Key learnings are now emerging from the meaningful use process under the HITECH (Health Information Technology for Economic and Clinical Health) Act, learnings that are particularly timely as the U.S. healthcare system evolves forward towards what will soon be a post-meaningful use future, even as healthcare IT leaders are faced with the reality of the need to revision physician documentation, said Douglas B. Fridsma, M.D., Ph.D., president and CEO of the American Medical Informatics Association (AMIA), and who had worked in the Office of the National Coordinator for Health IT (ONC) for five years, from November 2009 through October 2014, including as the Chief Science Officer at ONC from June 2011-October 2014.
Dr. Fridsma, who joined the Bethesda, Md.-based AMIA a year ago in November 2014, delivered a keynote address Tuesday at the Health IT Summit in Beverly Hills, held at the Sofitel Los Angeles at Beverly Hills, in Los Angeles, and sponsored by the Institute for Health Technology Transformation (iHT2, a sister organization to Healthcare Informatics, under the corporate umbrella of parent company Vendome Group, LLC). Expounding on themes he has been sharing recently with healthcare audiences, Fridsma said that, in his perspective, five key learnings are emerging from the meaningful use process, even as it moves into Stage 3 MU and beyond.
Doug Fridsma, M.D., Ph.D.
First, Fridsma said, “Framing matters. Sometimes, you get the right answer to the wrong question,” he said, going on to stress that, in his view, “The bottom line is that health information technology isn’t architecture; it’s city planning. It isn’t that we’re going to have to build some ginormous building that everybody’s going to live in; it’s about city planning, knowing the right zoning laws, figuring out the right building codes for safety, figuring out the right infrastructure for water and electricity and all those things. So it’s an ecosystem in which people will build interesting things inside interesting buildings that we want to live in.”
The key point within that first point, Fridsma told his audience, is that “Governance matters; how you make decisions around federated systems is very important,” and, extending out the metaphor of urban planning, he said, “City planning is decentralized in its control.” What is evolving forward in healthcare IT, he stressed, making his second point, is a “socio-technical system. And that means that people are part of that system, they don’t just interact with the system.” Most significantly, he said, U.S. physicians are inevitably going to express their desires, preferences, dissatisfactions, and grievances with the ways in which healthcare information technology evolves forward, and given the cultural factors involved, the forward evolution of IT in healthcare will necessarily be iterative.
Many people in U.S. healthcare have expressed frustration over the gradual, iterative aspects of the industry’s IT evolution, but the reality, Fridsma said, is that the development of IT will necessarily be incremental, and as a result, he said, “Since we will learn as we go. So in health IT, you’ve got to start with little bites and learn from each of those experiences. So this notion of modularity is really important.”
Fridsma’s fourth and fifth points had to do with the broad context of IT evolution in healthcare. The reality, he said, is that regional and individual-market differences in healthcare will mean that “You’ve got to tolerate differences in semantics and sophistication” among clinicians and other end-users, and patient care organizations, across the U.S. “You’ll have rural physicians who barely have EHRs, and work via dial-ups. You’ll always have some folks ahead of the curve, and some behind the curve. That’s true of systems, too,” he added. “You’ll have legacy systems and new ones, and you’ve got to figure out a way to allow that heterogeneity to exist, even as you make things interoperable.”
Finally, he said, healthcare leaders will have to come to tolerate normal failures, for example, understanding and accepting that data security breaches will occur, and that “Nothing is entirely secure. So we need to focus on risk and recovery,” rather than believing that all breaches can be prevented from occurring in the first place. The reality for those would move the U.S. healthcare industry forward, he said, is that, “If you’re a leader in this field, your job becomes one of orchestration rather than command and control,” given the city planning type of governance involved in healthcare IT in the U.S.