Three stories, one theme - 6/16
The theme: Working around the system
I’m experimenting with different types of posts for this newsletter, and this is one of them.
I read a lot, and sometimes I find stories that aren’t enough for a full post but are too interesting to let slide. I’m sharing this batch of articles with that in mind. If you have strong feelings about a type of post, or ideas about what kind of content you’d like to see more of, hit the reply button and let me know!
The theme: Working around the system
At the risk of sounding too anti-institutionalist (I’m not!), a lot of great ideas come from working around bureaucratic systems. Of course, in an ideal world, the systems work right the first time.
One theme of this newsletter is that there are opportunities at the intersections. Another theme is that moving fast and breaking things isn’t an option in healthcare, but neither are incremental changes (and I think the story of what that means for health policy and startups is still being written).
Anyway, the three stories that stuck in my mind this week were all about people having to work around the system, for better or worse.
In some cases, like the DOGE blog post (all links below), it’s about trying to work around the system but finding out that the system is pretty complex, both software-wise and bureaucracy-wise. The author found that, before DOGE, the VA was already working on new, more user-friendly software (related read: Recoding America), and after a few days of complaining about his government-issued laptop, he got approval to upgrade to an engineering-grade MacBook. At the same time, he made some pretty obvious mistakes about how to operate within the gigantic bureaucracy that is the federal government, including giving a public interview, which ultimately got him kicked out of DOGE.
In the STAT First Opinion article, the author writes about how parents with medically complex children use ingenuity to keep their children alive, because the durable medical equipment (DME) process is broken.1 With just a few billing codes for DME, DME providers have a lot of leeway to choose the cheapest equipment available, leaving parents to design their own products with what they have. If nothing else, you have to click on the STAT article to see how parents are using InstantPots as autoclave machines.
Finally, a telehealth abortion provider let a New York Times reporter shadow her for the day. What struck me was how she uses a series of workarounds to protect the patients’ privacy, including storing hard-copy records offsite. I’m sure the thinking is more about avoiding prosecution, but given repeated health record hacks, it’s an interesting system. Of course, with the nature of her work, she only interacts with each patient once (the story quotes the provider as having experienced very few follow ups for potential complications, none of which turned out to be emergencies), so paper records are easier to maintain than for other types of care.
DOGE Days (Sahil Lavingia blog)
A broken system forces parents to DIY hospital-level care for their medically complex children (STAT News First Opinion)
If you’re a DME expert, please email me! I need to understand more about how this works.