This “illusion of certainty” certainly exists more for those outside healthcare than within.  Upon additional review of the Healthcare Reform Act, it seems to me that the authors have a different understanding of providing healthcare than currently exists.  Why else would anyone think that they poses all the knowledge and foresight to understand with clarity the eventual outcome of any specific act?

I just don’t get it.

According to the press release, the strike is over nurse/patient ratio’s (a measurement of the cost of working as an RN) and protection against threats to retirement (a benefit of working as an RN, and perceived benefit of working under unionization) which is dubious.

What will be missing from this debate is the incredibly onerous process someone has to go through to become an RN, and the fact that nurses insist on doing everything themselves.

I know first hand how difficult it is to work as an RN.  It’s hard work physically and emotionally, and I continue to have great respect for those who continue in the field.  Still the training to become an RN, is difficult and expensive, though the exam to become an RN is not.  I just spoke earlier with a woman seeking to be an RN with a 3.4 GPA and who can’t get in, clearly something is wrong here.  I know it’s expensive to train an RN, but this is fixable when we have qualified individuals eager to enter into the field, but no room.  This can be fixed.

Secondly, RN’s need to be able to relinquish tasks to others.  I recall many times working in ICU when we’d have two to four highly trained RN’s in a room, just trying to get a patient out of bed.  Clearly, this task didn’t require a team of all RN’s.  I often wondered how much easier it would have been for the hospital to go to the local Golds gym, and hire a few guys with no neck to work a few hours helping with the heavy lifting; just how much do you need to know to do that?

It will be very interesting to see how this plays out, still it’s only the beginning.  With the median age of RN’s approaching 53 years old, it doesn’t take a great deal of math to see that we have a problem in front of us which requires significant thinking and lots of leadership.

Thomas A. Coss, RN

Societies, and the economies that support them, are just a set or rules under which people have agreed to live, work and interact.  Some economies are seem to do a better job than others, typically that is because the rules are clear and evenly applied there by reduce confusion and risk.  America is one such economy.  Like looking out the windows of a busy airport to the dance of activity below, our economy may appear messy, certainly disorderly, but in the end it works amazingly well.  The dance of capitalism is quite wonderful to watch.  Occasionally things lip, and companies fall, but in the end the music continues and we do pretty well.

America has been goofing around with the rules a great deal over the past two years, which will for certain produce effects.  We hope these will be good, but from this perspective we don’t know for certain.  Clearly based upon historical precedence, there is every reason to be fearful.  What we know  for certain is that those experimenting with these rules will not be the only ones affected by them, typically they’re not affected at all, hence I offer this.

One simple perspective in less than 800 words.  I hope you enjoy

Tom

The downside of pen and paper is that the information contained on paper doesn’t aggregate well.  You can’t look back through it easily to assess what works and what does not.  In earlier days when a family physician took care of you from cradle to grave, it wasn’t a problem; as long as the physician stayed alive, he or she was a biologic historical database of what went on in a patients life.  Today, however, with highly specialized and fictionalized care, it’s a problem.  So why not the sluggish acceptance of EHR’s in the private sector.

To the casual observer the perception is that costs are real, and benefits vague.  These excuses are self-damaging and weak minded.  Time to get busy.

In this piece regarding Electronic Health Records and Clinical Trials from Chris Thorman of Software Advice speaks to one legitimate benefit often talked about, but seldom realized.  True, the use of practice data in clinical trials is limited, but it’s not zero, and it grows over time.   Identifying subtle changes in treatments over time, or simply identifying patients for whom detailed clinical studies are appropriate, will contribute to improving efficiency of bringing new drugs and treatments to market.  In so doing, a faster path to market results in a longer period under patent protection, and higher product lifetime valuation with lower costs.

In the end it looks like this: the medical practice of the future needs to begin now to design itself toward increasing  its efficient and percent of total annual revenue from cash.  This means providing services for which patients will pay cash along with discovering new means by which practices can contribute value and receive compensation outside the existing constraints of third party payment.  This includes EHR’s, but also means a way patients can create appointments on their own schedule 24/7, along with a means by which medical practices can keep in closer communication with their patients.

There is no stability or efficiency in health care without successful and vibrant medical practices.  It’s time for every practice to find an EHR that works for them and put it to use, along with systems and processesto build and manage closer relationships with their patients.

So this weekend, listen to those quiet men and women who “do not need to raise their voice” as they lay upon the united states economy the a new bondage of entitlement.  They will feel so good, and warm and pleased with their actions whose results will choke the oxygen out of our economy, crowd out investment, money for your child’s education, and make us all poorer.