Meaningful Use of Information

The health care debate related town halls have given the media enough sensationalism for all of us to be exposed to it on a daily basis. But try and actually find clear information on what the American Recovery and Reinvestment Act of 2009 covers and you will find yourself frustrated and annoyed with the lack of clarity around the topic.

So as usual I abandoned the government sites and started reading posts made by experts, vendors and people like you and me; each one trying to either understand the Act or extract one piece of information that makes a business case for a product or service. I started scanning for the term information technology and came across the Health Information Technology for Economic and Clinical Health Act, which is part of the 2009 American Recovery and Reinvestment Act of 2009. Through this Act the government has allocated $20 billion to health care information technology. It’s intended to achieve widespread adoption of health care IT systems and to enable electronic exchange of information to create a seamless, paperless exchange of information between health care providers, patients and the government. A portion of this $20 billion is allocated to providing incentives to physicians ranging from $40,000 - $65,000 if they can display meaningful use of health care technology systems. There is also a mention of saving the government $10 billion through improved quality of care, reduction of medical errors and duplicative care.

But wait…there is a catch! The twist to this allocation is that health care providers have to demonstrate “meaningful use” of certified electronic health record technologies (EHR). My first reaction was oh no…..here we go again, the health care IT industry will have to reinvent itself as EHR technologies.

“Meaningful use” is defined in the legislation as:

• Using certified EHR technology that includes electronic prescribing. The certification would be conducted by the National Institute of Technology (NIST)
• Using EHR technology that allows electronic exchange of health information
• Eligible professionals must submit information on clinical quality measures and other measures selected by the secretary of the Department of Health and Human Services (HHS).

There doesn’t seem to be much clarity around specifics of reporting meaningful use but health care providers are anticipating that the Department of Health and Human Services will provide specifics and clarity about what they will need to do to demonstrate meaningful use. Most providers will have one year – 2010 – to finish EHR implementation and put the infrastructure, applications and training in place to be eligible to receive as much of the incentive money as possible.

There are also some stringent requirements around security. For example, records cannot be sold, the penalties for violations have been increased, data must be encrypted and providers must keep an audit trail of whom they have shared information with.

So, what does this mean for information providers? There are numerous packages in the market that offer simple medical book keeping for small offices, there is off the shelf software for filing electronic claims, and then there are institutional health care administration packages for hospitals and hospital systems.

The “meaningful use” clause will require vendors to create a complete package or solution for health care providers. This includes networking capabilities for doctors, a patient portal where a patient can access their medical records electronically, and a feedback loop where patients have an opportunity to rate their physicians. The intent is to give incentives to providers who think of their practice as outcome driven rather than service oriented.

You can find the American Recovery and Reinvestment Act of 2009 at http://thomas.loc.gov/cgi-bin/query/F?c111:8:./temp/~c111rCLY0v:e181205:

Is Talent Overrated?

“People who do the common things in this life uncommonly well will command the attention of the world!” --George Washington Carver

My friend recently mentioned that she had read this book called "Talent is Overrated" where the author proposes that people are not necessarily born with a specific talent, some may have a physical advantage (such as height in the game of basketball) but for the most part a person's talent is the result of hard work, perseverance, and 10,000 hours of practice in the least.

Talent is the natural ability to do something better than most people can do it. This ability is fairly specific, it's innate, you are born with it, and if you are not born with it, you can't acquire it.

Based on this definition, author Geoff Colvin argues that Tiger Woods was not born with an innate ability to play golf. Tiger's father put a baby size putter in Tiger's hand at the age of seven months, propped him in a high chair in the garage and entertained him for hours by hitting golf balls into a net. By age four Tiger was taking golf lessons under professional teachers and played his first international competition at the Walker Cup after seventeen years of intense practice. Colvin goes on say that when asked about Tiger's phenomenal ability to play golf, both father and son cite the same reason: hard work.

The kind of intense practice that Colvin refers to in his book is not just a routine repetition of the same act over and over again but rather what he calls deliberate practice. Deliberate practice, a term coined by Anders Ericsson is characterized by several elements. It is activity designed specifically to improve performance, often with a teacher's help; it can be repeated a lot; continuous feedback on results is available; it's highly demanding mentally; and it isn't much fun.

I know you've zeroed in on the last point. Deliberate practice is no fun. Colvin explains that the reason it's no fun even though it's an activity you generally enjoy doing is because in deliberate practice you intentionally seek out what you don't do well and keep trying to improve it rather than continually practicing what you already do well. The good news about deliberate practice is that it's difficult, which means most people won't do it. So if you are willing to do it, it will distinguish you from the rest all the more.

So how would one apply the principles of deliberate practice to an organization? Here Colvin talks about the principles of great performance. He admonishes that the global economy, the move from financial capital to human capital has left no place for subpar performers to hide.

The primary principle of great performance within an organization is a true commitment to developing people by:
--understanding that each person in the organization is not just doing a job, but is also being stretched and grown
--finding ways to develop leaders within their jobs
--understanding the critical role of teachers and feedback
--identifying promising performers early
--understanding that people development works best through inspiration, not authority
--making leadership development part of the culture.

A great organization consists of great performers. And great performers have one key characteristic, passion. They are intrinsically motivated. When creative people are focused on solving a problem, the focus is the solution and not what the solution will do for them personally. Extrinsic motivators also play an important role in great performance. Not all work is creative all the time, rote work like documentation, accounting, communication, etc is not exciting or enticing but still needs to be done. In this case extrinsic motivators can go a long way in keeping people motivated.

According to Colvin, organizations typically fail at motivating their employees because they are prescriptive. You are assigned a project, you rarely ever have an opportunity to select your own project. Feedback is rarely constructive, nonthreatening, and work-focused. It tends to be personal and accusatory.

In conclusion, Colvin has tried to create a link between deliberate practice, great performance, creativity, passion and ultimately accomplishment. On a personal level he has provided some models for deliberate practice that are worth looking into.

From a software perspective I came across an interesting application of deliberate practice. Mark Needham, a software developer writes on his blog about the possibility of using design coding dojo sessions to deliberately practice good coding techniques. According to Needham "areas of practice for future coding dojos could be: Refactoring a code base, using tiny types, coding in a functional way, and so on." An interesting thought...

We would love to hear your thoughts on talent, practice, deliberate practice, design coding dojo sessions or any other concept you find interesting in this review.