Health Care Reform is Technologically Deficient

The debate on the news, in the streets, and on the Hill these days is health care reform—getting insurance coverage for those who lack it. And while this is an important and noble pursuit, there is something extraordinary absent from the health care reform discussion—and that is technology—in terms of how we get better care to everyone, the uninsured and insured alike?

We are living with a health care system that is functioning devoid of the most basic technology aids—such as electronic medical records, electronic scheduling, e-appointments with doctors using IM or video, electronic prescription handling, and much more.

If the finance industry is at the advanced end of the technology spectrum, the medical industry is at the extreme low end—and how sad a commentary is that: is our money more important to us than our health?

An article in Fast Company in May 2009 called “The Doctor of the Future” states: “This is a $2.4 trillion industry run on handwritten notes. We’re using 3,000 year-old tools to deliver health care in the richest country on the planet.”

The health care system is broken for sure, but it goes way beyond the 45 million American’s that lack insurance.

• “Health care accounts for $1 in every $6 spent in the United States.”
• “Costs are climbing at twice the rate of inflation.”
• “Every year, an estimated 1.5 million families lose their homes because of medical bills.”
• “Although we have the word’s most expensive health-care system, 24 counties have a longer life expectancy and 34 have a lower infant-mortality rate.”

Based on these numbers, the medical industry in this country is overcharging and under-delivering, and part of the reason for this–as Fast Company states is the lack of technological innovation: “one of the paradoxes of modern medicine is that it demands continual innovation yet often resists change.”

New medical technology programs are available that provide for a vastly improved patient experience.

For example, using the Myca platform the user-experience is simpler, faster, and cheaper. Here’s a view of how it would work: “your profile shows your medical team…to make an appointment, you look at the doctors schedule, select a time slot or at least half an hour and the type of appointment (in-person, video, IM), and fill out a text box describing your ailment so the doctor can start thinking about treatment. Typically follow ups are e-visits. A timeline doted with icons representing appointments lets you review the doctors comments, read the IM thread, watch the video of an earlier electronic house call or link t test results.”

Using other technological advances, we could also benefit the patient by being able to:

• Send electronic prescriptions to the pharmacy and automatically check for drug interaction.
• Enter a patient’s symptoms and test results and get a comprehensive software generated diagnosis along with the probability of each result as well as other pertinent tests for the doctor to consider.
• Provide electronic medical records that can be shared securely with medical providers including medical history, exam notes, tests ordered and results, and drugs prescribed.
• Utilize telemedicine for consultation with medical providers anywhere and anytime.
• And even apply robots to surgical procedures that result in less invasive, more effective, quicker recovery rates, and with less chance of infection.

None of this is science fiction…and this is all possible today.

Therefore, if we are going to call for a revamp to our health care system, let’s go beyond the coverage issue and address the logjam on quality of care for all Americans.

Absolutely we need to address the 18% uninsured in this country, but while we do that and figure out how to pay for it, let’s also deal with providing 21st century care to all our citizens through the modernization of our medical industry benefitting both the patients and medical providers through more efficient and effective care-giving.

Health Care Reform is Technologically Deficient

“Soft Hands” Leadership

Conventional wisdom has it that there are two primary types of leaders: one is focused on the work (task-oriented) and the other is focused on the relationships (people-oriented). Of course, the exceptional leader can find the right balance between the two. Usually though it is the people skills that are short-changed in lieu of getting the job done.

Personally, I am a firm believer in the military doctrine of “Mission first, people always!”—Although, I am certain that some leaders even in the military are better at exemplifying this than others.

With the global financial downturn, there is an interesting article in Harvard Business Review titled “The Right Way to Close an Operation,” May 2009 that sheds some light on this leadership topic.

In this article, Kenneth Freeman advocates for a “soft hands” approach when closing or shrinking an operation. This approach calls for leadership to “treat employees with dignity, fairness, and respect—the way you would want to be treated.”

Wow!!! This is great--A human-centric approach to leadership.

Unfortunately some unconsciously believe that being tough on mission means being tough on people too. However, there is no need to "flick the whip." There is another way. We can embrace people as human beings, work with them, have compassion on them, treat them well, and lead them towards mission delivery.

It doesn’t have to be supervisors versus employees--different sides of the bargaining table. It can be in most instances people striving together for organizational success.

For me, this ties right in to my vision for enterprise architecture to have a human capital perspective. Human capital is critical to mission delivery. We must not focus exclusively on process and technology and forget the critical people aspect of organizational performance. A stool with only two legs (process and technology) without the third (people) will assuredly fall.

Freeman states that even when doing difficult things like downsizing we can still treat people humanly, the way we would want to be treated. He says: “reducing a workforce is painful, but you can do it in such a way that people will someday say, ‘you know I once worked for Company X. I didn’t like the fact that they shut my plant down, but I still think it’s a good company.’”

Here’s some tips from Freeman as I understand them:

- Address the personal issues for the employees—why they are losing their jobs, how the closure will affect them, what you will do to help them land on their feet…

- Communicate early and often—“People need to hear a message at least six times to internalize it.”

- Get out there—“Be visible and personal. A closure or a downsizing is not an excuse for leaders to go into hiding.”

-Take responsibility—“The leader should take personal responsibility for the organization’s behavior.”

- Be honest, but kind—“Explain that the decision is being made for the sake of the overall business not because the people who are leaving have done a bad job.”

- Treat everyone fairly—“who stays and who goes should be decided on an objective basis.”

- Help people go on—“help people find jobs.”

- Maintain a quality focus—“leaders should regularly remind everyone of the importance of quality and keep measuring and celebrating it.”

Freeman goes on with other sensible advice on how to not only treat employees well, but also customers and suppliers “like valued partners.” He has a refreshing perspective on delivering results, while maintaining human dignity.

Here's the critical point:

Having a “soft hands” approach to people doesn’t mean that you are soft on mission. That can never happen. But it does mean, we remember that delivery of mission is through our professional relationships with people—employees, customers, suppliers, partners, shareholders and more.

Treating people with dignity, respect, and fairness will positively generate mission delivery for the organization.

“Soft Hands” Leadership

Information Management and Enterprise Architecture

Information management is the key to any enterprise architecture.

Information is the nexus between the business and technical components of the EA:

• On one hand, we have the performance requirements and the business processes to achieve those.
  
• On the other hand, we have systems and technologies.
• In between is the information.

Information is required by the business to perform its functions and activities and it is served up by the systems and technologies that capture, process, transmit, store, and retrieve it for use by the business. (The information perspective is sandwiched in between the business and the services/technology perspectives.)

Recently, I synthesized a best practice for information management. This involves key values, goals for these, and underlying objectives. The values and objectives include the following:

1. Sharing –making information visible, understandable, and accessible.
2. Quality—information needs to be valid, consistent, and comprehensive.
3. Efficiency—information should be requirement-based (mission-driven), non-duplicative, timely, and delivered in a financially sound way.
4. Security—information must be assured in terms of confidentiality, integrity, and availability.
5. Compliance—information has to comply with requirements for privacy, Freedom of Information Act (FOIA), and records management.

The importance of information management to enterprise architecture was recently addressed in DM Review Magazine, May 2008. The magazine reports that in developing an architecture, you need to focus on the information requirements and managing these first and foremost!

“You need to first understand and agree on the information architecture that your business needs. Then determine the data you need, the condition of that data and what you need to do to cleanse, conform, and transform that data into business transformation.”

Only after you fully understand your information requirements, do you move on to develop technology solutions.

“Next, determine what technologies (not products) are required by the information and data architectures. Finally, almost as an afterthought, evaluate and select products.” [I don’t agree with the distinction between technologies and products, but I do agree that you first need your information requirements.]

Remember, business drives technology—and this is done through information requirements—rather than doing technology for technology’s sake.

“Let me also suggest …Do not chase the latest and greatest if your incumbent products can get the job done.”

In enterprise architecture, the customer/end-user is king and the information requirements are their edicts.

Information Management and Enterprise Architecture

Don’t Get Put Out To Pasture and Enterprise Architecture

When an organization and its people don’t meet the needs of their users, they are sidelined; users will get their needs met elsewhere. It’s the nature of competition and the free market. And as enterprise architects, we need to make sure that our organizations are always meeting our users’ needs. The target architecture must reflect changing consumer tastes, needs, desires, and requirements.

The Wall Street Journal, 29-30 March 2008, reports that in India, milkmen, who used to be respected and productive civil services, have been put “out to pasture.”

In Mumbai, 300 milk delivery drivers show up for work each day, only to sit idle for their eight hour shifts—they read, nap, or play cards or sudoku. “The state government lost its monopoly on milk and consumer tastes changed. But because Indian work rules strictly protect government workers from layoffs,” the workers remain in a perpetual state of limbo.

In 2001, “private careers with higher quality milk swiftly won customers [away from the government dairy] by delivering milk to doorsteps [instead of to curbside milk stalls like the government milkmen did].”

Once the customer got the taste of the better milk and more convenient delivery, they “swiftly deserted.” The bar had been raised and now the consumers wanted, no demanded, the better product and service.

In the past, milkmen “lived in government housing near work, retired with a pension and often passed their jobs to their sons. ‘We enjoyed doing our work because it was a public service. Time flew by.”

But the government milkmen don’t meet the consumers’ needs anymore and now “most of the deliverymen, plus around 4,000 other dairy workers statewide” are on the “surplus list.”

“The dairy used to deliver around 250,000 gallons of milk each morning. Now it sends less than a quarter of that, delivered by private carriers, since the milk trucks were sold.”

One milkman stated: “We want work. Just give us something to do and we will work 10 hours a day instead of eight. I really miss my truck.”

The lesson is clear for organizations and their workers: deliver exceptional products and services to your customers and meet their every realistic need or they will go elsewhere (to the competition) and you will soon be joining the Indian milkmen and missing your delivery truck.

Don’t Get Put Out To Pasture and Enterprise Architecture