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The Strategy—the Only Strategy

July 12, 2009
by daphne
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I had a hard time finding hospital CIOs to talk about chronic disease management. Well, it suddenly dawned on me why: Most CDM takes place in the primary care setting. Duh.

Why should that be such a problem? Bad or non-management of CDM often lands these patients in the hospital (or back in the hospital) —needlessly. Isn’t the hospital’s job to make sure this doesn’t happen? This isn’t just an opinion--the way things are looking in Washington, this hospital-centric model is going down the tubes, fast. And it made me stop to think about the CIOs I talk to, all the time. What is their ultimate IT strategy?

If it doesn’t include primary care, that CIO is living in the past.

Unfortunately, for the majority of CIOs I talk to, their IT strategy is mostly about hospital-centric IT—an EMR, CPOE, EDIS, PACS. Sure, there are places where CIOs are doing great work linking their community docs in a variety of ways, including HIEs. And of course, IDNs like Kaiser et al have been doing this for years. But mostly, these hospitals are the exception.

Now, I know our CIOs have a lot on their plates right now. In too many cases they are just trying to keep the dike from breaking. But HITECH dollars are on the table already. Are you thinking about using them to link primary care to your hospital?

If primary care is not at the top of every IT strategy meeting you hold, I think the strategy is doomed.



So true. Do you think we'll live long enough to see payment reform? That's not just a paradigm shiftthat's the world upside down! A whole heck of a lot to unravel...

Savvy health system executive teams have "physician alignment" strategies that include the hospital's plans for primary care. Historically, these strategies were separate from HIT plans. HITECH should drive incorporation of "virtual integration" plans into broader physician alignment. To fully address HIE, Care Coordination and potential payment reform we must consider the business, clinical and technological implications.

Great point Robert. We keep talking about how to help people who are very sick, but we are too obsessed with political correctness to address the self-induced causes of illness such as sedentary lifestyles, smoking, obesity and non-obesity-related poor eating habits. We must do both, and there must be some financial disincentives for indulging in the aforementioned activities, along with financial incentives for opposite activities.

Payor? Vendor?
How about we nip chronic disease management by educating our children on nutritrion and exercise.
And why do we pay rather than penalize?
At some point we have to stop practicing medicine after the fact.

Just looking at the preventive side for a moment. And there are websites that do help with this. No fancy vendors or Medicare cost over runs. Just some fresh fruits and vegetables and a daily walk!

Yes, I do know we have to deal with the current problem, but we cannot save every self induced patient suffering with type II diabetes or smoking induced COPD or CHF from alcoholism/obesity.

A strong medical home (hate the term, but it works) program might help. However, for the next generation or two, we will be paying Trillions for self-induced chronic diseases. We ought to crank up the alcohol and cigarette tax as well as a "junk food" tax. It might just fix the Medicare problem.

Thanks for writing this post, It's very complementary to my post "A Leap Of Faith." When re-admissions aren't reimbursed, hospitals will have a business reason to extend their reach.  The first target will involve the chronic disease management, and even more specifically Congestive Heart Failure.

The interesting meta observation on all this:

No one  can't tear down functional silos (like in-patient and out-patient) with HCIT when those silos exist for reasons independent of the absence of HCIT.

Spun differently,

Most large HCIT change follows payment and regulatory reform.

I attended a HealthTech Net meeting in Washington DC yesterday and two presentations from health systems highlighted your points, Pam. Jim Oakes put this meeting together.

MedStar Health, a large 8 hospital and 240+ associated ambulatory practice groups outlined their strategies.

Anne Arundel Health System ('s CIO and CMO outlined their strategies. They're about a stand alone 300 bed hospital with typical community hospital characteristics.

They both shared project charters and governance structures that directly included technology, clinical integration, and operations.

The other pattern that I see broadly emerging is recognition that multiple vendors are required to address the degree of complexity and needs that these initiatives entail. Same pattern as seen with recent presentations by Johns Hopkins, UPMC, and other Savvy health system strategies.