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Scan Here

05/03/2021

Some people do not share in the thrill of new technologies. They overheat and pine for a world that has moved past them. They are called Luddites and spotting them in public is easier since the outbreak of Covid-19.

As restaurants began to reopen after that long and painful hiatus, they were required to adopt certain technologies to safeguard against increased risk of spreading the virus through dine-in eating. Along with wearing a mask while not seated at the table, there are contact-tracing protocols whereby your personal information is incorporated into a database that the restaurant can consult should a patron later succumb to the impartial disease.

And my favorite of all— the adoption of the electronic menu, using the camera on your smartphone to scan a QR code, which seamlessly directs you to a digital list of food and beverage offerings. This is when the Luddite is at the threshold of outburst.

Look for the person with mask drooping off one ear like a punitive earing and iPhone raised high in the air betraying confusion, longing for a list of appetizers but getting only an alien symbol, begging some moderately competent person to appear and shepherd them through the complexity of pointing the barrel of a smartphone at what is for all intents and purposes a kind of target sign marked “Scan Here.”

In terrible versions of this scenario a quarantined menu is drudged up from dusty retirement, re-sanitized and re-sanitized and re-sanitized and then begrudgingly delivered to the technophobe.

Do we resent such people? I fear so.

We resent them, I fear, because we have moved on. Modernization is there to fulfill consumer demands. During this insufferably long pandemic consumers yearned for the reopening of restaurants, a semblance of normalcy in a bewildering moment. And why wait five minutes for a hard-copy menu to come to your table when it can be readied instantly on your smartphone. The restaurants did their homework and zeroed-in on operational changes that would both accommodate our wish for them to reopen while making for the safest environment possible considering the trial at hand.

This is an example of what modernization can resolve. If we were a people comprised predominantly of Luddites, mitigating our strange new world would have been impossible because we would push back against technology, the very thing offering our deliverance. We perpetually would have been moored at home smearing a redundant condiment over our three hundredth turkey sandwich.

In one year, the entire medical establishment has seen how vital modernization is to patient care, and luckily, there was an infrastructure in place that provided the consumer with a metaphorical menu, if you will.

The problem presented was how to provide care which everyone goes on needing in spite of a pandemic— cancer doesn’t cede ground to a more popular disease—when the location of this care is deemed unsafe. Well, as with restaurants, the medical industry adapted, leaning heavily on modern technologies, the conveniences of digitization to fill in these gaps. Doctors began to refer to patient portals for requests for prescription refills, offered alternatives to in-office visits through Telehealth, relied heavily on longitudinal care and well-captured data to answer the kind of questions that otherwise might be answered during in-person visits.

It is my belief that what began as solutions to problems of the moment will become status quo in medical care.  Once the nation has reached an acceptable level of immunity, these changes will not be dispensed with. What parent wants to take their thirteen-year-old to an appointment every month for a refill of acne medication when it can be done electronically in the patient portal? Everything is moving in a technocentric direction, and providers must keep up with this change in the spirit of our time.

After all, it is better for the consumer. And whom else do we answer to?

 

What Fun Doesn’t Look Like

03/31/2021

A few days ago, The Wrap published a flattering article online about the peculiar joys offered throughout the pandemic by the sole remaining Blockbuster, which seems to enjoy timeless contentment in Bend, OR. That it took the uniquely disagreeable context of Covid-19 to remind the public of the “satisfaction” of going to the movie store should not be understated. Shining at the top of the list of virtues is that it gives people an opportunity to “walk around and [get] an idea of what they want to watch,” as opposed to beloved streaming platforms like Netflix and Amazon Prime that ask little more than brandishing the TV remote and enjoying a curated viewing experience made possible through modern and optimized technologies that record taste and suggest new ones.

Am I the only one who finds himself in a state of acute psychological duress even considering that ancient before-time when Netflix didn’t exist and the merchant of cinematic bliss was either anemic cable TV showings or the local video store, with its disorganized aisles and t-shirts and flavorless candy for sale? Contemplate all the frustrations alleviated by the advent of streaming platforms: no longer must you fight for the last copy of Men in Black II, no longer must you wallow in the turmoil of one more stop on the arduous commute home from the office, no longer must you stand in the unsmiling queue before the cashier fumbles through the directory trying to discern just which David Hampton you are, no longer must you endure all this only to discover five minutes into the screening that the film you methodically and nervously appointed tonight’s recreation is a complete flop, rendering the whole escapade humorlessly futile! Let Bend, OR enjoy its claim to the last Blockbuster, thank you very much.

The exceptional thing about evolution in technologies—and cultural embraces of them—is that they solve an inconvenience that the consumer had been unaware of but avidly adopted as soon as it was popularized. With the pitiful exception of the fetish for that one unkillable Blockbuster (and a fetish, of course, lays claim to a fixation not shared by the majority), Netflix necessarily erased the mind-numbing inefficiencies of the video store experience. Otherwise we wouldn’t be reading articles about the final Blockbuster!

Healthcare is not exempt from this type of consumer scrutiny. The majority of patients will no more tolerate providers that have not embraced modernization, whose practices do not incorporate patient engagement programs, alternatives to in-office visits, ways to prepopulate information and longitudinal care, than they would side with Family Video over Netflix or Amazon Prime. Optimization in healthcare, like any other industry, utilizes analytics to improve care, trim costs and gain efficiencies, all things the consumer is growing more attached to and would be pained to do without. Employing these technologies transforms practices and gives patients that modern healthcare experience they’ve come to expect.

Practices that resist modernizing, optimizing and transforming, anchor patients—that massive stratum of partial judges who dictate the future without having any foreknowledge of what it will look like—in a bleak sea of video stores that sooner or later they’ll flee, for a land where innovation has helped “realize” some unconscious wish.

Interoperability: A Love Battle

03/02/2020

It is in some ways flattering that in the great anonymous corners of the world there are known faction warring for our allegiance as consumers. We feel important, valued, both good feelings. This is perhaps one of the only upsides to a role otherwise troubled by a deluge of solicitations, misleading campaigns, trash beauty products, bad food, toothpaste, fad diets, false appeals to the heart.

Being vied for becomes a bit more muddled, however, in healthcare debates, an industry in which the consumer is even less surefooted due to the processes required in really getting a firm handle on that foreign organism that is the human body (I feel confident, for instance, making decisions about the right brand of cereal, yet I’d feel less good about applying that independence to heart medicine) and all the red tape that interferes with accessibility, not to mention the dire consequences of getting it wrong. But if you pay attention, bigwigs in the healthcare industry make appeals to us as consumers quite strongly too.

In February 2020, HHS announced that it’s adopting interoperability rules put out last year by the CMS and ONC aimed at addressing access, exchange and use of electronic information, and preventing healthcare organizations from using information blocking tactics. HHS director Alex Azar said the rules are “essential to building a healthcare system that pays for value rather than procedures, especially through empowering patients as consumers.” HHS, it appeared, made the decision with us at the fore of its mind.

Over the past few years much of the industry has begun shifting away from redundant fee-for-service models toward value-based ones. This has helped lower costs by pushing treatment courses on the merit of their effectiveness, not profitability. So when HHS announced it would be implementing measures for easier data sharing that push this evolution forward it was mostly seen as positive.

Yet shortly after the publication matters were complicated when healthcare software giant Epic, out of Madison, WI specializing in EMR and EHR software storage, sent a letter signed by an unavoidably lengthy list of hospitals citing concerns over patient privacy. Founded in 1970, Epic is one of the largest storage houses of EHRs so you would not be alone in seeing their defense as mere protection of a de facto stronghold using the guise of patient privacy to conceal this special interest. A more sympathetic view might see them as experts attuned to the complexities of software storage who worry that opening data sharing up for purchase and exploration by third-party IT groups might put at risk sensitive medical information.

The notable thing, though, is how both HHS and Epic cling to the noble position of being defenders of patient and consumer interest. But mark how differently, how interchangeably, the two employ the term consumer and patient, how malleable the term is, with HHS using the language of choice, empower, and Epic, defense and protection, and both reaching antithetical opinions over what is best for us. To be a consumer in this context is to be a very important abstraction, the most important empty chair in the room.

Regardless of who is closer to the truth both parties should take seriously their claims of devotion to the consumer by investing and not hamstringing innovations that might help solve some of the irrefutable headaches that plague this industry. As patients and doctors, as consumers endowed with the power of indifference and ire, it is high time for us to stop being seen as cynical pawns in this tumultuous debate over what is best for the consumer of healthcare while being largely excluded from the conversation. We should be courted as the formidable consumer base we are and looked at as discriminating entities more than willing to turn away from inferior practices, irrespective of which of our supposed protectors is claiming to hold us dearest.

A BRIEF, UNHAPPY HISTORY OF HEALTHCARE CO-OPS: WHERE ARE THEY GOING, WHERE HAVE THEY BEEN?

One of the Internet’s gifts—and occasional annoyances!— is its space for people to self-publish their alleged expertise on a subject. Surely this must be some form of purging. I feel an odd mixture of depression and excitement toward these online message boards. The writers on healthcare forums vary from doctors, hospital executives, and private insurers, to young families whose finances have been wrecked by medical expenses.