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President Obama: Don't Spend Money on Epic

January 3, 2009
by Suresh Gunasekaran
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I received the following news update through many colleagues and RSS feeds that I use.... ---BEGIN STORY The Boston Globe (1/1, Wangsness) reported, "As Barack Obama prepares to spend billions on health-information technology as part of his plan to revive the US economy, some specialists are warning against investing too heavily in existing electronic recordkeeping systems." In fact, David Kibbe, a "top technology adviser to the American Academy of Family Physicians," and Bruce Klepper, a healthcare market analyst, highlight "the challenges confronting Obama's proposal to digitize an enormous and fragmented healthcare system" in "a recent open letter to the President-elect." Klepper argued that "current systems are expensive, cumbersome to use, and cannot easily exchange information about patients' health histories and treatments among different hospitals, labs, and doctors' offices." And, although "Obama and many health-policy analysts support a large investment in electronic health records," Klepper and Kibbe advocated for spending "the bulk of" the package on "simpler and cheaper technology." ---END STORY ---BEGIN RANT Klepper and Kibbe do a great job of stating the obvious: current systems are expensive, cumbersome to use and cannot easily exchange information. Exactly, if they were perfect and cheap, everyone would have them and the President would not need to buy as all an EMR.

The real question at the heart of this open-letter is far more interesting than their contrived recommendation. If President Obama does invest a great deal in healthcare information technology and much of the money is directed at the EMR space, will it spur investment from new players (producing disruptive new solutions on new technical platforms with distributed architectures) or will this be the chance for some of the monoliths of the industry that have gotten us this far to accelerate their move to more nimble solutions? I, for one, don't know if I will continue to spend my money with Epic Systems, but it seems likely. After many years down this path, my clinical users really don't want to switch. We already have numerous technical staff and assets aligned with our Epic investment. The President would have to offer an enormous size carrot/stick to move us off of our current path. On the other hand, as the industry has dabbled with RHIOs in the last decade, we see that there is no financial incentive for everyone to collaborate across institutional boundaries. If we as a society believe that there is value to have a lifetime electronic record that follows us across facilities and care settings, perhaps the President can spur investment in that arena. For instance, a national health information service that keeps track of everyone's chronic conditions/summary medical history, list of doctors they've seen, active medications and allergies. Even then, the question remains will our existing vendors or a new generation of vendors meet the needs of the new marketplace?

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Comments

Suresh,
I think many of us are dancing around the same opinion. I posted an entry on my humble little blog a few days ago, entitled "Investing in Mediocrity?" (http://callitanything.blogspot.com/) in which I challenge the wisdom of investing government funds in the current market leading EHRs. For example, I respect what Epic has achieved in the industry we benefit at Northwestern but it's not good enough. And Vista certainly isn't good enough. We should find a way to dangle the carrot of big government money such that it stimulates good old fashioned free market innovation in EHRs and healthcare IT.

Suresh,
I think you hit on a couple of important points here. The one that most interests and intrigues me is this: an underlying question in all this is how any economic stimulus monies coming from the incoming Obama administration might change the face of the healthcare IT vendor landscape. When one looks at the history of healthcare IT vendors, it has largely been one of gradual recognition of the true needs of patient care organizations and end-users, along with a whole lot of failed experimentation along the way. Ultimately, greater interoperability and appropriate data-sharing need to come about. The question is, can the incoming administration press just the right levers in order to increase both provider adoption of clinical IT, and also really smart vendor innovation? I agree completely that we need more nimble solutions. The challenge, I think, will be to recognize the vendor landscape that exists now on the ground, while also to move our whole industry forward intelligently. And while providing monies for greater adoption would in itself be valuable, I'm certain we can do better than just thatif whatever portion of the economic stimulus package set aside for healthcare IT is spent wisely, we could really leapfrog forward as an industry. Here's hoping that takes place! Your thoughts...?
Mark Hagland

Pete,

Big Tomato. I like the VA system. It's pretty functional. However, it would be worst intervention in the history of the technology business if the government mandated that we all use an "old" system. It's much better if they mandate that we all use an "old" format. :)

Glenn-

Vendors complain a lot. Most of the time, it's that it's too hard to take our money off our hands. CIOs complain a lot. It's too hard to make users do their work like my software was written. This is old news.

Now your idea on standard hospital workflows....That could be something new. I'd have to see it to believe it, but it sounds good.

John-

I agree. I'm getting a litte stale. What are new technologies that need seed investment from your perspective?

Both types of investments need to occur.

There are very real near term gains in care quality and efficiency that can be achieved through investments in today's technology and applications. And one could wait a long time for the "perfect technology" to arrive.

There are also investments that need to be made in newer technologies and application approaches that will enable systems to be better at supporting workflow, incorporating decision support and achieving interoperability.

These investments need to be coupled with changes in reimbursment systems, training of people who can implement and support EHRs and means to assist the implementation efforts of small hospitals and physician practices

New technologies include (a) more intelligent/adaptive user interfaces, (b) superior, embedded workflow engines, (c) technologies that enable better control of data access (better privacy) and (d) superior ways to highlight to the physician patient data that is important.

Mark-

I think the potential is huge...the $$$ question is...what is the President's vision? Is it that too many HCOs don't use IT or that we need IT to be used for a specific purpose?

I think the government should fund/mandate the use of this money for a single purpose (or two). Active Medications, Laboratory Results, or Encounter Summaries. They would fund organizations efforts to automate and share this information in a standard format.

The money could be used to remediate your existing system or purchase a new one.

There should be no funding with out a stick (all hospitals must have X by Y date).

My .02.

Yes Suresh, but we are talking about the government. They dont always do what makes sense.

We are becoming more mobile and living longer - a complete EMR will become a more and more critical part of providing quality and econically sustainable medical care to a large general population of this type.
The goverment must provide the financial incentives (the tricky part) and work along with bodies such as RSNA and IHE that can provide the technical requirements for enterprise integration. If we start developing the incentives and guidelines now, old and new vendors will jump in and inovation will ocurr.
Something I hear vendors complain about is that in the states hospitals are free to develop workflows that they feel best meet thier needs. The result is that every hospital does things a little different, creating more complex and expensive integration scenarios. Government sponsored financial incentives around adopting a standard set of hospital workflows, can, if done right, simplifly the path to a complete EMR without hindering a hospital's ability to innovate around individual patient quality of care.

If it is a Government driven program, then I would think they would move down the path of the VA or Composite Health Care (DOD). Either way it would take a road tested system and migrate it out to other organizations.
OK, I have my target in place. Start throwing the tomatoes!

Suresh Gunasekaran

CIO

Suresh Gunasekaran's blog provides musings from the CIO of an academic health...