The Moon Walk

Posted in Jim at 2:36 pm by livefood

We owe a lot to the moon landing. More correctly perhaps, we owe a lot to the process that resulted in the moon landing and the discoveries that took place during and after the event. Science rocked our world then and it continues today.


I have to admit that I’m in favor of space exploration. I don’t want to travel in space. To be honest, I don’t like to fly. All right, I don’t like ladders even. While this may be a little TMI, it goes to my point that I support space exploration for reasons other than wanting to fly fast and high.

I love what space folks have brought to me. I love the small and powerful batteries. I love my computers. I really like the miniaturation going on. I love the world view that we can now enjoy. Space brought all this to us.

I can’t really put my arms around what will happened when we target Mars. I think I can dream of a few benefits of aiding other countries to plan and execute space programs. There could be some very big discoveries made when we invite more people to the think tank.

I had the privilege of attending one of the annual guest days at JPL a few years ago. That is a fascinating (and surprisingly small) facility. A year or so prior to the guest day, I was at a banquet where the featured quest was a Project Manager of the first Mars landing…I like the way they think. They are out of the box thinkers. Not what you might expect from a quasi governmental group. They certainly are creative and have to invent much of their technology or technological applications on the fly.

When I look around at the healthcare technology playground and think about how much heathcare and HIT can trace roots to the moon landing project, I am encouraged to think that we might consider continuing the space program so that some 40 and 50 years from now another group of people will be developing new and exciting health initiatives that we can not even conceive, let alone dream of.

Today marks the 40th anniversary of the moon walk. I can remember exactly where I was and what I was doing during the walk. I was at Farragut State Park in Idaho at the 69th National Boy Scout Jamboree. I “saw” the moon walk on a television that was about 12 inches small and projecting the worst, the grainiest, the most black and white picture I can ever remember seeing. Our phones give us better reception and pictures driving down the road than we could get back then.

Thankfully the broadcast was replayed on giant screens during one of our large gatherings in the ampitheater. If you can imagine witnessing that event with some 35,000 other people outdoors on a warm summer evening…it was pretty darn stunning. Of course it didn’t hurt any of us to know that Neil Armstrong is an Eagle Scout.

For most of us, today is just another Monday. It wouldn’t be so bad to just ponder what that moon landing has done for us and what well applied technologies can continue to do for all of us.

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Affordability and Availability Are Different Issues

Posted in Jim at 8:46 am by livefood

Not necessarily HIT, but I jumping out of my chair about this.

The big news earlier this week was the announcement yesterday of the House version of the healthcare reform bill. Of course it includes the infamous “government issue” of a national plan. The Congressional Budget Office unfortunately says that only some 11 or 12 million people will be covered by the plan. That’s only 25% of the estimated number of uninsured and only 5% of the population (or so..and in round figures). The GPO also estimates that the plan will be a whopping 10% less than similar private plans.

Take my premiums for example then apply that estimated 10% savings…is $495 a month affordable?

The average wage earner in the USA earns less than $30K. A young (early 30s) friend of mine told me yesterday that she thought that people should only spend about 5% of their salary in healthcare coverage. That would mean a premium of less than $125 per individual.

But my question continues to be, what is affordable? That same family of four with the single wage earner would be paying in excess of 10% of the wages by the time taxes and housing is taken from the wage. Where does affordability enter into the equation?

There is a huge difference between the concepts of availability and affordability. Most Americans have access to healthcare plans but can’t afford them. Making more healthcare available without the affordability component doesn’t solve many issues. Without defining “affordability” first and designing programs to fit that definition, the government is just offering more healthcare, something that is already there…and not addressing the costs.

I see this as being similar to the infamous “Bridge to Nowhere” in Alaska. Congress is compelled to make us feel good as they jump on the healthcare reform bandwagon. They want to build the program regardless of the destination. I really think they should define the destination in real American Dollars and for real American expectations.

The other question that Congress might like to ask, or perhaps they could have Jay Leno ask the question in one of his popular “Jay Walking” experiences is, “Hey Joe the Plumber (yes I know he was a temporary Republican icon, but he was the first name I coule think of), what would be a reasonable and affordable healthcare premium for you?” Don’t ask that question and you won’t have the answer which is critical to affordabiltiy of the program design.

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The $800K Bargain

Posted in Jim at 9:26 am by livefood

I picked this up on HIStalk. It’s a blog about what is happening in Healthcare across the nation. The owner/author is not fond of high priced “C Level” folks. It shows a bit in this piece.

“Hospitals in New York State have readmission rates that are much worse than average. The local hospital association (trade group) blames poverty, but didn’t offer an explanation of why Harlem Hospital Center excels and IT-loaded and $3 million CEO-led Montefiore Medical Center lagged.(I noticed while snooping around Montefiore’s federal records that even its chairman of dentistry makes $1.7 million a year, which seems absurd).”

Our local hospital is paying the new CEO about $800K. It’s a rather big controversy locally, but apparently the Hospital Director see the wage as a bargain in the current climate.

On a few blogs there was some banter about lowering healthcare costs by forcing pharma to bring product to market faster and for the Feds to allow it…and to develop procedures faster or let the Drs. perform more procedures that are currently deemed in the USA but performed in Europe and Asia.

These ideas might work IF the liablilty for the deaths and “other” issues could be taken care of. I would hate to be the firm that brought something new to the market quickly and then something went wrong and the law suit folks came to town (or went to town). Heck in today’s litigeous society, the drug or proceedure won’t even have to do any physical harm…frivilous is easy to get around…just the discomfort of how your friends and neighbors might look at you could create grounds to suit a pharma company or a unfortunate Doctor. Tort has to be addressed.

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22,000 In The Door but How Many Out?

Posted in Jim at 3:20 pm by livefood

I have been seeing a few more reminders that Walmart is going to add on something like 22, 000 new jobs during this next year. That’s really good news. I know, they might not pay the best in the World, but when you are wanting to work, any money is better than no money at the end of the week. I’m pretty sure that the work done on the floor of a normal Walmat wouldn’t appeal to someone graduating with an MBA, but like I said, any paycheck at the end fo the week is better than no paycheck at the end of the week.

I think we’ll see more of the 22,000 new job story as time moves along. Walmart is refocusing their IT departmental functions and moving the work to India. The contract for the out sourceing is millions of dollars in scope…probably offsetting the money gained through the 22,000 retail jobs. Walmart wouldn’t use the 22,000 new job claim to shelter them from the negative PR of sending the higher paying positons off shore would they?

The labor in India is 75% less per hour than the equivalent labor here in the USA. I can’t fault them for their business decision. I just hope they don’t hide from the decision and mask it with the 22,000 lower paying positions, although I think we can all agree that 22,000 new positions is a good thing and any job is better than no job (most of the time).

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Can Meaningful Use Be Certified?

Posted in Jim at 9:52 am by livefood

The drum continues the beat from HIMSS (through CCHIT) with the headline this morning,EHR Group to Feds: Keep CCHIT. The bit came out in HealthData Management. While CCHIT downplays the position of strength that the single certifying agency would have, there is little doubt that CCHIT would gain a bigger stick to play with in the field.

Once upon a time, in a galaxy far far away, URLs were doled out by only a very few and very protect groups, Network Solutions being one of them. In todays market there are dozens of players from which to choose to purchase and register a domain name. In part becase of the “deregulation” of the domain name market the pricing has gone down (in the sense of todays dollars vs that far away galaxy time). Even without a single domain registrar, new .”n” continue to be developed.

It is possible for a multiple certification system to work. If the web world, full of cowboys and cowgirls, can play in a sand box together within a mashup of registrars and hosting companies, I’m sure that EHRs can handle a multiple certification environment.

Single certification leading to a marketing tool wouldn’t exactly be a meaningful use, well, except for some.

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Careful, You Get What you Pay For

Posted in Jim at 11:02 am by livefood

Who will really be paying for healthcare if retailers are “forced” to pay a portion or all of the healthcare costs for employees? Consumers will…either those folks consuming from the business or not…consumers in general. If a retailer such as Walmart decides to raise their pricing to cover healthcare as a cost of business or takes a larger bite from the margins of their vendors…we all pay. The vendors who allow the discounts to Walmart pass their bite onto their other customers, who in turn pass the costs down the line until it hits you and I.

In a recent blog in the WSJ, blogger, Jacob Goldstein wrote an entry entitled, Should Employers Be Required to Help Fund Health Insurance?

In the blog, Goldstein, says, “When the biggest retailer in the country says employers should be required to contribute to their employees’ health-care costs, even as business groups are pushing hard against such an idea, there’s sure to be a fight.”

Maybe there will be a fight and maybe not. But story reminded me of a question we have been asking around here a lot lately. What is affordable healthcare? Has anyone defined affordable yet?

There is a direct relationship between coverage limits and cost of the insurances. It’s that way with the car, the home, and flood insurance. There are limits on insurance. Essentially you get what you pay for.

I’m not sure that I really want to have an insurance policy that limits my medical coverage to a bi-annual runny nose. I want a bit more meat on my insurance bones and know that it will cost me more. I walk a fine line between monthly premiums and co-pay amounts.

If you mash the old sayings, “Nothiny in life is guaranteed except death and taxes.” “There is no such thing as a free lunch” and “If it seems too good to be true, it probably is” you might find the baffling answer to what people are expecting from any sort of national healthcare program.

I’m really afraid that people in general are expecting more than can be delivered. There may be a gap between what the government has yet to define as affordable and what the public’s expectations of coverage are. I ge thte feeling from listening to clips that the government does not have a handle on what we might expect to recieve. I also get a distince feeling that many people are expecting to be taken care of at levels that exceed any reasonable expectation.

But first, a definition of affordable needs to be dealt with. To avoid a larger than life push back from the public, that definition should be made ooner than later.



Posted in Jim at 2:46 pm by livefood

Yesterday I received a resume that was perhaps 1/2 pages long. I didn’t print it out so I really don’t know how long it was on a piece of paper, but it was short. The applicant was not remotely qualified for any position we have worked on in perhaps a decade. So poorly matched in fact I would venture that the applicant really didn’t read the job description of the job to which she was applying.

But the complete lack of qualification was not the disturbing part of the story, it was the gross misspellings. Seven misspelled words in a 1/2 page of sparse printing. Some first impression the applicant will make when applying for a job she is qualified.

One should always check and then reheck spelling on resumes before they are sent. This advice comes from one of the World’s worse spellers. Spelling Bee champion I am not. If you read enough of my material you will see examples of my word butchering. Even through I don’t spell well, I do appreciate spelling and do not appreciate misspelling on resumes.

I have found that one of the common areas for misspelling on a resume is in the personal information such as the name, address, telephone and email of the applicant. Believe it of not, folks just don’t take a look at their own personal information, more than likely assuming that it’s correct with a quick glance.

Today, a resume came in using a work “dok” as a spelling for “doc,” the shorted version of “document.” My question then becomes, is “dok” a misspelled word of a lack of understanding of the language?

Perhaps not other issue, other than not being truthful, gives me pause to wonder about an applicant than misspelled words on the resume. I can over look a lack of qualification along with other points one can not control but, spelling can be controlled and checked. Applicants are in control of spelling on their documents.

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The Healtcare Reformation…still up in the air

Posted in Jim at 10:07 am by livefood

How should the Healthcare system be deconstructed and then reconstructed? Good question. But I don’t think our congressional folks know what to do.

There are so many competing interests it would be difficult, and for some impossible, to sort fact from fiction. The Wall Street Journal tried in their article: Separating Fact from Fiction on Health-Care Reform

Try as they might, even the WSJ falls a tad short in the article…but read the comments from readers and you can get a sense of what is being felt in the field…not the top of the corporate interests, but physicians and patients. Okay, som maybe a few of the comments are from the “C” level folks.

Some comments, “Why they won’t be able to compete is that they won’t have the negotiating leverage that the federal government has by virtue of that fact that the federal government doesn’t negotiate, they dictate.”…”Coverage does not equate to cost control. Cost control with the government plan will only be able to be achieved with some sort of rationing or queing system.”…”consider charging smokers and the obese insurance rates that are significantly higher (this is no different from charging the driver with DUI’s or speeding tickets more for auto insurance).”…”The government is taking advantage of the public’s rightful disgust at this situation in maybe nationalizing 1/7th of the economy. Isn’t there a simpler answer?”

The comments are across the board from the practical to the simply elegant, but listening to the American people is not something that congressional folks do all that well. They need to leave their offices and dress down a bit, eat at a McDonalds on just about any morning and listen to what the breakfast groups are groaning about.

It doesn’t help the congressional prespective to be participating in a healthcare plan that can be likened to the Cadillac of plans, something most people can’t consider as real.

The only things I know are that healthcare is important to everyone, even the healthy and that the healthcare industry is huge.

The rock I continue to stand on is that HIT can play a significant role in helping healthcare become better, both on the patient care side and the business side.

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This Is Not New

Posted in Jim at 2:01 pm by livefood

One of the newsfeeds I have pushed across my screen ran a story from Business Week in a section called Economic Unbound. The author, Michael Mandel had several charts and graphs on June 23 that show the employment picture, more specifically new job generation, for the past decade.

A Lost Decade for Jobs

The problem with the lack new job generation started prior to the last administration and is continuing today.

What is particularly scary to me is the number of government jobs created as opposed to the number of jobs created in the private sector. This phenom seems to be a model that we can easily carry forward. Continuing these paths can not be sustained as the tax burden to pay for the government jobs can not be supported by the decreasing growth rate in the private sector. At some point, and I’m quite sure some would argue that “some point” is now, the number of private sector jobs generating tax revenue will not be able to support the costs associated with the public sector jobs. Sort a “Economic 101″ type of deal.

So when you throw the lack of job generation of the past decade over the top of the more current job cuts (mostly in the private sector), the whole employment thing gets beyond scary into the downright frightening area.

The only shining beacon was that the heathcare sector on the charts has been good. We still believe that healthcare will remain a good job/employment proposition for the foreseeable future.

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Qualified to Make Tacos

Posted in Jim at 9:14 am by livefood

I was once in a position that I don’t want to be in again. I was unemployed and looking for work. Although I had been self employed previously and owned my own business…I did not have a lot of skills that were easily translated into a more-or-less normal job situation. I was looking for something new to do.

The agency I was working with had referred me to a fast-food-taco-establishment. It was an applicant paid position meaning if hired, I was going to pay for the referral. I had been told that the position was for a “manager trainee” so dressed appropriately and went for the interview.

Ha ha ha…some interview. We do interveiws during lunch now, but it is a whole lot different that that day in the taco joint. Sitting in one of the side booths (I chose one with the fewest smears of goo), I filled out the detailed application, handed the document and a copy of my resume over to one of the “associates” and waited…and waited…and waited some more.

When the young manager came out from behind the door to the back we said our hellos, he sat down and started to read the application. After a little bit of time, while continuing to look down at the paper, he mumbled that the positon he needed to be filled was to make tacos (and burritos, enchiladas and tosados even). He then informed me that I was over qualified. He looked up.

I looked him in the eyes and said to him, “How can I be overqualified, I have never made tacos before in my life.” I stood up and left.

What he really meant was that he didn’t think I would stay. He was probably correct. He might have meant that I would not be happy in the positon. He was probably correct about that also. He could have meant any one of a number of things, and he was probably correct about all of them.

He didn’t know it, but he was using a classic push back. I was hearing “over qualified” but really he saying I didn’t fit the qualifications to be successful in the long run. I’m pretty sure the 18ish looking young man didn’t know the wisdom of his words, but he might have understood the position a little better than I.

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