Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Monday, September 29, 2014


The Electronic Health Record
I have been following the development of the Electronic Health Record (EHR) for at least ten years and, although it is scheduled for an implementation date of 2015, it appears to me that there are several reasons to expect another delay.  This is especially true in the implementation of the dental component, which is of great interest to me.
Part of the reason for lack of progress is the pure complexity of integrating the various electronic services that have been cobbled together to satisfy very specific needs, defined by specialty, compensation, and broad, disparate delivery models.  This has resulted in a lack of a standard platform for data interchange.  There appears to be some recent progress in the process.  In dental Henry Schein has seized market share with their Practice Management software, Dentrix®, And in Medical a product called Epic® is dominant with their software for groups from small group practices to major hospitals.
And there are some obvious forward steps that are likely to improve healthcare delivery, while controlling healthcare costs.  I dental there is the implementation of what have been called “reason codes” of diagnostic codes embedded in the ICD-10 series of medical codes.  These will allow for development of Best Practices in dentistry by allowing Outcome analysis.  The likely result of such analysis will be a redistribution of healthcare dollars spent on dental services to increase preventive services and decrease cosmetic and unnecessary services, such as crowns on asymptomatic molar “cracked” teeth.
In medicine the trend seems to be a shift from paying for specific services to paying for health improvement.  The developing model is sometimes referred to as an Accountable Care Organization or ACO, a model that has save literally millions of dollars in Medicare costs since its adoption by CMS several years ago. 
One of the more intriguing developments of the HER is the arrival of an entirely new employment opportunity in the health field, which is the subject of this Post:  Scribes.
Medieval Scribe
The term is of ancient origin, at least as far back as the rise of the Egyptian civilization, where people educated in hieroglyphics and later the cuneiform alphabet, found themselves marketable to those less fortunate but wealthier.  Later, in medieval times, those who were literate were called upon to write books, specifically The Bible, until the advent of the printing press.  The story is that one scribe from that time, encouraged the Abbot to go to the original document instead of copying the copies.  The Abbot returned from his research dismayed that the word originally was “celebrate” and not “celibate”; a lesson in the value of editing.
Physicians have dictated their chart notes for years, partially because their handwriting was unreadable to other physicians.  What has changed, with the advent of the HER is that everything must now be electronically transmissible.  Even with voice recognition, the process is innately redundant.  Solution? Have an entry level Scribe shadow the physician and capture the conversation with the patient.  There are security concerns, and technological restraints, but these are being worked out.
A recent WSJ article discussed the blossoming opportunity for the field.  In 2010 there were 700 employees.  That number doubled by 2013 and is expected to peak at some 30,000 in the next few years.  Cost doesn’t seem to be a problem, since the physician’s time is a mitigating factor.  Training may be another issue.  I could find no standardized program, but I find that my granddaughter, which is studying to be a Court Stenographer, may have inadvertently found her future career.
I wish her the best.
PBS recently did a two-piece on Mark Twain.  In my next Post I will share how Mark Twain has intersected through my life and why his history is worth another look.  Please join me.

Thursday, September 18, 2014

Mary and Michael Chang

Michael Chang at the 2014 US Open
I was reminded, as I watched the first Major Tennis Final without a ranked player in recent memory, that Mary had a personal relationship with Michael Chang, who was on the screen almost as much as his new student, Kei Nishikori.  It was a coincidence that brought them both for rehab appointments: his for a tennis injury, and hers for an ACL injury that limited her brushing her hair and limiting how she put on a bra for about eight weeks.  She says that the table near table relationship never got past casual comments, but it was more than seeing someone famous at the airport.

And that got me thinking about how most of us will have occasion to meet some famous people through our lives; usually not live-changing events, but a memory that stands out for some time.

Tom Hanks as Forrest Gump
Although Mary’s life was no parallel to Forrest Gump, the fictional character who met Elvis Presley, “Bear” Bryant, John F. Kennedy and numerous others, she did have one more significant meeting: with Pat O’Brian, the actor who was unsuccessful in luring her uncle from a dental career in Wisconsin to Hollywood.  We saw him in On Golden Pond, when he was likely approaching eighty, and were impressed with the actor trait that dropped twenty years off his age, voice, and movement the minute he was in front of an audience.

She tells of one more: a Congressman from Illinois who, recognizing her need for nourishment held then two year-old Sean while she wolfed down a quick snack (when airlines still served food).  She doesn’t remember his name, possibly because he followed many similar Chicago politicians into infamy, but I remember he was a figure of national prominence.

We also met Peter Bonerz on more than one occasion at Marquette events.  You may remember Peter as a regular on the Bob Newhart Show.

My recollections include Pancho Gonzalez, who was ranked World #1 for a record eight years.  I met him at a cocktail party in   Newport, Rhode Island, where he was being honored and I had the good fortune to have a sabbatical year at the Naval War College.

My next one of note was Orson Bean, who I met in St. Thomas, an event I chronicled in my book, Harnessing a Heritage. I had an opportunity to meet him again about thirty years and at least two wives later (him, not me) when we saw him in a play at the Segerstron Center.

I’ve been fortunate through my life to meet many people, famous and/or in high positions, including dozens of dental Admirals, several of whom danced with my mother and were friends of my father.  Unfortunately, it seems like most of the ones I know have passed, some very recently.  In my corporate world, I met several leaders, the most impressive probably being Leonard. B. Schaeffer, who headed WellPoint for several of the ten years I was there.  I was fortunate enough to score a coup in 2000, when I got him to be the keynote speaker at the CADP Annual Conference.

My almost forty years of professional acting has put me on the stage or screen with several notable stars, my favorite being Danny DeVito, who is shorter than me and had trouble with his lines.

When I remember these contacts I am reminded of a true story I tell about meeting a corpsman friend, out of the service and into the dental supply industry.  He met Mary and me at a cocktail party and, after some “what have you been doing” chit-chat, left saying, “I want to thank you for changing my life.”  As he walked away, Mary asked me what I did, and I truthfully said, “I have no idea.”

It’s a humbling thought to think that I might be on someone’s list as Michael Chang is on Mary’s.  I’m sure that those of you who think back on your life will find people similar to mine and perhaps even instances similar to that of me and my corpsman.
In my next Post I intend to explore a new field of opportunity.  I am calling it The Rise of the Scribes.  Please plan to join me.

Wednesday, September 10, 2014

Band Concerts

Last weekend was Labor Day, traditionally the end of the summer.  That, and the notice that there was to be a free concert in downtown LA got me thinking about the Band Concerts I went to as I was growing up.

My home during those formative years (with the exception of when I was 8 and 9 and lived in California to see my father off to war) was Mason City, Iowa, a town famous for two musical events: the birthplace of Meredith Willson, of Music Man fame, and the airport where Buddy Holly took off on the Day the Music Died.

My mother went to school with Willson, and I attended the Surf Ballroom many times while in high school and college, but I was really aware of the music heritage of the city from the summer Band Concerts.

They were held in East park where there was a fairly large shell on Sunday evenings about eight o’clock.  The program was pretty formulaic: beginning with the National Anthem, followed by one or more overtures, featuring popular songs, show tunes, or light classical pieces. Somewhere in the program would be one or more featured vocalists.  The concerts always ended with a patriotic march of one sort or another.

It turns out the patriotic atmosphere was not accidental.  From the earliest times in our country’s history, concerts stirred the populace to pride and occasionally patriotic fervor to support whatever war was impending or present, or to commemorate those who have gone before.  In fact the precedent for municipal bands came from military bands, a fact not lost on anyone who lived for very long near our Nation’s Capital.

When we were stationed in the DC area, especially the tour I had at the Naval Medical Command, on the fringe of the Mall, we had many family visitors, who found so many of the free events, such as band concerts, to be an attraction for young and old alike.

As I was growing up, I assumed that every community of size, especially in the Midwest, had a community band.  After all, most had a band stand of one size or another right in the heart of town.  It turns out that Iowa was special. In 1921 a band composer named Karl King was influential in passing the IowaBand Law, which allowed communities to levy taxes to support musical groups to entertain the populace.

When I left Mason City for college, Dental School, and a career in the Navy I found military bands in abundance.  Not just in DC, but also at Change of Command celebrations.  One of my favorite quotes comes from a Marine wife, attending a Change of Command, who said, “Just when you’re about to throw the SOB out of the house, they dress up and have another parade!”

But, grand as those ceremonies were, I still have fond memories of meeting classmates under loose supervision after dark, in the summer, listening, holding hands, and building summer relationships.

Clyde McCoy
As I was researching for this post I was able to contact a high school friend named Jim Fitzgerald (no relation, as the small “g” would indicate), who actually played in some of those concerts.  He eventually parleyed that into a career, starting with a stint playing with the Clyde McCoy travelling band before developing a more traditional career as a school teacher.

Jim reminded me that his father had been the band master at what was then called a Junior High School, and the actual Band Concert Master was the high school band master, Carleton Stewart.  He always had the Mason City bands competitive for the state contests, and was likely the inspiration behind Willson’s Professor Harold Hill.

Along that line I have always contended that my mother, who worked for a while as a librarian at the Mason City Public Library, may have inspired the character, Marion the Librarian.  Meredith Willson was a year ahead of her in high school.
BTW, that free concert in LA was a DJ affair and probably had no patriotic music. Kind of sad.

Watching the US Open last weekend, I was reminded of how famous people come into our lives.  I’ll share that with you in my next Post.  I hope you will join me.