• Beginning a new journey.  Typically, when setting out on a journey – short drive, trip, flight, childhood utterance of “Are we there yet?” has been replaced with a consistent check of time on my cell, mobile device, or watch.  Almost from the very start, all sites are set on arrival.
• Beginning a new chapter.  My personal reading goes in spurts.  There are times I’ll crave reading a beloved author or intriguing book; other times, professional reading takes over.  A new book is equivalent with anticipation.  Anticipation, much like the song and ketchup commercial of the 1970’s, isn’t all that great.  One the first chapter is read, my eyes will go directly to the last chapter or book jacket to see how everything turns out.
• Beginning a fresh start.  To be honest, the use of fresh as an adjective for a start never has made much sense.

Each of the catch phrases elicits a sense of hope.  There is an inherent notion of change.  Human nature encourages the perception of change as an event or action that is positive – one that advances or propels you forward.  The belief of moving toward a better place perhaps is grounded in a Judeo-Christian perspective of the world.  Perhaps, it is simply the formed from a belief one would not depart or exit a place, time, activity that brought with it joy, acclaim, substance.

Change requires the input of energy.  Physical, emotional, mental – energy is required in some form to initiate either movement, transformation, or mental aerobics.  If the changed state did not bring with it something positive, why expel the energy?

Professionally, there have been numerous opportunities to lead, motivate, or facilitate a changed state.  Some have suggested that this is a reoccurring theme in my professional life.  If the wizard’s curtain is pulled back to expose the man (as opposed to the persona), it is apparent that I approach most change with a sense of dread or fear.  “Those who can do; those who can’t teach.”

It should be noted there is a difference between the quest for change and growth or development.  To demonstrate the point:

• I was born at 6400 north, grew up at 9600 north, and for spent the entirety of my adult life to date at 7300 north.  The width of this trajectory is about six or seven blocks.
• My sons were born in the same hospital that I was; third generation in the same hospital.
• My research and writing style was honed in a Jesuit prep school.  Aside from computerization of notes versus note cards, the style has not deviated.
• Filing cabinet or electronic document files are in the same layout today as they were thirty years ago.

I crave a sense of stability and order.  There are no apologies offered for this.  Stability and order provide grounding.

Concurrently, learning new ideas, challenging my abilities, craving new is also a part of my make-up.  The address is the same; adding new art, furniture, colors is exciting.  Over the years, I have held positions in six organizations.  Three of these relationships have spanned ten years each and two were two or three year engagements.  Within the organizations reflecting nearly three decades, the role and portfolio were in a constant state of flux.

We each end our lives with a series of “aha” moments.  One of mine was during a meeting at Ball State University.  We were in a quest to learn best practice of creating and leading innovation.  The director of the Innovation Center spoke about an entrepreneurial spirit and an intrapreneurial spirit.  The schizophrenia experienced in personal and professional endeavors was finally explained.  Change could coexist within a set of stable and defined parameters.

My mentors told me that this new role was written with me in mind.  The opportunity this change affords me is one that I have worked toward; encompassing nearly everything I love to do.  Anxiety and trepidation fill each step taken in this new journey.

I would love to read the last chapter of my professional life

We each have a part of the day that we own.  For mom, it was late night.  Dad travelled most of his professional life.  She would stay up until early morning at one point in her life doing oil painting sitting at the kitchen table.  Later, she would stay up watching TV or reading.  It wasn’t that she couldn’t sleep; she wanted to stay up to be sure that we were safe.

There were two shows that were her staples after the late news – Bill Maher and Letterman.  Letterman was her favorite.  In deference to Letterman, I would like to share with you my perspective what I believe to be Mom’s Top Ten Legacy.

#10 – Look good. Over the last few days we have been able to share stories with each other to get through the pain and I believe to cement a picture of Mom in our heads.  Mom was the oldest in her family.  Everyone that has described mom in the same way – always dressed, cut, contoured, perfect make-up, and her long perfectly polished nails.  There was an order to getting dressed in the morning.  It started always started with coffee and the news.  And then the getting dressed began.  Mom cared about how she looked and expected the rest of us to as well.  When Janice and I got married, one of the first things she did was take Janice to Chicago to go shopping and redo her make-up.   Style and color helped define who you were and how others saw you.

Marilyn Miceli Roger

#9 – Know what is going on around you and are part of it. Mom loves to watch the news.  Mom loves talking about current events, politics, the economy, and government.  She held strong views about citizenship, involvement, and politics.  Her views were known by all of us.  Mom was a democrat in case some of you were unaware.  When we lived in Carmel, all the registered democrats in Clay Township lived on our street.  Growing up in Indianapolis and going to Shortridge she knew Dick Lugar.  He was the only Republican she regularly voted for.  Mom took the boys with her to vote every election.  The polling staff knew that she would take them into the voting with booth with her and they didn’t question it.  When Eddie and Miles were old enough to vote in their first election, they drove up from Bloomington so we would all go vote as a family.  The asked if we were democrats because it was what we believed, because we were Jewish, or because Grandma said so.  The answer was yes.

#8 – Get real. Mom is a realist.  When she met our father, she found a man that was 99% dreamer.  Daddy never knew how to do anything small.  Mom wanted a Star of David necklace.  Daddy came home with a platinum and diamond necklace that was so large, when our house was robbed the necklace was left – no way anything that size could be real.  Daddy was wildly in love with Mar.  He truly believed she was the most beautiful woman in the world.  She was his wife.  Daddy wanted to move to Australia because he was positive that there would be tremendous growth and opportunity there.  Mom said that’s good, let us know what its like.  The more daddy dreamed, the more grounded and realistic mom became.  When daddy died so many years ago, there was a sense of adventure that never came back in her life.  She knew how to have fun.  She loved trips to New York or Florida with Mark, taking the kids on adventures.  But that bigger then life world of our father could never be replaced.

#7  – Lead don’t follow. So many people have said that mom would tell it like it was.  There was a post on Facebook that said she was a bull in a china shop.  I think I have heard the word strong at least a hundred times in the last 72-hours.  Mom was a leader but a benevolent leader.  For a woman of her age and growing up in the era she did, the traits of a good leader on a woman were not seen as a positive.  Describing a man as strong, single-minded, demanding excellence would be a positive.  For a woman, it would be a bull in a china shop.  When Mom first went on the Men’s Board of the BJE she would always make coffee before a meeting and clean up the table after.  One of her feminist friends said this was terrible.  Her response was that if she made coffee it tasted like something and when you give someone something to eat or drink, they treat you with respect.  As to the cleaning, she found that the doodles people wrote down in a meeting gave you insight into their thoughts.

Mom was the first female president of the BJE and one of the first women to break though to the men’s boards in the Jewish community.  She did this was strength, hard work, and grace.  For over 40 years she was a volunteer and professional at the BJE.  She believed every child should have the ability to receive a Jewish education.  She believed that the BJE should be a safe place for children.  She fought hard for what she believed in her heart was right.  Mom demanded funding because this is how you insure a generation of Jews.  This is how you insure commitment.  Some of you worked alongside Mom and some of you sat across the table.  She was formidable.  Her approach was reason, data, and having an answer before you asked a question.  At one point there was a decision to change the organizational structure and Mom should lead the agency.  She believed an educator needed to be at the top.  People would get frustrated opposing mom – she typically had an answer and she was usually right.

#6 – Innovation. Love gadgets and technology. Mom’s bedroom in her house in Broad Ripple had an amazing sound system.  She loved any new toy.  When something broke, she would take it apart and fix it.  Later in life she wasn’t crazy about computers; but once Eddie set her up with a laptop and she found blogs, news, and games, she was set.  When she learned that she could track off of us on navigator, she kept tabs with every trip.  Video games quickly became a passion of hers.  There wasn’t an electronic toy made that didn’t end up in our house for the kids.

#5 – Hoosier cooking.  As a child, mom would go out on produce runs with her father.  These would include an early morning breakfast at truck stops.  This was how she fell in love with dried beef gravy.  Her motto was very simple – she loved anything she cooked!  If it was a tenderloin from Borkeys, Toddle House chocolate pie, Hollyhock chicken, or fresh bread and spaghetti sauce – mom loved it.  Mark would buy butter creams for her.  The kids would take her to Daddy Jacks.  A good meal and conversation – mom was happy.

#4 – Order. There was a sequence to getting up in the morning.  There was a way the house should look.  Chokies never moved.  Everything has a process, a sequence, an order … and it shouldn’t be broken.  Janice said that mom was holding on because she was doing it on her on schedule.  Mom died at lunchtime.  It just made sense.  Coffee is to be made at the end of day so it will be ready when you wake up.  At the end of the day, check the kitchen, temperature, and the door.  Her grandfather, Pa, called her every night of her adult life to make sure the doors were locked.  If I stayed up late as a child I knew it was time to pretend to be sleeping when I heard, off, off, off, off, shut, lock, and latch.

Marilyn Miceli Roger

#3 – Be the world’s coolest Grandma.  Mom’s grandmother was the world’s coolest grandma.  Bubble would keep mom weekends when grandma and grandpa would go the Roof to dance.  They would go the Ayers Tea Room, movies at the Circle, cook.  This was her role model for what a grandmother should be.  When Eddie came along, she transitioned into the grandma role with a zeal and passion I had never seen in her since dad died.  Eddie and then Miles, Maddie and then Sammie – this was her purpose.  This was her lifeblood.  She never understood why her best friend would retire and move to Florida.  When the preschool went roller-skating, mom was in the middle if it all.  When the boys went to college, mom was there to move them in.  When the girls went to camp, mom would readily offer to help Janice move out GUCI only to immediately disappear looking for the Maddie and Sammie.  We have all posted in Facebook the last few days.  If you look at the kid’s posts, you’ll see Sammie and Maddie’s friends sharing stories about grandma.  Eddie and Mile’s fraternity brothers comforting the but also are sharing in the loss because a friend was gone.  Mom knew all of my friends, Mark’s friend, and the kids friends.  She was the cool grandma.

#2 – Love your children with all you heart. We knew Mom loved us.  She didn’t always agree with us, but she always loved us unconditionally.  Mark shared Mom’s artistry and he embodied daddy’s ability to dream.  When daddy died Mom sat Mark and I down and said we had to make decisions – the three of us.  She told us within days of dad’s death that it would be the three of us now taking on the world.  If we stayed close, stayed together, would survive.

When mom got married, grandma sat her down and told her she loved her son more then anything.  Now that Mom was in the picture, she knew could loose him and that wasn’t going to happen.  She told Mom she would never have a harsh word with her because she wouldn’t risk loosing her son.  She passed this same message down to Janice and to Randi.  Janice and Randi were her daughters.  They were her children.

#1 – Growing up we would go to the Maurer’s for holidays.  I would listen to Mickey describe the role his mother played in the family.  Adam Shapiro emailed Janice last night.  Adam was one of our kids that we watched grow up at IHC.  He said that Marilyn was our family’s Joan – his grandmother.   Over the years people would ask me how many Roger’s are there – it seems like whenever you see one, you see them all.  In reality, our family isn’t that large.  As all of you have shared your stories with Mark, Janice, Randi, Eddie, Miles, Maddie, Sammie and me the last few weeks, another thought that is a constant is that Mom was the glue that held everything together.  She was their friend, their mentor, their colleague, their older sister, and their older cousin.  The #1 legacy Mom leaves is all of us. When Mark serves as the next president of the BJE board, mom will be there telling him what to do.  When Janice chants Aveinu Malchainu, Mom will be sitting there beaming with pride.  When Randi guides Maddie and Sammie into adulthood, Mom’s compassion and love will be heard.  When Eddie creates that million-dollar computer program, Mom will say I told you so.  When Miles makes kugel for break the fast, mom will remind him to add a little extra cinnamon sugar.  At the end of Maddie’s first day in high school Mom will be the first one to want to hear every story.  When Sammie’s sense of humor shines, Mom will be there laughing the most.

One of these days I’ll be someone’s grandpa.  When we have Passover, have Sunday dinner, or tell stories about their great-grandma, if they think, “I have a cool grandpa,” it will because I learned from the best.

Hosting the Super Bowl was a forty-year dream come true.  Former Mayor William Hudnut III traveled with a caravan of Mayflower moving vans to Baltimore and picked up the Colts.  The city built a stadium without having a home team.  His predecessor, then Mayor, Richard Lugar, was focused on revitalizing the inner city and stop urban blight.  One strategy to do this was to bring people back to the downtown.  Conventions and sports were the ticket and key to the city.

Indianapolis hosted the Pan American games decades ago – and was successful.  Year by year, mayor after mayor, key their eye on professional and amateur sports as a way of making the city a major league community.  The Super Bowl was the prize secured by a former mayor; this week demonstrated that Indianapolis was no longer IndyaNOplace.

Everyone in the city – current and former residents of Indianapolis, grinned ear to ear with each day’s events during the Super Bowl.  By all accounts, it was a major success.  Even the weather cooperated!

Concurrently, the Indiana legislature was in session.  Indiana became the twenty-third state to pass Right to Work.  A demonstration through Super Bowl village highlighted the event.  Keeping their eye on the prize, the picketers were relatively quiet and did not disrupt the events or game.

As a side note, the football season almost didn’t happen this year because of a labor dispute and walkout.  The unionized players kept up the fight to secure benefits for its players.

One can argue for or against the right to work concept.  At the end of the day, it isn’t positive for unions.  The other legislative action demonstrated the grassroots nature of the Hoosier state and was the antithesis of Super Bowl hoopla.

The Indiana Senate’ passed a bill allowing Tuesday creationism to be taught in statewide classrooms.  Senate Bill 89 enables schools to teach religiously based perspectives of creation in tandem with evolution. An Indiana Department of Education spokesperson said Indiana would not develop any such curriculum or guidelines for teaching creationism in its public schools.

These three events demonstrate Indiana’s history, it present, and potentially its future.  All three events demonstrate what can occur when you have a single focus, dedication, perseverance, and implement strategies that are clearly designed to achieve a BHAG – big, hairy, audacious goal.  There are some who argue that spending on sports has been at the expense of infrastructure.  Right to work might bring in new business; it might destroy unions.  Teaching religious belief is clearly unconstitutional; proponents don’t care because they are focused on a single outcome.

If you see me riding in the cab of a Mayflower moving van, wearing a Colts hat, Super Bowl 45 jersey, and heading out of Indianapolis, you’ll know Governor Daniels signed this bill into law.  When I drive by, I’ll probably be muttering something like, “I can’t believe I live in Indianapolis!”

ICD-9 Procedure Code – 300.4 – Depression with anxiety.

A young woman – 16 years old, that we know was found in her bedroom by her parents last week.  They found her dead.  After months of diagnoses codes like these, she found it necessary to terminate her life.  Winter mornings during the school year should find young girls texting their friends, cramming for a test later in the day, reading notes left the day before by boys, or trying to decide what to wear for the day ahead.  On this day, this child lay motionless — the impending school day, drive home, or dinner-table discussion would not be an issue.

Clinical definitions of depression, anxiety, bi-polar, or suicide carry with them guidelines for diagnoses, procedure codes for reimbursement, protocols for management.  In a local hospital, social workers cubical, psychiatrist office, and school counselor’s files, undoubtedly there are notes detailing the causation, treatment plans, and medication regimes.  Hours of discussion between caregivers, providers, and family members took place; events of the past 24-hours may have been noted as an option, a potential event, or possibly an inevitable event.

Teachers, friends, family, clergy all will devote a portion of their day to questioning what happened – and why.  Second-guessing a conversation, a meeting, a tweet could have created a different end to this day.  Social media will ensure news of the death gets to all those who need to know – and countless others that don’t need to know.  Close friends will blog, text, tweet their innermost feelings about their friend.  Others who knew of her through a friend, attended the same camp, or were a friend of a friend of a friend will discuss the death as if they were  “BFFs.”

And parents will hug their children tightly without sharing any words.

In healthcare, the world typically is reduced to a series of electronic notes and procedure codes.  The procedure codes characterize an individual; reimbursement, treatment, coverage, care management are all dictated by three or four digits.   A child’s pain is converted to a four-digit description.  The ability of a parent to gain cost-effective care is dictated by a numeric value.  The ability to gain care and access to providers is at the discretion of a single decimal point.

After the child’s death, the digits are reduced to one – number of deaths.  The family will move through the necessary steps of bringing a life to its end.  Concerned teachers, family, clergy will gather the child’s friends; using the death an opportunity to avoid a similar fate occurring in the life of another child.  Within days, new discussions will fill the digital world of Facebook and friends will move on to the next event that fills an emotional void.

For a few short moments, electronic medical records and appointment schedules, social media and support groups, will be replaced by real human emotion.

Fortunately there is not a CPT or MSDRG procedure code for raw emotion.

"Dammit, Jim. I'm a doctor not a bricklayer"

The Association of American Medical Colleges recently released a statement that by 2015, there is a predicted shortfall of physician supply in the United State of 62,900 physicians.  Deemed a “critical shortfall” by the authors(1), the shortfall includes primary care physicians, specialists, and sub-specialists.

1. Distribution of physicians by geography.  Working toward a national access of consumer to physician standard in urban and rural areas.
2. Better articulate the role of primary care physician and specialist.  The role function in a medial home model, in a world dominated by EHR, or reduced reimbursement is vastly different than today’s standards.
3. Define a new business model for physician AND physician extender.  To support #1 and #2 above, physician in-fighting for patient panel size, solo-management by specialist of patient needs, and provider inability to document, record, bill easily must be wiped out of the industry.

I was watching a movie from the 1950′s recently on TCM.  The family practice physician lived comfortably, not wealthy and not poor.  Their lifestyle was difficult; essentially 24/7 coverage.  The physician’s son went to medical school and chose to be a hospital-based specialist becuase it was more lucrative, better hours, and a sense of reimbursement for the skills and competencies he brought to his patients.  The industry has experienced change and the providers have adopted and morphe into different business models.

Our challenge is to imagine a commencement address in 2021 calling on the new cadre of physicians entering the market to recall the purpose of their profession, understand the financial ramifications of this decision (perhaps more akin to teachers versus corporate giants), and the need to work collaboratively.

(1)  Source:  (c) 2010, Association of American Medical Colleges.

Toward the end of the calendar or fiscal year, the phrase “hope is not a plan” echoes through conference rooms, hallways, offices, and performance review sessions.  In a world of data, analytics, predictive models, strategic plans, and business plans, there is an overwhelming (and endless) pool of data elements.  The hordes of MBA’s in leadership have formalized and institutionalized decision-making based on data; success is measured by translating all outcomes into specific values.  Case in point:

• Patient satisfaction measurement is based on a weighted scale.  The metrics used by NCQA for patient satisfaction have been designed to correlate with a numeric value or weight as its outcome.
• Personnel are measured based on objective criteria that is aligned with a weighed numeric value.
• Resource deployment and investment (e.g. adding a new physician, deploying an ambulatory site of care) must be supported by projections and return on investment.  The trend is almost always based solely on a historical average that is pushed forward versus building into the model change based on non-age and gender criteria.  The introduction of disruptive technology, care delivery patterns, reimbursement, legislative or regulatory change – all impact the trend and rarely introduced into the financially driven model because it is considered soft science, aka hope.

The reality is not all bad.  Healthcare and other industries historically would/have make/made decisions based on who yelled the loudest in a meeting, who nagged the longest, who carried the most political capital or weight, etc.  The migration to decision making based on analytics has been a slow process with many bumps along the way. 

When I joined an integrated health system in a strategy and planning function, it became evident that staff and leadership would request data for a project; yet, the decision was often already made.  The purpose of the data request was to have something in the appendix or to acknowledge that a conclusion was reached with more than a gut or single-minded perspective.  The analysts rarely, or barely, scoped out a problem or questioned a data request.  Requests would come via telephone, email, or administrative assistant.  Success was measured by how fast the data request was met.  Value was measured by the alignment of the information presented with the perspective or intent of the individual making the request.

This is not a good situation. 

The current environment is a cross-section of the window dressing data, pivot tables, weighed averages, and dozens of Excel worksheets.  It is rare when a staff person will walk into a meeting and present a recommendation based on what they believe or feel.  Perhaps their personal belief is costumed within a PowerPoint deck of charts and graphs, an attempt has been made to make the committee or board believe the recommendation was gleaned from objective data and predictive modeling. 

Recently, a client contacted me and questioned the forecast for current volume of new and established visits.  Their disbelief was based on the low market penetration resulting from a comparison of current volume and predicted volume.  Their disregard of the model value was questioned because it could not be broken down and attributed to specific, objective, measures.

My initial reaction was to support the predictive model.  Rather then question the caller, I began to probe and understand what the cause of the disbelief.  This was a model, a predictive model, a forecast.  It was a value based on a series of objective data points, research driven assumptions, and mathematical calculation.  The value was crafted from the use of neural network technology and went through various stages of validation, tweaking, and computation.

The predictive model was a best guess – a hope. 

Early in my professional like I assumed the mantle of data driven decision making.  Marketing was too soft; strategic marketing was based on objective criteria.  Operations based on a budget target were insufficient; a multi-year, measureable, analytic strategic business plan was the right way to go.  After three decades, I find myself relying as much on experience, feeling, and hope as I do on the measures.  Today, a scan of the information will create a sense of right or wrong.  Hoping we will reach an objective has some level of objective criteria involved; it is still hope.

Hope is personal.  It is emotion.  It is in your face belief for no tangible or tangential reason or purpose.  Hope comes from your heart and the experiences which have shaped who you are.  Hope is messy.  Hope is not black and white.  Hope is an enigma, without shape, without form.  Hope is grounded in the human senses very numeric values or equations. 

And, hope is an emotional driver that pushes, prods, pokes, and encourages when rational, data driven actions tell you to go in a different direction.  Hope can stimulate or depress.  Hope creates a force that can be harnessed to overcome the greatest of barriers or the darkness of failure.

I want to hope.  I want to believe that success is always possible.  I want to hope for a future akin to what brings me happiness.

Planning for hope requires setting aside the measures, dashboard, the analytics at a given point in the decision making process.  Planning for hope requires an emotional investment in your actions.

Hope is not a plan.  Hope is that special something extra, the secret sauce, that propels a plan to success.

ac·count·abil·i·ty.  noun \ə-ˌkau̇n-tə-ˈbi-lə-tē\. ..the quality or state of tə-ˈbi-lə-tē\. ..the quality or state of being accountable; especially : an obligation or willingness to accept responsibility or to account for one’s actions <public officials lacking accountability.  (Source:  http://www.merriam-webster.com/dictionary/accountability)

Accountability appears destined to travel the same journey as HIPPA.  Current HIPPA regulations barely resemble its intent — protection and security of personal health information. The last time I went to my physician and pharmacy, after signing countless HIPPA forms, I “signed in” by writing my name on a clipboard.  In plain sight were the names of everyone who had been in the office or picked up a script before me on that day.  Where was the privacy and protection?

Quality of care, efficiency, and cost containment is the rationale for increased accountability of care.  Laudable (and necessary) goals are the underpinning of regulatory and legislative reform that emphasizes greater coordination, integration, and alignment of care delivery.  Building a medical home, integrating electronic health information, and aligning physicians, payers, hospitals have saturated industry discourse. The final regulations for CMS Shared Savings Program and accountable care organizations in October flooded industry chatter, C-suite agendas, and even blog sites.

One on one dialogue with colleagues indicates the journey is grounded with a strong belief the result of integration, shared knowledge, and coordination is a solution for industry ills.  The barriers – real and perceived, are mammoth.  The information technology and operational realignment required to support the discourse are financially impossible and resource improbable.

This is not advocating abandoning the vision of accountability.  It is a plea for a reality check.  The ACO comment period recently concluded evidenced the investment – resource, financial, human, technology, concerns of healthcare enterprises.  If the decision on the board room table is to apply for ACO or a decision to employ the full medical staff, leadership and governance may not be taking into consideration the need to build a foundation that supports these new structures.  Transformational change is not akin to a joint replacement.  The organizational transformation envisioned requires operational and cultural investment, clearly defined strategic vision, and informed resource investment within an abbreviated timeline.

Operationally, accountable care becomes action through a medical home model, value based purchasing, bundled pricing, accountable care organization, and other programs, processes, and models that create linkage from one provider to the next, one site of care to the next.  Any consumer or provider is quick to point out the need and relative value or increased sharing between care givers and sites of care.  Decades of specialization and sub-specialization have resulted in greater life saving efforts.  Concurrently, the ability to retain the knowledge and rationale from one healthcare decision to the next is virtually impossible.

The need for technology solutions that parallel accountability of care are at the forefront of resource requests, investments, and staff focus.  Standardization and extensible data models allows the gap between our current and future state lessen – most often the barrier is the ability to provide sufficient capital to fund these investments.

The cultural change required supersedes the financial investment.  A lesson learned from the HIPPA journey is that inherently we do not like to share information.  Under the veil of confidentiality, the notion of sharing outcomes, decision making, or clinical indicators is guarded.  When the information is shared, the barrage of questions regarding integrity, standardization, and decision making input occurs.

Case in point – prior to knee replacement, an MRI was conducted.  The results of the MRI could not be sent directly to the patient.  Results were to go to the primary care physician and ordering physician; not to the patient.  The cost of the MRI was borne by the patient, the MRI was of the patient, and the results impacted the health of the patient.  Obtaining the results (including a copy of the scan) was at the discretion of the ordering physician.

The cultural change required to adapt to greater accountability in care must be industry-wide.  It is improbable that greater accountability can occur unless the system is completely transparent.  Pilot programs or unique sub-sets of the care delivery system are insufficient to build the integration and responsibility required.

Your death at fourteen carries with it no rationale explanation.  The journey you have been on the last few years with cancer prematurely moved the boy into a man; making decisions decision that belies the burgeoning physical change to adulthood.  The parents left to mourn and imagine what could have been,  The friends who, like you, had to grow up quickly to understand what has happened, are forever changed.

I know you so well; but really never spent any time with you.  Your dad, the Old Man, and I are colleagues and friends.  For a decade we worked together.  We moved from colleagues to friends immediately.  Sharing a passion for our work in healthcare was matched by our passion for family.  The result was time spent together in discussion over physician engagement, the need for new technology, or strategy for neurosciences — always included were updates, stories, or anecdotes about you, your mom, and my family.

The Old Man and I are co-workers, colleagues.  First and foremost, fathers.

News of your death stopped time.  My immediate response was to provide support to your family.  Impossible.  There is nothing to be said or done that could fill the void or lessen the pain.

The next impulse was to call Eddie and Miles, my sons.  Again, there is no rationale explanation for this.  Hearing their voices was comforting.  Knowing they were okay was important and at the same time ironic.  Texting and calling my sons meant I wasn’t experiencing the pain your mom and dad were going through.  I apologize for such a selfish act.

Your dad and I collectively have over sixty years in healthcare.  We understand the process, clinical decision making, and options available for patient and family.  We both have made decisions based on financial resources, patient needs, and family needs.  We sat through countless seminars and workshops devoted to caring for the whole family versus the patient.  We participated in budget sessions where purchase of a disruptive technology and investment in a clinical protocol was bypassed due to financial constrains or prioritization.  We often used the phrase “the patient first” and use the “patient experience” as reasoning for decision making.  But, it was all in the third person.

I would like to think that we are caring and compassionate individuals.  Yet, once a decision was made or budget approved, we moved on to the next issue at hand.  Once the meeting concluded, we moved on and rarely thought about the potential impact on a patient or family member.

The next time your dad and I meet for breakfast, the world will be changed.  I’m sure we will discuss work a little and catch-up.  Then, the conversation will move into more important matters – you, Eddie, and Miles.

The next time I pour over an Excel spreadsheet or a predictive model,  I want to think about you.  Knowing you humanizes the data.  Your life is a constant reminder that at the end of the day, every decision made changes a life, a family, our world.

Be good, Che.  I look forward to sharing stories about you and your accomplishments with your dad again very soon.

Brandon

Two articles caught my eye in the last couple of days.  One from the Washington Postand the other from a blog posting.  The first dealt with the need for data transparency and the second with convergence.  Healthcare may be the one venue in which the combination of data transparency and convergence is greater than the sum of its parts.

Entrepreneur Yuri Milner believes that in any 48-hour period, there is more data created than the totality of humanity’s efforts in the past 30,000 year.  His forecast is that by 2020, the same amount of data elements will be created in one hour.  Data is often masked as proprietary data.  One need not go any farther than the HIPPA regulations of 2012.  They share nothing with the original intent and origins of healthcare privacy regulation and legislation. 

Convergence is viewed as a subset of innovation. The brining together of disparate services, resources, programs, or parts into a single, unique and different product is the outcome of convergence.  The authors dealing with convergence stated that convergence has “gone wild.”  Citing a shirt that was laced with bug replant, convergence in our modern society as negative and without value.

“Convergence gone wild” is an oxymoron.  If the objective of innovation is to provide a strategic benefit, the determination of a good or bad strategy will come with time and in consumer response.  While the example you cite is a far stretch from the iPhone, iPad, or even Diet Coke Lime® or the ability to purchase only muffin tops – consumer demand will be the final determinant.

Convergence is deeper than consumer will or strategic proliferation.  Implementation of convergence strategies is closely aligned with efficiency and effectiveness.  Incorporating management theories de jour – Deming in the 70s to Lean in the 90s, convergence supports the notion of integration, collaboration, efficient investment of resources, and most importantly the opportunity to provide a new resource that the consumer didn’t realize was possible.  In some cases, convergence is the operationalization of a vision or the what if conversation.  Other times, convergence is the response to that’s simple…why didn’t I think of it. 

Convergence is the result of new and/or disruptive technology applies to the status quo.  The opportunity of millions of data elements for decision making coupled with the technology to mold those data elements into information that the human mind can comprehend, is amazing.  Our ability to understand the value in this type of information and the rationale for investing in data warehouse to support transparent data integration, is either our hope for the future or our barrier to continued growth.

Convergence ultimately is an advance; bolding going where no person has gone before*.   The value a convergence solution offers is measured in its change quotient as much as its financial impact.

*Homage to Gene Rodenberry, Star Trek.