No Shortage of Material for Satirical Health IT Web Sites

by George Lauer, iHealthBeat Features Editor

After a fall vacation in the Caribbean, a restful holiday at home and a toast to the new year, the visionaries from SEEDIE and Extormity say they're ready to help usher in the digital age of U.S. health care.

If you're not already familiar with the work of these two health IT organizations, you should probably check out and before proceeding much further with this feature. What you're about to read will make a lot more sense, or at least you'll be better armed to appreciate the non-sense, after a visit to these sites.

SEEDIE is the Society for Exorbitantly Expensive and Difficult to Implement EHRs. Extormity is explained online like this: "At the confluence of extortion and conformity lies Extormity, the electronic health records mega-corporation dedicated to offering highly proprietary, difficult to customize and prohibitively expensive health care IT solutions."

iHealthBeat caught up with Extormity CEO Brantley Whittington and SEEDIE Executive Director Sal Obfuscato (not their real names but the only ones we know) for a look back at how health IT arrived at where it is today in America and where it's going next. The two "executives," who have been anonymously spoofing the health IT industry in general and EHRs in particular with their satirical Web sites for a couple years now, agreed to answer a few questions about "meaningful use," certification, social media and the future of SEEDIE and Extormity.

iHealthBeat : You have some unusual ideas about expanding the definition of meaningful use of EHRs. Are those ideas gaining any traction?

Whittington/Obfuscato: Our "Whine Into Water" lobbying campaign has been a partial success. On one hand, many of our vendor brethren have joined us in urging HHS to slow down, avoid overreaching and phase meaningful use in over a long period of time -- at least as long as it took James Cameron to conceive, shoot, edit and release "Avatar."

On the other hand, the proposed rule published late last week did not water down meaningful use guidelines to the extent we advocated. We have been vocal about our efforts to lower the meaningful use bar while being more creative in our definitions. For example, embedding a philosophical alert in an EHR application such as "I think, therefore I am" increases the likelihood that physicians relegated to clerical data input will remember to think clinically.

Our aim is simple -- to create the illusion of doing more, while creating tangible benefits for the slow and plodding EHR vendor community. Rest assured, those of us in the exorbitantly expensive and difficult to implement EHR camp will use the public comment period to flood CMS, HHS and ONC inboxes with pleas, appeals, petitions, entreaties and threats.

iHealthBeat :  How do you see social media fitting in to the new landscape of digital health care in America?

Whittington/Obfuscato: Perhaps you missed our recent alert on SEEDIE Twitter certification -- a 140-character pledge that enables EHR vendors to achieve certification with an online attestation and a check for $30,000. You can now follow SEEDIE and Extormity on Twitter, underscoring our belief that social media have a place in the health IT world. Extormity is also working on a lab results Facebook page where patient results are placed online for all to see. While some have raised privacy concerns, the so-called "Facebook generation" does not hesitate to post titillating photos and thus is unlikely to shy away from sharing HDL levels or ultrasound images.

We also see an opportunity to use "crowdsourcing" for diagnostic purposes, enabling physicians to use social networking to get diagnostic input and effectively spread medical/legal liability.

iHealthBeat : Before the holidays, you equated the certification of electronic health record applications with the process of certifying turkeys. Has that analogy won any converts and have your ideas changed any minds at HHS?

Whittington/Obfuscato: Not surprisingly, we have encountered far less resistance to certifying turkeys than certifying EHR systems -- largely because meaningful use of a turkey is much easier to achieve. For a turkey to be considered interoperable, it simply needs to integrate with gravy, stuffing, mashed potatoes and candied yams studded with melted miniature marshmallows. In fact, we have petitioned IHE for space at this year's HIMSS Interoperability Showcase so that we can demonstrate holiday meal integration using HITSP standards. Quality measures such as ensuring the turkey is ready for consumption are easy to demonstrate, as most turkeys have embedded a pop-up timer -- the poultry equivalent of integrated clinical decision support.

iHealthBeat : The recently reorganized Office of the National Coordinator for Health IT has outlined an ambitious process to get the U.S. to embrace and use health IT. Do you have any advice for the ONC?

Whittington/Obfuscato: Hey ONC, keep the money coming! Most of us in the health care IT community butter our croissants with the profits we generate as we sell our exorbitantly priced EHR systems. Sure, there are more affordable Software as a Service alternatives out there, but those EHRs do nothing to support shipments of costly hardware or provide jobs for the IT professionals who support our overly complex legacy architectures.

We serve our clients by serving up big dollar client-server solutions. To successfully drive adoption of these outmoded and over-engineered systems, we need to put more stimulus money in the hands of doctors and hospitals. Those doctors and hospitals can then endorse those checks right over to us, enabling us to lock these health care providers into long-term contracts designed to keep our revenues flowing.

In addition, we strongly urge ONC to allocate grant money for expensive projects destined to fail. The recently announced "Beacon" program will enable a handful of progressive communities to accelerate health IT gains already made, showcasing the value of widespread adoption and use. We are proponents of a counterbalancing program we are calling "Ground Fog" that sheds light on communities where EHR adoption is ill conceived and poorly executed.

Vendors like Extormity can implement SEEDIE Certified solutions which can serve as a "don't do it this way" warning, while squandering tens of millions [of dollars] in funding. While these negative object lessons are expensive, they are valuable nonetheless.

iHealthBeat : Do you have any advice for the various government and private agencies formulating strategies to secure and use some of the federal stimulus money to expand the use of health IT?

Whittington/Obfuscato: Our advice comes in the form of two words lifted directly from our strategic plan -- lip service. Don't just pay lip service -- get your lips augmented to Angelina Jolie-like proportions and lock them onto the latest meaningful use lingo. Make it appear as though you are a huge proponent of interoperability -- maybe even demonstrating integration at an industry event with some hastily concocted code you have no plans of ever commercializing.

Embrace the idea of reporting quality data, responding affirmatively in your RFP responses while keeping your fingers tightly crossed. Combine the terms CPOE, health disparities, SNOMED, medication reconciliation, population health and privacy in one sentence, mesmerizing grant proposal evaluators with your command of industry terminology.

Say what you must to secure the money, plan on fabricating some favorable outcomes data, and get ready for your stimulus cup to runneth over.

iHealthBeat : Are you ready to tell the world who you really are?

Whittington/Obfuscato: Extormity and SEEDIE started as something of a lark, recognizing the need to poke fun at some significant issues that are hampering the spread of health care IT adoption. Late-night inspiration aided by a wee dram of single malt inspired the idea, and from there the material wrote itself. After creating Web sites for each entity and capturing the attention of health care IT bloggers and online media like iHealthBeat, we were overwhelmed and pleasantly surprised at the response -- literally tens of thousands of Web visits in a few short weeks. Feedback was positive, and several thousand Web visitors signed up to receive regular electronic alerts. We stepped back for a few months, evaluated the reaction of the community and realized there is no shortage of satire-ready source material to keep the joke alive.  

Extormity and SEEDIE remind us that while this is serious business, we can sometimes take ourselves too seriously. These parodies of all too realistic scenarios are meant to provoke dialog, entertain and prod us to look at our industry through a different lens. As the health care IT sector heats up in 2010, we plan to continue churning out material in order to keep all of us honest and laughing as we work overtime to realize the hoped-for benefits of the shift from paper to electronic records. At some point during the first half of the year, we will "come clean" and let the world know who is behind the curtain. In the meantime, we are evaluating any and all suggestions from our fan base, including the development of Extormity and SEEDIE T-shirts, mugs and other merchandise!  

Finally, we intend to keep Extormity and SEEDIE alive for as long as possible, even after we reveal our true identity. Frankly, operating a fictional EHR vendor and certifying body is so much easier than running the real thing.

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