Why Hospitals, Doctors Trail the HIT Revolution

A lot of very bright people are convinced that the current healthcare IT revolution will happen last at hospitals and in doctors' offices.

Some of them are in significant positions of influence. One such influencer is Chris Wasden, a managing director and innovation practice leader at PwC. I caught up with Wasden at the recent HIMSS conference, and what follows are some excerpts of our conversation.

HLM: Do we have enough technology but not the logistics to deploy it in healthcare?

Wasden: I don't believe that we are ambitious enough with regards to what we want to accomplish, and so we are applying too much technology to do nothing more than create digital versions of the current world, and we're not trying to create a new world.

HLM: I'll give you a perfect example. On the front page of HealthLeaders this morning is a story that says 87 percent of physicians say they get too many alerts.

Wasden: This is the analogy that I give often times. How successful would the pharmaceutical industry be if the business model in pharma was you have all these smart scientists inventing new technologies, getting patents, and then what the pharmaceutical industry does is they license the patent to individual physicians and sell them a chemistry set and say make as much as you want.

But that's what we do in technology. We have all these guys invent technology, then they give it all to the doctors and say, I'm sure you'll figure out something to do with this. Good luck.

Doctors want technology to be as simple as writing a script for a drug. We'll even provide a monitoring service for it, and you doctors, as far as you're concerned, you're done. That's what technology has to do for doctors. I'm going to find out only when someone else has got a bazillion alerts, and everything they've tried still isn't working, and you actually need to see me again.

But I'm not going to get all the alerts. I'm not going to monitor you. Someone else is going to do all that. I'm just going to see you when everything else has failed.

HLM: I guess the question you're posing is, who is that someone else?

Wasden: Basically you've got these new systems integrators that are emerging on the scene that are saying, we're going to take all the complexity of all this technology and we're going to simplify it for you. Doctors are going to be the last in the healthcare ecosystem to adopt most of these new technologies. Consumers are going to drive it. Employers are going to drive it.

We're very bullish on the employers driving, because within five years, I think almost no employer is going to have a defined benefit for healthcare. They're going to have a defined contribution.

Here's your money. If you want to go to an exchange and get your health insurance, fine. If you want to get it through us, fine, but the amount that we're giving you is capped. You want more than that, you pay for it yourself.

If you look at behavioral psychology, you find that people actually have five times the receptors for pain that they do for pleasure. So you've got to have these carrots and sticks. You've got to have metrics. They need to be objective. They can't be self-reported.

The other problem is that unless you have the inpatient, the outpatient, the lab, the claims data, patient-generated data, you don't have a perspective on what the patient needs or what's going on.

Everyone has one piece of that information, but they don't have the entire picture. From a consumer perspective, there's no EHR system that I've found anywhere that enables you to collect patient-generated data and integrate it into the record.

HLM: There's talk about it in the Health IT Standards Committee.

Wasden: I'm writing a chapter for a book right now on all the barriers among providers to patient-generated data, and the reality is, providers don't want patient-generated data. You have this alert issue. "All it's going to do is give us all these alerts we don't want."

They've got issues around privacy and security. They've got issues about liability. This is an interesting one. Right now, if I have no information on you, no digital information, and I make a diagnosis, and I'm wrong, what's the downside? Some other doctor's going to say that I was wrong, but that's his opinion, and he wasn't there at the moment.

What's the patient know? The patient doesn't know anything. So it's my word against somebody else's word. If I have a lot of digital information, now there's a fact base. What sort of risk am I now exposing myself to when there's actually data and facts as opposed to my opinion? So my liability goes up a lot, by adding digital information, so they're concerned about that.

HLM: So is that where government comes in and says you will do it? Does that make any sense? A lot of people say that's the worst solution.

Wasden: So I was with the chief medical officer for CMS, and I was talking about all these issues, and he asks me, how do we get more rapid adoption of mobile health solutions? If you look at a mobile health technology, versus a traditional clinical technology, a mobile health technology generally costs one tenth, so you can eliminate 90 percent of the cost of the device by moving it to mobile versus the traditional model.

HLM: There's a lot of things you can do with these devices.

Wasden: My recommendation: Stop paying more for the old way versus the new way, and pay a lot less for the new way than for the old way. So if you want doctors to adopt a mobile health solution which has the potential to be a third to a half less costly, then pay a third to a half as much for that solution, and pay even less for the old way, and you'll get immediate adoption.

Doctors don't want that! Hospitals don't want that! I worked with the CEO of one of the largest academic medical centers in the country, and they did an exercise where they looked at all of the unnecessary testing that they did, to see if they could eliminate it.

What they found is if they eliminated unnecessary testing, they would go bankrupt. Our entire healthcare system is based upon unnecessary testing. It is! We have new technologies that can easily eliminate a third to a half the cost of healthcare, that we provide no incentive or support to adopt, and so in the absence of all that, what's going on? Consumers are adopting it. Payers are adopting it. Employers are adopting it.

Physicians and hospitals will be the slowest to adopt.