The Edge

Most children look forward to the school days when they really never enter the classroom at all: field trips. Of course, field trips were always explained to parents on permission slips as “educational experiences,” but try telling that to an eight year old.

Field trips have the same effect as an adult; I spent Thursday’s work day at a medical interoperability conference. Sounds vague and uninteresting? Let’s try an example.

Your child is very sick. So sick they have to go to the hospital. You go to visit them in the hospital and the room is overflowing with medical devices, most of which are hooked up to your child, some of which are powering each other. Through the long wires, connected to the cold, boxy structures, which beep every half minute, you see your child, lying in their hospital bed, asleep. All you want is to hug them but you can’t. Will you accidentally bump one of these monitors and inadvertently hurt your child?

Medical interoperability: making devices talk to each other. What if you had one device that could monitor 20 things, because it could send signals remotely? What if because of this you could hug your child?

You can’t though because what this conference was about was why medical interoperability isn’t a reality. It doesn’t exist. Machines don’t talk to each other and state of the art technology is the term used by hospital executives to describe devices that can send results to a printer. How did medicine become the least innovative sector of our economy?

There’s no business interest in making them talk. It’s like when Apple and Microsoft created their computers, with separate operating systems, that didn’t talk to each other. They don’t want to talk to each other because then you won’t buy more of their products. They want you to be reliant on them. It’s the same thing with medical devices, including electronic health records, which are quickly becoming the future of medicine because of payment reforms. Essentially–the government promotes the use of electronic systems because that’s how the government gets its performance measurement data so that they can pay the doctors and hospitals for giving quality care. Bye, bye fee-for-service, hello value-based payments.

Only there isn’t quality care associated with these systems, most doctors, hospitals and patients say, because they’re too worried about trying to make these systems work. It’s time consuming and expensive. Doctors should be focused on the patient, not on a screen.

Enter Malcolm Gladwell, highlight of the field trip. What is Malcolm Gladwell going to tell us about medical interoperability, you ask? Well he’s got three stories, actually, the most important one, I think, being the story about the edge.

If you’re not at the edge, the breaking point, the do-or-die moment… then you’re not going to act.

When do we get to the breaking point?

It’s not a question that the conference answered. Maybe that’s because we don’t know. We don’t know what it takes to spur change. And we can say that about a lot of problems the United States is facing. We think we’re at the point of urgency, when something must get done but we don’t do it. Gladwell suggested it’s a framing issue. But we had 20 children die in Sandy Hook Elementary and we didn’t do anything about guns or mental health. Framing issue?

It might take awhile, but electronic health records will be easy to use, someday. Luckily for those, it’s a technological development that is just going to have to happen. So in some ways, it’s nice to know that what seems annoying now will improve over time, because there’s a consumer demand for it, albeit not a strong one. On the other hand, not every issue is so easily remedied. It seems so frustrating that we are able to identify problems and not agree on solutions. But it’s worth wondering if what Gladwell spoke of–being on the edge–is exactly where America is now. This divisiveness in our country is unsustainable. Even Glenn Beck apologized for contributing to it. And you have to wonder what it will take–who it will take–to get us to the other side.

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