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Faulty Arches: The Myth of HIT Adoption

February 9, 2009
by Pam Arlotto
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In ancient Rome, when the scaffolding was removed from a completed Roman arch, the law read that the Roman engineer who built the arch had to stand beneath it. The point was, if the arch came crashing down, he would experience problems first hand. Millions of dollars have been spent building electronic medical records and laying the ground work for a national health infrastructure. The federal government is preparing to incent HIT “adoption”. Yet, the recent report from the National Research Council’s Report - Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions and many articles on the unintended consequences of HIT indicate that we are building more than one faulty arch.

If we step back to examine the goal of “adoption”, what do we mean? For HIMSS Analytics, with the EMR Adoption Model, adoption means the system is turned on and operational within a provider organization. MGMA, The American Academy of Family Practice Physicians, the Commonwealth Fund and many other organizations track diffusion of specific functionalities within the physician community. Yet none of these models track effectiveness, outcomes or benefits of the deployments. Ultimately, our goal should be value not adoption. Once value is realized, adoption will occur.

In our book, “Beyond Return on Investment: Expanding the Value of Healthcare Information Technology” we defined value as technology’s impact on the business/clinical performance of the enterprise. In recent years, the industry has assumed that value was a given and assumed a “just do it” mentality. The reality, however, is that value realization must be planned for, managed and measured – and accountability must be assigned.

  • What is the return on investment to your healthcare enterprise of clinical and business technology during the past three years?
  • What specific applications in your portfolio are delivering value?
  • What incremental investments in the short term will take the value of your portfolio to the next level?

Many of the arches built in ancient Rome were not faulty – they are still standing today. To ensure a similar fate, we must shift the discussion away from adoption and toward value realization.

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