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CIO and/or CMIO role: Keep Patient's Away From the ER ?

September 2, 2008
by Joe Bormel
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There's been a lot of discussion about HCIT in this political season, and the topic of ER utilization and traffic has come up in different ways in these blogs. It's clearly one of the central indicators about the health and financial well being of the US health care system. That's got to be true at large hospitals and clinics as well?

A few weeks back, we covered "Average ER Waiting Time? Planning for the Future, the Long View"where we looked at the CDC data showing a trend toward longer waits and fewer ERs.

In today's WSJ, there was Scott Gottlieb's article, "Michelle Obama Is Right About Avoiding the ER" where the author, a practicing physician, walked through the economic, liability, and patient interest view of getting patients to local health clinics, instead of ERs.

Connecting the dots, do CIOs, CMIOs, and other CXOs have a larger, explicit role in wiring the care community?

Or, are the economic forces still too strongly driving traffic to the ERs?

How do you see this issue?



Dr Anthony Palmer wrote a letter to the editor in WSJ today, refuting Rep Pete Stark (d., Calif), titled: Good Care, but Only If You Can Find It.

His point:  More fundamental than ER access, increasing numbers of patients on Medicare cannot "find physicians and hospitals which can afford to care for them because of ... [low] government payments."

This tends to support the 'economic forces too strong'  for CIOs/CMIOs/CXO's to have impact argument above.

On a personal note, in the Baltimore-Washington-NorthenVirginia area where my family lives, we lost the relationships with several of our physicians (the two doctors of both of my parents, and the internist that my wife and I were seeing) because of the shift to concierge medicine. Several of the smartest, most conscientious, and compassionate docs I know personally felt this was their only recourse.

This is a complex issue and it's very real to me and my family. Basic care is getting more fragmented every year.  For all the talk of system-ness, social, financial, political, consumerism, and other drivers are pushing even harder in the other direction.  Fragmentation that is unlikely to be substantially impacted by CDA4CDT in the next ten years.  Obviously, I hope I'm wrong.

Villainization, whether of CMS, physicians, provider organizations, or political parties is not leadership. A first step in leadership is framing the question correctly, measuring and discussing the system performance today (the CDC data is a good start, as are intelligent blogs), and then, elaborating and experimenting with the options.

I'd like to see a large enough entity tackle the cost, quality and access balancing act, and drive down the fragmentation problem. Based on personal experience, and the recurring 'sad' stories of fellow bloggers here, executives, and friends, we all have a lot of work in front of us.

Can anyone tell me anything about the nature of that concept, 'entity' I just used?