Nashville: The New Hotbed for Health IT Innovation

There are only a handful of regions in the United States that have the knowledge base, capital access, local leadership, and infrastructure to be the innovative leader in health IT. And Nashville, TN, is a "tremendous contender," said David Brailer, MD, PhD, chairman of San Francisco, CA-based Health Evolution Partners, during the Nashville Health Care Council's forum on health information technology and the economic stimulus held nearly two weeks ago.

It has been awhile since we've heard from Brailer, the former National Coordinator of HIT. He joked how arriving in Nashville on Southwest Airlines was a completely different experience than his last visit when he arrived on Air Force One. Brailer was joined by William W. Stead, MD, associate vice chancellor for strategy and transformation at Vanderbilt University Medical Center, Don E. Detmer, MD, president and CEO of the American Medical Informatics Association, and Dave Goetz, Jr., commissioner for the department of finance and administration for the State of Tennessee.

Jonathan B. Perlin, MD, PhD, who is the chief medical officer and president of clinical services at HCA and was recently named chair of the Department of Health and Human Services Health Information Technology Standards Committee, moderated the panel.

The panel focused on three questions:

• How to make the HIT investment in the stimulus package the most effective?
• Are the goals realistic?
• Will the increased regulation of the HITECH Act stifle innovation?

Brailer echoed a sentiment that I've heard repeatedly. Namely, that adopting HIT is not enough. The technology should be adopted in a manner that changes the fundamental delivery of healthcare by driving quality, efficiency, and transparency. He also expressed concern that Washington may not be able to move beyond financing IT to change the world of care delivery.

“We are pushing health IT instead of pulling it and I think that leads to inefficiencies," said Brailer.

The incentives will get the industry moving in the right direction, he said, but providers may have to wait longer to receive stimulus funding than many people realize. "The money will not be a tsumani but a trickle," he said.

Brailer also said he doesn't believe that having a regulated market will stifle innovation as long as the end objectives allow free play, innovation, and competition.

Stead agreed, saying that a regulated approach can work but it must redefine interoperable information as information that can be reinterpreted as knowledge evolves, separate data from applications so different kinds of computer systems can access it, and limit the use of standard data that has one and only one meaning.

In order to see reductions in cost and improvement in quality, Stead said that the industry has to change the nature of practice itself like coordinating care across the continuum and practicing evidence-based medicine. For the technology to work it has to be "architected so it can support change and adapt to change," said Stead.

When it comes to leveraging health information exchanges, Goetz said that the solutions need to be simple, thoughtful, and meet clinical goals. "We try and build information sources that can then drive value," he said. "We won’t get value without simplification."

And even though Goetz said the goals of the HITECH Act will be difficult to meet, he thinks the healthcare community will find a way to make it work.

Detmer is equally optimistic about the opportunity the stimulus package provides, but he is still not convinced that the rate of change will move more quickly than it is currently moving. "It is a tremendous opportunity," he said. "But workforce and training issues are quite real."

Simply having a good technology isn’t enough to remove the barriers of cost, change, disruption, and risk, said Brailer. "Healthcare entrepreneurs must actually understand how the healthcare delivery system works so they can actually make a change in it.”

The technology is only worth it if you are going to get a 40% to 60% improvement in value, said Stead. The stimulus package offers the healthcare industry a real opportunity to innovate. But to capitalize on that, Stead said, "we have to be willing to stop playing defense around a model that is not sustainable."