Neupert On Health

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Before you finalize your Health IT shopping list

Before you finalize your Health IT shopping list

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The mad dash for health reform continues in earnest as stakeholders from all parts of the health ecosystem work to inform, engage and encourage the incoming Administration.   The need for reform is obvious and the dialog is positive -- I continue to worry that 'soundbite solutions' will get in the way of a serious discussion of principles, desired outcomes and alternatives to achieve a good return on investment on 'change.'

As a business guy -- one that has worked on startup initiatives over most of my life -- I tried to put into context what it means to invest an 'incremental $50B' in health IT.    It sounds like a lot of money -- something on the order of $83k per practicing physician -- we ought to be able to do something spectacular for that kind of money.

There is a new study out by the National Research Council of the National Academies that takes a look at what types of computational technology and investments are best for improving health outcomes.   I recommend folks read it (full disclosure I was both interviewed and a reviewer).   Many folks I talk with in the computer science industry recognize the huge benefits that will be gained in medicine and health outcomes with thoughtful investments in information technology.   Many (myself included) are technology optimists and believe that information technology will ultimately disrupt and transform health delivery.

But to achieve this transformation -- we have to acknowledge the reality of the institutions and systems currently in place; we have to invest in the new kinds of architectures and IT systems that will deliver real value over time.   This report is bi-partisan and a timely reminder of key principles by experts -- one that I hope informs the health reform spending debate before folks finish their HIT shopping list and count too much on electronic health records as a simplistic cure-all. 

The study acknowledges the need for comprehensive patient data, empowerment of consumers/families with personal health information and for flexibility in systems design to enable new advances in biology to be integrated effectively -- among many other principles.

Here are a few of the topline recommendations (pages S-9 and S-10) from the report I chose to highlight because they are so important and often get lost in the 'soundbite solutions' debate:

  • incentivize clinical performance gains rather than the acquisition of IT, per se
  • encourage initiatives to empower iterative process improvement and small-scale optimization
  • develop the necessary data infrastructure for health care improvement by aggregating data regarding people, processes, and outcomes from all sources.
  • insists that vendors supply IT that permits the separation of data from applications and facilitates data transfers to and from other non-vendor applications in sharable and generally useful formats

If the country is going to invest $50B in incremental health IT -- we all want it to be invested wisely.   The question is; what will generate the most benefit and how can we accomplish it?  We should be building an asset with this investment - and the asset is not an application per se -- but a health data asset that can be used to improve both individual outcomes and the performance of the institutions and the system overall.    Individuals should be encouraged to create and manage their health data asset and to learn how to share it to achieve better outcomes and interactions with the health delivery system.   Similarly - health enterprises should invest in building and sharing health data assets that enable them to have a culture of process improvement over time.   

Comments
  • Like you, I believe that information technology will ultimately disrupt and transform health delivery. However, that assumes that the right IT solutions are applied not to the current model for healthcare delivery – which is broadly believed to be broken and in need of substantial reform -- but to a future model that has yet to be defined.  Of the various customers/stakeholder/users of the heathcare system, patients and their families are probably the only group with sufficient incentive currently to modify their behavior to align with a new IT-based model for improved management and communication of healthcare data (so long as they aren’t shouldering a greater share of the cost).  Aligning the business models of clinicians, hospitals and insurance companies would appear to be more complex and challenging. And I haven’t heard about THAT work having been done yet.  So, your question – “what will generate the most benefit and how can we accomplish it?” – needs to be applied to ALL the customers/stakeholder/users in a way that will appropriately incent the needed changes, including collaboration among them, in a way that does not now exist.  Once we have that, we’ll know better what specific needs and imperatives the “IT solutions” must be applied to solve to help facilitate the kind of “reform” people are talking about.

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  • Interesting article indeed. I agree with the seven points you summarized, but the main goal the article suggests is Knowledge Driven Healthcare. This means we not only have to focus on efficience of processes but also at the quality and where possible reduce the risks of human errors. This is a long way to go but with appropriate chronological steps possible in time.

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  • "Wow," it is actually nice to read a post from someone that knows a subject well and is able to get their direct across.I am really looking forward to your next post.

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