Even my 4-year-old granddaughter knows what a silo is: the iconic brick, wood, concrete, or metal structure that keeps one harvest from another on a farm. With all the change in agriculture, we would actually be hard pressed to find a farm with the iconic silo, but still.
The silos in health care are infamous, rather than iconic. The physical barriers are reinforced with regulatory barriers, time constraints, virtual constraints, and -- most unfortunately -- attitudes.
Look around you and notice all of the physical constraints. Do you remember them being as pervasive even just a few years ago?
- Key cards
- Locked file rooms
- Locked drawers
- ID cards
- Files face-down
- Disconnected hallways
- Tree lined atrium replaced by cubicled offices
- Windows blocked by required notices
- Distances across town, across farmland, or just down the hall
- Diverse institutions. Long Term Care, Home Care and Hospitals
Of course, with technology so integrated with our days, there are also the virtual barriers we experience:
- Log ons and passwords
- Telephone tag
- Not enough integration
- Too much integration and too much data
- Packed email boxes
And, saddest of all, we have attitudes that separate us:
- Not my job.
- Competition. True story, overheard at a medical meeting in an urban center.... Older chairman of department to you surgeon: “Yes, I will grant you privileges, as long as you just do emergencies and never do cosmetic surgery. Welcome.”
- Outside of my scope of practice.
- I’m not allowed to do that.
- I’m just doing what I am told.
- I’m not comfortable with that.
- I don’t do that often enough.
- That is too time consuming.
- Medicine is a business. It needs to be run like Disney.
It is not enough to blog about it. It is not enough to complain. Each of us should do something, but where should we start? "We" meaning all of us; lab techs, aides, super-specialists, advanced practice nurses, doctors of what ever board certified -ology should get started!
We are not going to change HIPAA and the legions of other state and federal regulations, at least not right away. There are not enough of us to protest (maybe there are and we merely need the 17 year old Hong Kong activist to lead us). We will not get doors unlocked, IDs removed, logons discarded. So, the only thing left, and indeed the core of the problem, is our attitude. We need to regard the patient as our responsibility, not our institution's responsibility. We need more us and we, and less them and you in our language and in our thought. We need technology that promotes these good attitudes, not technology that blocks them. We need technology that empowers action based on these attitudes, not technology that dispirits them.
Hybrid Store-and-Forward Telemedicine Can Help Defeat Silos. Here's how:
Image courtesy of docsearls on Flickr, used under Creative Commons rights.