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Speaking of Change

April 17, 2007
by Charlene Marietti
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To achieve the level of change required to transform the U.S. healthcare system, technology will be essential, but not enough.

No one can dispute that the healthcare industry is in the midst of dramatic change. However, no one can quite foresee exactly what that means or what that will entail. We all know and agree that the current U.S. care delivery system is broken. Inefficiency might be forgiven if outcomes were superior –— or even acceptable. But they're not. And we're in a pickle.

One thing everyone can agree on is that there are no quick fixes. The problem is so big, so complex and directly affects so many different stakeholders that consensus on changing anything continues to stretch across lengthy debates and extended political maneuvers. The inefficiencies that plague healthcare are one of the industry's biggest challenges. "Every inefficiency has its constituents," governance consultant James Orlikoff, president of Orlikoff & Associates Inc., Chicago, told CIOs at the Spring CIO Forum jointly sponsored by the College of Healthcare Information Management Executives (CHIME) and Health Information Management Systems Society (HIMSS) in New Orleans in February. There are simply too many beneficiaries wrapped up in the complexities of the current U.S. healthcare system and each of whom is looking out for his or her own best interests.

"You never get a paradigm shift unless there's a funeral. The keepers of the old paradigm must die".

To bring about the paradigm shift necessary to fix the U.S. healthcare system, slight alterations in habits and work patterns, minor reassessments of workflow and restructured payment schemes won't be nearly enough. Orlikoff says drastic change will be required and every individual will be required to change.

Such change won't happen overnight, nor will it be wholeheartedly embraced. It requires more finality than that. "You never get a paradigm shift unless there's a funeral," Orlikoff declares. "The keepers of the old paradigm must die." Fatalistic, yes, but people with no ties to "the way it was" or "the way it has always been done" will be required to make such changes.

I couldn't help thinking of the preponderance of healthcare IT marketing strategies of many companies that tie their system's superior benefits to development by an end user. This is most prevalent among electronic medical record vendors with physician-developers — and runs absolutely counter to Orlikoff's premise. Setting aside the fact that one person's workflow is one person's workflow, building a system that replicates existing work patterns, most of which have evolved around paper and pen, cannot contribute much to change.

The subject of change was also on the minds of Stamford, Conn.-based Gartner research analysts when they compiled their annual advice to CIOs timed for delivery at HIMSS. Number 1 of the list of "The CIO's Top 10 Best Moves for 2007" is "Get in front of change." Encouraging CIOs to actively embrace and lead change, analysts recommend that they build relationships that will enable them to help drive organizational goals to improve care delivery and expand services.

Can the healthcare industry undertake such dramatic change? Some say that if it doesn't, the economy will implode. But these changes will be painful and they will have a personal effect on every stakeholder. Orlikoff advises CIOs, "You will not be able to stimulate a paradigm shift within your organization until you stimulate a paradigm shift in you." He provocatively asks, "What are you going to do differently to facilitate transformational change?"

It's a question — and a challenge — for each and every one of us, every day.