Curbside Consult with Dr. Jayne 11/7/11

You all know how much I love things from South Carolina, so it’s with an extra smile that I congratulate Pink Glove Dance winner Lexington Medical Center of West Columbia, SC. Their entry really does have it all – from the early morning cleaning crew to pink glow sticks at the end of the day. I’m particularly impressed because they captured parts of the hospital that some of us forget about – like the engineering department (the guys with the umbrellas) and the child care center – with plenty of other clever bits in between. In honor of the win, $10,000 will be donated to the Vera Bradley Foundation for Breast Cancer. BTW, don’t miss the biohazard ninjas at 2:23.

From my comments on shoes and finding the best martini, some of you might think Dr. Jayne’s idea of the great outdoors involves poolside cocktails at the Ritz Carlton. Big surprise though — I spent the weekend camping. Good, old-fashioned sleeping bag on the ground in tent-style camping. No electricity, no running water. The weather was chilly, but fantastic. It was great to be away from technology for at least a little bit (except for the guy in our group who was texting in his tent – I believe that’s a camping faux pas, but I wasn’t going to wriggle out of my mummy bag to tell him to quit.)

Camping can be a great equalizer. It’s hard to know whether you’re a Suit, a Doc, or IT staffer when you’re all wearing jeans and either a ponytail or a ball cap. (I didn’t go camping with work people, but I did go camping with an IT staffer, a postal carrier, and a project manager as well as other assorted folks, so it was an interesting mix.)

Watching people set up camp definitely reminded me recent IT adventures in the “you get what you pay for” category. The inexpensive vendor with the iffy support that you contracted with because you only needed them as a bridge technology? Very similar to the budget tent with the iffy instructions that took entirely too long to assemble and will never, ever go back into its stuff sack. (And a shout out to my tent provider – yes, you are correct, your tent IS the bomb, I’m sorry I ever made fun of how much you paid for it, and BTW you’re never getting it back.)

Being away from the constant electronic and political spin cycle was good and allowed for some time to think about where our tech-enabled lifestyle has gotten us and how far apart we are from the vast majority of people in the world. One of the women in my group mentioned that she had never eaten a breakfast that had been cooked over an actual fire. Considering that’s how many people in the world today still live on a daily basis, it seemed kind of sad that we’re so out of touch from what many consider true basic needs. Our near-worship of technology and making things easier and more efficient has also made us more prone to heart disease, diabetes, obesity, depression, anxiety, and stress-related illnesses, which add to the high cost of health care.

We’re spending billions on expanding, enhancing, upgrading, and turbo-charging health information technology when there are people in the world (and even in our own country) who have no access to health care. We forget that there are people who have to walk miles to access clean drinking water. Things like that kind of put some of our daily IT trials and tribulations in perspective when you’re considering that level of resource disparity in our world.

While contemplating all of this under a cloudless starry sky (after having confiscated my tent-mate’s iPhone and its fascinating but atmosphere-spoiling astronomy app) I started thinking about what it really is that I do for a living. When I left solo practice to begin my journey at the Big Hospital and in academia, I was motivated by how many patients I’d be able to impact by moving to the next level. Moving next to the Large Health System and now to my current position, the potential for impacting patients’ health should be even greater. It’s a long way from three thousand patients in a private practice to several million patients across a multi-state organization, but some days it doesn’t feel very impactful.

I know from the numbers (which I crunch daily thanks to software, reports, registries, and endless dashboards) that we are moving the needle. On a month-to-month basis however it is agonizingly slow. We’re building a better mousetrap, but is a mousetrap what we really need? Where is the true innovation? Do we instead need an ultrasonic way to repel the mice from the area, obviating the need for a mousetrap? Or maybe we’ve over engineered, missing entirely the fact that if we’re living on a farm, we’re going to have mice, and we need to be focusing on something else entirely?

The people who deal with the mice on a daily basis feel like they’re no longer stakeholders in the process. Putting it in healthcare terms, insurers, large health systems, and federal entitlement programs are driving legislation that pushes us away from individually focused care and into a widget-making mentality. Patients aren’t the same and neither are providers. Among large health systems, there are great differences (and for some, differences even within their own organizations.)

We’re exactly a year from the next presidential election and I think it will be interesting to see where we are when the big day rolls around. By November 2012, we’ll know who’s been naughty and who’s been nice in the game of Meaningful Use attestation. We’ll watch some vendors bomb and some victors emerge. The big question: will we actually be making more of a difference in the lives of the patients we serve? Or will we ourselves be mice reaching for cheese and hoping to avoid the snap of the trap? Only time will tell.

Have a question about healthcare expenditures, CPOE, or which knot to use to hang your bear bag? E-mail me.

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