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Disaster in the Making

December 31, 2009
by Anthony Guerra, Editor-in-Chief
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Every time I think HITECH legislation is bad, a closer look reveals it's worse

As I write this column, we're only days away from tallying your votes for the “HCI Innovator Awards.” Though your work is just now concluding, our editorial staff finished up a few weeks ago, after we reviewed the 60+ nominations to arrive at our top 15.

And while those 60 entries covered every type of hospital IT project, a majority of this year's entries were striking for their post-EMR implementation focus. So though the nation is transfixed on getting electronic records into hospitals and physician offices, industry-leading organizations - innovators - are figuring out how to plumb their deep functionality, and keep these mission-critical systems up and running.

Keeping them up and running is something I learned about first-hand while covering IT on Wall Street from 2000 to 2004. And, of course, we all know what life-changing event took place during those years right in the heart of the financial services industry. Post 9/11 Wall Street was, naturally, obsessed with disaster recovery technologies and strategies. Every firm trading stocks, it seemed, soon boasted a new executive in charge of ensuring business continuity.

Wall Street had automated decades before disaster recovery became something the industry couldn't ignore. Automation, in and of itself, takes copious capital dollars, with disaster recovery often seen as “something important we'll get to, but can't afford right now.” How many people are walking around without insurance, just because, “It won't happen to me”?

CIOs have accepted that the massive application loads being dropped onto their infrastructures require major refitting, or complete reconstruction. But fortifying the foundation is just the first step. Hospitals need to take it to the next level, with sophisticated plans for backing up their data centers. Hospitals need to plan for the possible collapse of their infrastructure due to a natural disaster, act of terrorism or cyber attack. They need plans for how to move patients from hospital A to hospital B without losing power to life-sustaining biomedical equipment, or the EHR.

Over the last few years, we've written extensively about disaster recovery, but this is a different time. Before HITECH, when going electronic was voluntary, organizations could move at their own pace, figuring a certain level of disaster recovery spending into their plans. But no one is taking about such things today, despite all the pressure to go electronic.

Just like every other aspect of healthcare IT, the big players have it well in hand. But in the post-HITECH world, the majority of players are far from big. They're the 50-250 bed community hospitals, the one-to-five doctor practices. These organizations are doing absolutely all they can to comply with HITECH's meaningful use requirements and qualify for the incentive payments, with no time or funds left over to spend on business continuity.

Unfortunately, this is just one more side-effect of government intervention's unintended consequences. The more interviews I do, the more it seems policymakers are operating on a combat model of acceptable losses, on the premise that to bake a cake, you have to break a few eggs.

Of course, any systemic change is painful, but I can't stop thinking that shoddy HITECH legislation will make this conversion exponentially more so. There are going to be more “losses” than anyone anticipates, and more than a few broken eggs.

We should have gotten something better than HITECH from our legislators. We could have had the move to e-health take place along a slower and more sensible path. Instead, we're entering a three-to-five year land rush, a mad frenzy of activity. Let's just hope it's not a complete disaster.

Anthony Guerra, Editor-in-Chief
Healthcare Informatics 2010 January;27(1):8