Dog Days

Hi.  It\’s me again.  No, I\’ve beed doing fine; my writing slow-down is not due to calamity, catastrophe, apostrophe, or even syndactyly.  I\’ve been working hard, working like a dog.
That\’s a strange expression, \”working like a dog\” in that my experience with dogs is with our pooch, Holly.  This is Holly\’s idea of a productive day:


Our cat, of course, makes Holly look industrious.  Zander (AKA Lard-Butt) considers a day productive when he\’s either conned us into feeding him twice in the morning or if he\’s found a new unique place to sleep.


There is a reason why I\’ve never heard the expression: \”working like a cat.\”

So, what\’s been so all-consuming that I can\’t sit down and write?  My computer system.  I know it may sound nerdy and lame, but I\’ve been putting every ounce of my creative energy into building a system.  It\’s driven by two main things: trying to give the best care I can, and doing so while avoiding personal bankruptcy.  Fear of the latter is strong motivation.  So I\’ve been pouring myself into this task like nothing I\’ve done before.  My goal is to build a system that will:

  1. Organize information.  My care will only be as good as the information I have.  It should be presented in a way that gives me just the right amount of information, with the ability to get more when I need it.  
  2. Cope with the flood of incoming information.  Take the piles of communications coming in and route it to the proper storage place, use the information to make decisions, communicate it with the patients, and decide on follow-up.  This is an enormously difficult task.
  3. Integrate with every communication tool possible.  Most doctors don\’t do this because they rely on office visits for income, and that hinders the care they give.  Communication is care, and I want to have good communication that is enlightened by good information.
  4. Create a shared medical record with my patients.  I am convinced that my patients will get the best care if they have access to their information.  But this needs to be done in a way that is both simple and secure.  I want \”one stop shopping\” for people to communicate or look at their records.
  5. Keep my books.  I don\’t want to go bankrupt and don\’t want to go to jail for keeping disorganized books.  It\’s possible to get freed from the fear of Medicare audits, but not from IRS audits.
  6. Organize the future.  There are far too many missed opportunities for care.  Integrated task-management (shared between patient and their care team) is my goal.
  7. Grow with me.  If I accomplish 1-6, my practice will grow.  I don\’t want that growth to outpace my system.

So far I\’ve been focusing on 1, 2, and 5, with eyes on  the rest.  I\’ve made great progress, but there\’s much more needing to be done.  My ultimate goal of this is to build working prototypes of both this practice model and the software that will enable it to be more than just a side-show, an alternative for doctors who want to escape.  I believe that this is truly better care.  It is focused on what the patient wants: to be healthy and to spend as little time thinking about their health care as possible.  It\’s working so far, but it can be much more than it is now.

Once I prove concept of this practice model through the software, I hope I will have lots of folks wanting to use it and transform it into something bigger and better. I don\’t intend, however, on selling the software; I plan to make it open-source, developing it through contributions and donated talents of others.  It\’s the practice model that has the potential to transform health care, not the software.  The software is the infrastructure, like roads or utilities, on which a new model of care can be built.  I will do just fine financially if the practice model works; I don\’t need to make money off of software.

So I am working with people to help make this a reality.  This software won\’t work for most doctors, as it doesn\’t focus on the center of their financial universe: the doctor\’s office.  Care has been held hostage to the office visit.  Communication tools allow care to happen outside the office, and that\’s bad business in the typical office.  I need software that will do things that would harm most practices: keep my office empty, keep my patients healthy, handle little problems that would lead to bigger ones, and give patients the tools to take care of themselves.  This is why most EMR software could never work with this type of practice: it supports the doctor-centered, office-based care system that I abandoned when I started this practice.  I am looking for people who understand this fact, who get the fact that this is not about software; it\’s about care.

I am sorry for the silence.  I am especially sorry to my patients who probably wondered what\’s going on.   I plan on reaching out to each of you, optimizing your care and making sure the records I build will be worthy of being shared with you.  I also plan on making the patient experience as simple as possible.  There should be only one place to go (on the web or in an app) to contact me, fill out forms, look at your medications, and see your records.  It\’s got to be simple, and it\’s got to work for everyone, not just the computer savvy.

Finally, I am working on ways to partner with businesses to give care for their employees.  The interest in this is huge, and there may be insurers out there willing to give cheaper high-deductible plans to people who have a doctor that is hell-bent on keeping them from ever paying out their whole deductible if possible.  I want all of my patients to be healthy: something the system I left would never allow.

There\’s a word for my pursuit of this lofty goal.


3 thoughts on “Dog Days”

  1. Dr. Rob,Congratulations! Sounds like you’re well on your way to having a system that many (physicians and patients alike) will envy and attempt to emulate.
    You’ve probably thought of this, and of a solution, but a red flag was raised in my mind by the fact that you’re planning on making the computer system open source: This leaves potential for unscrupulous people to add holes or bugs to the software that would allow for outside access to patient information. To prevent the potential for compromised security, will you have safeguards, such as a person in charge of approving any edits made to the software?

  2. Of course your software (your code) isn’t important–it’s the design and intentions of your software that matter. Expand this model and a glimmer of hope in the chaos is visible.

  3. Dr. Rob,
    You have no idea how much I’ve tried to persuade my primary doctors to allow me to “EMR” their office for FREE and with FREE lifetime support. Let me know if you could use my help.

    skphilip at gmail dot com

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