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Running Before You Walk

May 31, 2009
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I’ve been giving this a lot of thought, and I’ve decided that the key to being a successful quarterback in the NFL is the ability to quickly and accurately read defenses.

So, I’m going to make a concerted effort to teach my grandson how to read NFL defenses. He has a lot of potential.

I’m going to buy the most extensive cable package, TIVO all the games, and spend three to four hours daily working with the kid. Once he’s established his successful career, I can move into a nice little place on his complex. With all the economic uncertainty, I think you need a good retirement plan.

Of course, Caleb is still about a month away from his third birthday, and has to use both hands to carry a football. That’s him in the Mickey Mouse shirt.
Caleb Harvey
Chad Pennington
OK, so that’s a really stupid idea. The truth is, everything that’s hard takes time to build.

Every concertmaster started out playing Twinkle, Twinkle Little Star. You can’t win the Tour de France without learning to push the pedals on a tricycle.

Trying to do the advanced stuff without laying the foundation guarantees failure. It causes frustration and abandoned projects. In some cases it can be downright damaging. (You don’t teach a Little Leaguer to throw the curveball if you want him to still have an elbow when he's 16.)

Earlier this month I attended a meeting for CIOs of medium-sized enterprises, regardless of industry. There were several other healthcare CIOs there, but also IT leaders from government, industry, education, and the non-profit sector. I’d advise taking advantage of that sort of opportunity for cross-pollination whenever you can.

One of the keynote speakers was Geoffrey Moore. Moore wrote Crossing The Chasm in 1991, a seminal work in the field of innovation and technology. In my academic field of Technology Management, it’s one of those indispensible works that everyone reads and quotes to prove that they are members of the club. I was pretty pumped about getting to meet the guy.

Then he made a statement that made me say, “HUH?”

“All of the foundational IT systems are now in place. The organizations that will be successful will be those who can leverage all that data to inform their decisions.”

Foundations in place? Doesn’t he know about the adoption problems in healthcare?

In discussing the point with him later he was, of course, aware of the challenges in healthcare in general and healthcare IT in particular. He was a bit bemused at all the people who had questioned that premise for other industries as well.

(I’ve said for a while that healthcare may be the most important industry with inadequate IT utilization, but we’re not the only one. Take a look at education and law and tell me they’re further along. I have a few ideas why those three professions have similar issues; it would make an interesting topic for someone’s master’s thesis. Feel free to use it if you want- just give me a footnote and let me read it so I can learn something.)

So what’s the point?

It feels to me as if we are at risk of falling in love with the potential of our IT “out there” and failing to lay the necessary foundation. We will have data exchange, community health surveillance, and advanced evidence-based clinical decision support.

BUT NOT until we do the hard (and boring) work of defining standards, building out infrastructure, and designing local repositories.



Very interesting post. You're right. There is much focus on EMR implementation and adoption but little focus on the critical infrastructure that needs to be in place to enable the flow of information between these heterogeneous systems EMR offers potential interoperability and the proper infrastructure will let us realize the potential .
There are both public and private data exchanges today that are enabling information sharing to reduce administrative costs and improve quality of care. Others in the healthcare space can learn from the technical foundations that they have put in place. For example, there first must be some type of integration or services layer using ADT messages via HL7 and other communication protocols to make any sort of information exchange possible. Second, an enterprise master person index or patient registry that links patient records, regardless of their format, from participating applications is essential to ensure proper patient identification when accessing the records. Third, is a portal or EMR that can apply some logic to the data and create a meaningful view of the patient and the relevant medical history.
It is important that these components comply with industry standards to ensure wide-spread integration, scale to support hundreds of millions of records as the information exchange grows, maintain historical demographic information to identify patients over time, ensure privacy and be adaptable enough to support evolving interoperability requirements. If policymakers promote the adoption of these critical infrastructure components in addition to EMR we will realize patient centric and coordinated care through widespread information interoperability much, much quicker.

Really interesting points, Mark. When Moore said that all the foundational IT systems are in place, I take that to mean that the healthcare industry has developed a blueprint for successful EMR adoption. That the hospitals with the necessary resources have figured it out, and that there is a formula for success. But that's just my take.

I also love the tie-in with NFL QBs. Two years ago, I saw Peyton Manning play in a game against the Giants, and I was amazed at how well he read defensive schemes and was able to anticipate where receivers were going to be (regardless of the play). You can bet that as a kid, he mastered the basics - the foundation - before learning any of the fancy stuff. A very wise blueprint for success, I think.

Actually, the expression Moore used was "systems of record." I was paraphrasing a bit.

I think that his focus was on industries OTHER than healthcare, for example banking, manufacturing, retail. The point was that all those industries have built their systems of record- their foundations. Now they are sitting on this gold mine of information that they gather as a by-product of doing business. They need to be thinking about how to use that data to give themselves competitive advantage.

Most of us aren't there yet.