The HIMSS January 2007 Standards Insight posits a shift from a positive HIT outlook to a negative outlook over the past year and a half. My take is as follows. The "high" to "low" arc referenced spanned 18 months-too short a period to assess either success or failure. I, for one, feel the earlier assessment was much too optimistic, and the latter assessment, too pessimistic. We need to reduce the variation in our HIT expectations, in much the same way we need to reduce variation in clinical outcomes. HIT products and services continue to be oversold and over hyped. There is a huge gap between promise and performance. In truth, all we are doing is chipping away at a major dilemma--how to accelerate the transition from a paper culture to a digital culture in health. Technology is but one part of the answer. The larger issue is changing behaviors, power relationships, and institutional cultures, no easy task.
I was struck by the observation from the Premier study that "top performers were no more likely than others to have effective HIT." I don't think it means hospitals are ineffective in using HIT or that HIT is ineffective in enabling process improvement. Rather, I believe hospitals are ineffective in HIT use and HIT is ineffective in helping process improvement. The combination of these two factors is what is causing us dyspepsia.
It is inconceivable that HIT will not play a major role in the health system of the future. It just won't drive system overhaul. Such an overhaul will come from a combination of factors including rising costs, variation in quality, and increasing numbers of uninsured. Once the status quo becomes intolerable, and it hasn't yet, change will come, and HIT will be part of the solution. For now, we all need to keep our expectations in check regarding HIT.
Friday, January 26, 2007
Tuesday, January 16, 2007
Suggested Reading Lists
The HIT field is awash in studies, reports, newsletters, and press clippings. It takes a major effort to stay current, and there is a need for a rating system, or some other discriminating device to lesson the reading load for busy IT stakeholders. In my judgment, these three sites are an essential starting point for any HIT tracking system: the AHRQ National Resource Center for HIT, the Markle Foundation, and the eHealth Initiative. The following articles are my first attempt at a "top ten" reading list. The articles on this list are accessible, insightful, and provocative.
1. Gary Baldwin. (November 1, 2005). Bringing order to CPOE: 10 Make or Break Steps (and 5 myths). HealthLeader
2. Gerard F. Anderson, Bianca K. Frogner, Roger A. Johns, and Uwe E. Reinhardt. (2006, June). Health Care Spending And Use Of Information Technology In OECD Countries. Health Affairs, 25(3), 819-831.
3. Jonathan Oberlander. (2003, August). The Politics of Health Reform: Why Do Bad Things Happen to Good Plans? Health Affairs Web Exclusive, W3 391-W3 404.
4. Nicholas G. Carr. (2003, May). IT Doesn't Matter. Harvard Business Review, 41-49.
5. Rainu Kaushal, David Blumenthal, & Eric G. Poon. (2005). The Costs of a National Health Information Network. Annals of Internal Medicine, 165-173.
6. Sheera Rosenfeld, Shannah Koss, Karen Caruth, & Gregory Fuller. (2006, January). Evolution of State Health Information Exchange/A Study of Vision, Strategy, and Progress (AHRQ Publication No. 06-0057).
7. (September 2006) Massachusetts Technology Collaborative, CPOE Lessons Learned in Community Hospitals
8. (25 September 06) eHealth Initiative, Improving the Quality of Healthcare Through Health Information Exchange; Third Annual Survey Report
9. (October 2006) National Committee for Quality Health Care, CEO Survival Guide: Electronic Health Record Systems
10. (September/October 2005) Hillestad R. et al, Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs
1. Gary Baldwin. (November 1, 2005). Bringing order to CPOE: 10 Make or Break Steps (and 5 myths). HealthLeader
2. Gerard F. Anderson, Bianca K. Frogner, Roger A. Johns, and Uwe E. Reinhardt. (2006, June). Health Care Spending And Use Of Information Technology In OECD Countries. Health Affairs, 25(3), 819-831.
3. Jonathan Oberlander. (2003, August). The Politics of Health Reform: Why Do Bad Things Happen to Good Plans? Health Affairs Web Exclusive, W3 391-W3 404.
4. Nicholas G. Carr. (2003, May). IT Doesn't Matter. Harvard Business Review, 41-49.
5. Rainu Kaushal, David Blumenthal, & Eric G. Poon. (2005). The Costs of a National Health Information Network. Annals of Internal Medicine, 165-173.
6. Sheera Rosenfeld, Shannah Koss, Karen Caruth, & Gregory Fuller. (2006, January). Evolution of State Health Information Exchange/A Study of Vision, Strategy, and Progress (AHRQ Publication No. 06-0057).
7. (September 2006) Massachusetts Technology Collaborative, CPOE Lessons Learned in Community Hospitals
8. (25 September 06) eHealth Initiative, Improving the Quality of Healthcare Through Health Information Exchange; Third Annual Survey Report
9. (October 2006) National Committee for Quality Health Care, CEO Survival Guide: Electronic Health Record Systems
10. (September/October 2005) Hillestad R. et al, Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs
Tuesday, January 9, 2007
Newt Gingrich's Remarks
Today, I listened to Mr. Gingrich present his vision of a "21st Century Intelligent Health System" to the Delaware Valley Chapter of HIMSS. Prior to the webinar, my bias was that he was playing the health care card to enhance his national image and position himself to run again for higher office. Time will tell. On the other hand, he did impress me with his grasp of the issues, and his ability to get his message across. He is clearly a force to be reckoned with, and I believe he'll help break the current logjam in the health IT debate. Many of the things he said resonated with me. Here are some examples.
a. Health is essentially a moral issue.
b. Focus first on saving lives, and cost savings will follow.
c. A simple argument for EHR's--"paper kills."
d. The inevitability of a digital health system--the issue is when, not if.
e. An EHR makes sense from a public safety standpoint, especially when disaster strikes.
f. See past the system noise and political theater about HIT. There is bipartisan interest in moving forward in this arena.
Check out the Center for Health Transformation for additional information on Mr Gingrich's vision and initiatives.
a. Health is essentially a moral issue.
b. Focus first on saving lives, and cost savings will follow.
c. A simple argument for EHR's--"paper kills."
d. The inevitability of a digital health system--the issue is when, not if.
e. An EHR makes sense from a public safety standpoint, especially when disaster strikes.
f. See past the system noise and political theater about HIT. There is bipartisan interest in moving forward in this arena.
Check out the Center for Health Transformation for additional information on Mr Gingrich's vision and initiatives.
Monday, January 8, 2007
What I'd like to See in 2007
In no special order, in 2007, I'd like to see the following.
a. A state making a commitment to ehealth connectiveness, in the same fashion that Massachusetts set itself on a path to universal coverage, and became a trend setter.
b. EHR vendor consolidation. There are too many vendors chasing chasing the early adopters in the industry.
c. President Bush's signature on a Federal HIT bill, which among other things, gives permanence to the ONCHIT.
d. A successful start to the Dossia experiment, and double the number of large industry sponsors.
e. Expansion of open source EHR offerings. My dream is to witness the health care equivalent of Firefox, Wikipedia, or Linus.
f. More success stories for RHIO's, in every region in the country.
g. Google Health and Quicken Health making their mark on the industry.
h. The private health care sector moving past resource constraints, competitive matters, and other assorted excuses, to forge true region-wide information exchanges.
i. Measureable success toward the joint AHIP and BCBSA pledge to provide a functional PHR by 2008.
j. Agreement and implementation, by all accrediting bodies, of a single set of quality and patient safety measures.
a. A state making a commitment to ehealth connectiveness, in the same fashion that Massachusetts set itself on a path to universal coverage, and became a trend setter.
b. EHR vendor consolidation. There are too many vendors chasing chasing the early adopters in the industry.
c. President Bush's signature on a Federal HIT bill, which among other things, gives permanence to the ONCHIT.
d. A successful start to the Dossia experiment, and double the number of large industry sponsors.
e. Expansion of open source EHR offerings. My dream is to witness the health care equivalent of Firefox, Wikipedia, or Linus.
f. More success stories for RHIO's, in every region in the country.
g. Google Health and Quicken Health making their mark on the industry.
h. The private health care sector moving past resource constraints, competitive matters, and other assorted excuses, to forge true region-wide information exchanges.
i. Measureable success toward the joint AHIP and BCBSA pledge to provide a functional PHR by 2008.
j. Agreement and implementation, by all accrediting bodies, of a single set of quality and patient safety measures.
Tuesday, January 2, 2007
Dossia Musings
Briefing:
On December 6th, 5 US Companies (Walmart, Intel, BP America, Applied Materials, and Pitney Bowes) announced a plan to provide digital health records to their employees, dependents, and retirees. Omnimedix, a non profit firm based in Oregon, will build and run the new system. The sponsoring employers will chip in $1.5 million apiece to construct a data warehouse to store and update the e-records. The stated goal is to cut costs by having consumers coordinate their own health care among doctors and hospitals. Independent studies suggest that employers with an established Dossia System could save about 7% in healthcare costs.
Intel and Walmart had been having separate discussions with the CDC, and the agency suggested that they combine their efforts to press for digital health records. Craig Barrett, Intel's Chair, and Linda Dillman, the leader of Walmart's health care initiative, would appear to be the major spokespersons for the initiative.
At this reading, neither the AHA nor the AMA have specifically endorsed the initiative. Support has come from the Federal government, The American Academy of Family Physicians, and the National Association of Manufacturers.
Musings:
a. This initiative, together with Googles' and Intuit's announced intentions to enter the e Health market, suggest that the private sector is ready to play a major role in the digital transformation of health care.
b. The sponsoring companies could benefit on the revenue side as well. For example, Intel sells chips that power PC's and giant file servers.
c. Apparently, key employers believe the health industry isn't moving quickly enough to digitize health records. Intel's Barrett claimed the industry is incapable of modifying itself.
d. I doubt this initiative will have the same impact as Walmart's RFID requirement for it's vendors. The only comparable force facing the health care industry is the US government, and the political will to spur system change is lacking.
e. The jury is out as to whether employers and insurers will use the information to deny employment or insurance coverage.
f. Will the patient/consumer turn out to be the best integrator of health information? Perhaps over the long term, but in the short term?
On December 6th, 5 US Companies (Walmart, Intel, BP America, Applied Materials, and Pitney Bowes) announced a plan to provide digital health records to their employees, dependents, and retirees. Omnimedix, a non profit firm based in Oregon, will build and run the new system. The sponsoring employers will chip in $1.5 million apiece to construct a data warehouse to store and update the e-records. The stated goal is to cut costs by having consumers coordinate their own health care among doctors and hospitals. Independent studies suggest that employers with an established Dossia System could save about 7% in healthcare costs.
Intel and Walmart had been having separate discussions with the CDC, and the agency suggested that they combine their efforts to press for digital health records. Craig Barrett, Intel's Chair, and Linda Dillman, the leader of Walmart's health care initiative, would appear to be the major spokespersons for the initiative.
At this reading, neither the AHA nor the AMA have specifically endorsed the initiative. Support has come from the Federal government, The American Academy of Family Physicians, and the National Association of Manufacturers.
Musings:
a. This initiative, together with Googles' and Intuit's announced intentions to enter the e Health market, suggest that the private sector is ready to play a major role in the digital transformation of health care.
b. The sponsoring companies could benefit on the revenue side as well. For example, Intel sells chips that power PC's and giant file servers.
c. Apparently, key employers believe the health industry isn't moving quickly enough to digitize health records. Intel's Barrett claimed the industry is incapable of modifying itself.
d. I doubt this initiative will have the same impact as Walmart's RFID requirement for it's vendors. The only comparable force facing the health care industry is the US government, and the political will to spur system change is lacking.
e. The jury is out as to whether employers and insurers will use the information to deny employment or insurance coverage.
f. Will the patient/consumer turn out to be the best integrator of health information? Perhaps over the long term, but in the short term?
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