the highly paid men with stay-at-home wives were the worst because they never seemed to understand that not every husband is the family’s major breadwinner).

Obviously and unfortunately, my frustrations weren’t unique to HIT. In fact, the same challenges exist in just about every industry, which is probably why there are only eight women CEOs running Fortune 500 companies. If you are a woman who chooses a career AND motherhood, you face challenges that only other working moms appreciate. The role models in our hospitals and companies are few and far between. While we can all name a few women that have shattered the glass ceiling, these leaders are the exceptions.

So, here we have Sarah Palin, a real mom who is potentially the country’s next VP. She got where she is by some combination of brains, ambitions, timing, good looks, and luck. We can appreciate that she has to take a baby on the campaign bus. Her kids aren’t perfect. She has critics who think she should be staying home with the kids. Unlike Condoleezza Rice or Janet Reno, she has a family. And if she can succeed, then it gives the rest of us hope that maybe more of us will have a chance to run a hospital/IT department/software company one day.

That’s how Sarah Palin is relevant to HIT.

Observations from the Epic User’s Group Meeting

Epic is an engaging, dynamic company. They definitely put on a good show. But the smart observer can figure out their MO.

When Epic wants to build a new software tool or enhance an old one, they put a couple of recent college grads on the project. After "research", and whatever that involves and an hour or two of client Webex’s, they release the upgrade. If QA is done, it’s by other non-clinical people.

When a client complains, especially a doc, they shower them with attention, phone calls, a trip to Madison. "We want to work with you and hear your feedback." Then, after a number of back and forths, all volunteer time on the doc’s part, the module is improved. This can take years.

Meantime, no one really asks "Why didn’t you do a better job building the thing before you released it?" Anyone who does and doesn’t volunteer to pitch in is not a "team player".

Who loses in this game? The doctor/nurse/lab tech, and then the patient, who suffers through the risk of alpha software.

Who wins? Epic, who doesn’t seem to ever pay a dime for this expert help. Kaiser Permanente seems to be learning this the hard way.

Do other companies play this game? Has anyone ever been a paid expert for Epic design? Does Boeing design airplanes this way?

From the Mailbag

Got questions for Mr. H or Inga? E-mail them over!


Dear Inga,

Did you see where one of the AAFP directors suggested EMR vendors are part of a big Ponzi scheme and the only ones making money are the vendors? What do you think? – Carlo P.

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Dear Carlo,

Dr. L. Gordon Moore is the doctor who apparently doesn’t like EMR vendors. What Dr. Moore said supposedly said was, “Beware of the monolithic, expensive IT vendor, because there are always things they don’t do well. The whole thing can be a Ponzi scheme. The only ones making money from most of these products are the vendors selling them.”

First of all, is there something about making a profit that should make a vendor ashamed? Of course EMR vendors are trying to make a profit. Making a profit is a good thing because it means your vendor is more likely to stay in business to support you and continue developing the products.

So, was Dr. Moore suggesting his EMR did not help his practice become more profitable? Is that why Dr. Moore bought an EMR??? In my experience, the physicians who utilize EMR most successfully are those who initially went into the project looking to improve patient care (by making information more readily available, records more complete, reminders automated, etc.) EMRs can definitely increase efficiencies, which might make the practice more money. Of course some vendors and solutions are better than others and there are always things a particular vendor doesn’t do well as another. This is true with both the monolithic and expensive vendors and the nimble and inexpensive start-ups.

Bottom line, Carlo, I don’t think Dr. Moore is the kind of guy I’d have fun chatting up at a cocktail party.

Dear Mr. H,

I saw a reader comment in an earlier Readers Write about the problem with meetings. What is your take on them? – Lorena

Dear Lorena,

I detest meetings. Really. They are like gases – they expand to fit whatever space and time is allotted to them, yet nothing ever results except a vow to hold even more meetings to which even more people are invited. I don’t like attending them and I don’t like conducting them. I will do anything, including faking an emergency page or coughing spell, to escape back out into the sweet, cool air of freedom.

The really bad ones are when the suit-du-jour is running a meeting of the worker bees. Everybody’s jockeying for the boss’s love and admiration, so it will take twice as long as usual to achieve nothing. When a boss is present (hint: they’re the ones with the suits who came late and are furiously keying BlackBerry e-mails instead of listening to people who actually showed up in person) they will pretend to be fully engaged by randomly spouting out one of these non sequiturs:

  • Make sure you document that
  • Let’s put that in the parking lot
  • How about a bio break?
  • Schedule another meeting with (cast of thousands)
  • E-mail me the details
  • Give me a completion date
  • Send me a list of the risks involved
  • I need to review that before you send it out

Notice how none of these items really adds any value except to support the illusion that the boss is vital to the outcome?

Some people are meant to conduct valiant battles on a field of laptops, armed with minimal knowledge and maximal need to prove it. Others just get the job done instead of yammering about it.

Dear Inga,

What kind of sales tricks should doctors look out for when considering the purchase of a PM/EMR system? – Suspicious Doc


Dear Suspicious Doc,

Are you buddies with Dr. Moore, by chance? Since when did EMR vendors get put in the same category as used car salesmen? Although I do recall hearing about this sales guy who used to “hide” a second PC and switch box underneath the table during a demo. At just the right moment, he would switch from the computer running the PM software to the one running the EMR. He was such a pro at it that prospects never realized the two products were in no way integrated. He was smooth.

Anyway, I think one thing important to understand is if the software version you are reviewing is actual live and in production. If it is a pre-release version, that is ok, but it’s important to understand whether or not the version you are looking at is fully tested and the one you will be getting. Also, definitely talk to other practices and ask them about implementation, support, and whether or not the software works as advertised. If you believe a particular function is critical for your operations, make sure you talk to at least one practice (anywhere, any specialty) that uses that feature.

Finally, assume that in most cases that whatever price you are presented initially can be negotiated. It’s likely that the vendor is more concerned with the total contract amount than individual line items. If they throw in a PC or an extra day of training, understand the value of the item so you can access if it represents 1% or 10% of the total deal. If you are offered a lease option, keep in mind the sales rep (and maybe the company) receives some sort of commission for the lease, so they may be willing to give you a little bit better deal on the total price. Also, lease rates can usually be negotiated if your credit is good.

Dear Inga,

I know a female sales rep who slept with a hospital IT person and her company’s product was chosen. Is that common? – Ms. Kitty


Dear Ms. Kitty,

That is a one of the oldest sales tricks ever (check out the Old Testament). Seriously, I guess I am just naïve enough to believe that women (or men!) don’t give up their bodies to win business. I bet what happened with your female sales friend is that she just happened to find true love with that IT person and her product just happened to be the best solution.

Dear Inga,

I loved your avatar! I was in love with your mind before, but now that I realize you must also be beautiful I’m beginning to think we might be made for each other. By the way, are you getting all sorts of cyberspace love letters from wacky IT nerds? – Obsessed Fan

Dear Obsessed Fan,

Um, you are the first. (that was a pretty creepy e-mail.)

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Currently there are "28 comments" on this Article:

  1. I like HIS talk – but please, this is a waste of time tonight…

    Please stay focused.

    [From Mr. HIStalk] It’s from readers, so I’ll welcome that as a call for higher-valued submissions.

  2. When I worked for Epic I considered myself a “paid expert”. I had 17 years in the nursing field with 10 of them as a Family Nurse Practitioner. There are also a number of physicians and nurses that work for Epic. We all gave feedback to R&D. If we saw something that didn’t work, we would let them know and it would be incorporated. Unfortunately (or fortunately) healthcare is not cookie cutter and what works in one situation may not work in another. Having worked in implementation and with other vendors, I’m always amazed at how the facilities customize the software. I don’t see that as changing in the near future.

  3. There is almost nothing “standard” about the healthcare delivery process in America. All our clinicians are trained at different schools and everyone has a different approach…

    The need for standards alone will revolutionize the healthcare delivery process…ultimately that will be driven by the consumer.

  4. I must concur with those who find presidential politics to be somewhat misplaced in this forum. That said, if there are potential effects to the HIT industry from actions taken in Washington, what better place to discuss them? For what do you read if not for that? An analysis of some new web architecture? Matthew Holt’s rose-colored vision of socialized care? I think there is room for all of this and more. Keep it dynamic Mr. H.
    Like it or not, Washington’s eye is on the HIT world. With vendors, providers, RHIOs, and would-be regulators hoping for a chance to gorge themselves at the public trough (filled with YOUR money), don’t expect that to change anytime soon. In the meantime, readership has been growing, has it not?

  5. Another suggestion when reviewing the vendor’s demo system is to listen exactly to the answer – there are large gaps between “we have that live at our sites”, “we have that in the next release”, and “we can do that”.
    “Can do” may mean years off, not on the product roadmap, and unable to provide reasonable pricing.

    PS – I miss the BrevIT. I appreciated the financial insights.

  6. Epic is a religion and those that bought it “drank the kool-aide” Has ANYONE got it up and running successfully and under budget.

  7. Mr. H – Please let’s be careful with the political comments. Let’s keep this politics free except where it directly relates to HIT. I could go on how I disagree that Palin is an example of women in the workplace etc., but I will let political dogs lie.

  8. Re: Palin.

    Most cringe inducing HISTalk piece, ever. That’s not saying much, because I don’t remember ever cringing reading HISTalk, but boy did this get me started or what.

    I’m probably taking the risk of not getting this comment approved, but here goes: I can’t help but picture “Wlima” reading the next piece about Epic and competency, nodding in approval. And completely missing the irony in that.

  9. Please, leave discussions of Sarah Palin and how she is a representation of a successful working mom out of HIS. Her story is as irrelevant to my liife as a working mom in HIT as Angelina Jolie’s working mom story.

  10. “Wilma’s” article talks about women in HIT and our issues that men just don’t get. Replace “Sarah Palin” with “Geraldine Ferrara” or “Hillary Clinton” if just seeing Palin’s name pushes your panic button and tunnels your vision. The letter is about equality, not politics. FYI, I’m a tree-hugging liberal.

  11. “Wilma’s” article has no specific application to HIT, but instead she has used the Palin piece as a way to leap on her soapbox about something about which she feels strongly. I understand the argument, but I disagree with the forum in which it was presented.

    As for Epic, I have been a part of a successful implementation, on time and under budget. The unfortunate part for me is the reason for the success was only due to internal staff and some consultants. Epic was a sea anchor. Only by ignoring their ‘good install’ plan can anyone stand a chance in getting their system implemented. Their screaming lack of clinical experience among the implementation team, and the mentality of their project managers is a major hurdle to overcome.

  12. Sarah is the epitome of the Peter Principle. If the USA was just dying for a woman VP or President, there are 1000 smarter and more qualified woman to choose from.

    I’d prefer not to see the SP discussion on this forum. I’m a FT+ working mom of many and the assumption that women like me will just embrace SP b/c she is similar to us ludicrous. I’ve been a working mom for 13 years and always felt shunned upon by conservative families, and now I’m on a pedestal because it’s convenient… I could go on and on, getting my muzzle now… BTW – my hubby also has to take work home, go to ped appts, he is not let off the hook because of his gender.

  13. I don’t care that Sarah Palin is a women. We all get sex assignment upon birth it is either on or the other.

    I don’t care that she has kids. There a tons of people that have kids and face challenges, single mothers, single fathers, etc. Each family has to make sacrifices and trade offs for their family. In fact you should feel sorry for those kids whose parents never make a sacrifice for them.

    What I care about is what the REPUBLICAN ticket will be doing in terms of healthcare, and specifically HIT. I see the ticket has the grandiose ideas. But the question is will HIT be used in achieving cheaper costs? If so , how? I would enjoy seeing more detailed explanations to the following from McCain..

    From McCains, own website…..

    INFORMATION TECHNOLOGY: Greater Use Of Information Technology To Reduce Costs. We should promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines.

    MEDICAID AND MEDICARE: Reforming The Payment System To Cut Costs. We must reform the payment systems in Medicaid and Medicare to compensate providers for diagnosis, prevention and care coordination. Medicaid and Medicare should not pay for preventable medical errors or mismanagement.

    STATE FLEXIBILITY: Encouraging States To Lower Costs. States should have the flexibility to experiment with alternative forms of access, coordinated payments per episode covered under Medicaid, use of private insurance in Medicaid, alternative insurance policies and different licensing schemes for providers.

    TRANSPARENCY: Bringing Transparency To Health Care Costs. We must make public more information on treatment options and doctor records, and require transparency regarding medical outcomes, quality of care, costs and prices. We must also facilitate the development of national standards for measuring and recording treatments and outcomes.

    What histalk2.com could do is put a compare contrast between the two candidates to better inform us what their positions are in regards to Healtcare and HIT.

    I would rather talk about the differences and details of their plans. I could care less about discussion about whether the candidate has in innie or an outtie between their legs.

  14. Barb: Thank you for the Sarah Palin comment. I am not sure why she induces such frothing at the mouth in so many people. I rather like her. What you said, though, is correct: Look at Hillary or Geraldine or any other female politician. Even Nancy Pelosi who I detest…. they are all success stories.

    Thank you for having enough neutrality to see that!

  15. Epic finishes a ton of installs on time and on budget. When you ask around you find the real scoop. As for Sea Anchor? Wow, those people were hard working and smart. Didn’t know healthcare but definitely helped get across the finish line successfully.
    Sure some sites run long but they seem to have more of an organizational history of running long no matter the vendor.

  16. Thanks “I now have a clear understanding” for really putting the SP discussion in proper perspective and for offering a constructive alternative to the gender rant. As “Queen” I’m an “innie” but am growing tired of the gender card being played.

    We need people in leadership who can be creative and diligent enough to develop and implement viable solutions to our HIT (and other) national challenges. While I respect and admire working moms for the challenges they face, this neither qualifies nor invalidates an individual for national office. It’s just fluff to prevent discussion of the real issues.

    In particular I found the list of “a few things you never expected or wanted” to be quite offensive. Such a list could be drafted for almost any human condition but…it’s unfortunate that this one is so whiny and emotional; almost validating the stance that women are too sensitive for “men’s work”. The author’s choice to attempt to “have it all” is just that, a choice in her situation (and don’t EVEN get me started about the big CHOICE that SP would like to deny ALL American women). It’s hard to take all of this seriously when it makes light of the plight of the millions of Americans who have no choice but to work in low paying jobs to support a family with or without the help of a spouse.

    A through, thoughtful comparison of the candidate HIT proposals would be quite enlightening and a service to HIStalk readers.

  17. I am the CEO of InterOPERANT. I have two Senior Partners. One is male, and one is female. They both bring world class talent to our company – in equal measures.

    I believe in hiring the best. This includes males, and females of all colors, races, etc.

    Males and females are different by design – and they balance each other at every level from leadership to staff.



  18. Wow! Such bile. A quick note to those successful HIT folks who happen to share Palin’s sex: whether or not you understand it or agree with the practice, many people vote based upon their feelings of “he/she is like me.”
    Queen – was it really so offensive or does it hit too close to home? I only ask because of the bitterness that flows freely in your reply. Clearly Wilma took a different path than you. I know many women with kids who must work, and I find them largely conflicted. Many would rather be at home (younger kids mostly), and any time they sacrifice career for family they beat themselves up the way Wilma has (even if they are happier). They resent the sacrifices that they as women must make, that their male coworkers need not make. The irony is that your reply is more whiney and emotional than was Wilma’s piece, and your contempt is plain as day. Nothing in Wilma’s writing was so offensive as to warrant a response like that, unless she touched a nerve with her family stories. Wilma, most of us appreciate your story, and I have several friends who would probably relate to every word.

  19. I am penning a letter to send to Obama and Mccain requesting information on how they would see HIT playing into their plans. I will put the information together and resubmit it as a reader response. I would like your feed back, what questions would you liked answered or topics addressed. Please keep it HIT related, anything that is an outlyer will be excluded.

    my email address is samtmatalone@yahoo.com, please send me any questions you would like submitted or topics discussed.

    Also who ever penned Wilma’s letter knows her recent topical history. I suggest Googling Wilma Pearl Mankiller.

    Sorry Mr. H. and Inga if I am stepping on your toes, just wanting to stop talking and start doing. I think that used to the old American way.

  20. Ok, I must chime in here (again)…

    I am a male, single father, and raising a baby girl I adopted from China. In addition, I am the CEO and Managing Partner of InterOPERANT (www.interoperant.com) you can see a picture of her on our contact page…

    Sometimes I think we as Amercians have gone soft. Have we?

    Let’s just get beyond all these gender issues and fix healthcare for our future genenration;) In IT we run “value and investment centers” – let’s make them work!



  21. Don: Bravo!

    I apreciate the way you get right to the point and sidestep all the mealy mouthed complaining. There are bigger issues here and I think the news media and many people blow things like gender way out of proportion.

  22. Regret that my response was taken as “bile” and fostered the implication that I’m bitter towards or contemptuous of working mothers. I’m not at all and will again reiterate that I have total respect for the challenges they face. Wompa1 has totally missed my point and I wonder if he’s not already downed a large glass of GOP koolaid?

    My point is that SP’s “working mom” story has nothing in particular for to do with HIT or her candidacy for vice president. The GOP is using her as a puppet (and it’s all the more contemptible for denigrating her in doing so) to get people “like her” to vote in their favor. Working adults struggle around the world and I just think it’s wrong to use the working mom story as a hook to further Republican ideologies. Although I don’t have children, I have nieces, nephews, godchildren and extremely close relationships with their working mothers and “get” the conflicts they face.

    People are people – and I resent this blatant attempt by the GOP to manipulate and divide our country because of a “woman’s plight”. This deification of working women is empty and for political ends. I agree DON – we’ve all gone soft! I thank and applaud WORDS INTO ACTION for his/her initiative and will email topics as suggested (unless HIStalk or Inga come up with another option for talking about the real issues).

  23. Did I truly miss it, or did you not articulate it properly the first time? I was responding more to the offense you took at a working mother’s introspection. You felt the need to berate her for trying to walk the line between career woman and mother. You could not even forgo the chance to toss in the abortion comment (what has that to do with HIT?). Perhaps most of her story also had little to do with HIT, but your overreaction smacked much more of emotion and a “why is life not fair” attitude than did her piece. The GOP is going after the biggest group with which they might get some traction. 2/3 of white women (nationally, mind you) identify as Democrat. It comes as no surprise that they are playing politics there – isn’t that what they do? Your phrasing clearly identifies you on the other side (more nanny-state, guns-are-bad, programs for the children, and such). For the record, I dislike most Republicans. I am a libertarian. I only reregistered as a Republican (this year) to vote for Ron Paul.
    Incidentally, you’re right – we have gone soft. Now back to HIT

  24. Why is it that the GOP is automatically using her as a woman? Maybe they just want real change, which is what Obama talks about… yet he made the typical mainstream choice in Joe Biden instead of doing the radical thing and picking a woman, like Hillary Clinton.

  25. Interesting information about EMRs. I’ve been in healthcare for 28 years in both practice and working for a vendor. The “we’re different from everyone else” statement at the beginning of a project is code for “we don’t want to change”.

    Installing any type of HIT is like any good quality program. Its not the change to one particular component of your organization that makes you successful. Its changing a lot of your processes. Doctors who don’t want to use the EMR because it slows them down should probably not be surprised to see their incomes start to drop. Medicine is complex and success is measured in better patient care AND in efficiencies for everyone in the practice. The WHOLE practice deals with patients — not just the docs or nurses. If the doc is the primary beneficiary of technology then there is only a very small improvement.

    If the doctor still depends on a staff member to pull records for refill authorization and doesn’t understand that the whole process is slow and fraught with delays that really tick patients off then he/she will be subject to the age old impact – customers will leave and find a better caregiver (i.e. lower incomes).

    Oh, and remember, you are so unique that no one else has the problems with refills that you have.

  26. As a person who has worked in the past, demonstrating software for a vendor… Keep these things in mind:
    (1.) If the demonstrator says the product can do something, ask if that functionality would be CUSTOM, is it information that would have to be captured in a customer defined screen, or if it is part of the software application that they are demonstrating that day.
    (2.) Ask if the demonstrators receive any type of “commission” on the demonstration if there is a resulting sale. If they do, keep that in mind when watching the demo.
    (3.) Don’t allow an audience member of a demo to try and pull the demonstrator all over the board. If they do it’s not only difficult for the demonstrator to show you the highlights, but the demo ends up only focused on that one persons concerns. This goes for any MD’s present as well. The demo should be for all, not for one specific person, unless it is a one person department.

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