Time to Move Beyond the Stimulus Hype and Get to Work

Kathryn Mackenzie, for HealthLeaders Media, March 3, 2009

The United States healthcare system is going to become digitized. By allotting nearly $20 billion for health information technology, President Obama has set in motion a fundamental change to our entire healthcare system that many experts agree has been a long time coming. The period we're in now is that nebulous time after a bill has become law, but before any tangible change takes place when all the blogs and message boards come alive with opinions, hypotheses, and predictions about what this infusion of cash will mean in practical terms for the country's hospitals and physician practices.

Is HIT enough to fix our broken system of care? Are electronic health records mature enough for a deployment of this scale? What about interoperability issues? What about standards? All important questions. But perhaps not the right questions, says Peter Basch, MD, a clinical leader for EHR implementation at MedStar Health, a community-based network of eight hospitals and other healthcare services in the Baltimore/Washington region.

"We're chasing a target and that target is technology adoption. But you have to realize that once you've adopted that technology, you're basically embracing a care neutral and a safety neutral and a quality neutral tool. Without understanding how to use that tool to achieve the administration's goal of reforming and improving our healthcare system, we stand very little chance for improvement," he says.

Basch offers up this example: Would simply giving every high school student a computer automatically improve test scores? Probably not. But if you put computers in the hands of motivated students who have good teachers and a good teaching plan with a solid strategy for how to use this technology to achieve their goals, well, then you stand a chance for improvement.

"One thing that has always vexed me is that as this stimulus bill got closer and closer to being announced, we started seeing an increasing number of disparate studies. One showing that HIT has no value, then the next one tells us HIT has negative value, and the next one shows HIT has positive value," says Basch. "My thought is, stop staring at your feet and look forward."

The bottom line, says Basch, is that HIT is not magic. Yes, digitizing our existing system can lead to improved outcomes, but how much good can it really do in a healthcare system as disjointed as ours? "No matter how sophisticated the technology, if it's being used in a broken infrastructure, it will just make bad processes happen more quickly. To see mediocre or hopefully better HIT optimize quality, safety and effectiveness, health IT has to be implemented in a healthcare system that is far less broken than the one we have today," he says.

So where does that leave us? Basch says lawmakers should not just be looking at adoption of HIT, but should be placing just as much importance on revamping the payment system. "An EMR can do no more than support the business processes of the health system. If the system contains fully aligned payment incentives that lead to participants doing well by doing good, then maybe health IT can realize its full potential," says Basch.

For CIOs who are working on the frontlines of this movement, your job now is to be in constant communication with your hospital's clinicians to find out what kind of technology would really make a difference in the quality of care they offer, says Basch. "Of course, we all want to be paying close attention to the definition of meaningful use. Beyond that I would hope that health systems will move beyond looking at HIT as just a project, but look at these implementations for what they can accomplish," he says.

The technology is never going to be perfect. And the "experts" could probably spend from now until eternity debating the virtues of EMRs. Maybe now our time would be better spent concentrating less on simply increasing adoption numbers, and more on fixing what's broken in our healthcare system.

Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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