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Thinking Differently About HIT Value

February 13, 2009
by Pam Arlotto
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The entire healthcare industry has been forced to think in different terms as we weather the recession storm

Immanuel Kant, the great German philosopher, was in the habit of keeping paper and pen on his bedside table. Often he would wake up in the middle of the night and jot down a thought or idea—then go back to sleep. One morning he awoke convinced he had discovered the answer to a problem that had puzzled him for months. While dreaming he had dazzling insight that seemed to break his mental log jam. He seized the paper on his bed side table eager in anticipation. There he found the words: “think in different terms”.

The entire healthcare industry has been forced to think in different terms as we weather the recession storm. Bill Holman, CEO of Baton Rouge (LA) General Medical Center asks, “…what type of healthcare industry will survive (the recession). We can’t go back to where we were…American’s deserve a better, more efficient healthcare. The economy is a mandate to change.” (HealthLeaders, February 2009). So the question becomes for HIT, how can we help create a different healthcare industry?

If we accomplish this, there will be no debate around the value of HIT. But first we must think in different terms. Most agree that technology for technology’s sake is not the answer. Value should be defined as technology’s impact on the business/clinical performance on the healthcare organization (and ultimately on the patient).

Every healthcare organization that has invested in HIT, should examine the value received to date. Compare the level of change and the outcomes experienced—both revolutionary and incremental to the investment of leadership expertise, capital and operating funds. Some organizations will be pleased with what they see–they will have good stories they can use to help build the case for more aggressive change. Others will be disappointed and need a midcourse correction. While others may not be able to fully answer the question.

As an industry, we have been planning, deploying and managing IT using the same approaches we have used for the past twenty+ years. Now is the time to think differently.





Pam, your insights inspired me to write yesterday's post on using frameworks to break the cycle and think differently about Health IT value.

In your book and HIMSS presentation work, you've used a fabulous framework that stratifies value of initiatives against their 'do-ability,' specifically organizational challenges/risk of that initiative.

Have you given much thought to how CMS should define 'Meaningful Use' of certified solutions by qualified providers, possibly factoring in the reality of do-ability?

Thanks Tim!

Between the Roman Arch's and Immanuel Kant, Pam, you cover a lot of metaphorical ground. But your point is very good. If we are to think differently and hope for better results in Healthcare IT, it needs to begin with taking the physicians into consideration. The addition of technology has made just about every other information-dependent industry far more productive...but in other industries, technology it hasn't demanded that the highest-paid resources (doctors in this case) become data entry clerks. Many providers already feel like they are on a volume treadmill...with less revenue resulting from more work. Now add government incentives/funding, industry compliance standards, and outcomes-scrutiny and we're heading for perfect storm, with what could be a LOT of wasted time and funds.

Want to try something different? Add "usability" to the healthcare IT product metrics. Functionality is important interoperability is desirable ePrescribing is a great idea, but "usability" is vital — all is wasted if the technology doesn't allow providers to work more efficiently and get a rapid return on their investment. Even Kant would see measuring usability as "thinking in different terms."

Pam, good blog post. Also, I read with interest your (similar) article in Hospitals / Health Networks magazine.

Useability is a critical component of value. Recently, I had the opportunity to work with three physicians. Initially, the conversation focused on what was wrong with the system—its lack of useability. So, we agreed to think in different terms, focusing not on the system but how they worked together and with the clinical staff of their hospital. Once again, the discussion focused on what was wrong and how each had a different and unique perspective. Gradually, each doctor turned to what worked well. They examined opportunities to collaborate for targeted change and a willingness to work with IT to incorporate three standardized processes. The discussion wasn't revolutionary, realization of the total value of the system still a long way off, yet each physician left the room "owning" a step toward making the system more useable — and thinking in different terms.

Your insight and approaches, as usual, are insightful. Dialogue around variation in wants and needs regarding the chart, as well as, variation in wants and needs regarding other clinical processes starts to demonstrate the extreme level of customization, work arounds and "just because I've always done it that way" we have in the healthcare sytem. To be most effective, we must consider the very foundation of our care delivery model. How should it change, can we innovate and standardize, and what should we eliminate.

Great point Pam and welcome to the HI Blog!

Pam. To your point, when I hear CIOs talk about what's really painful, it's not IT integration, it's the challenges of changing workflow and getting clinican buy-in.

Great dialogue.

Pam, I strongly agree with your guidance that framing the situation is critical to getting physicians to move in the right direction.

One approach that I've seen work miracles is to start off a session with the open question, "what's wrong, if anything, with the paper chart?" (This is obviously most useful before they got a system if they're already frustrated over usability issues, this may not be an option.)

Every time I've seen this done in medium to large size groups, several patterns are immediately visible. The variation in wants and needs becomes clear. The passionate desire for improvement transcends the tendency to be quiet, passive, and sit close to the exit.

The sources of frustration with the existing systems come out these are often workflow or policy issues that are largely or completely unrelated to any information system. Yet, this becomes a forum for those issues.

And they (the physicians) point out the problems with paper. Typically, a) only one person can have a paper chart at a time, b) you have to find the chart, c) it's hard to read what's been written on paper, d) it's not organized based on how I need it, etc. There's always one or two more issues that you didn't expect.

At this point, a rudimentary electronic system, although flawed itself, starts to look clearly superior to the pre-automation state.

The common alternative is to hold out a new system as a solution, inviting attacks.