Tuesday, April 18, 2006

Kelly on IT

The recent posting on information technology, titled What is the Problem? stimulated the following response from fellow alum and now healthcare consultant John Kelly:

The blog on IT, in general, I agree with. Yet, I think even when we get beyond the issue of viewing IT as a force to be reckoned with rather than a tool to improve operations, we still face the enormity of the challenge of converting IT applications into actual improvements. In my last five years at GL [Gunderson Lutheran in LaCrosse, WI] we did have alignment around the goal of IT. In my short tenure in Wausau, all three health systems appear (from my view) to have agreement on ‘what’ we’re trying to solve….yet (this is the point), getting the operational improvements proves tremendously costly (time and money) and very elusive. The micro economics of computer technology, almost always makes the task at hand more time consuming (in the moment it is executed). Takes longer to: a) schedule a patient using computer, b) fill a Rx, c) enter a note, etc….it is only in the macro economics that computing technology seems to have value added….hence our micro economic incentives have not yet gotten aligned with our macro economic goals.

Monday, April 17, 2006

What is the Problem?

The Spring 2006 issue of Frontiers, a journal published by the American College of Healthcare Executives, carries a letter from long-time friend and colleague, Paul Hofmann. Responding to an earlier issue devoted to the electronic health record, Paul reminisced about an article that appeared in 1967 suggesting that total hospital information systems were at least ten years away. The article provoked disbelief. The common assumption was that such systems were just around the corner.

And here it is, nearly 40 years later, and we are not there yet.

Paul suggests that one reason has been an inability “to identify and address the organizational and other obstacles impeding cost-effective implementation.”

That reminded me of a question I found useful during my years in healthcare management. When discussion about an issue seemed to lose focus, I liked to ask “what problem are we trying to solve?” My experience was that people are often not clear about that or have different views of it. I once asked that question of several physicians serving on a committee to plan the electronic medical record in the hospital where I was working. I got a different answer from every one. That makes it hard to come up with a solution that works.

In the diffuse power structure of our healthcare delivery system, healthcare managers have necessarily focused more on relationships than on operations. So they have dealt with information technology more as another force to be reckoned with than as a tool for improving the way things are done.

I am sure things will move faster if, before undertaking to implement information technology, the people involved come to a clear and common understanding of what problem they are trying to solve.

Friday, April 14, 2006

Some Day We’ll Have to Face It

The March 23 issue of AHA News Now, the daily e-mail news bulletin of the American Hospital Association, reported a meeting on the previous day of the Citizens’ Health Care Working Group, a panel authorized by Congress to recommend reforms to the nation’s health care system. The group expects in June to release interim recommendations for public comment.

According to the report, “Participants at yesterday’s [3/22/06] meeting, Web cast from the University of Michigan, generally supported universal health care coverage and thought everyone should share in the cost. They also supported efforts to encourage healthful behaviors and disease prevention, lower administrative costs, and increase price transparency to allow patients to be informed consumers.”

I found two things in this noteworthy.

First, the bias in favor of single payer is not even subtle.

Second, there is no suggestion that care might be delivered more efficiently.

Our system of delivering care cannot forever grow faster than the economy as a whole. So some day the question of efficiency will have to be faced, however reluctant we are to do it.

Wednesday, April 05, 2006

Unintended Consequences

President Bush is making a big thing out of his Health Savings Accounts, or HSA’s. For the benefit of those who have been hiding under a rock somewhere for the past few years, An HSA is a fund, owned by you, to which you are allowed to make tax-deductible contributions, provided you use the money to pay your medical bills. You must also have a health insurance policy that has a high annual deductible. (People on Medicare are not eligible.) Anyone interested in knowing more should go to http://www.ustreas.gov/offices/public-affairs/hsa.

This is the Bush free-market approach to health care reform. The idea is that people who pay their medical bills with their own money will make wiser decisions about the use of services. In addition, they presumably will shop around for care, thereby causing health care providers to become more efficient.

HSA’s are clearly good for the banks and other financial institutions that hold the money, but I include myself among the skeptics who doubt that they will have much of a direct effect on the health care economy. Individual patients simply do not have enough financial clout to put economic pressure on providers.

There may, however, be an unintended consequence. In the process of paying their own bills, HSA owners may become more aware of the cost of care and of the inefficiencies of the health care system. If so, they may become more supportive of health care institutions and executives who try to do something about it.

That would be positive, no doubt about it.

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