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Maybe We Have Squandered Half of Our Healthcare IT Dollars, But Which Half?

March 1, 2009
by James Feldbaum
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Excitement over the new Healthcare IT spending initiative has been somewhat tempered by the lack of specifics. Our track record of success with individual Health Information Exchanges and RHIOs has been less than inspiring. The list of exchanges that have failed or not advanced passed the pilot stage outnumbers present proposed projects (that will change soon with availability of funding). No one can expect physicians, most of who practice in groups of ten or less, to individually research, purchase, and implement an EMR. My gut tells me that the effort must be consolidated in HIEs and RHIOs to make available access to an EMR and to facilitate the exchange of information between existent EMRs in the community.
Forgetting the present issues defining “meaningful use” of the EMR (there is good data already out there), we need to directly address some of the reasons that have led to our historic lack of success.
I invite ideas, additions, and conversation.

  • Despite common goals we have extraordinary variation in strategy, technology and implementation.
  • We lack standards or consistency for:
    • Technology solutions
    • Funding
    • Legal issues surrounding information sharing
  • We lack emphasis on cooperation and shared learning between localities, regions and states.
  • We have very few provider driven initiatives. It is difficult to coordinate efforts between stakeholders.
  • Up to now most projects are not financially sustainable. Do we now have a compelling business model?
  • Business models have not proven to be cost effective for most physician practices. Established medical practices are more costly to convert away from paper than nascent ones and older physicians are less anxious to invite change.
  • State legislators have not made HIT a major priority and in many cases have enacted obstacles rather than solutions.
  • Privacy, privacy, privacy…
    • There is no consistent legislative and legal direction (see previous blogs)
    • We have been remiss in providing provider and patient education and we lack aggressive public relations to dispel myth and paranoia.

It is critical that we seize this opportunity. We have a responsibility to spend our resources, both human and financial, wisely. We have a laundry list of factors that have derailed our most sincere previous attempts at implementation. We must be careful not to repeat our mistakes.

An expert is a person who has made all the mistakes that can be made in a very narrow field. Niels Bohr (1885-1962)




Nice elaboration of the issues.

I agree with your gut. The EMR needs to be thought through and executed in an EHR, ie community perspective. Please see my recent post "Lance Armstrong and PHRs" for some thoughts. In short, we know healthcare demand is strongly impacted by diet and exercise these are both political non-starters! They may be genuinely impractical or irrelevant in other, very American and very human ways.

In the same spirit of frustration over lack of specifics, I've offered a new post today. Please consider it inspired by your post here, as well as your prior comment on the Lance Armstrong post.

Lastly, I strongly resonate with two points we made here:
1) the need to coordinate efforts, and
2) learn from the past ("mistakes", I'd prefer to dub them 'experience')

Thanks again for another wonderful articulation of the challenges and opportunities before us.

How can those of us who understand this and "have been there" help the administration to understand these issues?