Blurred Lines, Complex Worlds

Gary Baldwin, for HealthLeaders Media, January 28, 2008
Years ago Sports Illustrated ran a cover story on the Chicago Bears' star linebacker. It was called "The Complex World of Mike Singletary," and showed a line diagram of the various intricate maneuvers that Singletary considered on a given play.

As I prepare stories for HealthLeaders magazine, I often think of that cover headline, inserting my source's name into that "complex world" slug. Last year at a software user group meeting, I talked to the CIO of a well-known academic medical center. My first question, "how many hospitals are in your system?," was really just an effort to break the ice. But I forgot the "complex world" principle.

The CIO launched into a five-minute description of the multiple hospitals within the health system and the various ownership and governance relationships therein. To oversimplify, some of the hospitals were owned, the others were "affiliated." But that label does not do justice to the tangled nature of the hospitals' structure and leadership. Throw in a health insurance plan, and you have a Rube Goldberg machine. After a while, the CIO just stopped, and sighed, "Well, it's complicated."

Our exchange speaks to one of the key reasons that adopting computer technology in the healthcare setting is so difficult. It is the square-peg, round-hole scenario on steroids. This particular CIO said the institutional complexity came to the forefront when the health system enacted its data sharing privacy agreements under the HIPAA law. Figuring out who the "business associates" were proved exceedingly difficult, she said. So if you can't figure out easily who has the legitimate need to view which record, how in the world can you ever hope to use computer technology to facilitate the transaction?

Technology can compel the modern health system to revisit its org chart, however convoluted. In the case of this academic medical center, the CIO observed that the line between IT and biomedicine was blurring. That's because the hospital wants to feed data from its devices into its EMR. In years past, the IT department had little oversight on biomedical devices. Now that the data coming from these devices is moving into the EMR, that is sure to change. Maybe the complex world of healthcare can be simplified after all.

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at
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