Wednesday, December 23, 2009

Just finished a long comment on a health care discussion in LinkedIn: click here while you can.
That link won't last so I wanted to document my portion of the discussion which I think makes sense without the rest of the discussion. I've included a blockquote on the one section that I think you need to see to l make sense. Healthcare is something that we all need to work on since our government appears to be dropping the ball.

1) With regard to Electronic Health Records, I think that the lack of standards within the medical community is the biggest obstacle to its adoption. With the exception of my childrens' pediatricians, every doctor I visit is still recording health information on paper because the data entry aspect is not worthwhile to them. It's quick and easy to write out a variety of types of information on paper. Computer entry would result in too much time spent in order to pick the "right" box.

The Pediatricians on the other hand have measurable data points that they want to show to the parents and can easily using the software. Prescriptions are also easily entered and attached to the files so they can keep track of how much medicine is being assigned (not given, that's up to the parent) to the child. And this information leads to a perception of quality in the mommy networks that feed the pediatricians new patients.

Unfortunately until there is another way to measure health care beyond individual services, this will not change. Docs get paid for the service, not the data they record. And insurance companies will not pay for recording information, except as parts of pilot programs or where a Hospital is the insurer and they need the information for their own records.

I worked for an insurance company that was working on risk adjusted payment systems based on episodes of care. In the next generation of the software, we would have worked toward including additional information (such as lab results) to insure that the doctors were working within best practices, but the company decided to shut down the program because they could not figure out how to explain it to their core type of customer.

What healthcare needs is a total makeover. It should be turned into a system. That would certainly be nice. But itís not going to happen. Letís face it. There are too many political and social obstacles to deploy centralized planning throughout the entire healthcare industry.

So hereís a fallback position: Simply offer a parallel approach to what we have now. That would be a ďpublic optionĒ for healthcare delivery. It would be available to anyone who wants it. Unlike the existing approach to healthcare, users of The Public Healthcare System would not be able to visit care providers whenever they want. They would have to go through a triage process, entering their symptoms and other relevant information over the Internet or at a kiosk. And, of course, everything would be documented in an electronic health record.

These data would be evaluated by trained humans and/or intelligent software, to decide the most cost-effective course of action for each patient. Perhaps self-care is indicated and would therefore be guided. Or maybe some lab tests should be administered before the patient wastes a doctor visit just to get those tests requisitioned. Sometimes a nurse practitioner would be best positioned to handle the episode. Or the problem is beyond the scope of any primary care provider; so the patient should go directly to the appropriate specialist.

2) With regard to Health care, the "public option" parallel described by Joe W. is exactly the type of system that seems reasonable, but the political wings of the government would swoop down as "evil, socialized medicine". Removal of human elements, leads to a "harsher face" of health care that the majority of Americans would feel is substandard.

Professional services tend to be the last place for technology to penetrate. Even though we might use a kiosk to order our deli meats; the idea of giving basic health information to a machine before we could see a doctor or nurse would be a deal breaker.

I agree that triage is needed where health resources are limited, but the limiting nature of using triage when there is no perception of limited resources is not politically feasible.

"Unlike the existing approach to healthcare, users of The Public Healthcare System would not be able to visit care providers whenever they want." This would be the single largest sticking point. This is what HMOs tried to do. They failed. Miserably. People in the US feel that it is their right, to go to whoever they want and this is the core issue in the healthcare debate. Large insurance companies continuously make the statement that free choice of providers leads to higher premiums. This is simple and unfortunately true. Providers charge whatever the market will bear and when someone is sick they will pay just about anything to get better. The only market that was more predatory in my opinion was the funeral business. At least with regard the funerals, you actually can shop around before you need the services, even though most do not.

Standards of care and collection of data need to happen. We all agree on that. We just can't agree on what they should be. Yet.

Thursday, November 12, 2009

Managing Multiple GMail Accounts

See this guy gets it. If you have multiple accounts, you want an easy way to manage them. But MailPlane just costs too much for what little it does. And it would break functionality that typically works otherwise.


Personally I think that it's Prism for Firefox FTW.

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Customer Service Rant

There is an article over at the marketplace site about customer service and whether the customer is always right even in these times when we seem to be looking for the lowest price. There is a comment that it depends on the price. The higher the price the better we expect customer service. I don't disagree, but don't fully agree with that idea.

I think that we have all started to expect the bad customer service so that when we find we need it we wonít be disappointed.

On top of that so much of what we buy has become commoditized to the point that we didnít care where the product came from or where it was purchased.

The rare ďnewĒ thing is what now commands the premium and only for a short period of time unless you are willing to pay extra for the customer servicce (see Appleís AppleCare as a prime example)

When the majority of folks think they are doing well again we may begin to uncommoditize more of our purchases and expect better service that we are willing to vote for with our dollars.

In the mean time we need to look for the niche companies that still care but donít have too much of a premium on their productís cost and hope they (and we) survive.

Portions of the above were left as a comment on the marketplace page listed above. Don't like it. Get your own blog!

Wednesday, September 02, 2009

RSS and me
Started trying to get my Internet addiction under control through the use of some judicious tools. Primary was the idea that I should be using RSS more to surf more efficiently.

For those who know what RSS is skip this paragraph. Well you donít really have to, but you can. Iím going to go with the analogy of TV Guide for RSS. See in the old days you used to be able to buy this tiny little digest (on slightly better than average newsprint) that had a list of all the TV shows in your area.This was before the days of 500 channels of cable/satellite/Internet downloads with nothing on. RSS is similar in that it is supposed to be a small text file that tells you about the latest stories on the site. The best thing about the format is that it can contain anything -- a short summary of the story, the headline, or the whole story itself. That is up to the web site operator. That is the beauty of RSS. In most cases right now you can use RSS to find out whatís happening on your favorite site right now, without actually going to the site. Why do that? Loading the full web page takes a lot of resources on both sides of the equation and RSS cuts down on the number of resources used. Especially for Blogs that have a lot of content published over a day. The RSS file helps keep resources needed lower.

I have tried to use a couple of different RSS readers in the past but never got to a place that made it feel more useful than just opening a bunch of webpages in a browser.

Iíve tried the Firefox Smart Bookmarks which you can access quickly via the bookmark menu and still have the BBC Headlines loaded on my bar, but it only ever contains the headline, not anything about the story. This is not useful in my opinion. Iíve also tried using Sage, but never felt that using the sidebar was an effective way of looking at what I wanted to see.

Next Time: Times, Google Reader and Evenbox

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Tuesday, September 01, 2009

Spent a little while reading about the impending doom. No not hurricane season, the purchase of Marvel Comics by Disney. The thing that freaked me out (besides the wolva-mickeys; I do like the spida-mickeys though was the idea that the heroes who were traditionally based in the real world and all of itís problems were now part of the happy, happy joy joy world.

The things that most people missed was that Disney is actually a fairly progressive company in many areas. They embrace all cultures, all people, all money. Diversity is great as long as youíre smiling while you accept the questís Visa (official card of Disney Resorts) for their purchases.

The merger will be a good thing for both companies. Marvel gets a company that can leverage the heroes in an organized way. Disney gets a boy-oriented set of characters that they can now merch as well as the Princess and the Fairies. They both get to cash in on the new wave of Comic Action movies that bring in the cash even if they arenít the best, but have enough fanboy service to keep the core talking them up.

Personally I canít wait for when the contracts are up with Universal. I think the imagineers and Marvel will have a great time in the Savage Land portion of Animal Kingdom, or the Marvel Pavillion in EPCOT and Adventure Land will never be the same.

Thursday, February 26, 2009

A Year of Thanks

I've been reading a bunch of essays and books with my down time and the one that has been sticking with me the most comes from Tom Peter's websute ( If you don't recognize the name, he's the guy who co-wrote "In Search of Excellence" and more. One of his essays says that a good thank you is "the rarest of gifts". This has stuck with me more than I thought possible. So consider this the beginning of Dave's year of Thank You's


Friday, May 11, 2007

I work for a company that believes in the concept of price transparency for health care. The question I have is whether we should look for greater transparency throughout everything we do and how that could change how we interact with different people.

Transparency in a gaming environment could lead to a spectacular death on a PS3, XBox or even a Wii.

Transparency at work is something that I wonder if we would be interested in really doing.


Wednesday, May 09, 2007

This is yet another attempt to jump start my blog. Maybe even figure a way to may a few pennies to let me get the toys that would be fun to play with if I didn't have a job to keep me busy.

I've got a few topics that I plan to start writing on, but if anyone is actually reading this, put a comment on this post to let me know.

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