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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.

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