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Steering the Healthcare Ship: A Call to the Logical, Not the Loud

February 20, 2015
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The other day I was on the subway coming into our New York City office when two people, presumably a couple, were really going at it verbally. For at least five minutes, insult after insult, swear after swear, was screamed by the woman, who in this particular instance, apparently wanted the entire train—and perhaps the entire city—to hear her gripes. Thankfully, both of these people got off the train at the next stop, putting everyone’s ears to ease.  While I’ll never know (or care) who was more at fault or who was right in this argument, I figured that if a woman is going to scream this loud at 8 a.m. in a crowded subway car, most likely she’s a little kooky. But for the rest of us who had to hear this delightful conversation, it will indeed be the words of the loud woman that we will remember most.

This little anecdote is a reminder that those who shout loudest aren’t always in the right just because their voice is heard most. We see this in all aspects of life—on TV, radio, in person, on Twitter, everywhere—people think that screaming, moaning, and speaking in hyperbole means that their points count more than others’.  This applies to health IT, too. The industry is going through a massive period of change, one where people will have all different opinions about said change. But it’s important to remember one thing—the opinions that you hear might not always be the most accurate ones.

Last week at the iHT2 Health IT Summit in Miami, Fla. (the Institute for Health Technology Transformation, iHT2, is a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC), I had a conversation with the CMIO of a Florida health system about this very topic. He asked me about the media’s stance on everything that is happening in healthcare, particularly related to the shifting landscape from a volume-based system to a value-based one. He further asked me how the media can help tell the voices of the people in the middle, rather than the ones on the extreme ends. These were interesting questions, and to be honest, I didn’t have the best answers for him at the time. We can only report on what we hear, right? Is it our fault that the reasonable, patient people aren’t the loudest ones? But after I left Miami, I thought more about it, and realized that this CMIO was right. Healthcare is no different than anything else in this regard—the extremists might very well be scaring the ones in the middle.

Listen, it’s really easy to say ICD-10 is useless, or we should call it quits on meaningful use, or that EHRs are a waste of money, or that patient engagement is unrealistic, or that true interoperability will never happen.  The people that have these viewpoints are the ones that get heard most frequently. But are they right?

It was fascinating to see what the folks at the Cleveland Clinic are doing with technology. At the iHT2 Miami Summit, C. Martin Harris, M.D., Cleveland Clinic’s CIO, delivered a keynote presentation about how his organization has adapted to the shift by establishing four key principles: quality, safety, care coordination, and cost effectiveness.  To help meet these goals, Cleveland Clinic became an early adopter of EHR technology, with the goal to create a single tool so all of the organization's caregivers could use it in caring for the patient. The EHR is at the core of everything the health system wants to do as we move forward in the new healthcare, Harris proclaimed. I can go on and on about all of the tools the Cleveland Clinic is using to better care for their patients and get them more engaged in their health, but that’s what this article is for. Granted, this is one health system that has significant resources and ability to make these types of changes, but it is an example of an early adopter that’s having real success. Dr. Harris’ keynote wasn’t flashy, sexy, or loud, but you know what it was? Efficient, forthcoming, and full of results.

Speaking of results, many people have made the point that the bottom line is not what we thought it would be when we began on this path years ago. And to a degree, they’re right; it has taken longer than anyone thought. Plenty more needs to be done, and much more alignment is needed. But that doesn’t mean that it’s time to give up. The CMIO I spoke with in Florida compared this shift to a massive ship that has been moving one way for its entire voyage, but suddenly needs to be steered in another direction.  This “turn” the ship will make cannot happen overnight, and what’s more, it will need serious push, force, and instruction to get it going another way. The healthcare industry is no different, the CMIO told me. It will take years to make this change, and more than even time, it will take a commitment. Commitment from providers, payers, patients, and the feds. Right now, we don’t have that, and one reason for that might be because the reasonable people in the middle might be getting overtaken by the extremists on the ends. That has to change.

I think health IT conferences like the one I just went to, in addition to the gigantic HIMSS one coming up of course, provide a way for the industry to hear the voices of the logical, rather than just the loud. These events are full of CIOs, clinical informaticists, and other healthcare IT leaders who are trying to make it work in the new healthcare, but need direction. This change undoubtedly takes a major cultural shift, one that I wouldn’t expect the extremists to understand. So call me naïve, but I just so happen to think that if all of these people come together and provide this direction, then perhaps this healthcare ship will finally turn the way it was intended to.