Monday, July 25, 2011

Nurture Dissent

In ancient Mesopotamian judicial systems, it was against the law to convict a suspect of a crime without a dissenting judge or juror.  In other words, the system recognized the imperfection of human judgement and ensured that every suspect and different point of view should have at least one advocate.  A 100% consensus judgement of guilty was not allowed.

Every major business decision should include at least one major dissenting opinion in the debate.  If not, there's something wrong with the decision making culture... and leadership would be better served to find a dissenter.

RFP: Cayman Islands Enterprise Health Information System

The Health Services Authority of the Cayman Islands is engaging in the selection of a core vendor to supply an Enterprise Healthcare Information System. HSA defines a “core vendor” as an extension of its senior leadership who shares the same vision and values to constantly evolve and improve clinical, financial, and administrative operations.  Qualified vendors are encouraged to respond with their proposal no later than noon, 23 September 2011. 

At present, the core enterprise applications are provided by the Cerner Corporation.  The contract for those services expires in June 2013.  The RFP begins a re-compete process for the award of that contract. The intent is to evaluate other vendors and products, and determine if it is in the best interests of the Cayman Islands to remain in partnership with Cerner. Cerner will be invited to participate in this re-compete. 

The RFP can be downloaded from the Central Tenders web site here.

Saturday, July 23, 2011

Making Small Healthcare IT Start-Up Easier

Many friends and professional colleagues are taking advantage of the growth in healthcare IT spending to start their own companies, which I think is great.  Quite a number of them call me for a sympathetic ear to lament about their administrative burdens.  In the mid-1990s, I was a founder and partner in a very successful IT consulting and software development company... but the idea of doing it again makes me shudder.  The administrative paperwork, payroll taxes, and corporate taxes were a NIGHTMARE to manage-- one of the most stressful and distasteful uses of my time, ever.  Equally stressful and expensive was providing affordable, high quality healthcare coverage for our 50 employees.

More and more, I am convinced that the most effective way to stimulate the economy and efficiency of small business employment and innovation would come through the elimination of payroll and corporate taxes for companies with less than 100 employees... with an eye on eventually eliminating payroll and income taxes for all companies and employees...and replaced with a national, simple sales tax.  No more IRS, no more tax loopholes.  You buy something, you pay taxes. End of story.  Seven states (Alaska, Florida, Nevada, South Dakota, Texas, Washington, and Wyoming) and virtually all US cities operate on this "no income tax" economic model.  Can you imagine filing a tax return for your city?  Of course not... we've come to expect a sales tax as a means of funding local government and infrastructure.  Likewise, making no-frills, affordable healthcare coverage available through a government-run program-- i.e., making Medicaid/Medicare available for purchase-- would be enormously helpful to small businesses.  I am absolutely convinced that these two concepts would jump-start small business growth like we've never seen before.  And I'm equally convinced that the concepts would find support among enough Republicans and Democrats to make it happen.

Why not, during this time of economic and unemployment crisis, try this "tax free status" for small companies as a federal experiment for five years?  How about a five year experiment for small employer buy-in to Medicare and/or Medicaid?

Below is a great excerpt from a related blog in The Economist.  The full blog can be found here.

"We need to stimulate the prospects for employment, but we also need to make it easier for people to just work in ways that may not show up in the official unemployment stats. You can think of this as tearing down barriers to "self-employment", if you must. Clearly, decoupling health benefits from employment would help a lot. Less obviously, but at least as importantly, we need to eliminate the insane patchwork of regulations that keep folks from legally cutting hair for money in a kitchen, or legally making a few bucks every now and then taxiing people around town in a 1988 Ford Escort. De-formalising and de-bureaucratising labour certainly makes it harder for government to track who has paid what to whom, who owes how much in various taxes, and so forth. But it would be truly pathetic if the legal/economic organisation of our society was optimised for government surveillance and tax collection and not for the exercise of autonomy in pursuit of a meaningful life."

Sunday, July 10, 2011

HITECH the Only Bright Star in $1T Darkness?

Arguably, the only investment from the US federal stimulus money that might have a long term return on investment (ROI) is the money being invested in healthcare computerization which should eventually drive down costs and improve quality.  Unfortunately, that money-- the HITECH (Health Information Technology for Economic and Clinical Health) Program-- is being spent on mediocre but very expensive health information systems products, so the ROI will be minimal and require at least 5 years to least 5 years.

In the US, we continue to elect politicians who make promises to maintain and/or increase federal spending and/or reduce taxes.  We can't have both.  As this chart below clearly indicates, we've been on a steady mismanagement of tax revenue vs. tax spending since the early 1980s-- when the rate of the curve started to take off under the Reagan administration.  In the past three years, the curve has gone straight up under the Obama administration.

Federal spending can only improve the situation described in this graph if that spending is invested to increase business productivity.  Unfortunately, the Obama administration spent--not invested-- $1T in stimulus money on short term job creation--hiring for the sake of hiring-- not long term investment to aid local economies and business productivity (new technology for manufacturing, more efficient transportation; business venues that generate jobs, taxes and local economies; lower cost fuel, less burdensome tax laws, new software engineering techniques, scholarships (not student loans) in critical skill areas, etc.). That $1T in stimulus money is now gone and so are those short term jobs.  In my hometown, the Civilian Conservation Corp, born from the federal stimulus money of the Great Depression, built the county fairgrounds.  That venue hosts innumerable events that continue to contribute to the local economy, 80 years later.

Anyone who campaigns and suggests for one moment that we can change the direction of this curve without cutting Medicare/Medicaid, Defense, and Social Security benefits...AND raising taxes is running for short re-election, not long-term leadership of the United States.

Credit to the US Federal Reserve, St Louis for this graph, Kevin L. Kliesen and Daniel L. Thornton.

Sunday, July 3, 2011

Let People Tell Their Story

People, including the people you work with and especially kids, have an innate need to tell their stories…their yarns.  Don’t try to pick the stories apart.  Sometimes specific facts matter, and sometimes they don’t.   Be keen to the difference.  And definitely don’t just sit there, saying nothing.  Help them tell their story.  Help them weave their yarn.  Better yet, live life with them and help them build the memories and experiences that build their stories. 
Life is more fun that way for everyone.  :-)

There is a long series of events and situations that I've observed over many years that helped me finally understand this--no single event in recent past.  :-)

Nuclear and Healthcare Decision Making

Nuclear warfare operations was my data-driven decision making environment before the healthcare phase of my career. It was all about recogni...