Tuesday, February 27, 2007

Uncommon Common Sense

Recently, I ran across a podcast sponsored by Deloitte called "Sharing the Health: The Promise of Health Information Exchanges." John Halamka and John Glaser (HIT household names, to be sure) were the featured panelists. I commend this podcast to you without reservation, because their views are devoid of hype, and grounded in the hard realities of HIT transformation in this country. Here is my take-away list.
a. HIT may be able to reduce the 15% redundancy rate in medical practice, but the 15% cost savings for payers equates to 15% income loss for practioners, who won't suffer that kind of income reduction lightly.
b. Two winning business propositions for HIE's are e-prescribing and sending discharge summaries to referring MD's.
c. The information exchanges are a social good, and therefore, governments need to play a major role in their funding--certainly well beyond the current support levels.
d. President Bush's goal of most Americans having access to EHR's by 2014 is unrealistic (I've often referred to it as a "mirage," not a vision). This vision will take decades to be realized. We'd better set in for the long haul.
e. Leadership will come from the States, and not the Federal government. The States can serve as funders, convenors, standard setters, and trust builders.
f. Payer sponsored personal health records are intended to capture market share. The payers are powerful, well funded, uncoordinated, and present real problems for the RHIO's community coordinating function.
g. BEWARE of the grant funding model, unless the grant covers 100% of the work to be done.
h. A shakeout in the RHIO world is forthcoming, akin to the dot com bust of the past. We're in an era of "irrational expectations." They anticipate that about a dozen HIE's will achieve financial sustainability (Out of 160 HIE's currently in existence).
i. There are much more pressing system needs than HIT (i.e., the uninsured). Sobering, but true, I believe.
j. RHIO's may have a better chance to thrive in regions with few payers, local ownership, and non profit structures.

Tuesday, February 6, 2007

2nd Annual HIMSS Blogger Meetup

Be sure to check out the 2nd Annual HIMSS Blogger Meetup in New Orleans, outlined at the Healthcare IT Guy. It should be an interesting session!

Thursday, February 1, 2007

Early Adopters

For some time, I have been interested in the characteristics of the early adopters in HIT. The annual 100 "Most Wired Hospitals" list for 2006 seemed like a good place to start an examination. There were 13 new members in the 2006 listing, and if memory serves me correctly, the annual turnover on the list is about 15%. So, who are the institutions who have maintained the rating for all 8 years of the survey? Turns out there are 7 - Avera Health from Sioux Falls, MeritCare from Fargo, Partners from Boston, Sharp from San Diego, Hackensack University Hospital, the University of Pittsburgh Medical Center, and Valley Health System in Winchester, VA. On the surface, we can find no symmetry relative to geography, hospital type, or size. The answers lie within, apparently.
Turning to Wikipedia, we find the following:
Diffusion of innovations theory was formalized by Everett Rogers in a 1962 book called Diffusion of Innovations. Rogers stated that adopters of any new innovation or idea could be categorized as innovators (2.5%), early adopters (13.5%), early majority (34%), late majority (34%) and laggards (16%), based on a bell curve. Each adopter's willingness and ability to adopt an innovation would depend on their awareness, interest, evaluation, trial, and adoption. Some of the characteristics of each category of adopter include:
Innovators - venturesome, educated, multiple info sources, greater propensity to take risk
Early adopters - social leaders, popular, educated
Early majority - deliberate, many informal social contacts
Late majority - skeptical, traditional, lower socio-economic status
Laggards - neighbours and friends are main info sources, fear of debt
The 8 institutions are "Innovators,"to be sure, and have sustained their edge, when the diffusion rate of HIT was growing rapidly.
From my vantage point, I would think the internal reasons why the 8 have maintained their rating are: continuity of leadership, a culture which values innovation, sustained financial success, and thoughtful implementation of HIT initiatives.