Tom Munnecke’s Eclectica

If you go to a restaurant, its very common to find the wait staff swiping a security card before they order your food.  The kitchen computer prints out a perfect copy of your order, and at the end of the meal, you have an itemized list of everything you’ve ordered.  This is an amazingly efficient and secure system – the management doesn’t want the staff slipping their friends free hamburgers or whatever.

If you go to a hospital, however, it’s likely that your doctors orders are hand written, and perhaps faxed to the pharmacy over a public phone line.  This information, which may have life-critical implications, may have no security, no computer verification, be delayed in transmission, misinterpreted by the staff, or misdirected to the wrong patient.  Computer order entry systems have been a hot topic for decades, and the cost of manual system in patient safety has long been recognized. (See 200,000 preventable deaths per year? and The National Health Emporer has no clothes)

If we accept the conclusions of the Institute of Medicine’s study To Err is Human then preventable medical errors (44,000 per year) are one of the leading causes of death in the US)

Why should even mom-and-pop restaurants have secure, online order entry systems to protect their food orders when hospitals dealing with life-critical information, prone to fatal errors still use clumsy, manual, insecure systems?

Having designed hospital computer systems for 30 years, I understand that a hospital order entry system is a complex task, much more complicated than a restaurant.  But with the right initiatives, it can be done.  The VA has been doing online order entry for decades.

The industry IS capable of maintaining integrated data bases… For example, see Health Insurers quietly keep blacklist.  The insurance industry has an extremely efficient blacklisting system that maintains files on you:

Trying to buy health insurance on your own and have gallstones? You’ll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.

What’s more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs.

So, when it comes to figuring how to deny coverage to you, the industry has managed to create seamlessly integrated, state-of-the-art information systems.  When it comes to protecting patient safety, well, they are still trying to figure out how to deal with this… for over 20 years.

Restaurants and insurance companies didn’t require any federal agency or stimulus money to be stimulated install state of the art secure systems they did it out of their own (possibly nefarious) self-interest.

The problem is a lack of incentives, not lack of stimuluses.

The problem is that we are dealing with a Disease Industrial Complex, not a Health care system.

Updated: Mar 30 to use stockholders equity instead of Market Cap as the baseline for their 1% equity contribution, improving their grade from D- to C-.  my mistake.

I’ve researched Google Foundation’s history, as near as I can gather from public documents.   This is not a simple task, and I might well be wrong (and am very happy to be corrected.)  However, it seems to me that Google is significantly in arrears in the follow through to their promises of 2004.

Google has made a single contribution of $90 million in 2005 to its foundation.  Shareholder equity in 2005 was $9,418,957, so this met their 1% promise. Since then, their stockholder equity has increased to $28,238,862, 1% of which would indicate a total of a $282 million contribution.

Google.org states that it has committed $100 million to grants and investments.  However, 1% of their earnings amounts to $141 million, and required disbursements from their foundation amount to $15 million, bringing their promised amount to $156 million. If we deduct non-charitable use investments from their $100 million commitments to date, we end up with only 40% of their total promised contributions.

I respect the many philanthropic and better world investments that Google has made, but it has also made a promise to the public and its investors that I think needs to be carefully documented and reviewed.

I stand ready to be corrected in summaries, but until then, I have to issue Google.org a C- in their performance to date in meeting their original promises.  Below are my detailed calculations. Continue Reading »

At a Armed Services Comittee hearing yesterday, AHLTA managers presented a rosy future for the $4-going-on-$6 billion system. (see AHTLA is Intolerable) Whereas just last year it was called “Intolerable,” now we hear promises of future success:  Ward Cascells, Deputy Assistant Secretary of Defense for Health Affairs: “I’m wary of over promising, but I’m excited about this chance for us to be leaders in nation in EHR.”

However, I have been getting a stream of messages from AHTLA who don’t have much confidence in what was said on the hill:

• “It was ironic, that within 5 minutes of the live feed, that AHLTA went into Fail-Over.  Sure wish there was a Live feed from our clinics to show the impact.  Still Fail-Over is better than no connectivity, which had previously been the case.  Providers still hate Fail-Over and find it so slow and unreliable.”
• “No one will ever admit the failure of AHTLA, it’s just too expensive, when they can tout the terabytes of garbage data the system contains.  We have yet to get a single operational report out of the system.”
• “Duplicates!  I can’t even begin to tell you the mess and the costs to clean up the duplicates.  Some are introduced by CHCS users by forcing duplicates by creating “”dummy” SSNs, but AHTLA failed to integrate the necessary matching algorithms software for the CDR.  They are just now acquiring the critical tools needed for this.  CHCS was nearly shut down by the GAO for Duplicate Patients.”
• Another AHTLA user wrote his congressman yesterday: “I urge you to hold DoD personnel accountable for this abysmal and costly failure which may have adversely the health management of literally millions of DoD personnel.“
• “AHLTA is more than Intolerable…It’s the 3rd highest reason listed by the Army at the June 08 AUSA Conference Providers are leaving the military…”
• ” Health IT is so deeply political that common sense and patient welfare (not to mention the clinician user experience) often seems to be mere afterthought.”

If the hearing attendees were AIG executives, explaining that they had spent $4 billion of taxpayer money and wanted $2 billion more to improve it, and that their actions had adversely affected the health care management of millions in an abysmal and costly failure, Congress and the press would have been calling for scalps.  But apparently federal bureaucrats can just blow smoke on the hill with impunity, promising results that will happen on someone else’s watch.

I say fire the bunch of them tomorrow, holding them accountable for the mess they’ve created.  And demote every one who approved this slow-moving train wreck in the past.  And create an AHLTA “Hall of Shame” for all the world to see who are the contractors and vendors who helped make this such a fiasco.

Here are some comments to Peter Groen asking for comments on the future of health care information technology (see end of message for details)

Peter, this is all interesting research… 2040 is as far from now as the initial 1978 Oklahoma City VA/DoD/IHS meeting was in our past.

In looking back at the trajectory from 1978 to now, I think that some of my key lessons learned are:

Future Binding. When I designed MailMan in the early 1980′s, I knew that the Internet was coming, and spent a lot of time talking to folks at ISI in Marina Del Rey, who were just developing the SMTP mail protocol, (Jon Postel, in particular).  However, I had only a very primitive IDCU communications infrastructure to work with.  So, I designed MailMan as if it had access to the internet using TCP/IP, and then built a protocol (SCP) that emulated it in whatever form was available over time.  The MailMan handshake would figure out the best performing mutually understood protocol, and so the network could “ratchet up” to higher and higher performing protocols in a self-organizing manner.   I think the process worked pretty well, and it got me started thinking about how one builds systems that are bound to the future (rather than the past).  We could think of Cobol as an early binding language, MUMPS as a late binding language, and the MailMan technique as a future binding approach. Continue Reading »

I’m organizing a booth at the San Diego Science Festival Expo at Balboa Park April 4, 2009.  The booth will be at the California Plaza, near the Museum of Man, booth number 404.  The theme of the booth is The Science of Happiness, and we will be conducting an experiment to see if happier people are more creative.  This is based on the science of Positive Psychology and Appreciative Inquiry.    Visitors to the booth will be given the opportunity to take a brief survey with one of the student volunteers.  The survey will ask a few questions, then given a simple creativity quiz.  We will tabulate the results and then follow up with classroom discussions of the experiments.  If you would like to participate, drop me an email at munnecke@gmail.com

This is a very big rock that I’m pushing up a very big hill, but I guess I try it one more time.

I just ran across this hearing announcement from the House Armed Services Committee:

“The Joint Military Personnel and Terrorism, Unconventional Threats and Capabilities Subcommittees will meet to receive testimony on Department of Defense Health Information Technology: AHTLA is “Intolerable,” Where Do We Go From Here?”

Continue Reading »

Dear Megan,

It’s great to hear of your new role as general manager of Google.org.  I have fond memories of our chats as fellow Fellows at Stanford’s Digital Visions Program and the Uplift Academy workshops.  (I took your advice about solar cookers and moderated my enthusism for them).

I’ve been tracking Google’s philanthropic goal to devote 1% of Google’s equity and profits to philanthropy for some time now, and even blogged a bit in 2005 about it when it seemed to be lagging: What Ever Happened to Google’s 1% Better World Funding? See my current report card from my analysis of things to date)

Recall that Google’s SEC IPO filing said:

“We intend to contribute significant resources to the foundation, including employee time and approximately 1% of Google’s equity and profits in some form. We hope someday this institution may eclipse Google itself in terms of overall world impact by ambitiously applying innovation and significant resources to the largest of the world’s problems.”

Continue Reading »