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An Important, Sometimes Forgotten, Perspective

December 30, 2008
by Neal Ganguly
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I've read HCI's blogs with great interest, and am honored to be given a chance to share my perspectives with you as well. I'll start with a few level setting thoughts on community hospitals. According to the American Hospital Association, of the over 5,700 registered hospitals in the US, almost 3,000 are not-for profit, non-governmental community hospitals. This massive block should be able to wield a lot of power in the marketplace, yet the cottage-industry mentality of healthcare has left us fragmented, without alignment, and ill prepared to meet the integration demands of a changing healthcare environment. This poses significant challenges for community hospital based IT departments who are usually competing for funding with clinical departments. Limited funding & staffing make the prospect of major technology implementations a scary proposition for IT managers, and even when the funding is available, end-user expectations often outstrip reality.

Is it all doom and gloom? I believe the answer is no. Many community hospital's have recognized the need to build a strong technology infrastructure and are beginning to classify IT infrastructure as importantly as other utilities. Once that strong technology infrastructure is in place, the 'fun' can really begin. Themes like Patient Safety, Productivity, Physician Affinity, and maybe even (dare I say it?) Profitability can be explored. IT can be (actually, must be) an enabler for all of these themes. But we must also be able to prove value within our organizations. It's the challenge that I'm facing every day, and I'm sure many of you are as well. How do we integrate IT into the strategic direction of the organization? How do we demonstrate the value for IT investments? How do we defend the hiring of IT staff vs. clinical staff in a tight budget environment. In upcoming blogs, I'll talk about some of my thoughts on these challenges, and look forward to hearing from others to see where we can ultimately find best practice. I'll also dabble in some discussions on future items such as the concepts of the medical home, RHIOs, genomics, etc. You know - how will they impact community healthcare? Who will pay for these things? And other such concerns.



The comparison to the creation of the interstate highway system is a good one. In that case, the Eisenhower administration committed the financial resources of the federal government to streamline commerce. Hopefully, the Obama administration has the vision to commit the signficant financial resources needed to create a healthcare IT infrastructure - and understands the societal / economic benefits that will accrue from that investment.

One thought though. Roadways were always primarily a public works / governmental responsibility, albeit a local one, even prior to the creation of the interstate system. I wonder how the complexities of the public / private / corporate / individual players in healthcare will impact reaching the goal of a national health IT infrastructure?

I think you are absolutely correct. Building the interstate system in the 50's and 60's was a long gloomy prospect. All many could think about is where you wish the interstate system would go (and many people still thought that we would stick the old state highway system that preceded it). Putting in the infrastructure took time and patience the real innovation started after the system was in place.
The real "fun" will begin when the business leaders of the organization start counting on the new infrastructue to drive organizational initiatives.
In many ways, I feel like sometimes we are carpenters with a bag full of hammers looking for a nail. I think we are finally designing better hammers (IT tools) that fit the nails (business challenges) that our organizations face.
I think when the hammers and nails better fit, the funding will better fall into place.