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RomneyCare, HCIT and STEEEP

July 31, 2008
by Joe Bormel
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In today's WSJ (7/31/2008), there's a Letter to the Editor,
At Least RomneyCare Is a Start,” written by Matt Zibell. It’s all about the role of HCIT in the upcoming election. It doesn't say that.

STEEP: It’s helpful, perhaps, to summarize that there is broad, societal agreement that, at a high level, healthcare should be: [ The STEEEP term is in broad use ]


Of course, the policy decisions on whether those attributes should be defined by the market (us, as providers, consumers, payers, and others), or by ‘government bureaucracy,’ to stay with the author’s words. If you frame it that way as the author does, the market approach wins. (Actually, the RomneyCare experiment is much more sophisticated than that simplification.)

It’s pretty clear that there are a few other societal issues that drive the equation, including pluralism (we’re Americans, we demand choice; some of us are even Texans, which goes one step farther), entitlement (including very valid pre-existing commitments), and a clear preference for some degree of employer-basis and private economic risk assumption (including insurance).

So, that notwithstanding, when you apply the implications of how HCIT plays into STEEEP, the implications, risks and assumptions diverge rapidly.

Look, for example, at the acquisition and coordination costs of care (seeing your doctor, building out Medical Home, more broadly rolling out VA models, etc). Most of us in HCIT know immediately that the access and communication issues and implications are wildly different. So are the costs.

Is anyone interested in discussing this in the blog? Where is JD Kleinke when you need him?

Excerpt From Kleinke (2005):
The U.S. health care marketplace’s continuing failure to adopt information technology (IT) is the result of economic problems unique to health care, business strategy problems typical of fragmented industries, and technology standardization problems common to infrastructure development in free-market economies.



I love acronyms. STEEEP: Safe, Transparent/Timely, Effective, Efficient, Equitable, and Patient-Centered. Hope it is okay using this in my day-to-day. I would have to add an 'A' for Affordable to use it where I've done my work.
Past experience has been that the 'Effective and Efficient' have been the deal-breakers with Providers. I have had to agree with most of them.

I am pleading with any that read these Blogs, shout out your successes so that those like me that are wanting to make significant advances before they retire may learn from your experience.

Thanks for your comment. STEEEP comes from the IOM's crossing the chasm, as far as I can tell. Here's the language:

STEEEP Principles

S — Safe Care: The patient's safety comes first.

T — Timely Care: Patient care will be delivered in the most timely manner possible.

E — Effective Care: Patient care will be based upon the best science available.

E — Efficient Care: Patient care will avoid waste of time, money, and resources.

E — Equitable Care: Access to care will be provided to all in an equitable manner.

P — Patient-Centered Care: Patients will participate fully in care decisions.

When I used it in the original post, I included Transparent. That came from a modification introduced in use by the CMO of a major payer. That's interesting.

The "A for Affordable" is a fascinating perspective. My first reaction, and probably that of many other readers was "Isn't Affordable adequately implied by one or several other letters." The "Equitable" might somehow imply affordable, right?

As I pondered a few more moments, I appreciated that your comment was really much more profound. For example, 'affordable' to the consumer (cf patient), 'affordable' to society (cf single-payer system), and in an economic system, 'affordable' compared to what (cf comparable-services-on-the-market).

For now, I've concluded that 'Affordable' is not implied clearly by STEEEP. 'Affordable' is related but separate.

A test case might be, "What is the affordable right price for laser eye surgery?" I think that highlights that STEEEP is distinct from Affordable.

I think this is a very interesting perspective you raise, as we humbly try to improve our healthcare system with HCIT. We could get to very high values in STEEEP and not achieve affordability.

Joe Bormel

Healthcare IT Consutant

Joe Bormel