I was recently in New Orleans and coincidently listened to an interview with Robert Wachter of the University of California, San Francsico talking about health IT and his new book on where the nation stands regarding electronic health records (EHRs).
Somehow, the temptations of the French Quarter and the problem of EHRs combined in my mind to produce the image of the nation’s health system out on the town, binging on HITECH Act ARRA money, blackout drunk, and waking up married to some very inappropriate electronic health record system.
This isn’t exactly how it happened, but most of the bloom does seem to be off the rose of the electronic medical record and we are in a phase of regret and disillusionment. Physicians have been complaining for years about the hours added to their days by the workflow disruption of digital data entry and the breach in the relationship with patients created by interacting with the computer, rather than the person. At the same time most of the anticipated fabulous features of EHRs are still in the anticipated stage.
Over the weekend, I walked past my wife and kids watching the new season three of Netflix’s House of Cards and was stunned to see the evil President Frank Underwood ranting at his cabinet to get on with designing his jobs program that would be funded by slashing the “entitlements” of Social Security, Medicare, and Medicaid that are “sucking us dry.”
I gave an impromptu lecture to the family on the folly of this policy position—I’m not sure they noticed. And of course, we’ve also written many times about the false narrative of zero-sum intergenerational conflict. (Read Pitting Older Adults Against Children Is a Zero-Sum Game and Analyze This: Misleading Federal Spending Stats Pit Children Vs. Older Adults.)
But what can anyone do when even television writers feel comfortable with this notion that the benefits that older adults earned in their lifetime of work are a dagger to the heart of the nation? While Underwood is certainly a morally compromised character, in this scene he is actually portrayed as the hero, taking decisive action in the face of a roomful of indecisive, equivocating, naysaying bureaucrats.
As Orson Welles might have said: “We will evaluate no program before its time.”
One of the first things you learn in “foundation school” is how easy it is to kill even great programs by evaluating them before they are ready.
Nothing innovative starts working on day one as well as it will with practice, adjustment, and refinement. Even more deadly is an evaluation with low-cost methods that doesn’t really provide the information you want and need. One of the painful lessons I’ve learned is to always buy the highest quality and therefore most expensive evaluation you can afford, because it’s cheaper in the long run.
“Whoever said nothing is impossible obviously hasn’t tried nailing Jell-O to a tree.”—John Candy
As the year comes to a close, there are many lists of the best and worst in almost every imaginable category for 2014. Here at Health AGEnda, we have made an annual practice of reviewing the workforce in training data—specifically, the number of graduating resident physicians choosing additional training in geriatric fellowship programs—published in the Journal of the American Medical Association (JAMA). (Read Boxing Day Brings Glad Tidings for Geriatrics Field from 2013, Decline in Geriatric Fellows Defies Pay Boost: +10% = -10% from 2012 and Falling Leaves, Falling Numbers from 2011.)
I recently saw one of my charts presented (without attribution ) in a Washington briefing session on the workforce available to care for older adults, so I guess I have to keep updating them.
The opening session of the Hartford Change AGEnts Conference in Philadelphia last week.
Last week was the capstone of the first-year rollout of the Hartford Change AGEnts Initiative. This projects aims to engage and support all prior John A. Hartford Foundation health and aging grantees to focus on making systematic, large-scale practice change in the care of older Americans.
More than 160 Change AGEnts converged on Philadelphia for an intensive, day-and-a-half conference that was packed from start to finish with opportunities to learn, share knowledge, and network with others from different parts of the country and different disciplines. It was an energizing experience, not only because it gathered so much of the Hartford Foundation’s most precious assets—its people—in one place, but also because we learned more about the work already underway to improve care. We also saw new relationships and ideas emerge that will advance our mission.
For almost 20 years, the Gerontological Society of America (GSA) has been one of the John A. Hartford Foundation’s key grantee partners.
The organization served first as the home of the Geriatric Social Work Initiative (GSWI), then as the coordinating center for the National Hartford Center of Gerontological Nursing Excellence (NHCGNE) , and most recently, as the basecamp of the Hartford Change AGEnts Initiative.
So the GSA annual meeting, being held this week in Washington, DC, is a tremendous opportunity to connect with long-standing friends and meet new ones in the field of aging, as well as to check in on long-ago grants and plan new ones.
Last week, the Journal of the American Medical Association (JAMA) published a large and well-designed study of a post-hospital readmission reduction program called the “virtual ward,” which grew up in the UK and was tested by our cousins to the north in Toronto.
The model partakes of some elements of other evidence-based work done by John A. Hartford Foundation grantees, including Mary Naylor’s Transitional Care Model, the Society of Hospital Medicine’s Project BOOST, and Eric Coleman’s Care Transitions Intervention.
A press release and JAMA Report video are available for those who don’t subscribe to JAMA.
Last week, the Institute of Medicine released a new report titled Dying in America.
The committee that worked on the report included some long-time grantees and friends of the John A. Hartford Foundation, such as June Simmons of the Partners in Care Foundation, Jean Kutner, a Beeson Scholar and faculty member at the University of Colorado, Diane Meier, leader of the Center to Advance Palliative Care, Patricia Bomba of Rochester, NY’s Excellus Blue Cross/Blue Shield, and Joan Teno of the Center of Excellence in Geriatric Medicine at Brown University.
As always, we are proud to be associated with leaders who give their time to explore such urgent issues.
Ever since I began working as a program officer at the John A. Hartford Foundation, I’ve tried to do my best to put myself in the shoes of the health professionals with whom we’ve worked and whose education and training historically has been one of our main concerns.
I’ve often found memoirs and other lightly fictionalized accounts to be the best way to get into the culture and daily experience of these health professionals. I’ve read Samuel Shem’s The House of God, countless memoirs of nurses and physicians, and even a very affecting memoir of a nurse’s aide in a nursing home.
One of the tricks of such reading is that we experience what our imagination and the author’s words together conjure in a special state of willing suspension of disbelief. Psychological research suggests that this process of imagination and purposeful lowering of critical skepticism is, in fact, what makes fiction so persuasive and engenders the feeling that novelists understand a truth about human character that other ways of knowing can’t match.