Given the $47 billion awarded in stimulus funding, it's clear the government's assumption is that healthcare information technology (IT) will deliver better care at lower cost. The IT industry and all the healthcare IT mavens are waving the flags and beating the drums.
But can current IT deliver?
I wrote a white paper for Microsoft in 2005 that suggested healthcare IT was not delivering on its promise then Microsoft Paper. And in January, The National Academy of Sciences' National Research Council (NRC) published a report that states it's still not delivering today NRC report..
The NRC report is a sobering breath of fresh air in a discussion that has grown stale and over-heated with the self-serving marketing efforts of the IT industry and chest-thumping, one dimensional reports of success. The report tells a far different story: current healthcare IT and all the billions of dollars we have invested in it "fall far short ... of what is needed to support the ... vision of quality health care." The caution is that the huge investment in healthcare IT is in danger of flatlining, if it's not already dead on arrival.
The problem is not a lack of money, interest or hard working, intelligent, compassionate people. The root cause of our dilemma is the deeply embedded conviction that we have to solve big complex, expensive problems with big, complex, expensive solutions.
What's wrong our with our current IT solution? The NRC report spells it out. It describes monolithic, expensive systems that are difficult to change - in fact, implementing and improving them can take years or even decades. Further complicating the issue is the fact that these systems' designs are tied to automation of current best practices - which often aren't "best" or even "good" and certainly aren't the future. They lack support or even understanding of the cognitive functions and needs of clinicians and staff. Finally, the report describes how poor designs can increase the chance for error, add to rather than reduce work, and compound the frustrations of executing required tasks without an effective way to rapidly problem solve and improve them.
In my work I have seen far too many examples of such problems. One health system "successfully" automated physician histories and physicals in such a way that for months 50 percent of the histories and physicals failed to arrive in time for the patients' surgery. This multimillion-dollar system was perfectly designed to not work.
On the other hand, I've learned that it is possible to improve healthcare IT to effectively deliver better care at lower costs. Recently brainstorming with a visionary technology entrepreneur, we came up with an idea for a healthcare IT system that a patient would wear on their wrist like a watch. The system would create continuity between every healthcare provider the patient encountered. Similarly, my soon-to-be-published book, Designed to Adapt: Leading Healthcare in Challenging Times (Second River Healthcare Press, 2009), describes a simple "Ideal Health Card" that would permanently solve the hassles and frustrations of registration and medication reconciliation.
I believe the healthcare IT problem relates to my frustrating experience as a healthcare executive searching for more data, better metrics and going to endless meetings to solve the big problems - quality, safety, profitability, compliance, paperless-records, etc. - while physicians and staff struggled with the multitude of small problems that eventually created all those larger issues.
As a Visiting Scholar at Harvard Business School, I studied those few companies that successfully managed complex, dynamic, unpredictable work and found three common principles that apply directly to our current IT dilemma. The successful few were extremely good at:
1. Developing their people to solve small problems as close to the work as possible
2. Using that problem solving to create a responsive, learning organization
3. Accelerating learning with simple, flexible, locally responsive IT
In other words, technology was not the solution; technology was a flexible, improvable tool that was used to accelerate the solution.
My twelve years of experience in testing, validating and improving real time problem solving capabilities in healthcare makes it very clear what delivering on the IT promise will look like. Systems that will deliver will be less costly, modular, fast, flexible, friendly, and responsive. Think smart phones, distributed networks, intraoperability and locally improvable.
Systems that won't deliver are the opposite. Think desk tops, laptops, expensive, centralized, massive roll-outs that can't be changed or improved until the next version is designed, built, purchased and implemented (again).
Unfortunately, the latter is what the NRC report says we are getting. The big IT train is already out of the station. We won't derail it, but we can accelerate work on the alternative that will deliver on the promise. We won't buy this solution. We'll make it, through disruptive innovation.
Fortunately, all the pieces to build fast, flexible, friendly, effective IT are out there waiting to be assembled, tested and improved. Mandl and Kohane's editorial, "No Small Change for the Health Information Economy" in New England Journal of Medicine ( NEJM editorial) is a good summary. I know small companies with great, patient-focused IT solutions in important areas like diabetes that are in development now. Government can help by creating safe harbors for development and directing funding into non-traditional, disruptive opportunities.
For disruption to succeed, it is essential for a few, visionary IT companies and healthcare providers to link together to create the new systems that will make current systems obsolete. We must start with the patient. Development must be embedded at the point-of-care to allow real time learning. The focus must be getting patients exactly what they need at continually lower cost. That's the way to fix healthcare.
We can't afford for our IT investments to flatline.
Dr. John Kenagy is a former Visiting Scholar at Harvard Business School and the author of the forthcoming book Designed to Adapt: Leading Healthcare in Challenging Times (Second River Healthcare Press, 2009).