Healthcare

A recap of reactions to the Healthcare Stimulus in the American Reinvestment and Recovery Act (ARRA)

Now that two weeks have passed since President Obama passed the American Recovery and Reinvesment Act, I took some time to reflect on the many, many comments that I’ve heard and read about whether the stimulus package is taking the right approach, and in general where we go from here.

The return on invesment of Healthcare IT – There are more than a few articles and blogs questioning whether there is an ROI for healthcare IT.   (See HIMSS for one example)  I think that those of us who have blindly assumed that automating current manual processes would guarantee a return on investment could benefit from such a dose of skepticism.  I’ve read in several places what I believe to be an extremely valid suggestion – test out healthcare IT like we do any other healthcare protocol:  using a clinical approach where the new method is evaluated against pre-existing methods.  What I will say though is that any blanket statement about the ROI of the implementation of IT in healthcare is like any other broad statement:  it may be accurate in some cases, but is virtually unthinkable to be true in all cases.   Like any other investment, leveraging IT in any business can be done well or poorly.  It’s a well known fact that some attempts to implement IT in healthcare have been debacles in the largest degree, but there are also success stories.  So in the coming weeks and months, I think we all need to be careful of speaking in platitudes.

Security concerns in going fully electronic – Lost in the din of questions such as “how do you define ‘meaningful use’?”, and “who is going to ‘certify’ EMRs?” has been the question of security.  Security was a brief topic during the panel discussion at the Transforming Healthcare Summit on February 26th in Boston, but it’s going to need to be a big topic to ensure that we proactively avoid any major security breaches of patient information in the next few years.  We need to learn the lessons that the financial, retail and government sectors learned in the past decade – particularly that a “first build it, then secure it” approach is a precursor to disaster.

Using an inclusive process as part of the implementation of health IT – Much has been made of so-called “failed implementations of health IT”, and there are more than a few blogs by doctors who rightly point out that poorly designed solutions have in fact made their lives harder.  (See here for one of a multitude of examples)  These concerns are valid and need to be addressed through good standards and good process.  If this stimulus turns into a gold rush, then it’s a guarantee that one output will be much more of this type of frustration from the user community.  What we need is a patient and methodical approach, as well as a decent set of standards to ensure interoperability between practices and hospitals.  Now that Obama has made his choice for the Secretary of Health and Human Services, high on the list of things she will need to do (once confirmed – which hopefully will be sooner rather than later!) will be to designate some group as the leader to drive these standards to clarity such that the real work can begin.

Lack of clarity around reimbursement and certification – I’ve thought a lot about this in the past few weeks, and at the macro level, I think the message behind what President Obama is doing is the right message:  “We need to move away from paper-based operations into a future of interconnectedness, where information can be shared quickly and effectively to increase quality of care and reduce administrative cost.”  I don’t think anyone would argue with this statement at this level of detail.  The argument starts, instead, at how to get there.  The incentive in the ARRA is to say to doctors – “we will help you to defray the cost of implementing this technology”.   The question that remains is whether cost has been the only barrier that has kept us from already achieving the aforementioned goal all by ourselves (without government intervention).  There is the question of good implementation versus poor implementation.  Like any field, there are individuals and companies in the IT field who are better and there are those who are worse.  Those in the healthcare field who would be consumers of IT products and services need to keep this in mind and push hard for references and other means to understand in which camp their vendor of choice belongs.  There might be ways that other entities (e.g. the Better Business Bureau) can play a role in helping medical practices pick good, capable service providers.

We must also recognize that beyond “good IT service provider vs poor IT service provider”, there is also the question of whether some people just don’t want to change.  There certainly are those in the medical field who are technology phobic and will fight tooth and nail to keep their practice the way it is.  We can’t waste our time and effort to convince these people otherwise.  Instead, the way forward is to find those are are willing to embrace new technology and to work with them to show that it can be done, and when it’s done well, the benefits far outweigh the cost.   This will convince those who are “on the fence” but willing to be convinced that they should join the group who are adopting healthcare IT, and not the naysayers.

The healthcare and IT industry must work together to address all the above items, and we must avoid the urge to rush ahead and do things for the sake of expediency, rather than for the sake of quality.  That said, President Obama has made it clear that it will no longer be acceptable to drag ones feet under the guise of a cautious approach.  We must seek a middle ground.

© 2009 medullan | blog.