Health Homes, Information Exchange, and RHIOs...Oh My! (Part I)

The latest buzzterm in New York healthcare is "health homes".  You might not have heard of this yet, and although currently geared toward the Medicaid community exclusively, within five to ten years this will likely be the model for all healthcare plans - including Medicare (although, it is worth noting, these are in 'government years').  As someone involved on the periphery of this new way of confusing healthcare, I can tell you it promises to be quite the accomplishment...for what value governmental promises carry.

Before discussing the clusterfluff that has been the attempt to manage and implement this massive endeaver across FOUR gubernatorial administrations (in six years, no less!), in this posting I will describe the background that led to this attempt at a solution (and, no, 'obamacare' does not have anything to do with this).

The year is 2006; gasoline is under $3/gallon, the unemployment rate has dropped to under 5%, and the Dow Jones is steadily rising toward its highest point ever (October 9, 2007 - I know, during the Bush Administration...).  Also, in New York State, a Commission on Health Care Facilities in the 21st Century is about to release a report...the now infamous 'Berger Commission' report.

Now, you may say to yourself, "gasoline is cheap (at least in hindsight), unemployment is at 4%, the stock market is doing well - times are good, jobs are secure, and a grand time is to be had by all", right?  WRONG.  Despite the 'shock and awe' that was the financial collapse at the end of 2008, at least in New York State government, the writing was on the wall, and significant advance preparation was made.

The sum impact of the report (also nicknamed the 'closing commission') was to close over a dozen healthcare facilities across the state, merge several more in overlapping (and non...) areas, and reduce services in still many more yet.  Ultimately almost 10% was slashed out of the state healthcare budget (which also happened to be the largest healthcare budget of any state in the country) overnight.  To say this did not have an impact on the financial crisis less than 2 years later is shortsighted to say the least.

There were several reasons given for the urgency and necessity of this de facto legislation (it was never actually voted in; it was simply not voted out - a brilliant 'auto-pilot' built into the original legislation leaving essentially no politician holding the bag for the blame); increasing healthcare costs (which has been true every single year since the dawn of medicine, and will be true every year to come), an alarming shortage of nurses throughout the state (some studies at the time stated that within 10 years NY would have only 20% of the nursing staff required to meet projected capacity), but ultimately - "we need to do healthcare smarter" was the battle cry that carried the day.  The phoenix that would rise from the ashes of the Berger Commission also had a name, and that name, conveniently, was 'HEAL-NY'.

HEAL-NY was the promise of $15 billion, across ten years (don't worry, we're on track...), to 'fix' healthcare.  I think it's important to point out that nobody had defined the problem of healthcare, other than "it's too expensive"; so, naturally, throwing more money at something that's already too expensive...somehow equates to less money spent ('Obamanomics', for all intents and purposes, could be called 'Patakinomics', and countless politicians before them).

In the next Health Homes post, I will talk about all the 'brilliant' ideas they came up with to spend the $15 billion check our tax dollars paid for...stay tuned.

To Mobile App, Or Not To Mobile App...

...is a very good question.

With Apple becoming the world's most valuable company, orgs like Google (about as "e-brick" and "cloud-mortar" as they come) purchasing long established mega-corporate names such as Motorola, and Facebook debuting as the new hundred billion dollar IPO, it is safe to say the dot-com bust of a decade ago has come full circle.  These prime examples, and many more, owe their corporate renaissance to one word: mobile.

Perhaps the most amazing thing about this, is not just that the success of these companies hinges on the success of mobile computing, but that mobile computing itself has yet to find its lynchpin of success, and is ultimately an extremely large gamble (with little supporting evidence to date, beyond "...but, oh, it will!" ).

That being said, we're well beyond the dawn of mobile technology (iPad 3, Droid 4.x, and even Microsoft has brought its behemoth resources into the mix with Windows 8) and, baring some major catastrophe that would make "all the bluetooths disappear from the atmosphere", mobile computing is here to stay; so we might as well take advantage of it.  But...should you?

There are some very important, basic questions to ask yourself before making the untethered plunge.

Is there an element specific to mobile computing that actually benefits you?  Now, I know how you feel; I feel it too.  You see the teaser ads, and count down the days to launch.  All the time secretly saying to yourself, "...this device!  This device will be the one that changes my life; no more laundry, double the salary, and trips to the fridge for caffeinated beverages will finally be meaningful!"  Although I have felt this way every single time, with every single new device launch; it is rooted in nothing.  The universal truth to new technology always seems to be: the more 'mythic' the hype; the more 'myth' the result.

Some natural aspects of mobile computing, though, actually do genuinely benefit and improve some (not all) technotility.  The ability to capture electronic signature without any additional peripherals, for example, is huge for transportation, merchant, service, and other industries.  GPS and location services help not only businesses, but also individual travelers practically anywhere on the planet (usually at no added cost!).  Having a camera in the palm of your hand that is connected to every other user and device on the Internet at any given moment has revolutionized the way humans connect and interact in unprecedented ways.  These are changes so significant, that they are no longer considered "hip" or "trendy"; they are the way we all live, from Manhattan to Mumbai, rich to poor, young to old.

Does what you're trying to accomplish require little data input?  Granted - half the phones out there today have a 'keyboard'; try writing a paper on it.  Better yet, try writing an e-mail on a 'virtual keyboard'.  "Yoda well send lake these" (You will sound like this) in no time flat.  There has been no shortage of ingenuity to attempt to overcome this major drawback, and even Apple recognizes it as such an "Achilles' Heel" that they have invested their money in dictation software - ignoring the problem altogether!  This is something that is not likely to change any time soon.

Many enterprising individuals have taken this into consideration; designing apps with mostly 'dropdown lists', 'selectable options', and other attempts at being intuitive as to what you are ultimately trying to accomplish (and both removing/limiting the effort involved).  And these attempts work great, but they tend to have very limited use and scope.

Is what you're trying to accomplish 'linear'? As annoying as scrolling, and scrolling, and scrolling some more can be - it's actually something mobile devices do extremely well!  It would be annoying to have to side-scroll all the time to view a Web site, but to swipe a finger every minute or so to advance to the next section takes no effort at all; and probably does less ergonomic damage than leaving your wrist pinching your nerves left and right on your mouse.

The downside of this is that not everything works well in a linear fashion.  E-mail, text, forms and pages tend to work well scrolling ad infinitum; spreadsheets do not.  Spreadsheets are very important tools (just ask someone who uses them... ), and tends to be where the phrase "bigger is better" finds a comfortable home.

There are more considerations to take into account as well, and certainly more will be forthcoming as time goes on.  The more "yes's" you can rack up, the better the decision to 'mobilize' will be.  As for me, I still tend to find comfort in the 'hybrid' solutions, such as:

Dell XPS 12" Windows 8 Ultrabook

Houston...We Have A Problem

Having worked with several organizations throughout the years, I have borne witness to many different styles of management operations; one universal trait (albeit to varying degrees) seems to be the habit of jumping to conclusions without making decisions.

It is no secret that change management is incremental at best, and altogether impossible at worst.  This is not because of lack of wanting change; it is not even because the change that is wanted usually is different between the various interested parties (although, that is almost always a certainty) - the simple fact is that, all too often, organizations 'choose' the change they think they want, without actually 'deciding' what change they actually need.  There are many reasons for this.

Implementing the right solution on the wrong problem.  One of the easiest things to do in your daily worklife is to identify your 'pains'.  And if you don't feel that you can, simply poll two or three neighbors, and they'll quickly find dozens of your pains (you may even have the good fortune of getting this feedback completely unsolicited... ).  Despite how easy identifying those problems often proves to be, it truly is no simple task to come up with solutions.

The crucial question disastrously left unasked, is what is the actual nature of the problem; is it a process problem, or is it an operations problem?  This is an extremely important distinction to make.  If an issue is a process problem, your solution should be limited to the confines of that particular process area, and leave the rest of your respective operations unaffected.  If an issue genuinely is caused by or affecting the entire operation, it warrants a much larger response - one that ultimately redefines the entire way you operate.  Unfortunately, many times, organizations tend to respond to process issues as operations problems, and operations issues as process problems.  Which ultimately leads to either not resolving the issue (due to limited scope), or creating altogether new issues (due to lack of foresight).

Trying to solve your old problem with a new solution.  Even for organizations that do categorize their issues well, many times can fall victim to overzealotry.  A really easy indicator that you might be in this situation is an overabundance of "buzzwords" used in defining your solution.  As an example; "Our 2.0 paradigm must leverage the virtuosity of the cloud, leave a green footprint, and maximize interdepartmental synergy on a cross-functional platform".  Don't worry if you don't understand that statement - it doesn't mean anything (and if it sounds familiar...turn, run, and don't look back).

Where this overzealotry goes awry is finding a solution, that may in fact meet your respective need, but ultimately either doesn't fit your organization, or would present an entirely new host of issues if implemented.  This could be as ridiculous as reducing transportation costs by purchasing cheaper ocean tankers to transport oil from Omaha to Pittsburgh, or as ludicrous as building a time machine to preprocess billing claims to improve cashflow.  As crazy as either of those scenarios sound, they're both less crazy than making radical, sweeping changes beyond addressing simple, pre-existing problems.

Although there are certainly many more problem scenarios, the key to avoiding all of these is fairly standard; the answer to a respective problem lies within the confines of that respective problem.  Assemble the involved stake holders (and only those stakeholders), map the problem across the appropriate process(es) and/or operation(s), and decide on the right solution for the issue(s) at hand.

And, most importantly, don't forget - leave it at that (other problems can wait for other solutions).