Thursday, November 27, 2008

Turkey for Thanksgiving

The Health IT Nerd has spies all over the world, and one of them sent me this from Australia.

Ahh, Australia. You know, I could stop right at this point, but I doubt anyone outside New Zealand would get the joke.

Anyhow, back to the article:

SPECIAL commissioner Peter Garling has prescribed a massive dose of IT to fix NSW's troubled public hospitals, and recommended a watchdog oversee e-health.

I found myself at a loss trying to figure out what parts of the article to quote. Only the crazed funny bits, I said to myself. Well, that didn’t eliminate any of it. So put down anything that you might spill, drop or snort, and read the article in full.

Peter Garling is a turkey, and he’s the main course for the Health IT Nerd’s Thanksgiving special. Like I said, any fool can figure out that Healthcare is completely screwed. And this fool did. And just like I said happens, he’s proposed a whole lot of IT programs that will fix healthcare up. I hope you like your turkey flavoured with stupid.

Let’s start with his proposed programs.

He says that NSW should have “critical infrastructure, hospital and community information systems and a statewide e-health record system”. Before I go on, I’ve heard about NSW. In a country full of blow-hard states with ever more obnoxious politicians, NSW tops the lot in venal corruption and plain buffoonery. In fact, the NSW politicians are now almost qualified to graduate to US Congress. But I digress.

So this Peter Garling fellow says that NSW should provide all these things – which probably comes as a surprise to their existing critical infrastructure and hospital systems – and it should do that in a timeline of four years, not the eight to fifteen (actually thirty) year timeframe. Because, you know, if you just wish for things and strike a pose, that’ll make it come true. I’ve heard this is called “Creating Your Own Reality”, and we've all see how well that works out.

So not only has our Thanksgiving Turkey already decided that it can just happen in a four year time frame, he’s already priced it out: $705 million – accurate to the third significant place. Unbelievable.

If that wasn’t funny enough, there’s this: “Mr Garling has called for an independent Bureau of Health Information -- separate from NSW Health -- to be established to access, interpret and report on all data relating to safety and quality of patient care”. Ahh. So, this is where the 4 years and $705 million comes from – creating a new government department. And since government departments don’t have non-negotiable contractual goals, you can fix the budget before hand, with total assurance that the money will be spent, exactly as planned. You can even tell right now that there won’t be any actual money for patient services here.

What goals does our Turkey have for his little stack of gold?

There will be no feel-good moment which comes from cutting the ribbon to open a new facility. However, it will surely save many lives, and protect many, many more from harm.

I’m at a loss for words. As I’m sure you’ve figured out, this is not something that happens to me very often. Even in the land of Nod Healthcare IT, you don’t often see someone proposing to spend that much money for no measurable outcome.

Ahh, Australia.

Anyone who had the misfortune to attend international Health IT conferences about 10 years ago will probably remember various chief high lord this and that from Australian governments giving serious presentations about how Australia was going to the lead the world in the use of IT to reduce the costs of healthcare while improving services.

So they should. Australians are tough, pragmatic people, and it’s not very easy for someone else to pull a smart one over them. Oh no. They’re too busy pulling a smart one over themselves to be caught like that. Put five Australians in a boat, and you’ll have five people with the hand on the tiller, all going in different directions. But they’ll actually only have their hand on the tiller when someone’s looking. Not for nothing do Australians use the Koala for their national symbol – an animal that sleeps for 23 hours a day, and is permanently stoned from the eucalypt leaves it eats.

The only thing that saves Australians from themselves is that they don’t know how to take themselves seriously. Which is why no one else does either. Are they a mini-America? Or just Euro-Wannabies? Do they have a socialist healthcare system, or a private free-market healthcare system like USA? Well, Australians sure can’t make their mind up, and no else can figure it out either. Anywhere else it would actually matter, but, hell, this is Australia. They’ll all just go and throw some prawns on the barbie, and whine about the government over one or two (or many) beers.

I only feel sorry that Thanksgiving is not an Australian thing – our turkey will probably just miss the fun.

I recommend that readers keep an eye out for mention of this in the next week or so. The first thing to know is that anyone with half a brain will instinctively know everything I’ve had to say, and will know just how stupid our Turkey is. So they’ll consider themselves free to take a self-serving position on it. How will the politicians posture to leverage the most advantage off the notion before they kill it? How will the technocrats try and stay away from any consequent project? Which vendors reckon they can get a piece of the action?

Well, it’s healthcare IT, and it ain’t meant to be pretty. I sure hope your turkey tasted better than this one.

The Health IT Nerd

I’m a Health IT Nerd. It’s all I ever do: living, breathing and sleeping Healthcare IT until I dream about it: patient records, diagnosis codes, web services, and Snomed expressions. I’d much rather dream about nurses (who wouldn’t?). Hell, I’d be happy to dream about the clerical staff. But no, it’s all bits and bytes and needles and XML for me: it’s not even worth it for me to sleep at all. So I hole up in my hovel with my computer, spending all my time on the internet pretending I know how to make Healthcare better.

That’s all anyone can do: pretend. No one has the faintest idea how to make things better, although you’d never know it, listening to the way the experts go on about how clever they are. But don’t be fooled: they’re either dishonest or just plain dreaming. Or deranged, that’s always possible with these people. The fact is: no one has any idea how to actually fix all the problems that exist with Healthcare or even just Healthcare IT.

Rest assured: it’s not like there’s any doubt about the problems. Any fool can see them, even with their eyes shut and their brain turned off, just the way everybody goes about these days. And most fools do see the problems. The trouble is, the problems are so big, no one knows how to fix them. Everywhere you turn, you can see lots of smart ideas floating around, but even a quick look will make it obvious that they won’t actually work. All they’ll do – if anything – is make someone a quick buck.

Of course, you’re thinking, that’s the problem: it’s all about the almighty dollar, profit for the fat pigs, making money off poor sick people. But even that’s not true. Healthcare is just so stuffed up, it’s pretty much about the only industry where you can say, “let’s do this, it’ll make us money” (or “it’ll save you money”), and half the audience sits around saying, “Like, so, what do we care? What we want to know is, is it good for the patients?”

As if the patients get to have any say in it.

In fact, it’s the patients that are the whole problem. If we took patients right out of the system, we could have unbelievably efficient healthcare. Heck, we could run the operating costs right down to zero, and the system would no longer produce “totally negative healthcare outcomes” (that’s somebody dying, to you and me).

But we can’t get rid of the patients, or their stupid addiction to their own positive healthcare outcomes, so instead, healthcare systems around the world gradually consume ever greater amounts of money on a scale that beggars the imagination. You can join in the game of figuring out how much it costs too – just think of a number, and keep adding zero’s until you run out of space: it’ll be about right (or not any more wrong than any other number you read). Every country is trying to figure out how to protect themselves from this monster, this rampaging beast that just keeps gorging itself on an ever bigger GDP slice. And USA, that paragon of economic efficiency, it spends even more on healthcare than any other country as a % of GDP, and with worse outcomes than many, so free-market economic efficiency is no answer.

It just gets worse too, when you consider what the economic outcome of a successful healthcare system is: an even more expensive Healthcare system in the future. The only way is up, baby, this is a one-way growth industry. Healthcare is the real Rocket Science.

One of the most commonly discussed ways to reduce the cost of healthcare is to leverage the efficiencies that IT can introduce. So it makes total sense – I’m sure you guessed it yourself: Healthcare spends less on IT industry as a percentage of total costs than any other industry.

But even a small percentage of a gob-smackingly large amount of money is still more money than you can poke a stick at, and there’s a huge stack of dollars going down. And all the vendors, from super-small one-man expert consultancies through to mega-large my-turnover-is-bigger-than-your-country’s-GDP multigalaxial corporations, they’re all positioning to get themselves a piece of that river of gold. And the trough is so big, there’s plenty of space for all of us (because yes, my nose is in the trough too – I know what I am. Oink Oink), no matter how ignorant we are. Even if you can’t spell EHR (and a big thanks to Microsoft Word for always correcting EHR to HER).

What all this means is that there’s a lot of real interesting things happening right now in Healthcare IT. That’s “interesting” as in the old Chinese curse, “May you live in interesting times”. And we do, so I just can’t sit back and keep my mouth shut anymore. So I’m going to sit in my hovel, run off at the mouth, and be the Health IT Nerd.

Note that I’m not the original Nerd. Oh no, that’s the War Nerd himself. Compared to the War Nerd, I’m nothing. I’m not even worth to tie his shoelaces and all that sort of thing. Even so, I’m honored to follow in the Esteemed Masters’ footsteps. Particularly because war is just like Healthcare – it’s not driven by any sensible financial outcomes.

You might say, war - that’s a really interesting subject! How boring is Healthcare? Who’s interested in that? Well, think on this: you might be able to avoid a war – if you're lucky – but two things are sure in life: death and hospitals (though not usually in that order). (If you thought I was going to say taxes, where do you think all your taxes are going to go in the future?) Anyway, I spit on war. Healthcare guzzles far more money than war, and we kill far more people in hospitals than die in war (and I don’t even have to count the freebies, the do-it-yourself deaths people accidentally prescribe to themselves at home). And unlike war, just about every country plays at having a healthcare “system”. Well, nearly every country. There are a few conspicuous exceptions in Africa. And I’m told I should mention Canada at this point, too, from what I’m always reading in the US media (and that must make it right).

So, healthcare IT: it’s the piggy in the middle between clinicians, managers, bureaucrats, patients, academics, corporations and technology. It’s chock full of crazy behavior, and the whole shebang is fueled by the biggest pile of dollars anyone has ever imagined.

So sit back, buckle in, and hold on tight, because the Health IT Nerd is gonna show you round.