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Dancing on the Precipice: Can CIOs Learn to Keep Rolling with the Waves?

October 13, 2013
by Mark Hagland
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Participants gathered in Scottsdale, Arizona last week at a time of unprecedented clarity in healthcare—despite the political turmoil on Capitol Hill

As I write this blog, Republican and Democratic leaders from the U.S. Senate are engaged in increasingly frantic talks to avert a potential default on the sovereign debt of the United States, as the deadline to lift the current debt ceiling approaches, with just days left before world financial markets begin to shudder under the weight of the conflict currently cleaving in the U.S. Congress in two. Meanwhile, we are nearly two weeks into a federal government shutdown that is already having very serious impacts on widely disparate elements of our society, from veterans about to lose their benefits to children who desperately need food stamps to survive, to restaurateurs and hoteliers in establishments just outside national parks finding their peak autumn business devastated by the shutdown.

At a time of such policy and political uncertainty, it was particularly fascinating to land in Phoenix, and to join the 750 members of CHIME (the Ann Arbor, Mich.-based College of Healthcare Information Management Executives) for the CHIME Fall CIO Forum in the suburb of Scottsdale, last week. Could one ever have picked a more tumultuous time for healthcare executives to meet?

Indeed, the tumult in the wider world touched the Fall Forum, called CHIME13, as Jacob Reider, M.D., Acting National Coordinator for Health IT, was grounded in Washington because of the federal government shutdown, and was not able to speak on Friday morning as planned. But Farzad Mostashari, M.D., who as of just October 5 had left his position as National Coordinator, and is now a visiting fellow at the Brookings Institution, was able to join the Fall Forum, and on Wednesday, offered attendees bracing comments, most particularly about the chances of any meaningful use Stage 2 extension—which he cited as highly remote—in a voice that was notably freer, post-federal service.

In the midst of this time of swirling eddies, and indeed, walloping vortexes, are CIOs battening down the hatches? Running for cover? Driving off on Route 66?? Actually, I found it quite heartening that the atmosphere of CHIME13 seemed more invigorated, more purposeful, than I had seen it in the prior few years. If anything, there was a sense of forward direction and determination this year at the Fall Forum that came through in presentations, panel discussions, and hallway conversations throughout the course of the conference.

Doubtless this is because, despite the shutdown/debt ceiling turmoil on Capitol Hill right now, the direction that the U.S. healthcare system is heading is clearer than it’s ever been—towards what we at Healthcare Informatics have been calling simply the new healthcare. That concept encompasses all the broad elements of the emerging new healthcare system: accountable care organizations, bundled-payment contracts, patient-centered medical homes, care management and transitions of care management, avoidable readmissions reduction, value-based purchasing, and above all, the broad population health management concept—that are fueling healthcare’s new horizons.

More than ever before, CIOs and other healthcare IT leaders know where they and their organizations need to go. So in contrast to, say, ten years ago, when, if one were to ask ten different healthcare CIOs where U.S. healthcare was headed in the next decade, one would get ten different answers, today, one would essentially get one answer (granted, still with a few different flavors), and that answer would be, as we at HCI put it, the new healthcare.

So the only question left is how to get there, what vehicles, strategies, and technologies to use, not what the destination is. And that is, frankly, energizing. And speaking with people like Rick Schooler of Orlando Health, it seemed clear to me that the pioneers of the new healthcare are going to get to the new “Oregon Territory” of healthcare, and once they get there, the pioneer wagons will never stop moving forward.

That is in no way to minimize the incredible difficulty of achieving everything that needs to be achieved to lay the strategic IT foundations for the new healthcare. This is an overall challenge the likes of which have never been seen before in healthcare, because it means preparing for a transformation of the U.S. healthcare system that has never before been demanded of hospitals, medical groups, and integrated health systems.

What’s more, as everyone has noted, just getting through the stages of meaningful use under the HITECH Act, successfully transitioning to the new ICD-10 coding system, and satisfying the most basic demands of the mandatory programs under the Affordable Care Act, including value-based purchasing, healthcare-acquired conditions reduction, and most especially, avoidable readmissions reduction, put all together, is a set of challenges unprecedented in both magnitude and tightness of timeframes, in U.S. healthcare.

But those pioneers that will succeed and will lead the way are themselves being led by leaders with vision, who are moving forward with vision. And all that is intensely clarifying as well.