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AMIA President: Learn to Surf Tsunami Waves Disrupting Healthcare

November 19, 2012
by David Raths
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Accountable care requires technology, change management skills, Fickenscher says

Fresh off his organization’s annual meeting in Chicago, Kevin Fickenscher, MD, president and CEO of the American Medical Informatics Association, stopped off last week at the Center for Biomedical Informatics (CBMi) at the Children's Hospital of Philadelphia to talk about the industry’s response to disruptive technological change.

Titling his talk “Healthcare 2020: From Gutenberg to Zuckerberg —Informatics and Technology for the New Care Delivery Models,” Fickenscher started by using the metaphor of a tsunami to describe the huge forces precipitating change in healthcare. Only when it gets close to shore does a tsunami become destructive, he noted, adding that the issue is not how to stop the disruptions impacting the industry, but instead to learn how to surf tsunamis.

Among the tsunami-sized changes he identified are:

• An accelerating large-scale consolidation among providers and the breakdown of traditional boundaries in a cross-industry convergence. “Who would have predicted a few years ago that WalMart would be in healthcare?” he asked.

• Work force globalization. IT services are moving to where they are less costly, including things like virtual radiology and dermatology.

• Society is moving inextricably toward an information democracy rather than a professionally dominated theocracy. That movement simultaneously empowers consumers and disempowers physicians.

Fickenscher, who joined AMIA in 2012, was previously chief medical officer for Dell Healthcare Services, where he led the health care information technology consulting practice. He said it is important for all stakeholders to “see the territory with new eyes,” re-examining how the industry operates. He said AMIA is a valuable resource for this purpose because it is multidisciplinary. “You get exciting discussions when you have all the disciplines in the same room,” he said.

Switching metaphors, he said that adapting to change would require greater teamwork in the move to accountable care. “We have built infrastructure for an individual sport, but now we are asking people to work as a team,” he said. That takes a whole different strategy. It is like asking individual golfers to play the Ryder’s Cup, a team event, he said. “My feeling is that we have a bunch of work in front of us.”

Achieving clinical transformation is about cultural change as well as technology, he said. One of the issues with EHRs is that we haven’t spent enough time on people and processes.

Another key is moving from a profession-centric worldview to a systems-centric worldview. In healthcare we have tended to think of ourselves as guilds, such as dermatology, he said. But he thinks the guild approach is dead.

“We have to move from a cottage industry to post-industrial care delivery,” Fickenscher said, and from non-integrated dedicated artisans who eschew standardization toward wise standards of care.

Where does informatics fit in? He said the ability to interface in healthcare offers the possibility of unbounded opportunity for discovery. But without standards, that effort is going to fail. “Currently we have a cacophony of data that needs to be managed, integrated, massaged, and distilled. It will only confuse us if we don’t take the next steps.”