Friday, January 26, 2007

Comment on HIMSS January 2007 Standards Insight

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.

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