Random Thoughts from a Restless Mind

Apple just released a smaller Tablet, the iPad Mini, and was razzed by the cognoscenti because it broke no new ground. “Reactive.” “The first  time Apple plays defense.” “Nothing to see here, people. We’re walking…we’re walking.” While the Apple Fan Boys (and Girls) were lining up to add to their Apple quivers, the rest of the consumer world reacted with a communal shrug. Why? No real innovation, and that was a surprise in the world of consumer electronics recently dominated by Apple’s serial innovation.

It makes you wonder a bit, doesn’t it, why there’s so little innovation in the world of medicine when it comes to the storage and transfer of information. With all of the cool stuff already available (voice recognition, “pens” that convert script to text, intuitive “next step” software), why do we have such stodgy, clunky software attached to yesterday’s hardware in all of our EMR choices? For heaven’s sake, we don’t even have a universal platform upon which the various and sundry products are built, and so we continue to have interoperability issues more than 10 years after folks started putting this stuff into play. Why is that?

Every computer product I’ve bought and used over the last 10 years has been easier to use than the one it replaced. Each one has allowed me to do more, and usually with a smaller and less expensive gadget. I know it’s a cliche by now, but my phone has more computing power than the first SERVER I bought to run an entire medical business. For $400. I can talk to it, order it to do stuff, and get all kinds of help I never needed faster than I could realize I needed it, and it fits in my pocket. Yet in a medical office state of the art consists of serial drop-downs and mandatory field entries that may or may not include anything germane to my patient. Able to chat with my cell phone through a bluetooth headset, my EMR demands my full, undivided attention, with gaze fixated on screen.

How come?

In the world of consumer electronics the game is all about predicting what the next, big “gotta have it” gadget or service will be. The most exciting and successful products almost invariably carve out new territory and then go on to viral-like growth because they fulfill a need. This kind of technological progress is so powerful that the people who buy this stuff abandon perfectly functional gadgets that do everything one needs or wants in favor of that next, new-better gadget. This phenomenon in turn drives the makers of consumer electronics to create, to innovate. But not in medicine.

Why is this so?

The so-called “market” for EMR is simply non-existent. The power of innovation, either in response to consumers established, stated needs and desires or in anticipation that something new and better will simply take off in the marketplace is non-existent. The kinds of companies that seemingly come out of nowhere were bludgeoned by government mandated requirements that tiny, bootstrap companies just couldn’t fund the effort. Big companies that innovate like a tiny start-up and create whole, new categories, like Apple, simply didn’t. They all just doubled down on old tech and old ideas, an entire industry making iPad mini’s and calling it progress. The perceived danger of innovating and then having a revolutionary product found to lack “meaningful use” stifled the entire industry. Innovation in EMR was DOA.

And now? Now we have the largest medical institutions in the country abandoning their own efforts at software development and marching like lemmings to the Epic sea. The real-world analogy would be the government saying that you could create any type of gadget you could think of to listen to music, but you can only sell record players and vinyl albums on which you must listen to the songs in the exact order in which they appear on the disc to be assured that the check would clear. Oh, and the doc or nurse could only listen through noise-cancelling headphones that would need to be removed in order to talk to a patient.

It doesn’t have to be like this, of course. All it takes is one company with a little vision and some gumption to find a single big-name player with the courage to see that the status quo is sick. Sure, the vast governmental bureaucracy needs to fix a target and then get out of the way so that something that looks like a real consumer electronic product can emerge. That’s all, really. One product that feels like as “0f course” as the iPod, discovered and purchased by one person who folks watch like TechCrunch, a dispassionate and largely uninterested government standing to the side, idle.

A 7″ computer that could power my company 7 years ago hits the market to a collective yawn? Is it really so much to ask for this type of innovation in EMR?

OK, so maybe this part was my fault. I probably would be a bit better at this Epic thing if I did it more frequently than once every two months. Guilty. The thing is, though, that every little thing Epic asks me to do has either already been done on paper, would go faster if it was done on paper, or both.

It takes two discreet steps to enter the software program, even if you are in a CCF institution and working on a CCF computer; it’s even more complex and takes three steps from the comfort of your own computer. I get the security thing; really, I do. I tried it both ways and failed. Epic failure. Again. So once again I had to call in the cavalry in the guise of the physician support team just to get into the system, finally achieving this milestone event after 3 attempts and a total of 100 minutes of work.

Success, right? I’m in. Nothing to do now but clean up my charts, sign this, attest to that, and away I go. Sure…about that. In the interim between my visits there’d been an upgrade, ostensibly to make using Epic easier. Another 45 minutes of frustration ended up in another phone call and a personal visit by one of the support staff to guide me on my adventure. Kinda like being roped to a mountain guide when you really have no business climbing that particular mountain, except on the mountain you chose to be there.

You’re probably wondering why there was such a big interval between my visits to the “mountain”, and why I chose to continue my Epic adventure now. Both have rather simple answers. I hate everything about this process and this program; I feel oppressed, literally, forced to use a bloated,  inefficient bureaucratic load of “make-work” that adds nothing but time and effort to my day, and so I naturally avoid it for as long as possible. How long? Well, long enough this time that the reason I found myself roped to my guide was the Registered Letter informing me that I’d ignored all of the notifications that I was delinquent in my charting and had therefor “voluntarily resigned” my staff position. Another 30 minutes with my guide and my slate was clean.

How, you might ask, had I possibly allowed myself to “voluntarily resign”? I’ve been a doc for some 25 years; I know the medical staff rules. I’ve been signing charts forever. My address, fax number, and email are all unchanged, and I’ve never missed a notification from the hospital before. Despite my obvious, transparent disgust with Epic and everything it imposes on me, it doesn’t make any sense to let that jeopardize my ability to do surgery at this institution by petulantly ignoring my medical staff requirements. How did this happen?

Easy. All of the notifications were messages only available when you log into Epic.

Sunday musings…

1) Hurtle. Now THAT’S a word that we should see more of in CrossFit.

2) Dog door. Please, please, PLEASE Santa.

3) Density. In Cleveland we are just now starting to see an increase in the density of Affiliates. Maybe not quite as “congested” as, say, Long Beach (whoa), but still, the second wave of Boxes no longer prompts a conversation of the “watershed zone” of overlapping Affiliate geography. More like “neighbors” now.

How is it working in other cities? What was the process like during the early parts of this phase?

Gonna be interesting.

4) Ask. “Always ask for the job.” While listening to a presentation as part of the launch of a new company (for whom I consult) the director of sales made this statement. Indeed, he spoke of NOT hiring a candidate for a job because he, unlike the other qualified candidate, did not explicitly ask for the job.

It’s seems rather simple and maybe even a little obvious, but how often are we faced with a situation where there is some degree of confusion about what we really want? Anywhere. In a job interview, a sales call, or while training an athlete.

At the end of the interview if you really do want it, always ask for the job.

5) Enough. I’ve been accused of being relentlessly positive. Guilty. Maybe a little Pollyanna-ish. Frankly, I’m gonna defend myself against the Pollyanna thing because my life has been like everyone else’s– sometimes bad stuff happens. Freakish events and one-off lousy stuff for the most part, but like anyone there have been a couple of prolonged episodes of badness that needed to stop.

Times when I had to say: “enough is enough.”

You know, that grinding negative stuff, hurtful stuff that just eats at your soul and colors your outlook on even the most magnificent life events. There are some things over which you have no control, of course (the illness of a family member), when you can’t just say “enough is enough.” That kind of stuff offers little recourse, few alternatives other than soldiering on.

No, the stuff I’m talking about here is stuff that you are allowing in your life. Maybe even enabling. Someone or something that insists on making you unhappy. Makes you feel unworthy or bad. You know the stuff: a bad job, dead marriage, an acquaintance who always points out what they view as your faults. Whether this comes in the cascading rush of a waterfall or the relentless drip of a leaking faucet, this is something that you need not suffer.

I’m not advocating throwing in the towel whenever anything is unpleasant or difficult. Not at all. Heck, we’re CrossFitters. We tough out stuff all the time, and put ourselves in position where we have to do just that all the time. No, what I’m saying is that our enhanced capabilities to endure hardship as an extension of our training to the world outside the Box does not obligate us to suffer unnecessarily at the hands of others.

Everything is NOT equal. Everything is NOT relative. Some things, some actions, some behaviors really ARE bad. At some level we do not need to choose to accept them any longer when we are being. It’s OK for us to say “no, this is hurting me,” and to walk away.

Sometimes we must find the courage and conviction to say: “enough is enough.”

I’ll see you next week…

Posted by bingo at October 21, 2012 7:37 AM

Sunday musings…

1) Amanuensis. The ultimate resume padding.

FWIW, I use one every day.

2) Libertinage. Oh, those crazy Frenchmen! Brings a whole new perspective to the vetting of candidates for higher office.

FWIW, I’ve never been to one.

3) Truth. Always tell the truth. How many times have you heard that? Come on, admit it…your Mom drilled that into you from the time you could understand anything more complex than a full diaper.

“Always tell the truth because then you don’t have to try to remember which lie you told to whom.” “Do you swear to tell the truth, the whole truth, and nothing but the truth?” “You can’t HANDLE the truth!” It all seems so simple, doesn’t it? Tell the truth. There’s merit to this, as there is in most of what your Mom taught you, but it’s probably more accurate and actionable to remember this the other way she taught it: “don’t lie.”

Turns out, the world is a little less blackandwhite and a little too grey to hew quite so closely to Mom’s dictum. At least when it comes to something very personal for some other person. Remember the Jim Carey movie “Liar, Liar”? Sometimes the truth is really rather painful and telling it might be more than just a bit cruel. Especially if you don’t HAVE to tell it, when you can allow kindness to trump a truth that doesn’t need to be played.

“Do these pants make me look fat?” QED.

4) GPS. This parenting gig is hard, man. Mentoring and coaching? They’re pretty tough, too. It’s that journey vs. destination thing, I think. You know, “it’s not the destination but the journey that counts”, or some variation of that. I call BS on that, and I’ll bet you do, too. The destination DOES matter. Eventually ya gotta just get there, wherever there happens to be, and whenever eventually happens to, well, happen.

That’s what makes those gigs–parent, coach, mentor–so tough. It all matters, destination AND journey, and the more you care about your child, athlete, or student the more they matter to you. Which is the more important though? For you as the parent, coach, or teacher I mean.

Two children from two different families set out to climb a mountain, journeys observed by parents who are involved in the planning and execution of these odysseys. Child and parent agree that achieving the summit is the goal, that having done so signifies success. All are aware that there is a well-established route to the peak, a direct path that offers a predictable and timely arrival with a high likelihood of summiting.

Both parents encourage their children to take this easier route; neither child does so. Both children safely reach the peak. One parent rejoices for the goal has been achieved without injury, the other expresses disappointment because the path chosen did not conform to the parent’s plan. The correct outcome occurred, but in this parent’s mind the wrong process got them there, and for this there is no joy.

This parenting, coaching, mentoring thing is hard, man.

Here’s one man’s take, for whatever it might be worth. Goals are important; destinations matter. There should always be one, a goal, a destination, programmed into that little GPS of life we all carry around for ourselves and for those we guide. And just like the GPS we use on our real-life travels, that little “life GPS” contains not only the most direct, quickest route to the destination, it also contains within a nearly limitless number of alternate routes, all of which will eventually deposit our traveller at that same destination.

We parents, coaches, or mentors are kinda like the voice in the GPS. Do we scold when the driver misses a turn (“take an immediate U-turn…”), or do we simply recalculate the route and plot a new course from a different direction? My bid is that we do the latter, that we behave like a “GPS+” that not only re-calculates the route but does so with an eye not only on the destination but also on choosing the safest route available from wherever that new launch point might be. You see, I think the journey DOES matter, but the only thing that should really matter about the journey to us, the parents/coaches/mentors, is that it be safe. “You have arrived at your destination” should be accompanied only by high-fives.

And maybe a tiny sigh of relief.

I’ll see you next week…

Posted by bingo at October 14, 2012 7:12 AM

In our world of friendly acquaintances there have been a couple of recent communication failures. Both of these failures occurred using modern technologies, and both turned out to be rather “epic”, as the kids would say. They’ve got me thinking about communication, the exchange of information.

Where does the responsibility lie when we enter into a conversation? Let’s define a conversation as the interaction between two people during which there is a purposeful transfer of some kind of information. Let’s refine that by saying that in this day and age we cannot define a conversation as simply as two people talking with one another. We have email, texts, FB chats and PM’s, Twitter @’s and PM’s, phone calls and Skype, and of course plain old face-to-face talking.

So, who has the responsibility to ensure effective transfer of information? Upon whom does it rest to make sure that facts or ideas have been successfully transmitted and received? How about the emotional content, the feelings that ride along with the data? Sometimes the emotional content is really the data that’s intended for transfer and is quite obvious, like the color guard accompanying a General. Oft times, though, the feelings attached to the words are as carefully and craftily hidden as a stowaway on a cruise ship.

Here’s my bid: the responsibility lies on BOTH sides of the conversation. Active, two-way listening is key. Engaging in the conversation means engaging the individual on the other side. It starts with the choice of vehicle and the recipient.  To whom am I sending this message? On the receiving end the vehicle should also be evaluated: who sent this to me? Think about it…the universe of topics on which you would engage your 75 year old grandparents via text is awfully darned small, and if you are a grandparent who texts you can’t “receive” disrespect in a text message filled with contractions and lingo–they come with the turf.

Some types of communication are not a conversation at all. For example, a status update is like a billboard, meant to be one-way, neither demanding nor expecting a reply. A conversation, on the other hand, is by definition bilateral. It requires active listening and anticipatory listening on the part of both people. One must be conscious of what that other person is hearing while you “speak. Indeed, you have to be “listening” even when it is you who is sending the message, actively trying to understand what your listener hears, anticipating the effect of your message. Fully formed communication involves giving thought to the effect of your transmission prior to hitting “send”, anticipatory listening.

A shared understanding of the power as well as the limitation of each method one might choose to utilize is necessary. A smaller vehicle creates a greater distance and so must transfer more basic information. More nuance or emotional content requires a different vehicle, at once larger (to include the details) and smaller and more intimate (so that each emotion can be seen as well as heard).

In the end we are social creatures, driven always to connect. The rules of communication have not really changed despite our ever-increasing connection and communication utilities. The more important the interaction the closer we must be to one another. Communication, no matter what vehicle we choose, requires that we listen better. Listen to what is said to us; listen to what we are saying; listen to what others hear. The responsibility for a successful communication is shared equally by everyone involved. Despite our newfangled world filled with ever more varied and convenient ways to communicate, the most effective strategy hasn’t changed in a few thousand years:

Listen better.

Posted by bingo at September 30, 2012 6:20 AM