Healthcare IT Gets Snubbed in “State of the Union”……So What!

I would not want to be the President right now. No matter what he said on Wednesday night, he undoubtedly would leave someone out; some initiative, some special interest, some high priority agenda item. Then how, with tackling the exorbitantly high cost of healthcare as the single highest profile item on his desk, did he forget to mention Healthcare IT (HIT)? Seriously, how?

There was no mention of the ARRA and HITECH money allocated to demonstrating “meaningful use” of healthcare IT that hospitals, doctors offices, healthcare clinics and every other possible recipient has been scrambling like chickens with their heads cut off to understand for the past 6 months. There have literally been new businesses created to analyze and make sense of this information; new government committees established to oversee the process; experts and pundits claiming this and that on national stages, radio shows, conferences; with all the press HIT has gotten from the day the President was sworn in, you’d think he would’ve give us a progress report, at least from his point view.

There was no mention of the EMRs, CPOE, Clinical Data Repositories, PACS, and Electronic Documentation that are all suitable candidates for the initial projects providers can tackle because of the availability of research and best practices available for these initiatives. No mention of the increased regulations from JCAHO, HIPAA, and CMS. No mention of the accessibility issue so closely related to the President’s broadband initiative that will determine patient accessibility beyond the hospital walls.

There was no mention of the strategies that CIOs, CMIOs, CEOs, and CFOs are utilizing such as data warehousing, clinical data marts, electronic capture of patient information through kiosks (just like when you check in at the airport); clinical alerting to increase compliance with Core Measures and other regulations; and using evidence-based decision making from strong data quality, discrete, standard, timely data collection, and last but not least, enterprise-wide data governance strategies.

Ok, so we were all left out, but as Tom Hanks would say “there’s no crying in baseball”.  Good thing for us, we don’t have time to sit and sulk.  First things first, get your act together.  You will never understand where your weaknesses lie and your opportunities for improvement sit without understanding the information you’re collecting, on a day-to-day basis, across the entire spectrum of your healthcare organization.  The average hospital has 120 different software applications, mostly transactional, that all have their own subset of data. Understanding this vast landscape, and integrating the data and transforming it, in a timely manner, into actionable information, is critical for any executive; the providers able to balance government demanding reform, patients begging for lower costs of care, researchers advancing the standards for higher quality, and the constant advancements in technology will be the ones who not only survive, but emerge from this recession stronger than when they entered. You will be looking for a roadmap!

2 thoughts on “Healthcare IT Gets Snubbed in “State of the Union”……So What!

  1. Ryan- your commentary is, well not harsh, but abrupt. I think that your points are clear and fair, for the most part. I think that those of us in the healthcare sphere are those most likely to hear and agree with what you are saying. Let’s get it right. Mr. Obama has the right idea, but I think it’s fair to say that those of us in the HC profession are not feeling well-served, so far, by the level of understanding projected by what we have heard.

    This is not a political blog and I hope you’ll keep it that way. Can you tell us more about how you think the major HC initiatives being proposed by the current administration may affect the HIT (to use your acronym) world, the professionals that are part of it, in the next few months, or year? You have a profound interest and insight, it would seem, in this subject. Will we prosper, or founder? Will our collective reality improve or become more challenging? Will we as a community respond to the challenges these new, yet still old problems pose? Will we embrace the President’s proposals or reject them as feeble and politically motivated? Are we up to this task? Are we above the political rhetoric or are we fundamentally mired in it? This is a big subject. We all are at risk here, yet also stand to profit as well. How do you see the risk vs. ROI balance developing in the next year, two years?

    Thanks for your opinion. This being a blog, after all, I hope you welcome me just throwing out what’s at the top of my mind, and the anonymous way I choose to do it. I’ll look for your response here.


  2. Joe,

    Thank you for your comment. I aboslutely welcome any respones I get, in any flavor. Anonymous is fine with me. I’ll try and answer some of your questions, although I know if I were to do them all justice, I could probably write a book on all of the topics you’ve elicited.

    You are correct, this is not a political blog, on purpose, which leads me to the answer to your first question – I don’t think any of the current proposals being offered and considered by the administration and congress will be effective or even implemented unless we change the nature of the entire discussion from a politically motivated, self-interest-serving, proclamation of agenda’s to an evidence-based, patient centric, quality-driven debate. It has become blatantly obvious that all members of the larger debate do not have the actual stakeholders best interest in mind; and when I say stakeholders, I am implying a hierarchy that puts the patient at the top, the altruistic non-profit clinics, hospitals, teaching institutions and supporters of a healthier country in the middle, and the purely for-profit associated businesses and entities at the bottom. I’m all for allowing market forces to do their thing, but for too long the needs of this hierarchy were served and prioritized from the bottom up and that fundamentally must change.

    Your second question, “will our collective reality improve or become more challenged?” This, I believe, is entirely up to the average consumer. The information to make informed healthcare choices and decisions is available, more and more every day. The ability to discern accurate, medically and evidence-based information from random tidbits and data points simply meant to serve special interests and question best practice is a skill that is required to navigate through all the information. In addition, consumers do themselves a disservice when they allow their ideology and political allegiances to obfuscate the best decisions to be made for their medical care. I strongly believe that blending these two has caused the political infighting and stall tactics we’re seeing currently in Congress. Continuing down this road will lead to limited reform with only the stakeholders with the deepest pockets and best lobbying firms interests served.

    “Will we as a community respond to the challenges these new, yet still old problems pose?” This, I believe, rests with those of us with the knowledge to help educate the public on the pitfalls of this industry to date. The medical care in this country is some of the best in the world; unfortunately the inefficiencies that plague the system have more to do with the consistent delivery, maintenance, management, and oversight of care than anything else. Fortunately, with we have the benefit of learning from others. Just because healthcare involves doctors and body parts and blood, doesn’t mean the problems the industry faces aren’t the same as say, banking in the 80’s. I’ve helped develop enterprise data warehouses for integrated health systems with their own health plan, hospital, and physician group that helps clean up data quality, integrate siloed application systems, and helps executives make evidence-based decisions from actionable data. These same principles were practiced and perfected by banks 20 years ago; we’re still applying the same principles just in a different industry. We need to continue to apply proven methods of improvement either based on research for clinical care or IT best practices for administrative efficiency if we are to improve the industry as a whole. One last point on this topic: this is exactly why the ARRA HITECH Act and other legislation aimed at helping reform healthcare should narrowly be focused on allocating resources for proven methods of improvement vs. experimenting with taxpayer dollars on what one particular group “might” / “hopes” will improve something (aka pork barrel spending).

    The “Risk vs. ROI” question is a good one. I believe we’ve been able to identify, and frankly have lived out in the past 5-7 years, the risk involved with supporting the status quo (e.g. lower levels of care quality, rising premiums, rising rates of chronic disease, and rising cost of care). In order to understand the ROI, performance metrics must be utilized to monitor the progress of our various initiatives (similar to what the Pioneer Institute is doing for MA health reform – I’m thinking of a quasi-Healthcare GAO type oversight without the red tape. The ability to quickly and easily identify tangible progress of healthcare initiatives, while at the same time retaining the choice to eliminate or stop ones that aren’t successful, is imperative.

    Lastly, I think it is critical for the right people and the right organizations to be identified that can be considered legitimate, qualified experts on the subject of healthcare reform. News organizations, Tea Party’s, lobbying firms, insurance companies, politicians, and special interests groups are not experts. Researchers, doctors, policy makers, think tanks (if I dare say the ones that remain less partisan) industry specialists like LeapFrog and the Studer Group, and some others are experts. Let’s make sure we prop these groups up as we move forward on our collective efforts towards reform.

    If you care to discuss this further, please feel free to comment here or contact me directly:

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