Thursday, April 27, 2006

The MedBiq Song

The MedBiq Song

Last night, I briefly performed at the 2006 Annual Conference of the MedBiquitous Consortium in Baltimore, MD. MedBiq is a standards development organization whose mission is to create a technology blueprint for professional healthcare education. I been serving on their Executive Committee for a few years, so when they found out that I had written a song for NCPDP's annual conference last year called "The Legend of Bob the DERF", they felt a little neglected. So I promised them a song too. (HL7 made the same request for their meeting coming up in September. At this rate, I figure I'll be able to put out a new CD - "Dr. Martin Does the Standards" - in a year or two.)

Here's the way I introduced the song and the lyrics. You can find a copy of the MP3 here.

Ladies and Gentlemen, it is indeed an honor and a privilege to stand before you today and offer up this little ditty – a trifle, really. I recall with delight the day our own Dr. Peter Greene requested that I pen a musical work worthy of the institution that bears the name MedBiquitous.

MedBiquitous! Why, one requires a graduate degree to simply utter the word! No doubt, a banal pop song or a hippie folk tune or – God forbid! – a Country Western ballad would never suffice. For MedBiquitous was not slapped together by coin-counting merchants in the back alley of commerce – or hacked by pocket protector donning computer geeks locked deep in the fluorescently lit bowels of some faceless monolith – no! MedBiquitous was conceived in the hallowed halls of academia – even more, within the dome of Johns Hopkins University itself.

Clearly, there is but one musical genre sophisticated – yet playful – enough to satisfy the need of an institution of such noble birth and regal bearing – the operetta!

So I do hope that Masters Gilbert and Sullivan are shining down on us now as we present to you the world premier of “The MedBiq Song”. Maestro, if you please…

The MedBiq Song
(To the tune of “I am the Very Model of a Modern Major General” by Gilbert and Sullivan)

If you want quality in CME activities to demonstrate
Or virtual reality for surgery to simulate
Or methods for ensuring that your Med Ed content's shareable
You'll find that there are many ways to do this that are terrible

If you need messages for transferring credentials proving licensure
Or means for tracking competence in ways you've never done before
Before you write me off and say this guy is just a dumb buffoon
Keep listening – I promise that you'll have your answer very soon

If you are posting all your healthcare publications on the Internet
But find that, when you search for them on Google, crap is all you get
Don't give up hope or sing the blues
Don't hang yourself or make a fuss
You'll be a hero if you use
Our standards from MedBiquitous

Yes, we have SCORM and LOM and XML and RSS as well as MEMS
And several more ridiculously complicated acronyms
That seem to have the solitary purpose of confusing you
Or making me seem smarter than the people I am singing to

But what we really seek are fundamental changes in the quality
Of everything related to all Med Ed methodology
We do this out of altruistic duty to posterity
(Though making loads of money in the process would be fine with me)

So if I've managed to persuade you or have piqued your curiosity
Please take to time to analyze MedBiquitous more carefully
And hurry down to Baltimore
Where all this stuff is happening
Whatever Med Ed has in store
You'll find our standards just the thing

Our task is great – we cannot do
This work alone, so join with us
Or kindy make a check out to
The order of MedBiquitous

© 2006 Ross D. Martin, MD, MHA
15 January 2006

Monday, April 24, 2006

The Earth is the Sky

The Earth is the Sky
(a song for Earth Day 2006)

The Earth is the Sky
The Earth is the Sky
Gaze into her deeply - she tells you no lie
The Earth is the Sky
The Earth is the Sky

The Earth is the Sea
The Earth is the Sea
All life flows out and returns faithfully
The Earth is the Sea
The Earth is the Sea

The Earth is the Sun
The Earth is the Sun
Her core warms us all and her warmth makes us one
The Earth is the Sun

The Earth is the Earth
The Earth is the Earth
Sun Sea and Sky can't replace all her worth
The Earth is the Earth

The Earth is the Earth is the Earth is the Earth is the Earth IS

(c)2006 Ross D. Martin, MD, MHA
Earth Day 2006

Thursday, April 20, 2006

Thunderous News from the ONC - Brailer Resigns

Thunderous News from the ONC - Brailer Resigns

It's not like the president was assasinated or anything, but the news that just popped into my inbox hit me pretty hard. Dr. David Brailer, the first National Coordinator for Health Information Technology, announced today that he was stepping down. The news was first reported (as far as I can tell) by the Financial Times of London - British spelling of programme and co-ordinate and all.

The Office of the National Coordinator for Health Information Technology (the ONC now, formerly ONCHIT with all the regrettable pronunciation varieties) has been underfunded and understaffed since its inception through executive order two years ago. But even in its anemic state, it proved a galvanizing force - a precise point of focus - for many of us around the country who shared Dr. Brailer's vision for an interoperable healtcare system that actually works because relevant information flows where and when it is needed.

That vision hasn't died today, but we shouldn't kid ourselves that this won't be a setback for those of us who want to make the dream a reality for the benefit of all. The lack of an articulate, politically savvy and truly brilliant shepherd of the Strategic Framework for HIT - even for just a short time - will mean that the tenuous alliances and strange bedfellowships that became a hallmark of the activities surrounding the ONC will be strained and many may break. Those who doubted or hesitated to commit will be even more wary in the next round. As hard as it has been to solve the unsolvable, it will be harder still.

There is no single person who has the power to transform healthcare. It takes more than a village. It takes all of us playing a part in a national - even global - symphony orchestra. But it sure will be hard to do it without David Brailer holding the conductor's baton.

Sunday, February 26, 2006

You Are What You Measure - Part II

You Are What You Measure - Part II

Google provided just 540 links to the phrase, but some of the highest ranking hits provided some good fodder. Leave it to the folks from MIT to provide a thoughtful treatise on the issue from 1998. Looking for something a little less heady? The Artful Manager penned a shorter article in 2003. So while I can't claim to be a Coin Dropper (see 10/9/2003 blog), at least I've got good company from similar thinkers.

You Are What You Measure

Your Are What You Measure

I keep trying to distill some common truths about the work many of us are doing on transforming healthcare through information technology. A lot of the drivers for employing HIT come down to this: You are what You Measure. If you've read Freakonomics, you know that introducing measurements into a system can significantly affect that system and you tend to get changes that optimize those measures, but those measures may not necessarily get you what you want.

Measure test scores for kids a la No Child Left Behind and you get improved test scores, but not necessarily kids who are more prepared for success in life. You can also get more teacher cheating to ensure that the test scores are better - sometimes to the detriment of the kids themselves.

We're experiencing the same thing in healthcare. Right now, we get high-cost, inefficient, and only partly effective healthcare because we measure (and pay for) activities over outcomes and outcomes over process improvement. We should be targeting measures that ensure we are constantly working toward process improvement. That's the goal! More later.

Thursday, February 16, 2006

Fog Kills

I've been thinking about the ultimate summary of everything I believe about what's wrong with healthcare and how to make it right. The answer?

Fog Kills

Did you just say "Ah" or "Huh"? Let me explain. Newt Gingrich is fond of pointing out that "Paper Kills." He's not wrong. He just doesn't tell the entire story. Paper (in other words, the lack of electronic health records) is just a part of the problem. The root problem is the fog of information. EHRs and even my personal mantra of "all electrons all the time" is part of the solution. But even if every bit of information in healthcare were managed electronically, it could simply lead to killing people much faster if not used properly.

The most electronically enabled part of healthcare is the means by which we pay for pharmacy claims (largely through pharmacy benefit managers). But PBMs benefit from the black box of the information they house within their walls and their contracts with both healthcare payers and pharmaceutical companies. While PBMs can, in theory, lead to lower costs and higher quality (a theory I would largely challenge in terms of their net effect), the part of their business model that is predicated upon the lack of transparency has the unintended consequence of hindering our collective ability to provide optimal care to patients.

PBMs aren't the only ones to blame here. Every sector of healthcare has contributed to the creation of information silos that lead to poor outcomes. Pharma companies have long benefited from the fog of information as they (for the moment anyway) have the upper hand on the gold standard, placebo-controlled, randomized trial data for their products and can outgun other attempts to counter their arguments. This point of leverage is quickly eroding as "evidence-based medicine" takes hold and payers' influence over prescribers increases. Doctors too. The misalignment of their incentives (they make more money when they practice bad medicine because they get paid for doing tasks and not for outcomes) is a major contributor to their active and passive resistance to pay for performance schemas.

The only solution is a systems-wide acknowledgement ("Hello. My name is John and I am a Fogaholic.") and a concerted, systemic transformation of healthcare. No single sector can afford to fall on the sword of transparency without all sectors committing to the same goal.

When omni-directional information flow in the healthcare marketplace (i.e., total transparency) is achieved, all sectors of healthcare will begin aligning with optimal health outcomes because any other behavior will become readily discoverable and will be ferreted out. Money will be made - but business drivers will wholly transform.

I'm out of time, so I can't elaborate further. Bottom line: Fog kills. So let's kill fog before it kills us all.