One of the profound pleasures and privileges of my work at Healthcare Informatics is the opportunity, every single week, to talk with the pioneers in today’s healthcare system, people from diverse backgrounds who are showing leadership in myriad ways. It’s wonderful to speak with leaders of all kinds—informaticists, clinicians, clinical informaticists, hospital, medical group, and health plan executives, and trustees, vendor executives, policy experts, and many others—all of whom are in their various ways helping to move the healthcare system forward on behalf of our communities and our society.
Every single one of these individuals is doing something tremendously valuable; and indeed, without the sheer diversity of their thoughts and labors, we could never collectively move the healthcare system forward as it needs to be moved forward right now.
Yet even among this select group, there are individuals who stand out for their exceptional vision; and one of these is Terry Carroll, Ph.D., senior vice president for transformation and CIO at Fairview Health Services in Minneapolis. I interviewed Dr. Carroll earlier this week in order to highlight his participation in the Healthcare Informatics Executive Summit, being held May 15-17 in San Francisco.
What was most significant about that interview? I’ll cut to the chase: what made my experience interviewing Dr. Carroll is very simple: he understands exactly what has to happen in order to lay the IT and data foundations for the new healthcare, and that is, we collectively have to find ways to build a core replicable sets of technological foundations, so that it doesn’t take our industry 25 years to build what’s needed in the next 25 months. Here’s the key quote from my interview with Terry Carroll, as far as I’m concerned. In responding to my question regarding what the biggest IT gaps are right now in preparing for accountable care, he said this:
“… I think we need to very carefully look at where we’re making our investments. EHRs [electronic health records] are necessary, but totally insufficient; what we really need to have is the analytic capability that’s totally underdeveloped in the industry. And primarily what we’re strapped with is that we spend so much energy doing the data management piece of this, that we run out of gas when it comes to doing the analytics that can provide value here. So there needs to be some redistribution of capabilities and resources.” In other words, everyone is out there reinventing the wheel, and that is taking up way too much of everyone’s time.
Terry Carroll loved the analogy I shared with him, which is this. When I was writing my first book, Paradox and Imperatives in Health Care (my coauthor was noted healthcare economist Jeffrey Bauer, Ph.D.), as part of my research, I flew down to Kentucky to visit the Toyota plant there, located in the town of Georgetown, near Lexington. I was visiting that plant primarily to explore the ways in which the famed Toyota Production System was being introduced into healthcare, and to ponder the connections in both directions. But the thought struck me, in reflecting on how the assembly line concept transformed auto manufacturing a century ago, that in healthcare and healthcare information technology, we’re still in the equivalent of the auto industry’s pre-assembly line production era, building care delivery, technological, and other processes “by hand,” as it were, every single time. Thousands of patient care organizations are developing evidence-based care delivery programs unique to their organizations; thousands of other organizations are beginning work on the readmissions reduction and value-based purchasing metrics sharing mandated by the Affordable Care Act; and many dozens of organizations are engaged in developing accountable care organizations from scratch.
Carroll’s idea is that data models like the ones being developed by collaborative of Premier health alliance members (and Fairview is deeply involved in the accountable care collaborative at Premier) are going to provide a huge rescue for the industry, as leaders of patient care organizations nationwide will be able to tap into solutions for developing both the programs and the information technology infrastructures to support ACOs, bundled-payment contracts, patient-centered medical homes, and so on. I concur.
The bottom line is simple: the myriad systems (process, organizational, reimbursement, technological, and so on) that need to be erected in healthcare right now need to be developed very quickly; yet most leaders of patient care organizations nationwide are struggling, isolated, to develop those systems one by one. As I told Terry Carroll, it’s like the pre-assembly line auto industry, particularly at the very, very beginning of auto manufacture, when cars were literally built one at a time, sometimes with unique arrangements of parts. Let’s see: we’re going to build a car, right? I guess we need a steering wheel… and oh yes, probably wheels, and, certainly, tires… oh, and maybe a handbrake would be a good idea! That’s how the IT foundations for the new healthcare are being generated right now, and at that rate, we’ll never get there.