A college preparing for a surge in freshman enrollment must spend time and resources developing a plan of action in terms of how to best accommodate the needs of their students.  While working with Enrollment Services at Westminster College, I was exposed to the strategy of ensuring there are enough dorm rooms in student housing, quality mentors to help with the college transition, and adequate programs to satisfy the varied interests of the entire student body.  The challenge is not only in providing quality hospitality to the incoming class, but maintain the high level of expectations to retain all students and attract future ones.  With the recent passage of federal healthcare legislation, the United States is expected to extend coverage to an estimated 34 million uninsured by 2019.  As our country plans to care for these individuals, we must ask ourselves; do we have enough hospital beds and can our current health care amenities sustain this adjustment in enrollment?

With a record breaking class on the way, it is essential that our country takes proper steps in improving the design of health care facilities to better suit our ever growing culture that’s centered on convenience.  Whether it’s a college, shopping mall, or health care facility, convenience is almost always dependent on location.  Essentially, more convenient health care locations will result in better access and lower costs to patients in both urban and rural settings.  However, unlike colleges and shopping malls, health care facilities are subject to Certificate of Need (CON) laws that regulate where and when they can operate.  According to the National Conference for State Legislatures, “The basic assumption underlying CON regulation is that excess capacity (in the form of facility overbuilding) directly results in health care price inflation. When a hospital cannot fill its beds, fixed costs must be met through higher charges for the beds that are used.”

The history of CON laws date back to 1964 when New York enacted the first statutes giving state government the power to determine the need for a hospital, which led to a federal mandate for CON laws under the Nixon Administration in 1972.  Specifically, the Missouri Hospital Association and other Missouri health care facilities are regulated by the state CON laws enacted in 1979 under RSMo 197.300-197.366 that haven’t been modified since 1996.  In 1987, the federal mandate of CON laws was repealed, which led to fourteen states eliminating them from their state laws.  Opponents of CON laws believe the system is flawed by political influence and insist an open market would better control the cost and needs of patients, ultimately leading to better access and convenience.

Once facilities are established and operating, they are only convenient if they can run effectively and efficiently.  A patient’s experience is impacted by length of their stay, exposure to infection or medical deficiency, and privacy.  No patient enjoys being crammed into a small, curtain separated room for an over-extended period of time.

Studies show that medical errors within hospitals account for anywhere between 44,000 and 98,000 deaths each year in the United States at a cost of $17 to $29 billion to our nation’s economy.   In their review Transforming Hospitals:  Designing for Safety and Quality, the Agency for Healthcare Research and Quality (AHRQ) says “In the midst of this construction boom, hospital planners have an opportunity to create safer and more effective facilities that enhance patient safety, improve the quality of care, increase workforce satisfaction, and reduce the cost of care.”

Ambulatory Surgery Centers (ASCs) have become a model illustration in how to effectively run a convenient health care facility.  ASCs are facilities where surgeries that do not require hospital admission are performed and have excelled in areas of cost, patient safety, and efficiency.  On average, an operation is approximately one half to one third cheaper at an ASC than a hospital.  In addition, most ASCs take pride in providing individual, private pre and post operative rooms.  In terms of infection control, a 2007 report found that 71% of ASCs did not have a single complication per 1,000 patient encounters.  In summary, all of this efficiency is coupled with the convenience of going home the same day of surgery.

With challenges ahead in our health care industry, we must accommodate for what’s to come without dismantling and dissatisfying what we have.  Winston Churchill said “A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.”  As a Missouri contract lobbyist, I consider it my responsibility and opportunity to advise policy makers in fixing errors in the past, expanding on areas of proven success, and exploring new and innovative ideas for the future.  Whether it is re-evaluating CON laws, utilizing ASCs, or implementing more environmentally friendly hospitals, the United States of America must prepare for our incoming class.

These children were about to be marginalized, forgotten. They were in limbo between adulthood and the haven of school because they were “incorrigible”: they’d broken laws, disrupted classrooms or violated public school safety codes. Some serious infraction had removed these children from their public school and funneled them into a labyrinthine system where education was unlikely and graduation seemed completely out of reach. These were the children Judge Edwards heard from daily, and it was only a matter of time before they ended up back in Edwards’ courtroom on more serious charges and with less hope.

The reaction from Edwards was superhuman. In April 2009, he saw opportunity in the closing of Blewett School on Cass Ave., and in a few short months he had a building, 45 community partners, and a Principal vetted by the toughest juvenile offenders to open ICA.

Innovative Concepts Academy, in just its first year, is getting local and national attention for the profound changes happening in the lives of the most “incorrigible” youth. A few ideas seem to be the pillars of this success, and are woven into every program:

ICA is a place to be safe. Sure, it’s replete with security tech and staff – but they also provide medical services and 3 square meals a day, counseling, and staff trained to deal with trauma victims. For Edwards, it’s not enough to treat symptoms like acting out in class: many of the kids at ICA may have witnessed violent crimes or may be in a situation that precludes success.

ICA is a place to learn – or for many students, the ONLY place to learn. A child expelled from school doesn’t lose access to classroom learning and accountability. A juvenile offender doesn’t while away time in a facility that further limits her opportunities. More than that, students get and learn respect. Some of the boys mention that adults take them more seriously when they’re wearing a tie. The entire staff and mechanism of the school reinforces the idea that effort is rewarded – even desirable – and that they are all capable.

Third, it’s a place to get inspired. While mandatory extra-curricular programs keep kids off the street and out of trouble, those 45 community partners have given ICA students a remarkable smorgasbord of activities that aren’t simply about marking time. Golf lessons, chess instruction, classical music, creative writing and ballroom dance are just a few of the ways students can spend their afternoons.

A St. Louis Magazine documentary of Innovative Concepts Academy ends with one young man at a piano knocking out beautiful riff after beautiful riff: for me, that made the ICA not just a good idea, but something we should cherish, support and replicate. Just think, a pianist, a chess master, an author, a thinker, a good parent, or a hard worker may be that child who was about to slip through the cracks.

The plight of students in St. Louis is often harsh. The dropout rate is untenable: some kids are homeless, others are hungry, and some are discouraged. In one year, a rejection of all the things that don’t work; a fresh start based solely on what at-risk kids need to choose a better path; and a resolute leader accomplished not just a good school, but also hope.

We now have hope that there are solutions to the problems that have baffled us – but only if we’re willing to be radical thinkers, and put our energy behind a good idea.

Many government relations professionals inevitably must face this kind of scenario within their issue management responsibilities.  The general counsel of your Fortune 500 Corporation, or perhaps even a major law partner of a retained firm by your employer, approaches you at a meeting or evening event to let you know that he has some great contacts that could help you solve your contract lobbying challenges.  Before you know it, several other calls have been made from other peers to you or even your supervisors encouraging you to make this worthy decision.

Now, it is up to you to independently-evaluate the claims and credibility of the referrals given by the legal universe, which may or may not truly specialize in working your state’s General Assembly.  You don’t have much time.  Your issue is calling out for help.  You need to maintain respect and rapport with internal company executives.  How can sort you out what is needed versus what is desired?

As someone who has managed contract lobby firms across 14 states for major corporate interests, I can relate to your director’s dilemma.  If you go along to get along with what seems to be a great resume, but the firm’s results prove lackluster, the burden of future results now fall on you.  However, if you choose to customize your own search, and someone other than the law firm’s pick is hired, now your reputation breaking rank from what others in your company recommended is now at stake.  The bottom line therefore becomes:  how can we hire the best lawyer-lobbyist if that person is among those in the mix?

As a Missouri contract lobbyist for nearly a decade, you can really observe notable differences for how law firms dedicate their lobbying time compared to other business models like ours.  As someone who also hires other lobbyists, including lawyer-lobbyists from time to time, there are unique pros and cons to having an esquire at your beckon call.  Here’s a list of questions worth raising to navigate through your choices that could make your director or manager’s job a little easier.

1. Beware the Billable Hour(s):  In certain, low maintenance, or early situations, hiring a lawyer-lobbyist on call by the hour may make some sense if your issue is highly-technical, limited to a brief transaction, or likely to deviate completely shortly into the future.  However, for most dedicated government affairs shops, this is the exception rather than the rule.  More often than not, as your contacts grow and your conflict matures, you often consume more variable time with your legislation than anyone might have predicted.  The larger long-run issue might be that you’ve now created workload where there are many incentives to delay ultimate solutions.  Some firms who like billable hours seek multiple client interests within the same environment, hearing, or venue even when their services from one client to another cannot be differentiated.  Firms with strong experience in their capacity typically aren’t afraid to assign a fixed retainer price priced to what they believe to be their own premium service.  Even if the law firm favors the billable hour, you can always learn a lot about how they value you as their future client by asking for a flat fee retainer.   Over the long run, firms that over-value their retainers don’t stay competitive in their market.  A flat fee prevents such debate from happening among both parties while your focus should be on your company’s issue(s).
2. Interview the “Of Counsel” Contacts for Specifics:  There’s no better place for a termed-out legislator, retiring finance director, or over-extended issue leader than the famed “of counsel” position within a major law firm.  No doubt if the LLP or LLC is pressing hard, you will meet one or more of these key influencers within their network.  So, when you do, here are some revealing questions about whether they might work for your project:  1) What percentage of your weekly time is normally-devoted to state & local government affairs duties?  If they contribute to matters important to you, they will want you to know about their specific functions (and locations).  2) If they claim to work in the hallways of your State Capitol, approximately how many days per year would they be present for longer than 10 hours each day this past session?  This answer is easy to verify among those who spend virtually every legislative day in those hallways.  3) If they drop names and political contacts, ask them if they can provide three references in the last six months on whose first-term campaign that they might have served, contributed, or assisted?  In Jefferson City, Missouri, your rolodex demands constant renewal with first-term Senators and Representatives if you expect to manage your issue in a term-limited world.
3. Explore their Best Examples of “Off-the-Clock” Leadership:  The partners of law firms know how many billable hours exist for virtually all of their reports.  That also means that firms performing legislative or political work also must sort and rank the non-billable community, pro-bono, or volunteer campaign work.  There are many functions, such as waiting out three hour hearings, waiting for House floor action at night, or attending weekend fundraisers, that should be really hard to justify in a law firm context.  Try to understand if your government affairs lead is a partner, or if not, to which division they report within the law firm’s universe.  It is not uncommon for lawyers to market to you other affiliations or related businesses that claim to have legislative, regulatory, or political relevance.  Find out now whether such contacts are in fact accessible to you under your flat fee retainer, or where such aides are “a la carte” premiums to leverage.  A network with strength in handling government affairs normally shows that depth and breadth across most of their office geography.  If an extraordinary individual operates on his/her own, ask them for several examples of how they maintain their base of influence when billable hours don’t apply.
4. Understand Any Pending Caseloads that May Apply:  Hiring an attorney with tremendous legal & procedural knowledge can prove to be a real asset, especially if such scope of work relates strongly to the key facts of your agenda.  However, retaining a lawyer-lobbyist who also maintains other case work outside your arena can also prove to become a significant distraction.  Much of the state & local legislative session lobbying requires a daily ministry of physical presence, along with a sharp policy focus on the ground to remain successful.  I know of several lawyer-lobbyists that don’t take much or any case work from December to May during the peak periods of Missouri’s General Assembly for this reason.  If your contact does engage in litigation or other legal work, find out on what Revised Statutes he/she normally operates.  Regardless of who you hire, this can be excellent way to index a wide variety of professional experience.
5. Find Out Who Reports & Attends on Their Behalf:  If a lawyer-lobbyist is well-established, he/she usually has some legal and/or legislative staff on which they depend.  At a minimum, you should know who these contacts are in case they become your host to a Capitol visit.  Such assistance is often useful when questions are raised from their weekly or monthly updates by email or newsletter as well.  However, comparing how such lobbyists dedicate their staff can provide you with many strategic clues about how their firm is governed.  Does their staff have any previous policy, political, or legislative experience?  Do they practice law, and if so, among what areas?  How familiar would such staff be to your industry, sector, or allied trade groups if your services required more attention?  Can the staff cite any examples of prospective clients that their firm declined due to “conflict of interest” concerns with existing clients?  If the company ethics and training programs are thorough, you should be able to reflect on what choices the firm has declined to become successful.

We wish you the best of luck with your government relations endeavors, no matter who you may choose.

“People are getting smarter nowadays; they are letting lawyers, instead of their conscience, be their guide.” – Will Rogers

As the long, enduring humidity of July baseball passes, the St. Louis Cardinals zone in on the final months of the regular season in an attempt to satisfy the interest of their fans and goals of their team with a playoff berth and World Series Championship.  Each year as the trade deadline approaches at the end of July, teams negotiate moves that will be mutually beneficial to each organization in regards to their current position and goals.  But whether it is spring training, mid-summer, or late October, it is expected that General Manager John Mozeliak and the Cardinals organization spends the majority of their time negotiating for the best players, coaches, and atmosphere that will provide the best path to victory and wealth for the City of St. Louis.  The same concept holds true in the profession of lobbying and the process of negotiation, whether it is the first week of session or the last.

The fundamentals of negotiation are the same at all levels of complexity.  The simple notion of “putting ourselves in the other person’s shoes” can be the backbone of a deal on the playground or on the Senate floor, as the ability to identify the varied interests of those involved gives one the power to recognize the game being played.  As stated in the Harvard Business Review, “differences, rather than common ground, are the raw material for most joint gains.”  In politics, legislators often take a position on issues based on the interest of the district they represent.  Therefore, rather than debating positions on an issue, a lobbyist can be more effective by identifying the interests of the legislator and their district in order to better negotiate a joint gain that will also benefit the priorities of their client.  Moreover, the reason the Missouri General Assembly consists of 163 State Representatives and 34 State Senators, is to process the differences in interests and negotiate laws that will provide better gains for the entire state in all areas of life.

A lobbyist main role is to watch the game, identify the interests of legislators and special interests, and negotiate the ideal, or if not, the best alternative option that best benefits their client.  A key component to negotiation is the art of listening.  As Harvard Professor, James Sebenius claims in Essentials of Negotiation, “Since agreement represents the simultaneous solution of all sides’ problems, solving their problem is part of your problem.”  By tuning into hearings, floor debate, hallway chatter, and media, a contract lobbyist is capable of understanding the opponents’ interests, which enables them to transition from identifying the game to recognizing the next step of opportunities to change the game.  There is an infinite assortment of ways to change the legislative process ranging through introduction of a bill, an amendment to pass a bill, and amendment to kill a bill, the overall passage of a bill, or preventing the passage of a bill. Each of these steps and everything in-between involves negotiation with everyone who has interest in the game.  In processing these negotiations, a lobbyist must determine: 1) what are the alternatives? 2) what are the critical uncertainties that rest upon each decision or outcome in the negotiation?, and 3) What objectives are trying to be achieved through the negotiation process.  Ultimately, a contract lobbyist is the manager of legislation on behalf of their clients, and must use their judgment on how to best negotiate their interests with the differences in the legislature.  An issue manager or corporate lobbyist must look at each trade or deal to decide if it will put them in a better position than their best alternative option.

While the St. Louis Cardinals only bring fans to the stadium for baseball games seven months out of the year, fans are watching year around as the team negotiates and strategizes to put themselves in a better position day in and day out.  Similarly, the gavel may not be active in Jefferson City twelve months out of the year, but as long as there are citizens in the State of Missouri, there are negotiations being made on how to better the quality of life.  A new election is a new draft with new interests, and the world of lobbying and politics is an ever changing game of negotiation.  Play Ball!!!

For a Missouri lobbyist and our media productions team, being a corporate sponsor of this weekend’s USS Missouri commissioning was a rare opportunity. For a moment, we were able to depart from the Missouri General Assembly, show-me state politics, and even the Fortune 500 arena of government affairs, to enjoy some sessions dedicated to preserving American freedom.

Yes, the ceremonies in Groton, CT still applied many of the usual special event dressings of our state & federal legislative world: two Governors shaking hands, several Members of Congress worked by Pentagon public relations brass, and many other constituencies lobbying for the new new thing.

But beyond the tweets and public speeches, you could still believe in the triumph of the American spirit coming together for a capital project on this scale. Governor Jay Nixon, fresh from his trip from Afghanistan, gave weight to the large number of Missourians sorted into the Naval Pier. Congressman Ike Skelton gave several living history examples from his family and beyond about how important such military efforts have been to the battled history of our democracy. Commander Rexrode and his dedicated team of submariner advocates gave incredible witness to the future of our global security using stealth-based technologies. All in all, watching the campaigns from various contractors, leaders, and public figures come together into one $1.8 billion vessel served as a sincere inspiration.

For Rachel and I, there were several personal reminders from this experience worth noting:

Our American government can still lead global innovation, but it must be remain accountable to every taxpayer.

Part of what made everyone affiliated with the USS Missouri so proud was that SSN780 was delivered in 65 months, ahead of schedule, and under budget by nearly $100 million. The sense of accountability and transparency among defense initiatives is now enabling a further expansion of the Naval fleet into FY 2011.

For States fortunate to still host American military bases or strategic assets, use it or lose it as your economic hub.

We were surprised to learn from the Governor of Connecticut that $8M of state monies have been appropriated to help expand the Groton base infrastructure. It seemed as if everyone from this region was keenly-aware that economic activity from these initiatives were as important (if not more certain) as doling out state industrial incentives for Pfizer, Ford, or Bombardier. We wonder if the same understanding is true among the Show-Me State’s Ft. Leonard Wood, Whiteman Air Force Base, and Southern Illinois’ Scott Air Force Base.

For those who doubt what discipline, leadership training, and team focus can do, stare into the young eyes of our nation’s soldiers.

When you look at the front lines of what defends our freedom today, it is hard not to be amazed about how well we can serve with the right structure in place. We should always challenge our next generation in all industries to pursue excellence, apply your best work ethic, and to work for a team for which you would give your life. It was heartening to know that the Saint Louis Science Center broadcast this commissioning live to help show others how to apply science.

The positive network effects from military science and technology has helped all Americans greatly today.

What economists would hail as positive network externalities are likely nowhere more accurate than from projects like the SSN780. As a private pilot, we flew to this excursion with a retired USAF bomber & A-10 pilot, and a retired army manager. During our discussion about how planes flew a generation ago, I was reminded just how military technology has been instituted within today’s system of general aviation. Our transponder codes to avoid mid-air collisions: once used as “identify friend or foe” fighter jet communications. Our tough, sturdy landing gear: aided greatly by “controlled crash” landings on Navy aircraft carriers. I can only imagine what SSN780 will do for us in the future once declassified.

Leadership and celebrity coach Anthony Robbins has said that: “It is in your moments of decision that your destiny is shaped.”

Commander Rexrode, may your destiny and decisions help shape many lives through peace in our time. The roads you take may be lonely, but vital to our society.

Growing up on a family farm in Southeast Missouri, we never gave much thought to the wide seasonal swings within our local weather. Today, as a pilot, and as a former corporate government affairs manager traveling across more than 20 states, I have come to enjoy the Show-Me State’s four distinct seasons. August is cherished more for what it leads to (NCAA & NFL Football, cool fall nights, and the conclusion of fall general elections), than for what it means to me in the present. September is near, and Missouri’s meteorological masterpiece called the month of October will soon be as well.

Thomas Jefferson once said, “travel makes a man wiser but less happy.” That same challenge must apply to those who serve our country. Take a look at this video of the Typhoon class of nuclear submarines that the Russians have deployed until 2019 and think about the dedicated lifestyles that all seamen must endure. Months at sea, under the water, ice, and sunset waves. Rigorous training in tight quarters for a phone call that should never come. Years away from family and friends as landlubbers like us enjoy the freedoms of our weekends and nights.

It seems easy to believe that these jobs must be filled by Nordic orphans raised by seals off the coast of Latvia. The truth is that our United States Navy depends upon native Missourians like you and me to keep our seaways secure from Somalian pirates, foreign occupations, & nuclear holocaust.

That’s why Pelopidas, LLC is so proud to have helped the USS Missouri Submarine produce this video:

While many friends won’t be able to see the most advanced naval ship ever built this weekend, there are other ways that you can help with small donations.

At your office, encourage your colleagues to raise a mug to celebrate a new chapter of Missouri history (login as “mightymo” promo code). Dedicate a corporate gift to become a corporate sponsor this fall. Take a moment to educate a child about how science and technology can be used in dramatic ways to protect our freedoms.

In part three of this blog series, we will post up photos and news from our trip to Groton, CT where Missouri elected officials like Congressman Ike Skelton dedicate this vessel to America. As I think about small town Missourians diving off the Atlantic coast into the abyss, the humid days of August already seem a lot cooler.

Quotes from the 1990 Movie: “The Hunt for Red October,” where Sean Connery fantasizes about American freedom after a life at sea:

Capt. Vasili Borodin: I will live in Montana. And I will marry a round American woman and raise rabbits, and she will cook them for me. And I will have a pickup truck… maybe even a “recreational vehicle.” And drive from state to state. Do they let you do that?
Captain Ramius: I suppose.
Capt. Vasili Borodin: No papers?
Captain Ramius: No papers, state to state.
Capt. Vasili Borodin: Well then, in winter I will live in… Arizona. Actually, I think I will need two wives.
Captain Ramius: Oh, at least.

“Washington, April 12, 1945 – Fate today raised to the highest administrative post on earth a plain, friendly man from Missouri – Harry S. Truman.

On the eighth of next month he will be 61. As he steps into the bright light of world celebrity he can look back on a career that began behind a plow on a 600-acre farm near Kansas City…”

The epic months that followed America’s closure to World War II remind us all how amazing it was to have our entire country doing what they could to protect our liberties. Part of what made Truman’s legacy so memorable was that he rose to challenges thought to be much larger than anyone might choose for themselves.

This week, I was fortunate to join the St. Louis Science Center in their hosting of the USS Battleship Missouri Memorial event, along with the St. Louis Navy League. Under the stars of the planetarium, we were reminded how the American spirit of freedom was transformed into this monstrous structure of teak wood, steel, iron, and ammunition named ole “BB-63” – the USS Battleship Missouri.

Most had come to know the “Mighty MO” of our Pacific fleet as the place where Japan surrendered to America. Its presence for this conflict alone is enough to retire it admirably. However, I was amazed to learn about how seamen and technology adapted itself over the decades to project its capabilities even as recent as Operation Desert Storm.

When you think about lobbing 2,700 pound projectiles at a precise range from 16-23 miles using the analog computers from the 1930’s, our computing systems of today owes much to this military experience. When I think about how my uncle must have felt at Pearl Harbor walking to church when the sirens went off, you have to believe that surviving ships like “Mighty MO” were a substantial inspiration as he flew across the Pacific into harm’s way.

When you hear about the dent in the ships’ side left after a Japanese kamikaze pilot tried to sink it, it reminds us all of the value of mental toughness over adversity. The Mighty MO has always been about more than naval superiority, it’s 45,000 tons gave each generation something onto which we can attach our emotions.

At our dinner event, we were each given a small piece of teak wood from this historic deck, now in process of a historic preservation in Hawaii. The battleship is all but retired, except for an appearance before a Universal Studios upcoming movie in 2012. However, just like decades before, the USS Missouri is adapting its mission again – this time for science educators and their pupils. Over the next month, many school groups will use it as their living history classroom. The St. Louis region is fortunate to have at least two strong advocates for science education within Admiral (Ret) Lee Metcalfe and General Duncan J. McNabb.

The torch defending our freedom now passes to the next generation. Just like before, our country is stepping up with something bigger and better. In my next blog, we will feature what’s next to come: the USS Missouri Virginia class of submarine.

Travis H. Brown

Derived from data from the Missouri Ethics Commission

Today, the Let Voters Decide committee submitted more than 209,000 signatures to the Secretary of State to place the measure on the November 2010 ballot. More than double the required number of Missourians signed the petition to place this question on the ballot.

The committee collected signatures in seven congressional districts, rather than just the required six. More than 210,000 signatures filling 104 boxes and 20,646 petitions sends a clear message that voters from all across Missouri want the opportunity to vote on this issue.

When this measure goes before voters in November, a YES vote would give voters in Kansas City and St. Louis the opportunity to decide every five years whether they want to continue collecting the earnings tax. A vote to repeal would phase the tax out gradually, over 10 years.

For Missourians not in Kansas City and St. Louis, a YES vote in November would prohibit local politicians from imposing an earnings tax anywhere in the state.

Based on the large number of signatures gathered, it is clear that Missourians want a say on local earnings taxes, and they will have their voices heard again on November 2.

For more information on the initiative, go to www.LetVotersDecide.com.

Follow Let Voters Decide on Facebook and Twitter.

After more than five years since we lobbied for a better medical malpractice system in the Show-Me State, occasionally we observe a stark reminder of just how far and fast our medical, biotechnological, and genomic systems are advancing.  Normally, through working with current and former lobbying clients like the Monsanto Company, AT&T, and the Missouri Society of Anesthesiologists, we can feel like our knowledge is updated, contemporary, and forward-looking.

However, the convergent technologies used with iphone devices, wireless communication, and vital life indicators all featured in this 15 minute video represented a brave new world for me.

For Missouri physicians, surgeons, dentists, and supervising care team leaders, imagine the numerous possibilities.  For Missouri hospitals, ambulatory surgical centers, and rural health clinics, consider the changing landscape for how care could be accessed in remote locations.  For patients and consumers, behold some real promises to improve patient safety, early intervention, and preventative health.

If only a fraction of these technologies prove useful, advocates and healthcare organizations will be faced with how make such practices fit into our patchwork of professional licensing, collaborative care, and healthcare reimbursement laws.  Given that techniques like telemedicine have already-been identified as a wave toward our healthcare future, maybe we should starting thinking sooner rather than later about ways to make our regulations more useful.