The Healthcare Tsunami

 The important people were here.  

They hung framed as faces on the wall at the National Press Club. The entire venue was dressed in marble, old polished wood, brass details and heavy drapes. Here were the symbols of the establishment: the status quo, the exclusive club. Within the room we filed in row, cameras pointing forward to the stage. 

The important people were here.  

The room was filled with tall beautiful people. Many were elder statesmen in their fields, their silver-white hair a testament to their years of labor whilst toiling for the good. They were doctors, aviators, scientists, and researchers. They were reporters, government officials and CEO’s. This summit day focused on Health Information Technology at a cross roads with Patient Safety. The speakers came to the summit, taking time from their busy schedules to address the assembled, catching the last flights out of town in order to speak on this day.

The day began at 8:30 in the morning as we viewed the documentary produced by TMIT (Texas Medical Institute of Technology) and The Discovery Channel: “Surfing the Healthcare Tsunami: Bring Your Own Board.” I set up my easel in the back of the room and my eyes touched upon the backs of those assembled. Even in the darkness lit by the flickering film, I knew many of those backs. They wore their souls as paint on fabric. I knew them not by their job titles, but by their struggles. 

In this room were the disadvantaged, the ones who were barely getting by. Some received care due to Medicaid, some worked long hours and still cared for their relatives. Some faced discrimination for their interests, their gender, their sexual orientation or the color of their skin. These who sat in a room of greatness had faced a crucible of pain.

The important people were here.

I painted the movie and the meeting. I was honored to witness the combination of many talents join together to reach a greater understanding of the immense struggle we face in reducing healthcare harm. Here was technology, health and information combined.

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I began the piece by painting with sharp brush stokes the oncoming wave. In a riot of attacking blue the waves descend upon a hospital building. I have been to many small towns where the hospital is the largest building. If there were a tsunami wave descending, I would scale the heights of the hospital and hope for the best. 

Upon this man-made summit a small crowd forms. They are fighting against the waves. To the far left a young teen in a hooded jacket holds a smart phone up toward the coming storm.  A series of conference tweets spool off the device. Here we see @TiffanyandLupus say “Silos Kill- Charles Denham #HITTMIT.  Then we see @Kaitbr’s “HITTMIT a collision between patients and HIT.” Next @Lygeia with “The rate at which technology is changing is shifting the landscape #HITTMIT.”  Finally, @TrishaTorrey states: “6th stage of grief is proactive survivor.” 

While painting this I noticed that every person tweeting the hashtag was female. I don’t think I have ever seen a twitter stream focusing on HIT so thoroughly dominated by women. Then, I looked at the panel currently speaking consisting mostly of men. I thought at this moment what a great unifying force technology brings. The voice once silent at the podium loudly comments online and the ripples of her thoughts spread far and wide.

Protecting the crowd on top the hospital are two blue angels. To the left, the larger fierce angel represents the “Blue Angels” themselves. Here the tools of aviation are arrayed in opposition to healthcare harm. As Dr. Charles Denham, our moderator and creative force behind TMIT, asked Aviation safety expert John Nance, “What if we had a NTSB (National Transportation Safety Board) in medicine?”  What if every surgery had a black box?  What if errors were revealed within days to the whole world so they would not happen to others?  Fellow aviators like Dennis Quaid work toward this end. Months before his twins were harmed, the same medication error happened to other children and resulted in their death.  Failure is great teacher. We remember with crystal clarity the worst moments in our life and the knowledge gleaned from mistakes made can be taught to others.

Below the guardian angel, a young patient stares at us. The wind of harm is almost blowing the gown off her back and her hair whips around her head in frenzy, but still she huddles protectively over a child younger than herself. Behind her a doctor holds a surgery checklist defiantly toward the wind. To the young girls right, another patient stands.  His Johnny gown is open and he holds his IV staff as though it is a battle standard. 

To the far right a little blue angel stands. She is Emily Jerry. She was mistakenly given a chemotherapy solution with 23.4% sodium when the amount should have been less than 1%. She died a painful death at the age of two. Eric Cropp, the on duty pharmacist responsible when a technician under his supervision made an error, went to jail. Emily’s father Christopher founded the Emily Jerry Foundation to support patient safety. Christopher publicly forgave Eric and speaks with him at medical conferences. Christopher believes we should focus less on blaming individuals and focus more on the system that allows such errors.

Emily is holding a life preserver that says HIT and patient. Throughout much of the day we heard about the power of technology to catch error, but the patient and family can act as a double check as well. So Emily hands this life preserver to a pit-crew member. NASCAR has learned the power of teamwork and transparency in keeping drivers alive. Medicine must do the same.   

 


Below and to the left of our crowd a black vortex swirls inward spinning money toward flames. This is our current payment model: a fee for service system paying for additional tests without requiring proof continuity of care and positive experiences. Here are quiet malpractice settlements with non-disclosure orders. Here is a dark silence that kills, while money burns.

To the right of the vortex is the HMS Community, a ship based upon the Titanic. We gather this day to stop the ship before it sinks.  We must redirect before iceberg hits or the oncoming wave capsizes this massive structure. If we fail a great deal of people will die and the majority of them will be those in "steerage."  


This is the 100^th anniversary year of the Titanic sinking. Here is a quote from the film of that name: Titanic (1997)

Ruth: “Will the lifeboats be seated according to class? I hope they aren't too crowded.”

Rose: “Oh mother, shut up! Don't you understand? The water is freezing and there aren't enough boats. Not enough by half. Half the people on this ship are going to die.”
Cal Hockley: “Not the better half.”

My late husband and I saw that film in the theatre.  It showed true love in a moment of utmost despair.  I am not talking about the relationship between the protagonists Jack and Rose.  No, I speak of the mother in steerage.   When she realized there was no way out for her and her young family she went back to her small cabin and read them a storybook.  As I read my Fred the Dark Tower, as Lewis Blackman read Dune, we read alone in hospital rooms as the ship sinks around us.  The power of the story can offer solace in our deepest despair.

But story can do far more than that.

Stories once told will spread, changing systems of care as well as s systems of thought. So this day, this painting, this documentary and all the speakers on Speakerlink.org encapsulate the patient stories that stream above the waves.  The stories will escape to build the world anew.

Yes, Hubris sunk the Titanic. The Hubris that bigger and better was an end in itself, and the designers of that ship disregarded the potential of communication technology.  But Hubris is more than just an over inflated sense of pride.  It is the subjection of those who are powerless by those in power.  It is harming those who cannot speak for themselves whether they are little Emily’s or men in open Johnny gowns. 

So within this painting the building is labeled “Hubris Hospital” for we are at a crossroads. We are at the collision of technology and tradition.  Technology is sharp.  It is made of glass, wire and hard data. When it presses against inflated egos and the rounded comfort of custom, it will pierce.  


Leave this post inspired to act.  Comment now on the proposed rule of Meaningful Use Stage 2. Make sure the patient voice is front and center.  Watch this Documentary and act upon it.  Join your local Hospital Board or patient advisory board, join Speakerlink.org.  


Whatever you do, speak up.  Be the siren that warns against the wave.