Get Involved: Your Chance to Comment On EHR Certification

It's a known political phenomenon that most people feel free to comment on how the government is running the country, whether or not these citizens employ their rights to the full extent.

Somehow a majority of the vocal population also manages to become miraculously glued to their easy chairs on election night, rather than getting out to rock the vote.

But healthcare administrators and practitioners are not that type of person - right?

I sure hope not...if so...get off the proverbial couch.

Here's your chance to get involved - at the policy generation level no less - on an issue of concern to all H/HC professionals - electronic health record (EHR) certification.

The Certification Commission for Healthcare Information Technology (CCHIT) has posted its 2008 draft of certification criteria for EHRs.

A 30 day comment period is open until December 22nd.

You need to do some significant homework before commenting though; read the detailed, thorough proposals from 6 service-line specific workgroups (Ambulatory - 67 page PDF, Child Health - 5 page PDF, Cardiovascular - 13 page PDF, Emergency Dept - 30 page PDF, Inpatient - 66 pages, Network - 27 page PDF) and then register/login to leave your opinions.

Here's a bit about CCHIT, an independent nonprof (verbatim from cchit.org):

"The Certification Commission is a recognized certification body for electronic health records and their networks, and a private, nonprofit initiative.

Our mission is to accelerate the adoption of health information technology by creating an efficient, credible and sustainable certification program."

Founded in 2004 by the American Health Information Management Association (AHIMA), The National Alliance for Health Information Technology (Alliance), and the Healthcare Information and Management Systems Society (HIMSS), the CCIHT was later funded (2005) by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), HCA (the Hospital Corporation of America), McKesson, United Health Foundation, the California HealthCare Foundation, and WellPoint.

Two years ago, the US Dept. of Health and Human Services awarded CCHIT with a contract to quote "develop, create prototypes for, and evaluate the certification criteria and INSPECTION PROCESS for electronic health records (EHRs)."

Before DHHS funding dries up, CCHIT must move to create a sustainable model and continue its work based on a feasible business ops platform.

CCHIT must engage multiple stakeholders to accomplish its mission, including:
  • Clinicians and provider organizations who purchase health IT products;
  • Safety net providers who purchase or receive health IT products;
  • Vendors who develop, market, install and support health IT products;
  • Payers or purchasers who are prepared to offer incentives for health IT adoption;
  • Health care consumers;
  • Quality organizations;
  • Public health agencies;
  • Clinical and health-services researchers;
  • Standards development organizations;
  • Federal agencies and coordinating bodies representing various Federal agencies as identified by the National Coordinator.
In other words, they must engage all of us.

Here's the deal - as both a healthcare consumer and a healthcare administrator, I want to see EHRs in full swing by 2015. I want to use them, and I want to offer them to clients/patients.

Can this be done? Perhaps - but only with all of our input.

I'll be working on my response next weekend.

The point? Good organization, great goal, good pedigree = well worth your time to read and respond.

Click here to comment.



There is so much for which I am thankful.

Close friends, constructive colleagues.

The fact that I have experienced both an excellent education (which is ongoing) and excellent healthcare (also ongoing, although I may wait a bit longer to receive it).

I am thankful for a family that tolerates my rough patches and celebrates my achievements.

This afternoon I received a letter of acceptance from Georgetown's Master of Health Systems Administration program. I sure as #$%^ am thankful for that.

I am thankful that patient-centric, user-generated health management gives me a forum to express all this wonderful gratitude, and channel it.

And tonight (this morning) a special thank you to my husband.

Here's something a little different to digest on Turkey Day:

How to Live - By Charles Harper Webb, from Amplified Dog. © Red Hen Press

"I don't know how to live."
–Sharon Olds

Eat lots of steak and salmon and Thai curry and mu shu
pork and fresh green beans and baked potatoes
and fresh strawberries with vanilla ice cream.
Kick-box three days a week. Stay strong and lean.
Go fly-fishing every chance you get, with friends

who'll teach you secrets of the stream. Play guitar
in a rock band. Read Dostoyevsky, Whitman, Kafka,
Shakespeare, Twain. Collect Uncle Scrooge comics.
See Peckinpah's Straw Dogs, and everything Monty Python made.
Love freely. Treat ex-partners as kindly

as you can. Wish them as well as you're able.
Snorkel with moray eels and yellow tangs. Watch
spinner dolphins earn their name as your panga slam-
bams over glittering seas. Try not to lie; it sours
the soul. But being a patsy sours it too. If you cause

a car wreck, and aren't hurt, but someone is, apologize
silently. Learn from your mistake. Walk gratefully
away. Let your insurance handle it. Never drive drunk.
Don't be a drunk, or any kind of "aholic." It's bad
English, and bad news. Don't berate yourself. If you lose

a game or prize you've earned, remember the winners
history forgets. Remember them if you do win. Enjoy
success. Have kids if you want and can afford them,
but don't make them your reason-to-be. Spare them that
misery. Take them to the beach. Mail order sea

monkeys once in your life. Give someone the full-on
ass-kicking he (or she) has earned. Keep a box turtle
in good heath for twenty years. If you get sick, don't thrive
on suffering. There's nothing noble about pain. Die
if you need to, the best way you can. (You define best.)

Go to church if it helps you. Grow tomatoes to put store-
in perspective. Listen to Elvis and Bach. Unless
you're tone deaf, own Perlman's "Meditation from Thais."
Don't look for hidden meanings in a cardinal's song.
Don't think TV characters talk to you; that's crazy.

Don't be too sane. Work hard. Loaf easily. Have good
friends, and be good to them. Be immoderate
in moderation. Spend little time anesthetized. Dive
the Great Barrier Reef. Don't touch the coral. Watch
for sea snakes. Smile for the camera. Don't say "Cheese."

Climbing - By Yours Truly (give me a break, I'm rusty...)

I have never enjoyed


10:33 pm on a Wednesday night and


the size of a pencil point

is highlighted

in the spotlight

over the dining table,

its web falling

just so

on the axis of rays

beaming down on the centerpiece

I carefully arranged -

An antique glove mold,

seed pod picked up

from the park

walking the dogs.

You wouldn’t notice

either –

The time spent -

The mold

fingers upstretched

towards light

they will not reach.

And the spider



its way to


Sleep well dear.

Dream and stir

as I sit

contemplating things that climb

and fall.


One Way to Solve a Healthcare Staffing Crisis...

Although DC isn't at the top of the list when it comes to many healthcare metrics, this program deserves a mention:

FREE Medical Assistant Training for DC Residents

Andromeda Transcultural Health offers the fourth Medical Assistant Training Program Requirements:
  • To be a DC resident with proof of residency (photocopy of any bill);
  • Resume;
  • Copy of an ID (driver's license and/or passport);
  • To have working knowledge of English and Spanish (or wish to learn);
  • And to have a minimum High School Degree or GED already completed.

The program is sponsored/granted by the Mayor's Office on Latino Affairs.

For more info, call (202) 291-4707 (x 118).

[Posted 11.607; reposted 11.20.07 - does that mean there are still vacancies? Come on DC!]

Breaking News: Things Don't Go Your Way, You Don't Pay...

From a ModernHealthcare.com email alert (10:48am EDT):

"Massachusetts hospitals will adopt a no-charge policy for certain adverse patient events beginning in 2008."

"Read more later today at modernhealthcare.com and in today's Daily Dose."


Why We'll See a Boom in the Health Management Industry

I'm no futurist, but stats like these are hard to argue with...thanks to Dr. Stanley Feld, another one of my hard-hitting healthcare heroes, for the great post this morning (dated October 22nd, sent via email).

How about them apples:
  • Complications of chronic disease consume 90% of Medicare spending in the US.
  • There are approximately (estimates differ) 47 million people without healthcare coverage in the US - almost 1/5 of those have household incomes approaching $50,000 annually (according to a New York Times article).
  • Exhibit A: Complications of osteoporosis can be decreased 50% IF the condition is recognized and treated effectively - however, many HMOs and other insurance providers won't cover bone density studies for women under 60. Annual Medicare spending for complications of osteoporosis hits 21B. Why would docs do proactive DEXA scans when the average scan costs $134 (Lewin group study) and physicians will only be reimbursed $34 by 2010?
  • We're pushing both fiscal and actual 'responsibility' for health maintenance onto patients...witness the rise of high deductible plans and interest in self-pay "you're responsible" systems like the Netherlands. Sure, the government will help you out if you can't pay, but the onus is on you.
When will we wake up and pay for health management? Better yet, when will we wake up and pay for health improvement? When will an ounce of prevention be worth a pound of cure?

Will the civic provision of healthcare services ever be on a level with providing elementary education, municipal services like fire, police, waste removal, and infrastructure maintenance? We're all paying into the communal melting pot for various services - why not make a portion of healthcare spending one of those services?

Many are afraid the provision of 'universal' healthcare or socialized medicine would lead to the collapse of the private system, with a loss of billions of dollars in revenue.

Yes, some revenue would inevitably be lost, certainly initially (first 1-5 years following implementation).

But new streams of revenue would be available for capture, presenting business opportunities.

As a (so-called) market-based, capitalistic system, some organizations would rise to the challenge to make money.

Such a change may actually bring about the return of competitive pressures in the hospital/healthcare market, as consumers take their individual dollars where they want to be treated.

If we have to pay doctors, hospitals, physical therapists, acupuncturists, etc. directly, we learn the real cost of our health. Then we learn the real value of prevention and health management.

There IS an industry model in which both public and private entities have successfully flourished, and even compete for the consumers' dollar: the higher educational system.

Public and private universities both do a booming business. The federal government effectively subsidizes some percentage (albeit very small and rapidly shrinking) of a student's education according to their ability to pay - just ask anyone who has to file a yearly FAFSA to apply for student loans/grants. The federal (and state government) also subsidizes some of the cost of that education en total, by funding a portion of the school's operating costs directly.

Yes, we've all asked these questions before. There's nothing new in this post. Except perhaps this example:

For one of my husband's recent Lab Corp tests (see this posting for background), the total charge of the procedure was $119.

CareFirst BlueCross BlueShield itemized the $119, less a "non-allowed" amount of $94.02.

Total payment for the claim? $24.98.

Let's see that number one more time: $24.98.

It's the last line that's priceless. It reads:

"The Total Patient Responsibility Is.......... $0.00"
(This Is The Amount The Provider Can
Collect From You For These Services.)


Congrats on the Book Deal Scutmonkey!

Normally my posts are very serious and analytical, touched with a healthy dose of idealism.

Today though I have to do the blogging equivalent of jumping around, clapping my hands, and squealing "yippee" in a really annoying nasal voice, thanks to hearing fellow blogger Scutmonkey's news.

First of all Michelle, I can totally identify with the response to a "big news" teaser...

It seems like if you're female and married and "of a certain age" (meaning anywhere outside pre-pubescent) whenever you make the "I have news" pronouncement everyone automagically assumes your uterus is burgeoning with new life and amazing rates of cell division.

Earlier this month our families were SURE we were pregnant, and unfortunately for them we hit 'em with the double whammy of "not yet" and "we're up and moving to the Netherlands - in about a month."

So loyal readers, big news from the medical/health/hospital blogosphere:

Scutmonkey, aka Michelle, proud author of The Underwear Drawer blog (which rarely focuses on underclothing accoutrements and usually sticks to the fascinating and humorous nuggets that show practicing medicine IS part of daily life and docs are NOT aliens in disguise from planet Medic0) got a book deal.

Awesome news Scutmonkey - you'll make us all proud as the female, more humorous Atul Gawande!

Did I mention she's also an anesthesia resident with a great eye for photography?

Now Scutmonkey, about that advanced copy...

Dress for Success DC - Great Gala, Great Nonprofit

Let's step outside the healthcare industry this weekend. Before the holiday rush begins, it's a good refresher to focus on things we value outside the world of work (like watching cheesy movies with the husband and Claussen dill pickles).

Also things like volunteering.

For Gen-X and Yers itching to expand their range of experiences, seeking fulfillment in work done outside the 9-5 often comes in the form of volunteerism.

As a Director for The Hanover Research Council, I realized pretty quickly I'd need to devote some of the social capital and knowledge I was gaining back to organizations who could benefit from my time and energy.

What a classic, idiotic, self-centric view.

It's a good thing I got involved with Dress for Success early enough to keep this "me" based view from veering toward pomposity (for the most part).

My time with the Dress for Success Washington DC affiliate, led by amazing Executive Director Jen McNulty, has helped me refocus from serving self to serving others - with DFS, its serving women who need a helping hand.

As Dress for Success Worldwide Board Chair Rosalyn Taylor O'Neale said at Thursday night's 5th Anniversary Celebration, the women who come through the doors (over 3,000 in five years at DFS DC) do the hard work.

All they're looking for is someone to do the easy stuff - support them as they decide to turn their lives around.

When women arrive at Dress for Success Washington DC, they're greeted by a volunteer who becomes their personal shopper, mentor, and job coach. The volunteer assists our client with work-ready outfits that build confidence, prepping them for the interview process.

At the Career Corner, volunteers teach computer/internet skills, (and often Jen herself - who serves as a down-to-earth model of supportive coaching) help the ladies with resumes, searching job postings, and practicing interviewing so they can wrap up that offer up with a bow and tie the job up tight.

Support continues after clients have secured a job - the DFS Professional Womens Group (PWG) members visit museums, attend workshops on developing professional skills, and help other DFS clients.

After directing guests at the event, which ran like clockwork thanks to the team of gurus from The Webster Group, volunteers got a seat at the table to enjoy the program.

At dinner, I sat with other volunteers - we were as diverse and celebratory a group as I've ever had the privilege to be a part.

The event was held at the Hotel Monaco, a Kimpton Boutique property, where you can get a companion goldfish delivered to your room for the duration of your stay.

For those of you interested in such things, Kimpton properties always showcase a great sense of style and nontraditional hotel design. Steps from the Verizon Center in downtown DC, Hotel Monaco is no exception.

Kimpton properties worldwide act as charity partners for Dress for Success branches, donating space for fantastic events.

Kimpton Hotels COO Niki Leondakis received an award - and her story about feeling intimidated meeting DFS Worldwide CEO Joi Gordon ("what do I wear to the meeting?") was just one example of the amazing connections made by women involved with Dress for Success.

When at your table you've got a newly-posted advisor in the University of Maryland system with a Master's in Counseling, a retired federal HR pro who has suited women at least once a week for several years and who edits the newsletter, 2 interns who are doing amazing work at DFS, the son of a DFS client who's an/actor, magician and unique personality (and I guarantee we'll see on Broadway or TV someday), a DFS staffer who is the godmother of another DFS employee and former client, and several other amazing volunteers, you're bound to have some of the most interesting conversations of your life.

What is it that pulled us all in at DFS and keeps us coming back for more?

Two things: The women we serve and Jen McNulty, who devotes as much time to mentoring volunteers as she does to coaching clients.

The women we serve. Amazing women with stories that deserve to be told, who are devoted to working in ways that make living better for their families.

Get involved with your local Dress for Success.

Give of your time, give of your money, but most importantly, give of yourself.

Women who walk through the doors leave with so much more than a suit. In wrapping them in the support they need to succeed, we weave a stronger fabric for the global community of women.

PS -the food was awesome!


Other Than DOA, Three Little Words You Never Want to Hear In Healthcare

Or healthcare administration education...

"That's not possible."

"It'll never work."

You may as well wave a red flag at a bull...

This afternoon I spoke with the well-published Dept. Chair at the illustrious institution I've chosen for graduate school.

We're getting along famously until one little thing throws a wrench in the works - the idea of international study. For a first year student. Who wants to do their coursework @#$backwards (the practicum first). In the, ahem, Netherlands.

I'll spare you the gory details for now, but it looks like several things will happen, especially since I am completely and embarrassingly hooked on this program:

1. Ideally my admission will be finalized (so I don't have to reapply) and I'll defer for a year.

2. I can transfer somewhere around 25% of my courses to my most-wanted Master's program, so I'll scope out a few classes at Erasmus in Rotterdam, which, God bless it, just happens to have an internationally ranked Institute of Health Policy and Management.

3. Meanwhile I'll do some awesome research and keep in touch with my Dream Program (which I'll name shortly).

4. I'll learn the ins and outs of the Dutch system, which, according to my soon-to-be Dept. Chair, is a "gold mine" for quality measurement and eldercare, among other high-impact areas of vital import to the US system.

And when faced with a question (in any field), let's make it ok to be curious and respond with these five word phrases:

"What'd you have in mind?"


"How would we do that?"


What Do The Docs Do on Their Downtime?

Uh oh...no health-related gallows humor in Holland...

I'll have to be careful over there in Nederland (and you thought nothing could be a bigger conversation-kill than a whispered "HIPAA").

From NL Planet:

"Dutch certainly has a rather unique approach to swearwords: sexually-based ones are less shocking, the worst being related to catching or having nasty diseases, a hangover from unhealthier mediaeval times. The worse the disease, the more insulting the curse, and the Dutch use a whole clutch of them: pleurisy, tuberculosis, the plague, smallpox, cancer... recently even Aids has been added to the list. To call someone an 'Aids sufferer', for instance, is a grave insult, so the system evolves continually. This can all be a bit unsettling for the unsuspecting newcomer."

I wonder how they feel about patients openly conversing with healthcare professionals about diagnoses and treatment options?


When the Healthcare Coverage Debate Comes Home to Roost

It was bound to happen sooner or later.

Those of us who are convicted will convict ourselves with the strength and, sometimes, the inflexibility of our beliefs.

In our efforts to 'convert' or 'convince,' those we love bear (at one time or another) the brunt of misguided proselytizing.

In other words, I was wrong, and it sucked. It won't be the first time, nor will it be the last.


Tonight the husband and I ate at a great little restaurant in Adams Morgan called Cashions.

We were very happy to see organic chicken and Eco Friendly Farm pork listed, but talk quickly veered off the topic of what we'd have to eat.

I'll apologize here to fellow diners elbow's length away, as a debate we had regarding consumer choice and coverage in the healthcare market got a bit more heated than my bowl of spicy squash soup.

The narrative that got us off to the races was this:

* Our patient has pain in a very specific spot below his last rib on the right side. This pain has been "annoying" and rates, at worst, a 1-2 on the 1-10 pain scale. Pain is aggravated with prolonged sitting. Patient is on no meds for this pain.

*Two separate visits/physical exams by a trusted internal med doc reveal no abnormalities. Sonogram reveals no abnormal findings. On first lab panel, liver enzymes were significantly elevated. On a followup panel, findings were well within normal ranges.

*When asked "what's wrong?," well-liked IM doc states something along the lines of "I don't see anything, but you know your body better than I do, what do you think it is?" Patient replies "something muscular?"

Now here's the kicker:

*Patient will be visiting same internal med doc in the near future. The patient has decided, pre-visit, that he/she will request additional diagnostic testing for phantom rib pain, which has caused no significant alterations to daily activities including vigorous exercise (running etc). Patient has noted increased pain during some runs, but has not discontinued activity due to pain.

Here's what got me going:

*Patient has determined that they will elect to request further imaging including CT and/or MRI just to make sure, especially if doc cannot provide a firm diagnosis.

*When asked if patient would make same selection of healthcare services if he/she was self-pay versus full (very nice) insurance coverage via employer 100% paid UHC plan, patient replied somewhere in the neighborhood of "hell no - I'd probably stop either before the sonogram or now - I'm not paying for it" (!!!!).

*Rationale for further testing included personal emotive rationalization of costs for exhaustive testing, even though further testing has not been medically indicated nor recommended by the physician to date (this may change during future exams or of course if symptoms/condition worsen). Comments included things like "well I'm not paying for it" and "I've paid into this plan for over four years."

When faced with actual cost realizations about how much further testing would 'really' cost versus how much the patient would see/be responsible for on a bill, patient was surprised, dismayed, and defensive.

All my fault, since the patient is my husband, and I failed to take into account that this 'teaching' opportunity would hit too close to home.

Here are the lessons:

* When patient is someone near and dear, carefully weigh value of 'debating' and 'promoting' education or your own personal agenda - those closest to you will (rightfully so) ALWAYS take this personally.

* Woe to those of us who forget that health decisions are always, always influenced by the personal - personal fears, personal CvB analyses, personal ability to pay or lack thereof, etc.

* My most important concern in this instance should have been what the patient was going through - what influenced him to consider options and how he makes his choices.

* Oh hell, he's my husband - my first concern is his health. The choices he makes are his. The costs and consequences are ours to bear.

*To thine own self be true: Examine why the issue raises your own hackles.

My motivation in discussing the need for patients to be educated consumers, COGNIZANT of the real monetary costs of their healthcare choices, actually grows from a strange sense of misplaced guilt.

After multiple ankle surgeries, for which I will NEVER bear the full burden of cost (thanks to managed care, without which I wouldn't have a working near-bionic billion dollar ankle), I am up walking and dancing barefoot at my sister-in-law's wedding, running half-triathlons and generally taking for granted the fact that I've received more excellent care than I can ever repay.

How can I give back to a system that literally saved my mobility? That allows me to enjoy things like a leisurely walk home without a cane? The fact that I can still wear 1/2 inch heels after being told I had less than a 10% chance of walking without a mobility aid?

The answer is simple: from the inside.

I'm not a doctor. I'm not a nurse. I'm not a counselor, or a physical therapist.

I am a manager. I am an innovator. I am a challenger of the status quo. I am a relationship builder. I am a person who calls my direct reports by their first names and worries about their families on the weekends.

What can I do to change the system? Get inside it. Make changes where I can. Continue to hope that improvements are possible. Proclaim that belief, and help others buy in.

The single most discouraging portion of our conversation tonight happened just after I'd realized I was arguing with my own demons, not the 'patient's.'

If I hadn't had insurance I wouldn't have had a great doc and a wonderful fixator and great followup care and the aqua therapy that allowed me to be up and weight bearing four months ahead of schedule.

The single most discouraging portion of our conversation tonight was when my husband looked me in the eye, after I apologized profusely for crossing the border of constructive conversation and personal empathy (veering dangerously close to 'preaching') and said:

"But I'm just one person. I can't do anything to change this."

And believed it.

Oh honey - people like us are the only ones who ever will.


It's Health Insurance Awareness Month in DC

News (verbatim) from the DC Dept. of Insurance, Securities, and Banking:

November Is Health Insurance Awareness Month

The District of Columbia Department of Insurance, Securities and Banking (DISB) has declared the month of November as Health Insurance Awareness Month to bring attention to the District of Columbia residents without health coverage, and to make health insurance information understandable and more accessible to the public.

"Having a health insurance policy is critical to having peace of mind, but for District of Columbia residents this coverage has become increasingly complex and unaffordable," said DISB Commissioner Thomas E. Hampton. "

It is especially troubling that approximately 10 percent of District residents are without health coverage. It is equally troubling to note that people who are uninsured receive half as much care as those who are."

Commissioner Hampton is hoping that by establishing Health Insurance Awareness Month, District consumers will better understand how to navigate through the complex products provided by health insurance companies, so they can acquire products and benefits that best fit their coverage needs.

Highlights of the month include:

  1. The launch of a one-stop website on health coverage options in the District. Currently being developed in partnership with the Department of Health and the Office of the Chief Technology Officer, the website will provide comprehensive information on health coverage options both in the market and through government-sponsored programs, as well as demographic-specific information on insurance options for individuals, families and small businesses.
  2. A weekly newsletter featuring consumer tips related to life-stage-based health coverage, including disability and long-term care insurance.
  3. A public forum on universal health coverage on Thursday, November 15, 2007, 10 am–12 pm.
    It will be held at the DC Department of Health, 825 N. Capitol St., NE, Room 2125. This is a discussion among local policymakers on universal health coverage moderated by AcademyHealth, the administrator of the Robert Wood Johnson Foundation’s State Coverage Initiative.

Additionally, Mayor Adrian M. Fenty has issued a proclamation, a sign of solidarity with DISB, to show the city’s commitment to closing the disparities in health coverage. DISB will continue to work with partners to host seminars and workshops in the community to increase the awareness on health insurance issues.

Will your organization consider working in concert with the DC initiative to make this a national awareness movement?

People who are educated about their health insurance coverage options are more likely to make educated coverage choices...and wouldn't we all like to be a part of that?


Challenge of the Week: Go Carbon Neutral

The husband and I are in Ashtabula, Ohio this weekend for his baby sister's wedding (Congrats Nicole and Allen!).

The weather is beautiful and crisp, the people warm and friendly, the wedding party is excited, the bride relaxed and the groom only slightly jittery, and the rest of the day should go smoothly.

In the past 4 days, however, just my husband and I (in our relatively fuel-efficient late model Accord) have driven over 9 hours (approx. 1000+ miles).

On Monday I'll purchase a TerraPass to offset our trip (I've written about them before, but also check out this month's issue of INC. Magazine)...

I'll also be purchasing one to offset the flight to Amsterdam in January (and yep Carolyn, I will indeed continue blogging from the Netherlands).

Enviro-consciousness is increasingly a factor in business operations in other sectors (and some healthcare facilities are being LEED certified by the US Green Building Council) - but how far is the hospital industry going? And are we going there fast enough?

So here's the question of the week (and a nifty project for your Decision Support team): What would it take for your hospital (or place of work) to go carbon-neutral?

(Note: It will probably take longer to get a good estimate of your facility's carbon footprint than to purchase the credits to offset it, but firms like Terrapass can also help you calculate this figure).

And how would you communicate your carbon-neutral goal to staff, community members, and other stakeholders? How would you 'sell' the competitive advantage to your exec. staff and Board?

Consider also the tsunami effect; even when your facility achieves carbon neutrality, what time/effort/money would it take to push the initiative out through your web of suppliers?

How much would the hospital have to pay if it offered 'carbon neutrality' as a benefit to every employee as part of the standard HR package (along with PTO, retirement benefits, etc).

What sort of incentives could the hospital offer suppliers (medical equipment, food services, environmental/custodial, etc.) who agree to go carbon-neutral, or at least cover the carbon footprint of sales trips/delivery to your hospital?

An annual eco-awards program would be an interesting next-step as you develop enviro-conscious best practices for your facility.