Unfortunately, Jon, that’s what Health Care is Like

In the past year, for my full-time job, I have been working with my coworkers to upgrade our electronic claims processing capabilities to the ANSI X12 837 data format, which is in EDI. Most of you know that I’m a big fan of XML over the legacy data formats, and in agreement, my team has bemoaned this project as a necessary evil. Unfortunately, the data format isn’t the worst part of working within the health care system. The worst parts of the health care system are the business processes and rules, which are never 100% true, meaning that a software system has to always be flexible enough to handle the exceptions. This is a problem when you are trying to enforce standards and best practices.  This also means that we will forever be stuck in a paper-pushing world until standards are designed AND enforceable by law.

For example, if a home designer designed a bathroom, and the home owner said “I work from home, and am the primary user of this toilet. I always use the lever to flush the toilet.” The designer finds a standard toilet and installs it in the bathroom. Then the home owner’s wife sees the toilet and says to the designer, “Oh no! It can’t work this way! I use the lever to turn on my sink.” To anyone, this sounds ridiculous. Who uses a toilet lever to turn on a sink? This is akin to how outlandish the insurance payers’ exceptions are that we have to handle in electronic claims processing. We all say “They’ll do anything to deny a claim”, and this couldn’t be more true. They will impose as many exceptions as possible, including not implementing and upholding nationally recognized data standards and identification codes (hopefully more on this later).

Now imagine a complex system where, instead of just the home owner and wife, we have 2000+ insurance payers, 300+ million patients (approximate population of our country), and who knows how many doctors (providers) we have to design for. Try to build a system that accommodates all of these stakeholders, and caters to the insurance payers whimsical ideas of using the toilet lever to turn on the sink.

So when Jon Stewart from the Daily Show scoffed at the Republican side of the debate, saying that their images of insurance business processes and diagrams are “scary looking disingenuous health care reform pop art” I felt compelled to respond. I’m sorry to tell you Jon, that’s what health care is like.

Disclaimer: I’m all for the ethos of universal health care reform, and I believe our country can get there. We just need to give our politicians the time to do their research to come up with a plan that really works.

60 Minutes Tonight

Anyone else just catch Don Norman on 60 minutes? The episode was about the “Revenge of the Geeks”. Essentially, they were saying that our lives are increasingly more electronic, and those electronic devices are increasingly more complex. As long as devices are complex, and the average individual can’t figure them out, geeks have work. With something new coming out every 2 months, geeks have job stability and the flexibility to learn new technologies. This means that they rule the world (at least from the perspective of 60 minutes). In response to that comment from the reporter, one featured geek said “Geeks might inherit the world, but they have no intention of ruling it”.

I only saw Norman for a short bit. He talked about a person that complained and said only an engineer from MIT could figure out the device. He replied that he an engineer from MIT and had no idea how to work that thing. He also introduced scope creep as the reason why most products are so complicated.

He talks about being called an uber geek here.