K.I.S.S Method

Ever since we published our whitepaper called Value-1000, I have been asked several times "why so simple?" "What about a transformation curve approach?", "What about weighting the measures"? Well folks, I subscribe to the K.I.S.S method. And I am not talking about smooching.

To weigh or not to weigh?
While weighting has it's benefits in some other industries, I just can't wrap my head around "weighing" a measure in healthcare. If we divide measures into several groups, then maybe. But when it comes to patient care measures, I don't think it is the right approach. Let me explain. There has been a paper published that talked about adding weights to severity of outcome. Arguably, Patient mortality can be considered the worst outcome ever and we can give it a weight of 100 (max available, let's say, for example's sake). So, we add a weight depending on the severity of the outcome. My problem is this: the weightage of any measure is decided by a person or a panel that decides that this should be the weightage given to a particular measure. An athlete who became a quadriplegic, but lived might argue that the severity of her care outcome is as severe as Patient mortality and hence should be given the same weightage. To me, it is subjective. The subjectivity in care should be left to the experts, if you ask me and that expert is not I. It is the "provider", in my humble opinion.

Curving
Sure, we can "curve". But to get to the curve, we still need to collect data points based on one or more algorithms for each measure.

So, in Value 1000, we are only talking about "one" approach of measuring quality in healthcare. The paper is not intended to be the "be all, end all" approach either. It is intended to generate discussion and ideas. So feel free to send me comments about it. And if you have a great idea on measuring quality, publish it!

Buzz (kill) Words!

If you have talked to a technologist or a technology sales person lately, you have certainly heard of SaaS, Cloud, Disruptive Innovation etc. Hmmm... "disruptive" innovation? Do you really have to say that innovation is "disruptive"? Didn't people stop riding horses to work when cars came around? So, when you are trying to choose your informatics solution, kick the first sales person that tells you that their solution is "in the cloud"!

Cloud is Water Vapor!
Don't believe me? Ask Larry Ellison, the CEO of Oracle (http://www.youtube.com/watch?v=8UYa6gQC14o). So what prompted him to give a (ahem) "passionate" speech about the cloud?
Let's examine the facts. If you really want to put your software "in the cloud", a fundamental engineering shift is needed than what is being purported as cloud computing. The closest thing we have seen to a truly "cloud" architected software, is the screensaver that SETI(Search for Extraterrestrial Intelligence...to you and me, that is looking for E.T! ) put out 10 years ago (http://www.planetary.org/news/2009/0521_SETIhome_Celebrates_10_Years_of.html). Yes folks, "Cloud" computing happened back then! People downloaded the screensaver, and when they were not using their computers, the screensaver kicked in and started analyzing data for SETI, sending data back to their main computers once the analysis was done.

What is being sold as "cloud" computing today is nothing but a software that resides on one or more servers at the vendor's data center. In other words......wait for it....an ASP model! Remember that term? Application Service Provider model? Remember all the VCs who wanted to invest only in ASP model companies? Now, here is the kicker. Application Service Provider - Software as a Service (SaaS). You "lease" the software. Just like leasing a car. See the similarity? Are you seeing a pattern here? So, yes, I agree with Mr. Ellison..." we change the term and think that we have invented technology...".

The point being, forget cloud, forget SaaS, look for "functionality" in the software. Can it deliver what you need? Once you have ascertained that, then you can think of where it is going to be hosted!

Value 1000 - A practical proposal for measuring quality

The healthcare industry is abuzz and almost obsessed with improving quality of care and reducing cost of coverage. While there are several proposals out there on how to do this, the big question still remains. How do we "measure" and "reward" quality? Mayo’s recent recommendation of Medicare Value Indexing is a step in the right direction. Well we took it a step further and explored some ways of actually implementing it.

Here is a proposal that we think could add value and is simple enough to implement. And don't flame me, you Six Sigma people! I actually do know karate!
You can download the white paper (it's FREE, people!) from here :
http://www.metaanalytix.com/whitepaper_value1000.html

Let me know your feedback

Buying an EHR - What you need to know

I have been asked many a time as to how to make the decision of buying an EHR system. I love cars, so I am going to talk about cars for a while! You may ask what car buying has to do with EHR buying. Read on!

Tool vs. Product vs. Solution
So you are in the market for a "fuel-efficient" car that can take your kids to soccer practice and be good enough to take you to work and shopping and you are proud to show your co-workers. You don't come back from that shopping trip with a spanner, do you? Nor do you buy just any car that is on the lot and walk away. Well, let's look at the evaluation criteria you employed in buying the car. A spanner is a "tool" that may have been used in the building of a car. The car itself is the "product". The "solution" was a fully loaded car (or minivan) with third row seating, fuel-efficient, loaded with fuel, registered with the state and a jazzy thing that you are proud to show your co-workers the next day!

So, let's break it down:
Criteria #1: Identify the need (you "needed" a new car which is why you were in the market)
Criteria #2: Choose the product ( Had to have a steering wheel, tires, doors, third row seating, fuel efficient etc.) that satisfied the need.
Criteria #3: Is the product green "certified"?
Criteria $4: Can I show it to my co-workers and not be ashamed?

Let's apply the same concept to EHR buying. There are several "tools" in the market. They might be "certified" tools. There might be several "products" in the market. They too, might be "certified". But the question you have to ask yourself is, is that "solution" going to fit my "need".

Criteria #1: So, identify your "need" first. Why are you buying the EHR? Compliance with ARRA? Want to make your practice more efficient? Reduce your costs?
Criteria #2: Choose the product. Can your practice run on it? What additional "functionality" do you need? Is it suited for the way you conduct your day to day business?
Criteria #3: Is it certified? (This question arises if your primary reason for adopting an EHR system is compliance and getting some of the stimulus funds)
Criteria #4: Well, this doesn't apply to EHR buying, but you can tout yourself to be on the "bleeding edge" (pun intended) of technology and show everyone how cool you are :)