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Thinking in Terms of Paradoxes

March 23, 2011
by Mark Hagland, Editor-in-Chief
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Moving Forward on Healthcare Reform Means Navigating Many Conceptual Challenges
Mark Hagland
Mark Hagland

If ever there were a time in history when we all needed to be able to begin thinking in terms of paradoxes, now would be it. The types, intensity, and volume of information hurtling towards us across all fields of knowledge and endeavor are, literally, mind-boggling. Take for example, some of the information coming out of climate change research these days.

Indeed, anyone interested in the complex paradoxes around climate change might want to go to, and check out the work of the Woods Hole Oceanographic Institution, the largest private oceanographic research institution in the world. The folks there are doing amazing research, particularly within their Ocean and Climate Change Institute, through its North Atlantic/Arctic Climate Initiative. For well over a decade and a half now, they've been tracking what's been going on in the North Atlantic just south of Greenland, where the gradual melting of the Greenland ice sheet is causing vast quantities of chilled fresh water to plunge into the warmer salt water of the North Atlantic.

Now, here's the paradox: the climatologists and oceanographers at Woods Hole believe it's quite possible that, should global warming intensify over the next decade or so, enough of the Greenland ice sheet might melt that it would cause an intense chilling of the waters of the North Atlantic, leading to a mini-Ice Age in northern and western Europe, where most countries (for example Ireland, the United Kingdom, and the southern coast of Norway) have for millennia enjoyed a warmer climate than might be expected with regard to their latitude, because of the warmth of the North Atlantic current.

In other words, global warming could lead to massive regional cooling. Who knew?

Healthcare and the healthcare IT sector are similarly beset with paradoxes and contradictions these days. On the one hand, federal healthcare reform and the HITECH Act are pushing provider organizations forward faster than ever to implement the information systems, especially the foundational clinical IS, needed to do things like reducing avoidable hospital readmissions (see this month's cover story, p. 10), creating accountable care organizations, and meeting such meaningful use criteria as documenting and reporting patients' clinical outcomes, for analysis and for reimbursement.

On the other hand, the very fact of a massive, industry-wide rush towards implementing the clinical IS needed to achieve these goals and others, is leading to massive shortages of all the human resources-particularly the clinician informaticists-needed to reach organizational success in this area. As G. Daniel Martich, M.D., notes in his interview (p. 41) in this issue, building successful teams of clinician informaticists is a complex journey, and not something that can be accomplished instantly.

In fact, Dr. Martich will be leading a discussion with a distinguished panel of fellow CMIOs and CIOs on that very topic, when he and I and others gather together in San Francisco for the first-ever Healthcare Informatics Executive Summit, May 11-13, in San Francisco. It will be exciting to hear what these industry leaders have to say about how to beat out the competition and build teams of clinical informaticists that can really take their organizations into the end zone, so to speak.

Doing so, of course, will mean facing a variety of conceptual challenges, some of them paradoxical. Yet that seems to be our collective destiny in the present moment. At least those of us toiling in the healthcare IT sector don't have to solve the incomparable challenge of climate change; mastering our own challenges will certainly be daunting enough.

Mark Hagland, Editor-in-Chief Healthcare Informatics 2011 April;28(4):08

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