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Why the Healthcare.gov Site Failed

In the Time Magazine March 10 2014 edition there is an article on how the Affordable Health Care Act’s Healthcare.gov site was fixed.

When the healthcare.gov site was launched in October 2013, a mere hundred or so users caused the site to crash.

Typical of government led initiatives, the different sections responsible did not work in unison and there was no clearly identifiable person in charge of the site. Different parts did not know what was going on, so each assumed all was well and progressing forward. The Centers for Medicare and Medicaid (CMS) spent over $300 million on building a website that did not work. Their tech people forgot simple things like creating a cache, where most frequently accessed information is stored in a layer above the database. In that way queries could proceed quickly and not tie up the entire site – this is done in commercial sites.

The White House was forced to hire properly skilled tech folks from companies like Google to revamp the health care website. The newly hired consultants found that the original government designed site “hadn’t been designed to work right…that any single thing that slowed down would slow everything down.” Many of these troubleshooters fixed the site at a fraction of their usual pay. The lesson is that rich government contracts are awarded to incompetent cronies or to the lowest bidder. Since this is not a meritocracy, it’s unlikely that contracts would go to the most qualified at the onset. The good news for the government is that others can be hired later to do repairs.

Since originally there was no leader of healthcare.gov, we will never find out who was responsible for this mess and why so much money was wasted in the first place.

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How I Use Twitter

With all the buzz online and in the news about the Twitter – how it should be used, the stock, can it make a profit, I decided to write about how I came to embrace Twitter. Before October 2013, I knew nothing about Twitter. I only started an account after attending a course in Social Media at the Mayo Clinic.

Around that time everyone, everywhere was chatting about the upcoming Twitter IPO. People asked what was Twitter, what was its role, how could one use it. Many predicted the IPO would not do well as it had yet to make a profit and some felt its growth was slowing.

I read “Hatching Twitter” by Nick Bilton who wrote there “were two completely different ways of using Twitter. Was it about me, or was it about you? Was it about ego, or was it about others? In reality, it was about both.”
For some, like celebrities, it is about sharing status, where they are, or what they are doing. For others it is about sharing news, more a “communication network, not just a social network” Bilton writes.

This disagreement underpinned that of two Twitter founders, Evan Williams and Jack Dorsey, which lead to each falling out as friends and partners.
I don’t care if Twitter ever makes a profit. I am happy to use it my own way as each and everyone of you can use it as yours.

As a professional, I avoid Tweeting about myself as much as possible. I use Twitter to post links to interesting articles about my work, health care and surgery. I can always go back to these references later. In that way, Twitter is a catalogue of my online professional musings and learning.

I attend several medical conferences a year. Twitter allows me to share what I learned from these meetings and some have gone so far as to say that social media tools like Twitter may make attendance at these meetings obsolete. I hope not. While at a meeting, I use Twitter to share information, start conversations, and share my adventure as a tourist with pictures of local sights, restaurant finds, and discussions of things to do.

On a personal note, I do use Twitter as a form of a diary. It matters little to me if my followers read it as I am tweeting for myself. I spend a lot of my leisure time travelling, eating out, reading and at the movies. Sometimes I forget what I did or when I saw something or travelled somewhere. I attribute this to age. So I record most of my day on Twitter so I can reflect back on these experiences and memories later. I expect that with time and a growing number of posts, going back to review these will become more difficult.

How you use Twitter will not be the same as how I do it. Perhaps you want chat about a topic, investigate an interesting topic, market or sell something. I wanted to write about the particular way I use this social tool.

Healthcare – The Moral Duty to Buy Health Insurance

Click on this link to read it – Moral Duty to Buy Health Insurance

Moral Duty to Buy Health Insurance

This article in JAMA was pointed out to me by my son. Tina was his fellow classmate in the Yale Philosophy Phd program. I understand this article caused a stir among celebrities.

The Road Ahead

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I learned a lot at Mayo this week and quickly applied it. I want to share this knowledge with my colleagues but the story would really play more like this:

One day I left my village and travelled to the city. I read many wonderful books and I came back to my village and told the villagers about these books. However they could not see what I learned nor could I show them because books are banned in my village.

I felt like a delegate from North Korea who came to the Mayo Clinic to learn about Social Media. Upon my return home, I was not able to show my country folk the value of Facebook, Twitter, Pinterest since my country does not allow access to these sites.

This is the problem I face at my hospital. I want to demonstrate to my colleagues the wonderful things that social media can do for their practice and for medicine and for their patients. The problem is the access to all social media on the Internet at my hospital is blocked. The only way to show them the benefits of social media is by taking them off campus.

Even more laughable is that all emails from my friends at the Mayo Clinic Center for Social Media are filtered out by my hospital system spam filters. So much for a two way conversation.

I want to start somewhere, for me it’s the bottom rung. I see a long climb ahead. I am a neophyte in these arenas but I have started my on my own. My employer will not support me and I suspect, some will try to stop me. They cannot stop me from expressing my views. I am not going to make defamatory comments. I do not plan to disclose any medical, personal, or confidential information. I will follow the ethical guidelines for Social Media use as outlined by the Mayo Clinic. Mayo Clinic Social Media Guidelines

Let light shine out of darkness as it says in the Bible 2 Corinthians 4:6

Geisinger Heath and Social Media

In early October 2013 the Geisinger Health system held a special one-day conference on social media. I was unable to attend since I was at the annual American College of Surgeons meeting in Washington DC.

I would hope that from such a meeting Geisinger would come out of the dark ages and start to allow its employees and others to access social media while they are on their facilities.

Since the meeting nothing has changed. Though wireless access now no longer requires a password when you get a message to ‘like’ Geisinger on Facebook while on it’s wireless system you find yourself instantly blocked.

Similarly, access to Twitter, Pinterest or any of the other important social media sites continue to be blocked. Any inquiry about the reasons are met with the answer that Geisinger is very concerned about patient privacy. Why can large systems like the Mayo Clinic successfully engage with social media? Is Mayo any less concerned about patient privacy than Geisinger, I doubt this is true.

Meanwhile patients and their family, doctors, nurses, other healthcare providers are walking around Geisinger most of whom are carrying a mobile computer in the form of a smart phone or tablet. These folks have the ability to photograph or film anything going on in the hospital so if Geisinger is so concerned about privacy why doesn’t it confiscate these devices at the door? Instead of metal detectors, Geisinger could install detectors for smart devices.

I am being facetious. My hope is that with time and I hope this time is soon, that the Geisinger system will allow access to Social Media. It is only through such access that the system can improve its engagement with patients and their families. The benefits are immeasurable.

Social Media and Surgery

I am like everyone is learning how Social Media interacts with Surgery, specifically my own specialty of Colon and Rectal Surgery.
The wrong thing to do is to turn away, say I’m too busy, I have enough patients to see. The key is not to look strictly at Social Media as a marketing tool.
Everybody has a digital footprint. All doctors can be found on every search engine.
Many things are being written about us, how good we are or who bad we are.
We have to write our own story I learned today. If we doctors don’t write our own story, someone else will do it for you.
We need to control our story, that is why we need to engage in Social Media. We have to drive the conversation.
We can’t stay on the sideline, we have to get into the game – now.