Wednesday, September 14, 2005

Health Care Still Doesnt Get IT

Healthcare Executive. a publication of the American College of Healthcare Executives, is directed, as its title implies, to executives in the field of health care. Its September/October 2005 issue features two articles on the subject of Information Technology (IT) as it relates to health care.

A full and careful reading of both articles reveals with unusual and, most likely, unintended clarity the conceptual fog that blankets the general subject of applying IT in the provision of health care.

Put in the simplest terms, IT is a management tool – a very powerful tool, to be sure – but a tool nonetheless. As such, it allows management to improve operations in ways that would otherwise be impractical – even impossible.

But if the potential of IT is to be realized, management must be clear about the operations it wants to improve, how it wants to improve them, and how it will use IT to do so.

That is where the application of IT in health care has foundered. The goals served by IT in the instances described in the Healthcare Executive articles range from physician order entry through vague quality improvement initiatives to creating a statewide patient identifier. The practical benefits, after discounting for the usual CEO hyperbole, have been unimpressive, to put it mildly. One of the articles states that “So far, many hospitals and health systems have not realized significant, or even positive, returns on their IT investments.” In other words, much of the money spent has been wasted.

Actually, one gets the distinct impression that the various IT projects mentioned were motivated not so much to improve operations as by the desire of healthcare executives to look progressive in the face of the growing chorus of criticism they face for being so slow to make productive use of IT.

The truth is that successful healthcare managers have never been operationally oriented. Instead they have focused on managing relationships with and among the guild-like power centers within their organizations, on managing finances, and on the growth and development of the institutions for which they are responsible. Tinkering in operations risks impinging on the carefully protected turf of one powerful guild or another and has, therefore, been avoided.

So what we tend to see in health care are flurries of IT activity that too often involve buying some popular application, or one being touted by an influential power center, in the hope that something good will come out of it in addition to bragging opportunities and short-term peace. The dismal long-term results are predictable.

One might put it this way – health care still doesn’t get IT.

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